Index to Financial Statements

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 10-K

 

(Mark One)

ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the fiscal year ended December 31, 20162018

or

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period fromto

Commission file number 001-32559

 

Medical Properties Trust, Inc.

MPT Operating Partnership, L.P.

(Exact Name of Registrant as Specified in Its Charter)

 

 

Maryland

Delaware

20-0191742

20-0242069

(State or Other Jurisdiction of

Incorporation or Organization)

(IRS Employer

Identification No.)

1000 Urban Center Drive, Suite 501

Birmingham, AL

35242

(Address of Principal Executive Offices)

(Zip Code)

(205) 969-3755

(Registrant’s telephone number, including area code)

Securities registered pursuant to Section 12(b) of the Act:

 

Title of Each Class

Name of Each Exchange on Which Registered

Common Stock, par value $0.001 per share of

Medical Properties Trust, Inc.

New York Stock Exchange

Securities registered pursuant to Section 12(g) of the Act:

None

 

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act.

Medical Properties Trust, Inc.    Yes      No                  MPT Operating Partnership, L.P.    Yes      No  

Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act.

Medical Properties Trust, Inc.    Yes      No                  MPT Operating Partnership, L.P.    Yes      No  

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.

Medical Properties Trust, Inc.    Yes      No                   MPT Operating Partnership, L.P.    Yes      No  

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Website, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).

Medical Properties Trust, Inc.    Yes      No                  MPT Operating Partnership, L.P.    Yes      No  

Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K (§229.405 of this chapter) is not contained herein, and will not be contained, to the best of registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K.  ☐..

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”filer,” “smaller reporting company,” and “smaller reporting“emerging growth company” in Rule 12b-2 of the Exchange Act (Check one):Act.

Medical Properties Trust, Inc.

 

Large accelerated filer

Accelerated filer

Large accelerated Filer

Non-accelerated filer

☐  

Accelerated Filer

Smaller reporting company

Non-accelerated Filer

☐  (Do not check if a smaller reporting company)

Smaller Reporting Company

Emerging growth company

MPT Operating Partnership, L.P.

 

Large accelerated filer

Accelerated filer

Large accelerated Filer

Non-accelerated filer

☒  

Accelerated Filer

Smaller reporting company

Non-accelerated Filer

☒  (Do not check if a smaller reporting company)

Smaller Reporting Company

Emerging growth company

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  

Indicate by check mark whether the registrant is a shell company (as defined in 12b-2 of the Act).

Medical Properties Trust, Inc.    Yes          No                  MPT Operating Partnership, L.P.    Yes      No  

As of June 30, 2016,2018, the aggregate market value of the 236,587,490362,344,450 shares of common stock, par value $0.001 per share (“Common Stock”), held by non-affiliates of the registrant was $3,598,495,723$5,087,316,078 based upon the last reported sale price of $15.21$14.04 on the New York Stock Exchange on that date. For purposes of the foregoing calculation only, all directors and executive officers of the registrant have been deemed affiliates.

As of February 24, 2017, 320,934,22522, 2019, 381,077,933 shares of Medical Properties Trust, Inc. Common Stock were outstanding.

 

DOCUMENTS INCORPORATED BY REFERENCE

Portions of the registrant’s definitive Proxy Statement for the Annual Meeting of Stockholders to be held on May 25, 201723, 2019 are incorporated by reference into Items 10 through 14 of Part III, of this Annual Report on Form 10-K.

 

 

 



Index to Financial Statements

TABLE OF CONTENTS

 

A WARNING ABOUT FORWARD LOOKING STATEMENTS

3

PART I

ITEM 1

Business

5

ITEM 1A.

Risk Factors

18

15

ITEM 1B.

Unresolved Staff Comments

38

31

ITEM 2.

Properties

39

32

ITEM 3.

Legal Proceedings

41

33

ITEM 4.

Mine Safety Disclosures

41

33

PART II

ITEM 5.

Market for Registrant’s Common Equity, Related Stockholder Matters, and Issuer Purchases of Equity Securities

42

34

ITEM 6.

Selected Financial Data

44

36

ITEM 7.

Management’s Discussion and Analysis of Financial Condition and Results of Operations

48

38

ITEM 7A.

Quantitative and Qualitative Disclosures About Market Risk

68

54

ITEM 8.

Financial Statements and Supplementary Data

69

56

ITEM 9.

Changes in and Disagreements With Accountants on Accounting and Financial Disclosure

120

94

ITEM 9A.

Controls and Procedures

120

96

ITEM 9B.

Other Information

121

97

PART III

ITEM 10.

Directors, Executive Officers and Corporate Governance

122

98

ITEM 11.

Executive Compensation

122

98

ITEM 12.

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

122

98

ITEM 13.

Certain Relationships and Related Transactions, and Director Independence

122

98

ITEM 14.

Principal Accountant Fees and Services

122

98

PART IV

ITEM 15.

Exhibits and Financial Statement Schedules

123

99

ITEM 16.

Form10-K Summary

131

106

SIGNATURES

132

107

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Index to Financial Statements

EXPLANATORY NOTE

This report combines the Annual Reports on Form10-K for the year ended December 31, 2016,2018, of Medical Properties Trust, Inc., a Maryland corporation, and MPT Operating Partnership, L.P., a Delaware limited partnership, through which Medical Properties Trust, Inc. conducts substantially all of its operations. Unless otherwise indicated or unless the context requires otherwise, all references in this report to “we,” “us,” “our,” “our company,” “Medical Properties,” “MPT,” or “the Company” refer to Medical Properties Trust, Inc. together with its consolidated subsidiaries, including MPT Operating Partnership, L.P. Unless otherwise indicated or unless the context requires otherwise, all references to “our operating partnership” or “the operating partnership” refer to MPT Operating Partnership, L.P. together with its consolidated subsidiaries.

CAUTIONARY LANGUAGE REGARDING FORWARD LOOKING STATEMENTS

We make forward-looking statements in this Annual Report onForm 10-K that are subject to risks and uncertainties. These forward-looking statements include information about possible or assumed future results of our business, financial condition, liquidity, results of operations, plans and objectives. Statements regarding the following subjects, among others, are forward-looking by their nature:

our business strategy;

our projected operating results;

our ability to acquire, develop, and/or developmanage additional facilities in the United States (“U.S.”), Europe, or Europe;other foreign locations (such as Australia);

availability of suitable facilities to acquire or develop;

���availability of suitable facilities to acquire or develop;

our ability to enter into, and the terms of, our prospective leases and loans;

our ability to raise additional funds through offerings of debt and equity securities, joint venture arrangements, and/or property disposals;

our ability to obtain future financing arrangements;

estimates relating to, and our ability to pay, future distributions;

our ability to service our debt and comply with all of our debt covenants;

our ability to compete in the marketplace;

lease rates and interest rates;

market trends;

projected capital expenditures; and

the impact of technology on our facilities, operations and business.

The forward-looking statements are based on our beliefs, assumptions and expectations of our future performance, taking into account information currently available to us. These beliefs, assumptions and expectations can change as a result of many possible events or factors, not all of which are known to us. If a change occurs, our business, financial condition, liquidity and results of operations may vary materially from those expressed in our forward-looking statements. You should carefully consider these risks before you make an investment decision with respect to our common stock and other securities, along with, among others, the following factors that could cause actual results to vary from our forward-looking statements:

the factors referenced in this Annual Report onForm 10-K, including those set forth under the sections captioned “Risk Factors,” “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” and “Business;”

Index to Financial Statements
the political, economic, business, real estate, and other market conditions of the U.S. (both national and local) and European, Europe (in particular Germany, the United Kingdom, Spain and Italy) political, economic, business, real estate,, and other market conditions;foreign jurisdictions;

the competitive environment in which we operate;

the execution of our business plan;

financing risks;

the risk that a condition to closing under the agreements governing any or all of our outstanding transactions that have not closed as of the date hereof (including the Healthscope Ltd. (“Healthscope”) transaction described in Note 13 to Item 8 of this Annual Report on Form 10-K) may not be satisfied;

3


the possibility that the anticipated benefits from any or all of the transactions we enter into will take longer to realize than expected or will not be realized at all;

acquisition and development risks;

potential environmental contingencies and other liabilities;

other factors affecting the real estate industry generally or the healthcare real estate industry in particular;

our ability to maintain our status as a real estate investment trust, or REIT, for U.S. federal and state income tax purposes;

our ability to attract and retain qualified personnel;

changes in foreign currency exchange rates;

changes in tax laws in the U.S., Europe or any other foreign jurisdictions;

healthcare and other regulatory requirements of the U.S. (both federal and state) and European, Europe (in particular Germany, the United Kingdom, Spain and Italy) healthcare, and other regulatory requirements;foreign countries; and

U.S. national and local economic conditions, as well as conditions in Europe, Australia and any other foreign jurisdictions where we own or will own healthcare facilities, which may have a negative effect on the following, among other things:

the financial condition of our tenants, our lenders, or institutions that hold our cash balances, which may expose us to increased risks of default by these parties;

our ability to obtain equity or debt financing on attractive terms or at all, which may adversely impact our ability to pursue acquisition and development opportunities, refinance existing debt and our future interest expense; and

the value of our real estate assets, which may limit our ability to dispose of assets at attractive prices or obtain or maintain debt financing secured by our properties or on an unsecured basis.

When we use the words “believe,” “expect,” “may,” “potential,” “anticipate,” “estimate,” “plan,” “will,” “could,” “intend” or similar expressions, we are identifying forward-looking statements. You should not place undue reliance on these forward-looking statements. Except as required by law, we disclaim any obligation to update such statements or to publicly announce the result of any revisions to any of the forward-looking statements contained in this Annual Report on Form10-K to reflect future events or developments.

4


Index to Financial Statements

PART I

ITEM 1.

Business

Overview

We are a self-advised real estate investment trust (“REIT”) focused on investing in and owningnet-leased healthcare facilities across the U.S. and selectively in foreign jurisdictions. We have operated as a REIT since April 6, 2004, and accordingly, elected REIT status upon the filing of our calendar year 2004 federal income tax return. Medical Properties Trust, Inc. was incorporated under Maryland law on August 27, 2003, and MPT Operating Partnership, L.P. was formed under Delaware law on September 10, 2003. We conduct substantially all of our business through MPT Operating Partnership, L.P. We acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases, which require the tenant to bear most of the costs associated with the property. We also make mortgage loans to healthcare operators collateralized by their real estate assets. In addition, we selectively make loans to certain of our operators through our taxable REIT subsidiaries (“TRS”), the proceeds of which are typically used for acquisition and working capital purposes. Finally, from time to time, we acquire a profits or other equity interest in our tenants that gives us a right to share in such tenants’ profits and losses.

Our investments in healthcare real estate, including mortgage and other loans, as well as any equity investments in our tenants are considered a single reportable segment as further discussed in Note 1 of Item 8 in Part II of this Annual Report onForm 10-K. All of our investments are currently located in the United StatesU.S. and Europe.

At December 31, 20162018 and 2015, we had $6.4 billion and $5.6 billion, respectively, in2017, our total assets were made up of the following:following (dollars in thousands):

 

 

2018

 

 

 

 

 

 

2017

 

 

 

 

 

(dollars in thousands)  2016     2015     

Real estate owned (gross)

  $4,912,320    76.6 $3,875,536    69.1

 

$

5,868,340

 

 

 

66.4

%

 

$

6,595,252

 

 

 

73.1

%

Mortgage loans

   1,060,400    16.5 757,581    13.5

 

 

1,213,322

 

 

 

13.7

%

 

 

1,778,316

 

 

 

19.7

%

Other loans

   155,721    2.4 664,822    11.9

 

 

373,198

 

 

 

4.2

%

 

 

150,209

 

 

 

1.7

%

Construction in progress

   53,648    0.8 49,165    0.9

 

 

84,172

 

 

 

1.0

%

 

 

47,695

 

 

 

0.5

%

Other assets

   236,447    3.7 262,247    4.6
  

 

   

 

  

 

   

 

 

Total(1)

  $6,418,536    100.0 $5,609,351    100.0
  

 

   

 

  

 

   

 

 

Other

 

 

1,304,611

 

 

 

14.7

%

 

 

448,816

 

 

 

5.0

%

Total(1)(2)

 

$

8,843,643

 

 

 

100.0

%

 

$

9,020,288

 

 

 

100.0

%

 

(1)

Includes $1.3$2.3 billion and $1.8 billion of healthcare real estate owned and other assets in Europe in 20162018 and 2015.2017, respectively.

(2)

At December 31, 2018, our total gross assets were $9.7 billion, which represents total assets plus accumulated depreciation and amortization adjusted for all binding real estate commitments and unfunded amounts on development deals and commenced capital improvement projects at December 31, 2018 – see section titled “Non-GAAP Financial Measures” in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Item 7 of this Annual Report on Form 10-K.

Revenue by property type:

The following is our revenue by property type for the year ended December 31 (dollars in thousands):

 

 

2018

 

 

 

 

 

 

2017

 

 

 

 

 

 

2016

 

 

 

 

 

  2016     2015     2014     

General Acute Care Hospitals(1)

  $344,523    63.7 $255,029    57.7 $187,060    59.9

General Acute Care Hospitals

 

$

596,426

 

 

 

76.0

%

 

$

488,764

 

 

 

69.4

%

 

$

344,523

 

 

 

63.7

%

Inpatient Rehabilitation Hospitals

   149,964    27.7 134,198    30.4 71,564    22.9

 

 

158,193

 

 

 

20.2

%

 

 

173,149

 

 

 

24.6

%

 

 

149,964

 

 

 

27.7

%

Long-Term Acute Care Hospitals

   46,650    8.6 52,651    11.9 53,908    17.2

 

 

29,903

 

 

 

3.8

%

 

 

42,832

 

 

 

6.0

%

 

 

46,650

 

 

 

8.6

%

  

 

   

 

  

 

   

 

  

 

   

 

 

Total revenue(2)

  $541,137    100.0 $441,878    100.0 $312,532    100.0
  

 

   

 

  

 

   

 

  

 

   

 

 

Total revenues(1)(2)

 

$

784,522

 

 

 

100.0

%

 

$

704,745

 

 

 

100.0

%

 

$

541,137

 

 

 

100.0

%

 

(1)

Includes three medical office buildings.

(2)Includes $101.6$113.5 million, $127.6 million and $83.0$101.6 million in revenue (primarily from rehabilitation facilities) from the healthcare real estate assets in Europe in 2018, 2017 and 2016, and 2015, respectively.

(2)

For 2018, our adjusted revenues were $816.9 million, which adjusts actual total revenues to include our pro rata portion of similar revenues in our joint venture arrangements. See section titled “Non-GAAP Financial Measures” in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Item 7 of this Annual Report on Form 10-K.

See “Overview” in Item 7 of this Annual Report onForm 10-K for details of transaction activity for 2016, 20152018, 2017 and 2014.2016. More information is available on the Internet at www.medicalpropertiestrust.com.


Index to Financial Statements
5


Portfolio of Properties

As of February 24, 2017,22, 2019, our portfolio consisted of 232276 properties: 215255 facilities (of the 220 facilities that we own) are leased to 3029 tenants, fivethree are under development, and the remaining assets10 are in the form of mortgage loans to four operators.operators, and eight properties are not currently leased to a tenant, including six Adeptus Health, Inc. (“Adeptus Health”) transition properties, as discussed in Note 3 to Item 8 of this Annual Report on Form 10-K. Of the 276 properties, 80 facilities are owned by way of joint venture arrangements in which we hold a 50% ownership interest.  Our facilities consist of 136160 general acute care hospitals, 79102 inpatient rehabilitation hospitals, and 1714 long-term acute care hospitals (“LTACHs”).

At February 24, 2017,22, 2019, no single property accounted for more than 3.6%3.7% of our total gross assets.

Outlook and Strategy

Our strategy is to lease the facilities that we acquire or develop to experienced healthcare operators pursuant to long-term net leases. Alternatively, we have structured certain of our investments as long-term, interest-only mortgage loans to healthcare operators, and we may make similar investments in the future. Our mortgage loans are structured such that we obtain similar economic returns as our net leases. In addition, we have obtained and will continue to obtain profits or other interests in certain of our tenants’ operations in order to enhance our overall return. The market for healthcare real estate is extensive and includes real estate owned by a variety of healthcare operators. We focus on acquiring and developing thosenet-leased facilities that are specifically designed to reflect the latest trends in healthcare delivery methods and that focus on the most critical components of healthcare. We typically invest in facilities that have the highest intensity of care including:

General acute care — provideprovides inpatient care for the treatment of acute conditions and manifestations of chronic conditions. TheyThis type of facility also provideprovides ambulatory care through hospital outpatient departments and emergency rooms.

Inpatient rehabilitation — provideprovides rehabilitation to patients with various neurological, muscular, skeletalmusculoskeletal orthopedic and other medical conditions following stabilization of their acute medical issues.

Long-term acute careLTACHs a specialty-care hospital designed for patients with serious medical problems that require intense, special treatment for an extended period of time, sometimes requiring a hospital stay averaging in excess of three weeks.


Index to Financial Statements
6


Diversification

A fundamental component of our business plan is the continued diversification of our tenant relationships, the types of hospitals we own and the geographic areas in which we invest. From a tenant relationship perspective, see section titled “Significant Tenants” below for detail. See sections titled “Revenue by Property Type” and “Portfolio of Properties” above for information on the diversification of our hospital types. From a geographical perspective, we have investments across the U.S. and in Europe. See below for investment and revenue concentration in the U.S. and our global concentration at December 31, 20162018(1):

 

 

(1)

Represents investment

(1)

On January 31, 2019, we announced the entering into definitive agreements to acquire 11 Australian hospitals from Healthscope for an aggregate purchase price of approximately $860 million. Pro forma for this transaction, our concentration as a percentage ofin gross real estate assets other loans,would be 77.2% and equity investments assuming all real estate commitments at December 31, 2016 are fully funded.22.8% for U.S. and International, respectively.

We continue to believe that Europe represents an attractive market in which to invest, particularly in Germany. Germany is an attractive investment opportunity for us given Germany’sits strong macroeconomic position and healthcare environment. Germany’s Gross Domestic Product (“GDP”), which is approximately $3,363 billion$3.7 trillion according to World Bank 20152017 data, has been relatively more stable than other countries in the European Union due to Germany’s stable business practices and monetary policy. In addition to cultural influences, government policies emphasizing sound public finance and a significant presence of small andmedium-sized enterprises (which employ 68%70% of the employment base) have also contributed to Germany’s strong and sustainable economic position. The above factors have contributed to an unemployment rate in Germany of 3.9%3.3% as of December 2016,2018, which is significantly less than the 9.6%7.9% unemployment rate in the European Union as of December 2016,2018, according to Eurostat.

Index to Financial Statements

Underwriting/Asset Management

Our revenue is derived from rents we earn pursuant to the lease agreements with our tenants, from interest income from loans to our tenants and other facility owners and from profits or equity interests in certain of our tenants’ operations. Our tenants operate in the healthcare industry, generally providing medical, surgical and rehabilitative care to patients. The capacity of our tenants to pay our rents and interest is dependent upon their ability to conduct their operations at profitable levels. We believe that the business

7


environment of the industry segments in which our tenants operate is generally positive for efficient operators. However, our tenants’ operations are subject to economic, regulatory and market conditions that may affect their profitability, which could impact our results. Accordingly, we monitor certain key factors, changes to whichperformance indicators that we believe may provideprovides us with early indications of conditions that maycould affect the level of risk in our portfolio.

Key factors that we consider in underwriting prospective tenants and in our ongoing monitoring of our tenants’ (and any guarantors’) performance include the following:

the scope and breadth of clinical services and programs, including admission levelsutilization trends (both inpatient and outpatient) by service type;

the size and composition of medical staff and physician leadership at our facilities, including specialty, tenure and number of procedures performed and/or referrals;

an evaluation of our operator's administrative team, as applicable, including background and tenure within the healthcare industry;

facility operating performance measured by current, historical and prospective operating margins (measured by a tenant’stenant's earnings before interest, taxes, depreciation, amortization, management fees and facility rent) of each tenant and at each facility;

the ratio of our tenants’tenants' operating earnings both to facility rent and to other fixed costs, including debt costs;

trendschanges in the sourcerevenue sources of our tenants’ revenue,tenants, including the relative mix of public payors (including Medicare, Medicaid/MediCal, and managed care in the U.S. as well as equivalent payors in Germany, the United Kingdom, Italy, and Spain) and private payors (including commercial insurance and private pay patients);

trends in tenanttenants' cash collections, including comparison to recorded net patient service revenues;

tenants' free cash flow;

the effectpotential impact of any legal, regulatory or compliance proceedings with our tenants;

the effect of evolving healthcare legislation and other regulations (including changes in reimbursement) on our tenants’tenants' profitability and liquidity;

the potential impact of any legal, regulatory or compliance proceedings with our tenants;

demographics

an ongoing assessment of the local and surrounding areas in whichoperating environment of our tenants operate;

theincluding demographics, competition, including the prospective tenant’s market position,  relative to competition;

evaluationstatus of medical staff doctors and physician leadership associated with the facility/facilities, including specialty, tenure and number of procedures performed;

evaluation of the operator’s and facility’s administrative team, as applicable, including background and tenure within the healthcare industry;

compliance, accreditation, quality performance and health outcomes as measured by The Centers for Medicare and Medicaid Services (“CMS”("CMS"), Joint Commission, and Joint Commission;other governmental bodies; and

the level of investment in the hospital infrastructure and health IT systems.

Healthcare Industry

The delivery of healthcare services, whether in the U.S. or elsewhere, requires real estate and, as a consequence, healthcare providers depend on real estate to maintain and grow their businesses. We believe that the healthcare real estate market provides investment opportunities due to the:

compelling demographics driving the demand for healthcare services;

specialized nature of healthcare real estate investing; and

consolidation of the fragmented healthcare real estate sector.

Index to Financial Statements

United States

Healthcare is the single largest industry in the U.S. based on GDP. According to the National Health Expenditures report dated July 20162017 by the CMS: (i) national health expenditures arewere projected to grow 5.1%5.3% in 2017;2018; (ii) the average compound annual growth rate for national health expenditures, over the projection period of 2017 through 2025,2026, is anticipated to be 6.0%5.5%; and (iii) the healthcare industry is projected to represent 20.1%19.7% of U.S. GDP by 2025.2026.

Germany

The healthcare industry is also the single largest industry in Germany. Behind only the U.S., Netherlands and France, Germany’s healthcare expenditures represent approximately 11.0%11.1% of its total GDP according to the Organization for EconomicCo-operation and Development’s 20132014 data.

8


The German rehabilitation market (which includes the majority of our facilities in Germany) serves a broader scope of treatment with over 1,233 rehabilitation facilities (compared to 1,165 in the U.S.) and 208.5 beds per 100,000 population (compared to 114.7 in the U.S.). Approximately 90% of the payments in the German healthcare system come from governmental sources. The largest payor category is the public pension fund system representing 39% of payments. Public health insurance and payments for government employees represent 46% of payments. The balance of the payments into the German rehabilitation market come from a variety of sources including private pay and private insurance. One particular focus area of investors in the German market is the healthcare industry because the German Social Code mandates universal access coverage and a high standard of care, thereby creating a robust healthcare dynamic in the country. Germany spends approximately 7.4% of health spending for inpatient facilities on prevention and rehabilitation facilities.

United Kingdom

Healthcare services in the United Kingdom are provided through the National Health Service (“NHS”). In 2013,2016, the United Kingdom spent 8.8%9.8% of GDP on healthcare. The majority of this funding for the NHS comes from general taxation, and a smaller proportion from national insurance (a payroll tax). The NHS also receives income from copayments, people using NHS services as private patients, and some other minor sources. In 2012, 10.9%2015, 10.5% of the United Kingdom population had private voluntary health insurance provided mostly through employers. Private insurance offers more rapid and convenient access to care, especially for elective hospital procedures. It is estimated that four insurers account for 87.5% of the market, with small providers comprising the rest. The total private healthcare market is about £1.47 billion. Demand for private health insurance rose by 2.1% in 2015.

Publicly owned hospitals are organized either as NHS trusts, approximately 9872 in number or as Foundationfoundation trusts, approximately 147150 in number. NHS trusts are accountable to the Department of Health while foundation trusts enjoy greater freedom from central control. An estimated 548 private hospitals are located in the United Kingdom and offer a range of treatments. Their charges to private patients are not regulated, and they receive no public subsidies. NHS use of private hospitals remains low with about 3.6% of NHS funding used for this purpose. The NHS budget was flat for the period from 2010is projected to 2015.grow 1.1% between 2015 and 2021.

Italy

The Italian national health service (Servizio Sanitario Nazionale) is regionally based and organized at the national, regional, and local levels. Under the Italian constitution, responsibility for healthcare is shared by the national government and the 19 regions and 2two autonomous provinces. The central government controls the distribution of tax revenue for publicly financed health care and defines a national statutory benefits package to be offered to all residents in every region — the “Essential Levels of Care.” The 19 regions and two autonomous provinces have responsibility for the organization and delivery of health services through local health units.

Public financing accounted for 78%76% of total health spending in 2013,2014, with total expenditure standing at 9.1%8.9% of GDP.GDP in 2016. The public system is financed primarily through a corporate tax (approximately 35.6% of the

Index to Financial Statements

overall funding in 2012) pooled nationally and allocated back to regions, typically the source region, and a fixed proportion of national value-added tax revenue (approximately 47.3% of the total in 2012) collected by the central government and redistributed to regions unable to raise sufficient resources to provide the essential levelsEssential Levels of care.Care.

In 2011,2012, there were approximately 194,000187,000 beds in public hospitals and 47,50045,500 beds in private accredited hospitals. A diagnosis-related group-based prospective payment system operates across the country and accounts for most hospital revenue.

Private health insurance plays a limited role in the health system, accounting for roughly 1% of total spending in 2009.2014. Approximately 15% of the population hassix million people are covered by some form of privatevoluntary insurance which generally covers services excluded under the Essential Levels of Care, to offer a higher standard of comfort and privacy in hospital facilities, and wider choice among public and private providers. Some private health insurance policies also cover copayments for privately provided services, or a daily rate of compensation during hospitalization. There are two types of private health insurance: corporate, where companies cover employees and sometimes their families; andnon-corporate, with individuals buying insurance for themselves or their family.

Depending on the region, public funds are allocated by local health units to public and accredited private hospitals. Rates paid to hospitals include all hospital costs including those of physicians. Funding for health is defined by the July 2014 Pact for Health which defines funding between $143.4 billion and $151.3 billion annually for the years 2014 to 2016.

Spain

The Spanish health system was established by the General Health Law of 1986. This law carries out a mandate of the Spanish Constitution, which establishes the right of all citizens to protection of their health. The National Health System (Sistema Nacional de Salud, SNS) is the administrative device set up by the law. Spain spendsspent approximately 9.6%9.0% of its GDP on health care. care in 2016.

9


Expenditures for private healthcare are 26.4% of total health expenditures and have been growing at a compounded annual growth rate of 1.7%. Approximately 80% of all Spanish patients use a combination of both private and public healthcare services.

PrivateIn 2014, private hospitals comprise 53%comprised 55% of total Spanish hospitals. Specifically, private hospitals and 32%numbered 421 while public hospitals accounted for 343 of Spain’s total number of hospitals.

Public expenditures on healthcare accounted for 5.9% of total beds. Private hospitals account for 24%public expenditures. They are projected to grow to 7.1% of hospital discharges, 30% of surgeries and 20% of visits to Accident and Emergency Services. Demand for private hospital services is increasing attotal public expenditures by 2050. In 2015, public spending on healthcare reached €68 million, a compound rate of 3.8%significant increase from 2008 through 2011. In terms of private insurance, the top ten companies€23 million spent in Spain account for 82% of the market.1995.

Our Leases and Loans

The leases for our facilities are generally “net” leases with terms generally requiring the tenant to pay all ongoing operating and maintenance expenses of the facility, including property, casualty, general liability and other insurance coverages, utilities and other charges incurred in the operation of the facilities, as well as real estate and certain other taxes, ground lease rent (if any) and the costs of capital expenditures, repairs and maintenance (including any repairs mandated by regulatory requirements). Similarly, borrowers under our mortgage loan arrangements retain the responsibilities of ownership, including physical maintenance and improvements and all costs and expenses. Our leases and loans typically require our tenants to indemnify us for any past or future environmental liabilities. Our current leases and loans have a weighted-averageweighted average remaining initial lease or loan term of 14.112.7 years (see Item 2 for more information on remaining lease or loan terms). and most include renewal options at the election of our tenants.  Based on current monthly revenue, approximately 99%more than 96% of our leases and loans provide for annual rent or interest escalations based on either increases in the U.S. Consumer Price Indexconsumer price index (“CPI”) and/or fixed minimum annual rent or interest escalations ranging from 0.5% to 5%3.0%. In some cases, our domestic leases and loans provide for escalations based on CPI subject to floors and/or ceilings. In certain limited cases, we may have arrangements that provide for additional rents based on the level of a tenant’s revenue.

Index to Financial Statements

RIDEA Investments

We have made, and willmay make in the future, investments in certain of our tenants in the form of equity investments, loans (with equity like returns) and obtain, or profit interests in certain of our tenants.interests. Some of these investments fall under a structure permitted by the REIT Investment Diversification and Empowerment Act of 2007 (“RIDEA”), which was signed into law under the Housing and Economic Recovery Act of 2008. Under the provisions of RIDEA, a REIT may lease “qualified health care properties” on an arm’s length basis to a taxable REIT subsidiary (“TRS”)TRS if the property is operated on behalf of such subsidiary by a person who qualifies as an “eligible independent contractor.” We view RIDEA as a structure primarily to be used on properties that present attractive valuation entry points. At December 31, 2016,2018, our RIDEA investments totaled approximately $105.8$14.2 million.

Significant Tenants

At December 31, 2016,2018, we had total assets of approximately $6.4$8.8 billion comprised of 231275 healthcare properties (including 80 real estate facilities held in 30joint ventures) in 29 states, in Germany, the United Kingdom, Italy, and Spain. The properties are leased to or mortgaged by 3029 different hospital operating companies. On a gross asset basis, (which is total assets before accumulated depreciation/amortizationas more fully described in the section titled “Non-GAAP Financial Measures” in “Management’s Discussion and assumes all real estate commitments at that time are fully funded)Analysis of Financial Condition and Results of Operations” in Item 7 of this Annual Report on Form 10-K), our top five tenants were as follows (dollars in thousands):

Gross Assets by Operator

 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

Operators

 

Total

Gross Assets

 

 

 

Percentage of

Total

Gross Assets

 

 

Total

Gross Assets

 

 

 

Percentage of

Total

Gross Assets

 

Steward

 

$

3,823,625

 

 

 

 

39.5

%

 

$

3,457,384

 

 

 

 

36.5

%

Prime

 

 

1,124,711

 

 

 

 

11.6

%

 

 

1,119,484

 

 

 

 

11.8

%

MEDIAN

 

 

1,075,504

 

 

 

 

11.1

%

 

 

1,229,325

 

 

 

 

13.0

%

LifePoint(1)

 

 

502,072

 

 

 

 

5.2

%

 

 

506,265

 

 

 

 

5.3

%

Ernest

 

 

500,397

 

 

 

 

5.2

%

 

 

629,161

 

 

 

 

6.6

%

Other operators

 

 

1,644,900

 

 

 

 

16.9

%

 

 

2,089,934

 

 

 

 

22.1

%

Other assets

 

 

1,012,962

 

 

 

 

10.5

%

 

 

444,659

 

 

 

 

4.7

%

Total(2)

 

$

9,684,171

 

 

 

 

100.0

%

 

$

9,476,212

 

 

 

 

100.0

%

 

   As of December 31, 2016  As of December 31, 2015 

Operators

  Total
Gross Assets
   Percentage of
Total Gross Assets
  Total
Gross Assets
   Percentage of
Total Gross Assets
 

Steward

  $1,250,000    17.5 $—      —   

Prime

   1,144,055    16.0  1,032,353    17.1

MEDIAN

   993,677    13.9  1,031,039    17.1

Ernest

   627,906    8.8  579,182    9.6

RCCH

   566,600    7.9  1,059,989    17.6

(1)

In 2018, LifePoint Health, Inc. (“LifePoint”) merged with RCCH Healthcare Partners (“RCCH”), who acquired Capella Healthcare, Inc. (“Capella”) in 2016. Any reference to either LifePoint, RCCH, or Capella represent the same entity.

(2)

With the Australian acquisition discussed in Note 13 to Item 8 of this Annual Report on Form 10-K, we expect to further diversify our concentration metrics including by operator. For instance, our concentration in Steward Health Care System LLC (“Steward”) would decrease to 38% of pro forma gross assets.

10


Steward

Affiliates of Steward Health Care System LLC (“Steward”) lease five41 facilities pursuant to aone master lease agreement, which has ahad an initial 15-year term (ending in October 2031) with three five-year extension options, plus annual inflation-based escalators. At December 31, 2016,2018, these facilities had an average remaining initial lease term of 14.812.8 years. In addition to the master lease, we hold a mortgage loan on fourtwo facilities with terms and provisions substantiallythat produce economic results in terms of day-to-day cash flows that are similar to thethose of our master lease agreement. The master lease and loan agreements includeagreement includes extension options that must include all or none of the master leased properties, cross default provisions for the leases, and loans, and a right of first refusal for the repurchase of the leased properties. We closed on theThe master loan agreement has independent extension options for each property and does not provide comparable cross default provisions. At December 31, 2018, we hold a 9.9% equity investment in Steward properties on October 3, 2016 for a combined investment of $1.25 billion, which includes a $50 million minority equity contribution in Steward.$150 million.

Prime

Affiliates of Prime Healthcare Services, Inc. (“Prime”) lease 22 facilities pursuant to five master lease agreements. Four of the master leases are forhave initial fixed terms of 10 years and contain two renewal options of five years each. The fifth master lease is for 15 years and contains three renewal options for five years each. Rent escalates each year based on the CPI increase, with a 2% minimum floor. At the end of the initial or any renewal term, Prime must exercise any available extension or purchase option with respect to all or none of the leased and mortgaged properties relative to each master lease. The master leases include repurchase options, including provisions establishing minimum repurchase prices equal to our total investment. At December 31, 2016,2018, these facilities had an average remaining initial fixed term of 8.16 years. In addition to leases, we hold mortgage loans on three facilities owned by affiliates of Prime. The terms and provisions of these loans are generally equivalent to the terms and provisions of our Prime lease arrangements.

Median

Affiliates of Median Kliniken S.à r.l.(“MEDIAN”) lease 5080 facilities (71 of which are owned by a joint venture arrangement – see Note 3 of Item 8 of this Annual Report on Form 10-K) pursuant to twosix master lease agreements. EachNone of the master lease agreement has an approximate27-year fixed term with noagreements have renewal or repurchase

Index options. The annual escalators for three of the master leases provide for increases of the greater of 1% or 70% of the change in German CPI. The lease term for these master leases ends in November 2044 for three of the facilities, December 2042 for three of the facilities, and August 2045 for three of the facilities. The 71-facility joint venture arrangement portfolio is leased to Financial Statements

options.MEDIAN pursuant to the three remaining master lease agreements. The annual escalator for one master lease, that representsrepresenting 15 facilities, provided for a fixed increase of the MEDIAN portfolio2% through 2017 and provides for fixed increases of 2% for 2017 and additional fixed increases of 0.5% each year thereafter. In addition, at December 31, 2020 and every three years thereafter, rent will be increased, if needed, to reflectby the positive difference between 1.5% and 70% of cumulative increasesthe change in German CPI.CPI during the review period. This master lease had an approximate 27-year fixed term ending in November 2040. The annual escalatorescalators for the other two master leaseleases that coverscover the remaining facilities ofin the MEDIAN portfolio providesjoint venture arrangement provide for increases of the greater of 1% or 70% of the change in German CPI. The lease terms for these remaining leases end in December 2042 for 36 of the facilities and August 2043 for 20 of the facilities.

LifePoint

Affiliates of LifePoint lease seven facilities (five of which are leased pursuant to a master lease agreement). The master lease agreement had an initial fixed 13.5-year term with four five-year extension options, plus annual consumer price-indexed increases, limited to a 2% floor and a 4% ceiling. The extension options may be exercised with respect to any or all of the properties. At the end of the fixed term and during any exercised extension options, the lessee will have the right of first refusal to purchase the leased property. At December 31, 2018, these facilities had an average remaining initial fixed lease term of 10.2 years. In addition to the master lease, two facilities are leased pursuant to stand-alone leases with a weighted average remaining fixed term of 10.1 years. The terms and provisions of these leases are generally equivalent to the terms and provisions of the master lease agreement.

 Ernest

Affiliates of Ernest Health, Inc. (“Ernest”) lease 2225 facilities including one under development, pursuant to a master lease agreement and two stand-alone lease agreements. The original master lease agreement entered into in 2012, covering 2019 properties, had a20-year initial fixed term with three five-year extension options and provides for annual consumer price-indexed increases, limited to a 2% floor and 5% ceiling annually.ceiling. At December 31, 2016,2018, these facilities had a remaining initial fixed lease term of 15.213.2 years. This master lease includes purchase options that allow the lessee to purchase the leased property at onan option price equal to the greater of fair market value of the lease property or the lease base increased by an amount equal to the annual rate of increase in the CPI on each adjustment date. All leases and loans are cross-defaulted, including the mortgage loans. In addition to the original master lease, Ernest affiliates lease the remainingtwo other properties including one property that is currently under development, pursuant to two separate stand-alone leases that have terms generally similarleases. At December 31, 2018, one facility (with a 15-year initial fixed term ending March 2033) had a remaining initial fixed lease term of 14.2 years and one facility (with a 20-year initial fixed term ending June 2035) had a remaining initial fixed lease term of 16.5 years. Each stand-alone lease has three five-year extension options and provides for annual consumer price-indexed increases, limited to the original master lease agreement. Furthermore, we hold a 2% floor and 4% ceiling. The mortgage loan on four facilities owned by affiliates of Ernest that willloans mature in 2032. The2032, and the terms and provisions of these loans are generally equivalent to the terms and provisions of the original master lease agreement.

Affiliates of RCCH Healthcare Partners (“RCCH”) (formally Capella Healthcare Inc.) lease six facilities (four of which are leased pursuant to a master lease agreement). The master lease agreement has an initial fixed13.5-year term with four five-year extension options, plus consumer price-indexed increases, limited to a 2% floor and a 4% ceiling annually. The extension options may be exercised with respect to any or all of the properties. At the end of the fixed term, and during any exercised extension options, the lessee will have the right of first refusal to purchase the leased property. At December 31, 2016, these facilities had an average remaining initial fixed lease term of 12.2 years. In addition to the master lease, two facilities are leased pursuant to stand-alone leases with a weighted average remaining fixed term of 12.3 years. The terms and provisions of these leases are generally equivalent to the terms and provisions of the master lease agreement.11


No other tenant accounted for more than 7%3.7% of our total gross assets at December 31, 2016.2018.

Environmental Matters

Under various U.S. federal, state and local environmental laws and regulations and similar international laws, a current or previous owner, operator or tenant of real estate may be required to remediate hazardous or toxic substance releases or threats of releases. There may also be certain obligations and liabilities on property owners with respect to asbestos containing materials. Investigation, remediation and monitoring costs may be substantial. The confirmed presence of contamination or the failure to properly remediate contamination on a property may adversely affect our ability to sell or rent that property or to borrow funds using such property as collateral and may adversely impact our investment in that property. Generally, prior to completing any acquisition or closing any mortgage loan, we obtain Phase I environmental assessments (or their equivalentsimilar studies outside the U.S.) in order to attempt to identify potential environmental concerns at the facilities. These assessments are carried out in accordance with an appropriate level of due diligence and generally include a physical site inspection, a review of relevant environmental and health agency database records, one or more interviews with appropriate site-related personnel, review of the property’s chain of title and review of historic aerial photographs and other information on past uses of the property. We may also conduct limited subsurface investigations and test for substances of concern where the results of the Phase I environmental assessments or other information indicates possible contamination or where our consultants recommend such procedures. Upon closing and for the remainder of the lease or loan term, our transaction documents require our tenants to repair and remediate any environmental concernissues at the applicable facility, and to comply in full with all environmental laws and regulations.

Index to Financial Statements

California Seismic Standards

California’sExisting law, the Alfred E. Alquist Hospital Facilities Seismic Safety Act of 1973 (the “Alquist1983 (“Alquist Act”) established a seismic safety building standards program, establishes, under the jurisdiction of the Office of Statewide Health Planning and Development (“OSHPD”) jurisdiction, a program of seismic safety building standards for certain hospitals builtconstructed on orand after March 7, 1973. It requiredThe law requires the California Building Standards Commission to adopt earthquake performance categories, seismic evaluation procedures, standards and timeframes for upgrading certain facilities, and seismic retrofit building standards. These regulations required hospitals to meet certain seismic performance standards to ensure that they are capable of providing medical services to the public after an earthquake or other disaster. This legislation was adopted to avoid the loss of life and the disruption of operations and the provision of emergency medical services that may result from structural damage sustained to hospitals resulting from an earthquake.  A violation of any provision of the act is a misdemeanor.

The Building Standards Commission completed its adoption of evaluation criteria and retrofit standards in 1998. TheUnder the Alquist Act required the Building Standards Commission to adopt certain evaluation criteria and retrofit standards such as:

hospitalsrelated rules and regulations, all general acute care hospital buildings in California must conduct seismic evaluationsare assigned a structural performance category (“SPC”). SPC ratings range from 1 to 5 with SPC-1 assigned to buildings that may be at risk of collapse during a strong earthquake and submit these evaluationsSPC 5 assigned to buildings reasonably capable of providing services to the OSHPD, Facilities Development Division for its reviewpublic following a strong earthquake. State law requires all SPC-1 buildings to be removed from providing general acute care services by 2020 and approval;

hospitalsall SPC-2 buildings to be removed from providing general acute care services by 2030, in California must identifyeach case unless the most critical nonstructural systemsfacility is seismically retrofit so that represent the greatest risk of failure during an earthquake and submit timetables for upgrading these systems to the OSHPD, Facilities Development Division for its review and approval; and

hospitalsit is in California must prepare a plan and compliance schedule for each regulated building demonstrating the steps a hospital will take to bring the hospital buildings into substantial compliance with the seismic safety regulations and standards.
standards developed by OSHPD.

SinceIn 2017, the Alquist Act, subsequent legislation has modified requirementsOSHPD adopted a new performance category that will allow hospitals to explore the possibilities of seismic safety standards and deadlines for compliance. Originally, hospitalupgrading nonconforming buildings considered hazardous and at risk of collapse in the event of an earthquake must have been retrofitted, replaced or removed from providing acute care services byto a new performance level that is not as rigorous. Under SPC-4D, buildings undergoing a retrofit to this level can continue functioning indefinitely beyond 2030.

The recent California AB 2190 bill (effective January 1, 2008; however, provisions were made to allow this deadline to be extended to January 1, 2013.

Senate Bill 499 was signed into law that provided for a number of seismic relief measures, including criteria for reclassifying buildings into a lower seismic risk category. These buildings would have until January 1, 2030 to comply with structural seismic safety standards. Buildings denied reclassification must have met seismic compliance standards by January 1, 2013, unless further extensions were granted.

California’s AB 306 legislation permitted2019) requires OSHPD to grant extensionsan additional extension of time to acute care hospitals that lacked the financial capacityan owner who is subject to meet the January 1, 2013,2020, deadline if specified conditions are met. The bill authorizes the additional extension to be until July 1, 2022, if the compliance plan is based upon replacement or retrofit deadline, and instead, requires them to replace those buildings by January 1, 2020. More recently, California SB 90 allows a hospital to seek an extension for seismic complianceor up to seven5 years based on three elements:

the structural integrity of the building;

the loss of essential hospital services to the community if the compliance plan is for a rebuild.

Owners of general acute care hospital is closed;buildings that are classified as nonconforming must submit reports to OSHPD describing the status of each building in complying with the extension provisions, and

to annually update OSHPD with any changes or adjustments.

financial hardship.

As of December 31, 2016,2018, we have 1310 licensed hospitals in California totaling investments of $542.9 million. approximately $507 million, which excludes investments of $15.8 million of medical office buildings not subject to OSHPD standards.

Exclusive of four hospitalsone hospital granted extensions byan OSHPD extension to 2020, all of our California buildingshospitals are seismically compliant through 2030 as determined by OSHPD. For our hospitals that were granted extensions, three (representing a total investment of $173.3 million) completed their seismic retro upgrades in 2016 and are currently awaiting final OSHPD reclassification. Our fourththe one hospital (with a total investment of $20 million) that was granted an extension, began retrofit planning this year, and we expect full compliance by theirthe 2020 deadline.deadline unless an additional extension is sought under California AB 2190 to July 1, 2022.

UnderIt is noted that under our current agreements, our tenants are responsible for capital expenditures in connection with seismic laws. We do not expect California seismic standards to have a negative impact on our financial condition

Index to Financial Statements

or cash flows. We also do not expect compliance with California seismic standards to materially impact the financial condition of our tenants.

12


Competition

We compete in acquiring and developing facilities with financial institutions, other lenders, real estate developers, healthcare operators, other REITs, other public and private real estate companies, and private real estate investors. Among the factors that may adversely affect our ability to compete are the following:

we may have less knowledge than our competitors of certain markets in which we seek to invest in or develop facilities;

some of our competitors may have greater financial and operational resources than we have;

some of our competitors may have lower costs of capital than we do;

our competitors or other entities may pursue a strategy similar to ours; and

some of our competitors may have existing relationships with our potential customers.

To the extent that we experience vacancies in our facilities, we will also face competition in leasing those facilities to prospective tenants. The actual competition for tenants varies depending on the characteristics of each local market. Virtually all of our facilities operate in highly competitive environments, and patients and referral sources, including physicians, may change their preferences for healthcare facilities from time to time. The operators of our properties compete on a local and regional basis with operators of properties that provide comparable services. Operators compete for patients and residents based on a number of factors including quality of care, reputation, physical appearance of a facility, location, services offered, physicians, staff, and price. We also face competition from other health care facilities for tenants, such as physicians and other health care providers that provide comparable facilities and services.

For additional information, see “Risk Factors” in Item 1A of this Annual Report on Form10-K.

Insurance

Our leases and mortgage loans require our tenants to carry property, loss of income, general liability, professional liability, and other insurance coverages in order to protect our interests. We monitor the adequacy of such coverages on an ongoing basis. In addition, we maintain separate insurance that provides coverage for bodily injury and property damage to third parties arising from our ownership of the healthcare facilities that are leased to and occupied by our tenants, as well as contingent business interruption insurance. At December 31, 2016,2018, we believe that the policy specifications and insured limits are appropriate given the relative risk of loss, the cost of the coverage, and standard industry practice.

Healthcare Regulatory Matters

The following discussion describes certain material federal healthcare laws and regulations that may affect our operations and those of our tenants. The discussion, however, does not address all applicable federal healthcare laws, and does not address state healthcare laws and regulations, except as otherwise indicated. These state laws and regulations, like the federal healthcare laws and regulations, could affect the operations of our tenants and, accordingly, our operations. In addition, in some instances we own a minority interest in our tenants’ operations and, in addition to the effect on our tenant’s ability to meet its financial obligations to us, our ownership and investment returns may also be negatively impacted by such laws and regulations. Moreover, the discussion relating to reimbursement for healthcare services addresses matters that are subject to frequent review and revision by Congress and the agencies responsible for administering federal payment programs. Consequently, predicting future reimbursement trends or changes, along with the potential impact to us, is inherently difficult.

Indexdifficult and imprecise.  Finally, though we have not included a discussion of applicable foreign laws or regulations, our tenants in the United Kingdom and Western Europe may be subject to Financial Statements
similar laws and regulations governing the ownership or operation of healthcare facilities including, without limitation, laws governing patient care and safety, reimbursement, licensure, and data protection.  

Ownership and operation of hospitals and other healthcare facilities are subject, directly and indirectly, to substantial U.S. federal, state, and local government healthcare laws, rules, and regulations. Our tenants’ failure to comply with these laws and regulations could adversely affect their ability to meet their obligations to us. Physician investment in usour facilities or in our facilitiesjoint ventures to own real estate also will be subject to such laws and regulations. Although we are not a healthcare provider or in a position to influence the referral of patients or ordering of items and services reimbursable by the federal government, to the extent that a healthcare provider engages in transactions with our tenants, such as sublease or other financial arrangements, the Anti-Kickback Statute and the Stark Law (both discussed in this section) could be implicated. Our leases and mortgage loans require theour tenants to comply with all applicable laws, including healthcare laws. We intend for all of our business activities and operations to conform in all material respects with all applicable laws, rules, and regulations, including healthcare laws, rules, and regulations.

13


Applicable Laws

Anti-Kickback Statute.  The federal Anti-Kickback Statute (codified at 42 U.S.C.§ 1320a-7b(b)) prohibits, among other things, the offer, payment, solicitation, or acceptance of remuneration, directly or indirectly, in return for referring an individual to a provider of items or services for which payment may be made in whole, or in part, under a federal healthcare program, including the Medicare or Medicaid programs. Violation of the Anti-Kickback Statute is a crime, punishable by fines of up to $25,000$100,000 per violation, fiveten years imprisonment, or both. Violations may also result in civil sanctions, including civil monetary penalties of up to $50,000 per violation, exclusion from participation in federal healthcare programs, including Medicare and Medicaid, and additional monetary penalties in amounts treble to the underlying remuneration. The Anti-Kickback Statute is an intent based statute, however, it has been broadly interpreted. As an example, courts have held that there is a violation of the Anti-Kickback Statute if just one purpose of an arrangement is to generate referrals despite the fact that there may be one or more other lawful purposes to the arrangement at issue.

The Office of Inspector General of the Department of Health and Human Services (“OIG”) has issued “Safe Harbor Regulations” that describe practices that will not be considered violations of the Anti-Kickback Statute. Nonetheless, the fact that a particular arrangement does not meet safe harbor requirements does not also mean that the arrangement violates the Anti-Kickback Statute. Rather, the safe harbor regulations simply provide a guaranty that qualifying arrangements will not be prosecuted under the Anti-Kickback Statute. We intend to use commercially reasonable efforts to structure our arrangements involving facilities, so as to satisfy, or meet as closely as possible, all safe harbor conditions. We cannot assure you, however, that we will meet all the conditions for an applicable safe harbor.

Physician Self-Referral Statute (“Stark Law”).  Any physicians investing in us or our subsidiary entities could also be subject to the Ethics in Patient Referrals Act of 1989, or the Stark Law (codified at 42 U.S.C. § 1395nn). Unless subject to an exception, the Stark Law prohibits a physician from making a referral to an “entity” furnishing “designated health services,” includingservices” (which would include, without limitation, certain inpatient and outpatient hospital services, clinical laboratory services, and radiology services,services) paid by Medicare or Medicaid if the physician or a member of his immediate family has a “financial relationship” with that entity. A reciprocal prohibition bars the entity from billing Medicare or Medicaid for any services furnished pursuant to a prohibited referral. Sanctions for violating the Stark Law include denial of payment, refunding amounts received for services provided pursuant to prohibited referrals, civil monetary penalties of up to $15,000 per prohibited service provided, and exclusion from the participation in federal healthcare programs. The statute also provides for a penalty of up to $100,000 for a circumvention scheme.

There are exceptions to the self-referral prohibition for many of the customary financial arrangements between physicians and providers, including, without limitation, employment contracts, leases,rental of office space or equipment, personal services agreements and recruitment agreements. Unlike safe harbors under the Anti-Kickback Statute, the Stark Law imposes strict liability on the parties to an arrangement and an arrangement must comply with every requirement of a Stark Law exception or the arrangement is in violation of the Stark Law.

The CMS has issued multiple phases of final regulations implementing the Stark Law and continues to make changes to these regulations. While these regulations help clarify the exceptions to the Stark Law, it is unclear

Index to Financial Statements

how the government will interpret many of these exceptions for enforcement purposes. Although our lease and loan agreements require lessees and borrowers to comply with the Stark Law, and we intend for facilities to comply with the Stark Law, where we own an interest in our tenants’ operations, we cannot offer assurance that the arrangements entered into by us and our facilities will be found to be in compliance with the Stark Law, as it ultimately may be implemented or interpreted. In addition, changes to the Stark Law could require our tenants to restructure certain arrangements with physicians, which could impact the business of our tenants.

False Claims Act.  The federal False Claims Act prohibits the making or presenting of any false claim for payment to the federal government; it is the civil equivalent to federal criminal provisions prohibiting the submission of false claims to federally funded programs. Additionally,qui tam, or whistleblower, provisions of the federal False Claims Act allow private individuals to bring actions on behalf of the federal government alleging that the defendant has defrauded the federal government. Whistleblowers may collect a portion of the federal government’s recovery — an incentive which increases the frequency offor private parties to bring such actions. A successful federal False Claims Act case may result in a penalty of three times the actual damages, plus additional civil penalties payable to the government, plus reimbursement of the fees of counsel for the whistleblower. Many states have enacted similar statutes preventing the presentation of a false claim to a state government, and we expect more to do so because the Social Security Act provides a financial incentive for states to enact statutes establishing state level liability.

The Civil Monetary Penalties Law.  The Civil Monetary Penalties Law (“CMPL”) is a comprehensive statute that covers an array of fraudulent and abusive activities and is very similar to the False Claims Act. Among other things, the Civil Monetary PenaltiesCMPL law prohibits the knowing presentation of a claim for certain healthcare services that is false or fraudulent, the presentation of false or misleading information in connection with claims for payment, and other acts involving fraudulent conduct. Penalties include a monetary civil penaltyViolation of upthe CMPL may result in penalties ranging from $20,000 to $10,000$100,000.  Notably, such penalties apply to each instance of prohibited conduct, including, for example, each item or service $15,000 fornot provided as claimed, and each individual with respectprovision of false information or each false record.  In addition, violators of the CMPL may be penalized up to whom false or misleading information was given, as well as treble damages forthree times the total amount of remuneration claimed.unlawfully claimed and may be excluded from participation in federal health care programs.

14


Licensure. Our tenants and borrowers under mortgage loans are subject to extensive U.S. federal, state, and local licensure, certification, and inspection laws and regulations including, in some cases, certificate of need laws. Further, various licenses and permits are required to dispense narcotics, operate pharmacies, handle radioactive materials, and operate equipment. Failure to comply with any of these laws could result in loss of licensure, certification or accreditation, denial of reimbursement, imposition of fines, and suspension or decertification from federal and state healthcare programs.

EMTALA. Our tenants and borrowers under mortgage loans that provide emergency care are subject to the Emergency Medical Treatment and Active Labor Act (“EMTALA”). ThisRegardless of an individual’s ability to pay, this federal law requires such healthcare facilities to conduct an appropriate medical screening examination of every individual who presents to the hospital’s emergency room for treatment and, if the individual is suffering from an emergency medical condition, to either stabilize the condition or make an appropriate transfer of the individual to a facility able to handle the condition.  The obligation to screen and stabilize emergency medical conditions exists regardless of an individual’s ability to pay for treatment. There are severe penalties under EMTALA if a hospital fails to screen or appropriately stabilize or transfer an individual or if the hospital delays appropriate treatment in order to first inquire about the individual’s ability to pay. Liability for violations of EMTALA includes,are severe and include, among other things, civil monetary penalties and exclusion from participation in the federal healthcare programs. Our lease and mortgage loan agreements require our tenants to comply with EMTALA, and we believe our tenants conduct business in substantial compliance with EMTALA.

Reimbursement Pressures.Healthcare facility operating margins continue to face significant pressure due to the deterioration in pricing flexibility and payor mix, a shift toward alternative payment models, increases in operating expenses that exceed increases in payments under the Medicare program, reductions in levels of Medicaid funding due to state budget shortfalls, and other similar cost pressures on our tenants. More specifically, certain facilities and departments such as LTACHs continue toand HOPDs face reimbursement pressures including those resulting from the passagebecause of the SGR Reform Act of 2013,legislative and CMS is also implementing regulatory restrictions and limitations on reimbursement for hospital outpatient departments, which could lead to decreased reimbursement for our tenants.reimbursement. We cannot predict how and

Index to Financial Statements

to what extent these or other initiatives will impact the business of our tenants or whether our business will be adversely impacted.

Healthcare Reform.Generally, the Patient Protection and Affordable Care Act, (as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the “Reform Law”) provides for expanded health insurance coverage through tax subsidies and federal health insurance programs, individual and employer mandates for health insurance coverage, and health insurance exchanges. The Reform Law also includes various cost containment initiatives, including quality control and payment system refinements for federal programs, such aspay-for-performance criteria and value-based purchasing programs, bundled provider payments, accountable care organizations, geographic payment variations, comparative effectiveness research, and lower payments for hospital readmissions. The Reform Law also increases health information technology (“HIT”) standards for healthcare providers in an effort to improve quality and reduce costs. The Reform Law has led and will continue to lead, to significant changes in the healthcare system. There are, however, continuing efforts to repeal and replaceWe believe the Reform Law.Law will continue to lead to changes in healthcare delivery and reimbursement for years to come, and it is likely that certain trends that have been in place since the passage of the Reform Law, such as development and implementation of cost containment initiatives, increased use of HIT and pressure on reimbursement, will continue irrespective of any future repeal efforts. We cannot predict the continued impact of the Reform Law or the impact of its possiblefuture repeal and replacement,efforts on our business, as some aspects benefit the operations of our tenants, while other aspects present challenges.

Employees

We have 5477 employees as of February 24, 2017.22, 2019. As we continue to grow, we expect our head count to increase as well. However, we do not believe that any adjustments to the number of employees will have a material effect on our operations or to general and administrative expenses as a percent of revenues. We believe that our relations with our employees are good. None of our employees are members of any union.

Available Information

Our website address is www.medicalpropertiestrust.com and provides access in the “Investor Relations” section, free of charge, to our Annual Report onForm 10-K, quarterly reports onForm 10-Q, current reports onForm 8-K, including exhibits, and all amendments to these reports as soon as reasonably practicable after such material is electronically filed with or furnished to the Securities and Exchange Commission (“SEC”). Also available on our website, free of charge, are our Corporate Governance Guidelines, the charters of our Ethics, Nominating and Corporate Governance, Audit and Compensation Committees and our Code of Ethics and Business Conduct. If you are not able to access our website, the information is available in print free of charge to any stockholder who should request the information directly from us at(205) 969-3755. Information on or connected to our website is neither part of nor incorporated by reference into this Annual Report or any other SEC filings.

Index to Financial Statements

ITEM 1A.

Risk Factors

The risks and uncertainties described herein are not the only ones facing us and there may be additional risks that we do not presently know of or that we currently consider not likely to have a significant impact on us. All of these risks could adversely affect our business, results of operations and financial condition. Some statements in this report including statements in the following risk factors constitute forward-looking statements. Please refer to the section entitled “Cautionary Language Regarding Forward Looking Statements” at the beginning of this Annual Report.

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RISKS RELATED TO OUR BUSINESS AND GROWTH STRATEGY(Including Financing Risks)

Limited access to capital may restrict our growth.

Our business plan contemplates growth through acquisitions and development of facilities. As a REIT, we are required to make cash distributions, which reduce our ability to fund acquisitions and developments with retained earnings. WeThus, we are somewhat dependent on acquisition financing and access to the capital markets for cash to make investments in new facilities.opportunistic investments. Due to market or other conditions, we may have limited access to capital from the equity and debt markets. We may not be able to obtain additional equity or debt capital or dispose of assets on favorable terms, if at all, at the time we need additional capital to acquire healthcare properties, or to meet our obligations, which could have a material adverse effect on our results of operations and our ability to make distributions to our stockholders.

Our indebtedness could adversely affect our financial condition and may otherwise adversely impact our business operations and our ability to make distributions to stockholders.

As of February 24, 2017,22, 2019, we had $3.0$4 billion of debt outstanding, which excludes the €200 million 5.750% Senior Notes due 2020 to be redeemed on March 4, 2017.outstanding.

Our indebtedness could have significant effects on our business. For example, it could:

require us to use a substantial portion of our cash flow from operations to service our indebtedness, which would reduce the available cash flow to fund working capital, development projects and other general corporate purposes and reduce cash for distributions;

require payments of principal and interest that may be greater than our cash flow from operations;

force us to dispose of one or more of our properties, possibly on disadvantageous terms, to make payments on our debt;

increase our vulnerability to general adverse economic and industry conditions; limit our flexibility in planning for, or reacting to, changes in our business and the industry in which we operate;

restrict us from making strategic acquisitions or exploiting other business opportunities;

make it more difficult for us to satisfy our obligations; and

place us at a competitive disadvantage compared to our competitors that have less debt.

Our future borrowings under our loan facilities may bear interest at variable rates in addition to the $0.8$0.2 billion in variable interest rate debt that we had outstanding as of February 24, 2017.22, 2019. If interest rates increase significantly, our operating results would decline along with the cash available for distributions to our stockholders.

In addition, most of our current debt is, and we anticipate that much of our future debt will be,non-amortizing and payable in balloon payments. Therefore, we will likely need to refinance at least a portion of that debt as it matures. There is a risk that we may not be able to refinance debt maturing in future years or that

Index to Financial Statements

the terms of any refinancing will not be as favorable as the terms of the then-existing debt. If principal payments due at maturity cannot be refinanced, extended or repaid with proceeds from other sources, such as new equity capital or sales of facilities, our cash flow may not be sufficient to repay all maturing debt in years when significant balloon payments come due. Additionally, we may incur significant penalties if we choose to prepay the debt. See Item 7 of Part II of this Annual Report on Form10-K for further information on our current debt maturities.

Covenants in our debt instruments limit our operational flexibility, and a breach of these covenants could materially affect our financial condition and results of operations.

The terms of our unsecured credit facility (“Credit Facility”) and the indentures governing our outstanding unsecured senior notes, and other debt instruments that we may enter into in the future are subject to customary financial and operational covenants. For example, our Credit Facility imposes certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate; and change our business. In addition, the agreements governing our unsecured credit facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined, on a rolling four quarter basis. Through the quarter ending December 31, 2016,2018, the dividend restriction was 95% of normalized adjusted funds from operations (“FFO”).NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of FFO,NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

Fromtime-to-time, the lenders of our Credit Facility may adjust certain covenants to give us more flexibility to complete a transaction; however, such modified covenants are temporary, and we must be in a position to meet the lowered reset covenants in the future. Our continued ability to incur debt and operate our business is subject to compliance with the covenants in our debt instruments, which limit operational flexibility. Breaches of these covenants could result in defaults

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under applicable debt instruments and other debt instruments due to cross-default provisions, even if payment obligations are satisfied. Financial and other covenants that limit our operational flexibility, as well as defaults resulting from a breach of any of these covenants in our debt instruments, could have a material adverse effect on our financial condition and results of operations.

Failure to hedge effectively against interest rate changes may adversely affect our results of operations and our ability to make distributions to our stockholders.

As of February 24, 2017,22, 2019, we had approximately $0.8$0.2 billion in variable interest rate debt.  However, we are a 50% equity owner in the joint venture arrangement with Primotop Holdings S.à.r.l. (“Primotop”), that has entered into €655 million of variable interest rate debt, which constitutes 26.5% of our overall indebtedness and subjects us to interest rate volatility. WeLike the interest rate swap used in the joint venture with Primotop, we may seek to manage our exposure to interest rate volatility by using interest rate hedging arrangements, such as when we entered into the $125 million of interest rate swaps in 2010 to fix the interest rate on our 2006 Senior Unsecured Notes due 2016, which were paid in full on October 31, 2016.arrangements. However, even these hedging arrangements involve risk, including the risk that counterparties may fail to honor their obligations under these arrangements, that these arrangements may not be effective in reducing our exposure to interest rate changes and that these arrangements may result in higher interest rates than we would otherwise have. Moreover, no hedging activity can completely insulate us from the risks associated with changes in interest rates. Failure to hedge effectively against interest rate changes may materially adversely affect our results of operations and our ability to make distributions to our stockholders.

Dependence on our tenants for payments of rent and interest may adversely impact our ability to make distributions to our stockholders.

We expect to continue to qualify as a REIT and, accordingly, as a REIT operating in the healthcare industry, we are severely limited by current tax law with respect to our ability to operate or manage the businesses conducted in our facilities.

Index to Financial Statements

Accordingly, we rely heavily on rent payments from our tenants under leases or interest payments from operators under mortgage or other loans for cash with which to make distributions to our stockholders. We have no control over the success or failure of these tenants’ businesses. Significant adverse changes in the operations of our facilities, or the financial condition of our tenants, operators or guarantors, could have a material adverse effect on our ability to collect rent and interest payments and, accordingly, on our ability to make distributions to our stockholders. Facility management by our tenants and their compliance with healthcare and other laws could have a material impact on our tenants’ operating and financial condition and, in turn, their ability to pay rent and interest to us.

It may be costly to replace defaulting tenants and we may not be able to replace defaulting tenants with suitable replacements on suitable terms.

Failure on the part of a tenant to comply materially with the terms of a lease could give us the right to terminate our lease with that tenant, repossess the applicable facility, cross default certain other leases and loans with that tenant and enforce the payment obligations under the lease. The process of terminating a lease with a defaulting tenant and repossessing the applicable facility may be costly and require a disproportionate amount of management’s attention. In addition, defaulting tenants or their affiliates may initiate litigation in connection with a lease termination or repossession against us or our subsidiaries. If a tenant-operator defaults and we choose to terminate our lease, we are then required to find another tenant-operator, such as the case was with our Monroe facility9 of the 16 transition Adeptus Health facilities in 2014.2018. The transfer of most types of healthcare facilities is highly regulated, which may result in delays and increased costs in locating a suitable replacement tenant. The sale or lease of these properties to entities other than healthcare operators may be difficult due to the added cost and time of refitting the properties. If we are unable tore-let the properties to healthcare operators, we may be forced to sell the properties at a loss due to the repositioning expenses likely to be incurred bynon-healthcare purchasers. Alternatively, we may be required to spend substantial amounts to adapt the facility to other uses. There can be no assurance that we would be able to find another tenant in a timely fashion, or at all, or that, if another tenant were found, we would be able to enter into a new lease on favorable terms. Defaults by our tenants under our leases may adversely affect our results of operations, financial condition, and our ability to make distributions to our stockholders. Defaults by our significant tenants under master leases (like Steward, Prime, MEDIAN, Ernest, and RCCH)LifePoint) will have an even greater effect.

It may be costly to find new tenants when lease terms end and we may not be able to replace such tenants with suitable replacements on suitable terms.

Failure on the part of a tenant to renew or extend the lease at the end of its fixed term on one of our facilities could result in us having to search for, negotiate with and execute new lease agreements, such was the case with our two South Carolina facilities — Bennettsville and Cheraw in 2015. The process of finding and negotiating with a new tenant along with costs (such as maintenance, property taxes, utilities, ground lease expenses, etc.) that we will incur while the facility is untenanted may be costly and require a disproportionate amount of management’s attention. There can be no assurance that we would be able to find another tenant in a timely fashion, or at all, or that, if another tenant were found, we would be able to enter into a new lease on favorable terms. If we are unable tore-let the properties to healthcare operators, we may be forced to sell the properties at a loss due to the repositioning expenses likely to be incurred bynon-healthcare purchasers. Alternatively, we may be required to spend substantial amounts to adapt

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the facility to other uses. Thus, thenon-renewal or extension of leases may adversely affect our results of operations, financial condition, and our ability to make distributions to our stockholders. This risk is even greater for those properties under master leases (like Steward, Prime, MEDIAN, Ernest,LifePoint, and RCCH)Ernest) because several properties have the same lease ending dates.

Index to Financial Statements

We have made investments in the operators of certain of our healthcare facilities and the cash flows (and related returns) from these investments are subject to more volatility than our properties with the traditional net leasing structure.

At December 31, 2016,2018, we have 11nine investments in the operations of certain of our healthcare facilities by utilizing RIDEA (or similar investments). These investments include profits interest equity investments, and equity like loansinvestments that generate returns dependent upon the operator’s performance. As a result, the cash flow and returns from these investments may be more volatile than that of our traditionaltriple-net leasing structure. Our business, results of operations, and financial condition may be adversely affected if the related operators fail to successfully operate the facilities efficiently and in a manner that is in our best interest.

We have limitedless experience with healthcare facilities in Germany, the United Kingdom, Italy, and Spain or anywhere else outside the U.S.

We have limitedless experience investing in healthcare properties or other real estate-related assets located outside the U.S. Investing in real estate located in foreign countries, including Germany, the United Kingdom, Italy, and Spain, creates risks associated with the uncertainty of foreign laws and markets including, without limitation, laws respecting foreign ownership, the enforceability of loan and lease documents and foreclosure laws. German real estate and tax laws are complex and subject to change, and we cannot assure you we will always be in compliance with those laws or that compliance will not expose us to additional expense. Additionally, as disclosed in Note 13 to Item 8 of this Form 10-K, we are expanding our operations into Australia, a geography we have never operated in, with the acquisition of a portfolio of 11 hospitals, which may subject us to new and unforeseen risks. The properties we acquired in connection with thefrom MEDIAN acquisition (as more fully described in Note 3 to Item 8 of this Form10-K) will also face risks in connection with unexpected changes in German or European regulatory requirements, political and economic instability, potential imposition of adverse or confiscatory taxes, possible challenges to the anticipated tax treatment of the structures that allow us to acquire and hold investments, possible currency transfer restrictions, the difficulty in enforcing obligations in other countries and the burden of complying with a wide variety of foreign laws. In addition, to qualify as a REIT, we generally will be required to operate anynon-U.S. investments in accordance with the rules applicable to U.S. REITs, which may be inconsistent with local practices. We may also be subject to fluctuations in local real estate values or markets or the European economy as a whole, which may adversely affect our European investments.

In addition, the rents payable under our leases of foreign assets are payable in either euros or British pounds, which could expose us to losses resulting from fluctuations in exchange rates to the extent we have not hedged our position, which in turn could adversely affect our revenues, operating margins and dividends, and may also affect the book value of our assets and the amount of stockholders’ equity. Further, any international currency gain recognized with respect to changes in exchange rates may not qualify under the 75% gross income test that we must satisfy annually in order to qualify and maintain our status as a REIT. AlthoughWhile we expect tomay hedge some of our foreign currency risk, we may not be able to do so successfully and may incur losses on our investments as a result of exchange rate fluctuations. Furthermore, we are subject to laws and regulations, such as the Foreign Corrupt Practices Act and similar local anti-bribery laws, thatwhich generally prohibit companies and their employees, agents and contractors from making improper payments to governmental officials for the purpose of obtaining or retaining business. Failure to comply with these laws could subject us to civil and criminal penalties that could materially adversely affect our results of operations, the value of our international investments, and our ability to make distributions to our stockholders.

Our revenues are dependent upon our relationships with and success of our largest tenants, Steward, Prime, MEDIAN, Ernest, RCCHLifePoint, and Adeptus Health.Ernest.

For the year endedAs of December 31, 2016, our top tenants were2018, affiliates of Steward, Prime, MEDIAN, LifePoint, and Ernest RCCH,represented 39.5%, 11.6%, 11.1%, 5.2%, and Adeptus Health representing 4.8% (based on fourth quarter revenue only when we closed the Steward acquisition)5.2%, 22.3%, 17.3%, 12.5%, 9.7% and 7.0 %, respectively, of our total revenues. gross assets (which consist primarily of real estate leases and mortgage loans).

Our relationships with these operators and their financial performance and resulting ability to satisfy their lease and loan obligations to us are material to our financial results and our ability to service our debt and make distributions to our stockholders. We are dependent

Index to Financial Statements

upon the ability of these operators to make rent and loan payments to us, and any failure to meet these obligations could have a material adverse effect on our financial condition and results of operations.

Our tenants operate in the healthcare industry, thatwhich is highly regulated by U.S. federal, state, and local laws along with laws in Europe and changes in regulations may negatively impact our tenants’ operations until they are able to make the appropriate adjustments to their business. For example, recentpast modifications to regulations concerning patient criteria and reimbursement for LTACHs have resulted in volumenegatively impacted volumes and profitability declines in certain facilities operated by Ernest.

We are aware of various federal and state inquiries, investigations and other proceedings currently affecting several of our tenants and would expect such government compliance and enforcement activities to be ongoing at any given time with respect to one

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or more of our tenants, either on a confidential or public basis. During the second quarter of 2016, the Department of Justice joined a lawsuit against Prime alleging irregular admission practices intended to increase the number of inpatient care admissions of Medicare patients, including unnecessarily classifying some patients as “inpatient” rather than “observation”. Other large acute hospital operators have also recently defended similar allegations, sometimes resulting in financial settlements and agreements with regulators to modify admission policies, resulting in lower reimbursements for those patients.

In November 2016, Adeptus Health disclosedOur tenants experience operational challenges from time-to-time, and this can be even more of a risk for those tenants that it raised approximately $57 milliongrow (or have grown) via acquisitions in liquiditya short time frame, like Steward, Prime, and others.  The ability of our tenants and operators to integrate newly acquired businesses into their existing operational, financial reporting and collection systems is critical towards ensuring their continued success. If such integration is not successfully implemented in order to address a cash shortfall that it reported was a resulttimely manner, operators can be negatively impacted in the form of inattention to revenue collection and expense controls and changeswrite-offs of uncollectible accounts receivable or even insolvency in its business model. Adeptus Health is a rapidly expanding company and has, during the second half of 2016, replaced its Chief Executive Officer, Chief Financial Officer and Corporate Controller.certain extreme cases.

AnAny further adverse result to Ernest,any of Steward, Prime, Adeptus Health, or one of our larger tenantsMEDIAN, LifePoint, and Ernest in regulatory proceedings or financial or operational setbacks may have a material adverse effect on the relevant tenant’s operations and financial condition and on its ability to make required lease and loan payments to us. If any one of these tenants were to file for bankruptcy protection, we may not be able to collect any pre-filing amounts owed to us by such tenant. In addition, in a bankruptcy proceeding, such tenant may terminate our lease(s), in which could negatively affectcase we would have a general unsecured claim that would likely be for less than the full amount owed to us. Any secured claims we have against such tenant may only be paid to the extent of the value of the collateral, which may not cover all or any of our abilitylosses. If we are ultimately required to service our debtfind one or more tenant-operators to lease one or more properties currently leased by such tenant, we may face delays and make distributions to our stockholders.increased costs in locating a suitable replacement tenant. The protections that we have in place to protect against such failure or delay, which can include letters of credit, cross default provisions, parent guarantees, repair reserves and the right to exercise remedies including the termination of the lease and replacement of the operator, may prove to be insufficient, in whole or in part, or may entail further delays. In instances where we have an equity investment in our tenant’s operations, in addition to the effect on these tenants’ ability to meet their financial obligation to us, our ownership and investment interests may also be negatively impacted.

We have now, and may have in the future, exposure to contingent rent escalators, which could hinder our growth and profitability.

We receive a significant portion of our revenues by leasing assets under long-term net leases that generally provide for fixed rental rates subject to annual escalations. These annual escalations may be contingent on changes in CPI, typically with specified caps and floors.  Certain of our other leases may provide for additional rents contingent upon a percentage of the tenant’s revenues in excess of specified threshold. If, as a result of weak economic conditions or other factors, the CPI does not increase, or the properties subject to these leases do not generate sufficient revenue to achieve the specified threshold, our growth and profitability may be hindered by these leases. In addition, if strong economic conditions result in significant increases in CPI, but the escalations under our leases are capped, our growth and profitability may be limited.

The bankruptcy or insolvency of our tenants or investees could harm our operating results and financial condition.

Some of our tenants/investees are, and some of our prospective tenants/investees may be newly organized, have limited or no operating history and may be dependent on loans from us to acquire the facility’s operations and for initial working capital. Any bankruptcy filings by or relating to one of our tenants/investees could bar us

Index to Financial Statements

from collectingpre-bankruptcy debts from that tenant or their property, unless we receive an order permitting us to do so from the bankruptcy court. A tenant bankruptcy can be expected to delay our efforts to collect past due balances under our leases and loans, and could ultimately preclude collection of these sums. If a lease is assumed by a tenant in bankruptcy, we expect that allpre-bankruptcy balances due under the lease would be paid to us in full. However, if a lease is rejected by a tenant in bankruptcy, we would have only a general unsecured claim for damages. Any secured claims we have against our tenants may only be paid to the extent of the value of the collateral, which may not cover any or all of our losses. Any unsecured claim (such as our equity interests in our tenants) we hold against a bankrupt entity may be paid only to the extent that funds are available and only in the same percentage as is paid to all other holders of unsecured claims. We may recover none or substantially less than the full value of any unsecured claims, which would harm our financial condition.

Our business is highly competitive and we may be unable to compete successfully.

We compete for development opportunities and opportunities to purchase healthcare facilities with, among others:

private investors, including large private equity funds;

healthcare providers, including physicians;

other REITs;

real estate developers;

government-sponsored and/ornot-for-profit agencies;

financial institutions; and

other lenders.

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Some of these competitors may have substantially greater financial and other resources than we have and may have better relationships with lenders and sellers. Competition for healthcare facilities from competitors may adversely affect our ability to acquire or develop healthcare facilities and the prices we pay for those facilities. If we are unable to acquire or develop facilities or if we pay too much for facilities, our revenue, earnings growth and financial return could be materially adversely affected. Certain of our facilities, or facilities we may acquire or develop in the future will face competition from other nearby facilities that provide services comparable to those offered at our facilities. Some of those facilities are owned by governmental agencies and supported by tax revenues, and others are owned bytax-exempt corporations and may be supported to a large extent by endowments and charitable contributions. Those types of support are not generally available to our facilities. In addition, competing healthcare facilities located in the areas served by our facilities may provide healthcare services that are not available at our facilities and additional facilities we may acquire or develop. From time to time, referral sources, including physicians and managed care organizations, may change the healthcare facilities to which they refer patients, which could adversely affect our tenants and thus our rental revenues, interest income, and/or our earnings from equity investments.

MostMany of our current tenants have, and prospective tenants may have, an option to purchase the facilities we lease to them which could disrupt our operations.

MostMany of our current tenants have, and some prospective tenants will have, the option to purchase the facilities we lease to them. There is no assurance that the formulas we have developed for setting the purchase price will yield a fair market value purchase price.

In the event our tenants and prospective tenants determine to purchase the facilities they lease either during the lease term or after their expiration, the timing of those purchases may be outside of our control, and we may not be able tore-invest the capital on as favorable terms, or at all. Our inability to effectively manage the turnover of our facilities could materially adversely affect our ability to execute our business plan and our results of operations.

Index to Financial Statements

We have 131160 leased properties that are subject to purchase options as of December 31, 2016.2018. For 10488 of these properties, the purchase option generally allows the lessee to purchase the real estate at the end of the lease term, as long as no default has occurred, at a price equivalent to the greater of (i) fair market value or (ii) our original purchase price (increased, in some cases, by a certain annual rate of return from lease commencement date). The lease agreements provide for an appraisal process to determine fair market value. For 17 of these properties, the purchase option generally allows the lessee to purchase the real estate at the end of the lease term, as long as no default has occurred, at our purchase price (increased, in some cases, by a certain annual rate of return from lease commencement date). For the remaining 1055 leases, the purchase options approximate fair value. At December 31, 2016, none2018, we do not believe any of our leases contained any bargain purchase options.

In certain circumstances, a prospective purchaser of our hospital real estate may be deemed to be subject to Anti-Kickback and Stark statutes, which are described on in the “Healthcare Regulatory Matters” section in Item 1 of this Annual Report on Form10-K. In such event, it may not be practicable for us to sell property to such prospective purchasers at prices other than fair market value.

We may not be able to adapt our management and operational systems to manage thenet-leased facilities we have acquired or are developing or those that we may acquire or develop in the future without unanticipated disruption or expense.

There is no assurance that we will be able to adapt our management, administrative, accounting and operational systems, or hire and retain sufficient operational staff, to manage the facilities we have acquired and those that we may acquire or develop, including those properties located in Europe or any future investments outside the U.S. Our failure to successfully manage our current portfolio of facilities or any future acquisitions or developments could have a material adverse effect on our results of operations and financial condition and our ability to make distributions to our stockholders.

Merger and acquisition activity or consolidation in the healthcare industry may result in a change of control of, or a competitor’s investment in, one or more of our tenants or operators, which could have a material adverse effect on us.

The healthcare industry has recently experienced increasedcontinues to experience consolidation, including among owners of real estate and healthcare providers. We compete with other healthcare REITs, healthcare providers, healthcare lenders, real estate partnerships, banks, insurance companies, private equity firms and other investors that pursue a variety of investments, which may include investments in our tenants or operators. We have historically developed strong, long-term relationships with many of our tenants and operators. A competitor’s investment in one of our tenants or operators, any change of control of a tenant or operator, or a change in the tenant’s or operator’s management team could enable our competitor to influence or control that tenant’s or operator’s business and strategy. This influence could have a material adverse effect on us by impairing our relationship with the tenant or operator, negatively affecting our interest, or impacting the tenant’s or operator’s financial and operational performance, including their ability to pay us rent or interest. Depending on our contractual agreements and the specific facts and circumstances, we may have consent rights, termination rights, remedies upon default or other rights and remedies related to a competitor’s investment in, a change of control of, or other transactions impacting a tenant or operator. In deciding whether to exercise our rights and remedies, including termination rights or remedies upon default, we assess numerous factors, including legal, contractual, regulatory, business and other relevant considerations.

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We depend on key personnel, the loss of any one of whom may threaten our ability to operate our business successfully.

We depend on the services of Edward K. Aldag, Jr., R. Steven Hamner, and Emmett E. McLean to carry out our business and investment strategy. If we were to lose any of these executive officers, it may be more difficult for us to locate attractive acquisition targets, complete our acquisitions and manage the facilities that we have

Index to Financial Statements

acquired or developed. Additionally, as we expand, we will continue to need to attract and retain additional qualified officers and employees. The loss of the services of any of our executive officers, or our inability to recruit and retain qualified personnel in the future, could have a material adverse effect on our business and financial results.

The market price and trading volume of our common stock may be volatile.

The market price of our common stock may be highly volatile and be subject to wide fluctuations. In addition, the trading volume in our common stock may fluctuate and cause significant price variations to occur. If the market price of our common stock declines significantly, you may be unable to resell your shares at or above your purchase price.

We cannot assure you that the market price of our common stock will not fluctuate or decline significantly in the future. Some of the factors that could negatively affect our share price or result in fluctuations in the price or trading volume of our common stock include:

actual or anticipated variations in our quarterly operating results or distributions;

changes in our funds from operations or earnings estimates or publication of research reports about us or the real estate industry;

increases in market interest rates that lead purchasers of our shares of common stock to demand a higher yield;

changes in market valuations of similar companies;

adverse market reaction to any increased indebtedness we incur in the future;

additions or departures of key management personnel;

actions by institutional stockholders;

local conditions such as an oversupply of, or a reduction in demand for, inpatient rehabilitation hospitals, LTACHs, ambulatory surgery centers, medical office buildings, specialty hospitals, skilled nursing facilities, regional and community hospitals, women’s and children’s hospitals and other single-discipline facilities;

speculation in the press or investment community; and

general market and economic conditions.

Future sales of common stock may have adverse effects on our stock price.

We cannot predict the effect, if any, of future sales of common stock, or the availability of shares for future sales, on the market price of our common stock. Sales of substantial amounts of common stock, or the perception that these sales could occur, may adversely affect prevailing market prices for our common stock. We may issue from time to time additional common stock or units of our operating partnership in connection with the acquisition of facilities and we may grant additional demand or piggyback registration rights in connection with these issuances. Sales of substantial amounts of common stock or the perception that these sales could occur may adversely affect the prevailing market price for our common stock. In addition, the sale of these shares could impair our ability to raise future capital through a sale of additional equity securities.

Downgrades in our credit ratings could have a material adverse effect on our cost and availability of capital.

On May 19, 2017, S&P revised its rating outlook on us to negative from stable and affirmed the BB+ corporate credit rating. As of February 24, 2017,22, 2019, our corporate credit rating from Standard and Poor’s Ratings Service wasS&P remained at BB+, and our corporate family rating from Moody’s Investors Service was Ba1. There can be no assurance that we will

Index to Financial Statements

be able to maintain our current credit ratings. Any downgrades in terms of ratings or outlook by any or all of the rating agencies could have a material adverse effect on our cost and availability of capital, which could in turn have a material adverse effect on our financial condition and results of operations.

An increase in market interest rates may have an adverse effect on the market price of our securities.

One of the factors that investors may consider in deciding whether to buy or sell our securities is our distributiondividend rate as a percentage of our price per share of common stock, relative to market interest rates. If market interest rates increase, prospective investors may desire a higher distribution on our securities or seek securities paying higher distributions. The market price of our common stock likely will be based primarily on the earnings that we derive from rental and interest income with respect to our

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facilities and our related distributions to stockholders, and not from the underlying appraised value of the facilities themselves. As a result, interest rate fluctuations and capital market conditions can affect the market price of our common stock. In addition, rising interest rates would result in increased interest expense on our variable-rate debt, thereby adversely affecting cash flow and our ability to service our indebtedness and make distributions.

Changes in currency exchange rates may subject us to risk.

As our operations have expanded internationally where the U.S. dollar is not the denominated currency, currency exchange rate fluctuations could affect our results of operations and financial position. A significant change in the value of the foreign currency of one or more countries where we have a significant investment may have a material adverse effect on our financial position, debt covenant ratios, results of operations and cash flow.

Although we may enter into foreign exchange agreements with financial institutions and/or obtain local currency mortgage debt in order to reduce our exposure to fluctuations in the value of foreign currencies, we cannot assure you that foreign currency fluctuations will not have a material adverse effect on us.

The United Kingdom’s exit from the European Union could adversely affect us.

On June 23, 2016, the United Kingdom held a referendum in which a majority of voters voted to exit the European Union, known as Brexit. Negotiations have commenced to determine the future terms of the United Kingdom’s relationship with the European Union, including, among other things, the terms of trade between the United Kingdom and the European Union. The effects of Brexit will depend on any agreements the United Kingdom makes to retain access to European Union markets either during a transitional period or more permanently. Brexit could adversely affect European and global economic or market conditions and could contribute to instability in global financial markets. In addition, Brexit could lead to legal uncertainty and potentially divergent national laws and regulations as the United Kingdom determines which European Union laws to replace or replicate. Any of these effects of Brexit, and others we cannot anticipate, may adversely affect us.

We currently hold, and may acquire additional, interests in healthcare facilities located in the United Kingdom and Europe, as well as other investments that are denominated in British pounds and euros. In addition, our operating partnership has issued, and may issue in the future, senior unsecured notes denominated in euros.euros along with borrowings denominated in British pounds. Any of the effects of Brexit described above, and others we cannot anticipate, could have a material adverse effect on our business, the value of our real estate and other investments, and our potential growth in Europe, and could amplify the currency risks faced by us.

RISKS RELATING TO REAL ESTATE INVESTMENTS

Our real estate, mortgage, and equity investments are and are expected to continue to be concentrated in a single industry segment, making us more vulnerable economically than if our investments were more diversified.

We acquire, develop, and make mortgage investments in healthcare real estate. In addition, we selectively make RIDEA investments (or similar investments) in healthcare operators. We are subject to risks inherent in concentrating investments

Index to Financial Statements

in real estate. The risks resulting from a lack of diversification become even greater as a result of our business strategy to invest solely in healthcare facilities. A downturn in the real estate industry could materially adversely affect the value of our facilities. A downturn in the healthcare industry could negatively affect our tenants’ ability to make lease or loan payments to us as well as our return on our equity investments. Consequently, our ability to meet debt service obligations or make distributions to our stockholders are dependent on the real estate and healthcare industries. These adverse effects could be more pronounced than if we diversified our investments outside of real estate or outside of healthcare facilities.

Our facilities may not have efficient alternative uses, which could impede our ability to find replacement tenants in the event of termination or default under our leases.

All of the facilities in our current portfolio are and all of the facilities we expect to acquire or develop in the future will benet-leased healthcare facilities. If we, or our tenants, terminate the leases for these facilities, or if these tenants lose their regulatory authority to operate these facilities, we may not be able to locate suitable replacement tenants to lease the facilities for their specialized uses. Alternatively, we may be required to spend substantial amounts to adapt the facilities to other uses. Any loss of revenues or additional capital expenditures occurring as a result could have a material adverse effect on our financial condition and results of operations and could hinder our ability to meet debt service obligations or make distributions to our stockholders.

Illiquidity of real estate investments could significantly impede our ability to respond to adverse changes in the performance of our facilities and harm our financial condition.

Real estate investments are relatively illiquid. Additionally, the real estate market is affected by many factors beyond our control, including adverse changes in global, national, and local economic and market conditions and the availability, costs and terms

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of financing. Our ability to quickly sell or exchange any of our facilities in response to changes in economic and other conditions will be limited. No assurances can be given that we will recognize full value for any facility that we are required to sell for liquidity reasons. Our inability to respond rapidly to changes in the performance of our investments could adversely affect our financial condition and results of operations.

Development and construction risks could adversely affect our ability to make distributions to our stockholders.

We have developed and constructed facilities in the past and are currently developing sixthree facilities. We will develop additional facilities in the future as opportunities present themselves. Our development and related construction activities may subject us to the following risks:

we may have to compete for suitable development sites;

our ability to complete construction is dependent on there being no title, environmental or other legal proceedings arising during construction;

we may be subject to delays due to weather conditions, strikes and other contingencies beyond our control;

we may be unable to obtain, or suffer delays in obtaining, necessary zoning,land-use, building, occupancy healthcare regulatory and other required governmental permits and authorizations, which could result in increased costs, delays in construction, or our abandonment of these projects;

we may incur construction costs for a facility which exceed our original estimates due to increased costs for materials or labor or other costs that we did not anticipate; and

we may not be able to obtain financing on favorable terms, which may render us unable to proceed with our development activities.

Index to Financial Statements

We expect to fund our development projects over time. The time frame required for development and construction of these facilities means that we may have to wait for some time to earn significant cash returns. In addition, our tenants may not be able to obtain managed care provider contracts in a timely manner or at all. Finally, there is no assurance that future development projects will occur without delays and cost overruns. Risks associated with our development projects may reduce anticipated rental revenue which could affect the timing of, and our ability to make, distributions to our stockholders.

We may be subject to risks arising from future acquisitions of real estate.

We may be subject to risks in connection with our acquisition of healthcare real estate, including without limitation the following:

we may have no previous business experience with the tenants at the facilities acquired, and we may face difficulties in managingworking with them;

underperformance of the acquired facilities due to various factors, including unfavorable terms and conditions of the existing lease agreements relating to the facilities, disruptions caused by the management of our tenants or changes in economic conditions;

diversion of our management’s attention away from other business concerns;

exposure to any undisclosed or unknown potential liabilities relating to the acquired facilities;facilities (or entities acquired in a share deal); and

potential underinsured losses on the acquired facilities.

We cannot assure you that we will be able to manage the new properties without encountering difficulties or that any such difficulties will not have a material adverse effect on us.

Our facilities may not achieve expected results or we may be limited in our ability to finance future acquisitions, which may harm our financial condition and operating results and our ability to make the distributions to our stockholders required to maintain our REIT status.

Acquisitions and developments entail risks that investments will fail to perform in accordance with expectations and that estimates of the costs of improvements necessary to acquire and develop facilities will prove inaccurate, as well as general investment risks associated with any new real estate investment. Newly-developed or newly-renovated facilities may not have operating histories that are helpful in making objective pricing decisions. The purchase prices of these facilities will be based in part upon projections by management as to the expected operating results of the facilities, subjecting us to risks that these facilities may not achieve anticipated operating results or may not achieve these results within anticipated time frames.

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We anticipate that future acquisitions and developments will largely be financed through externally generated funds such as borrowings under credit facilities and other secured and unsecured debt financing and from issuances of equity securities. Because we must distribute at least 90% of our REIT taxable income, excluding net capital gains, each year to maintain our qualification as a REIT, our ability to rely upon income from operations or cash flows from operations to finance our growth and acquisition activities will be limited.

If our facilities do not achieve expected results and generate ample cash flows from operations or if we are unable to obtain funds from borrowings or the capital markets to finance our acquisition and development activities, amounts available for distribution to stockholders could be adversely affected and we could be required to reduce distributions, thereby jeopardizing our ability to maintain our status as a REIT.

If we suffer losses that are not covered by insurance or that are in excess of our insurance coverage limits, we could lose investment capital and anticipated profits.

Our leases and mortgage loans, generally require our tenantstenants/borrowers to carry property, general liability, professional liability, loss of earnings, all risk and extended coverage insurance in amounts sufficient to permit the replacement of the facility

Index to Financial Statements

in the event of a total loss, subject to applicable deductibles. We carry general liability insurance and loss of earnings coverage on all of our properties as a contingent measure in case our tenant’s coverage is not sufficient. However, there are certain types of losses, generally of a catastrophic nature, such as earthquakes, floods, hurricanes and acts of terrorism, which may be uninsurable or not insurable at a price we or our tenantstenants/borrowers can afford. Inflation, changes in building codes and ordinances, environmental considerations and other factors also might make it impracticable to use insurance proceeds to replace a facility after it has been damaged or destroyed. Under such circumstances, the insurance proceeds we receive might not be adequate to restore our economic position with respect to the affected facility. If any of these or similar events occur, it may reduce our return from the facility and the value of our investment. We continually review the insurance maintained by our tenants and operatorstenants/borrowers and believe the coverage provided to be adequate and customary for similarly situated companies in our industry. However, we cannot provide any assurances that such insurance will be available at a reasonable cost in the future. Also, we cannot assure you that material uninsured losses, or losses in excess of insurance proceeds, will not occur in the future.

Our capital expenditures for facility renovation may be greater than anticipated and may adversely impact rent payments by our tenants and our ability to make distributions to stockholders.

Facilities, particularly those that consist of older structures, have an ongoing need for renovations and other capital improvements, including periodic replacement of fixtures and fixed equipment. Although our leases require our tenants to be primarily responsible for the cost of such expenditures, renovation of facilities involves certain risks, including the possibility of environmental problems, regulatory requirements, construction cost overruns and delays, uncertainties as to market demand or deterioration in market demand after commencement of renovation and the emergence of unanticipated competition from other facilities. All of these factors could adversely impact rent and loan payments by our tenants and returns on our equity investments, which in turn could have a material adverse effect on our financial condition and results of operations along with our ability to make distributions to our stockholders.

All of our healthcare facilities are subject to property taxes that may increase in the future and adversely affect our business.

Our facilities are subject to real and personal property taxes that may increase as property tax rates change and as the facilities are assessed or reassessed by taxing authorities. Our leases generally provide that the property taxes are charged to our tenants as an expense related to the facilities that they occupy. As the owner of the facilities, however, we are ultimately responsible for payment of the taxes to the government. If property taxes increase, our tenants may be unable to make the required tax payments, ultimately requiring us to pay the taxes. If we incur these tax liabilities, our ability to make expected distributions to our stockholders could be adversely affected. In addition, if such taxes increase on properties in which we have an equity investment in the tenant, our return on investment maybe negatively affected.

As the owner and lessor of real estate, we are subject to risks under environmental laws, the cost of compliance with which and any violation of which could materially adversely affect us.

Our operating expenses could be higher than anticipated due to the cost of complying with existing and future environmental laws and regulations. Various environmental laws may impose liability on the current or prior owner or operator of real property for removal or remediation of hazardous or toxic substances. Current or prior owners or operators may also be liable for government fines and damages for injuries to persons, natural resources and adjacent property. These environmental laws often impose liability whether or not the owner or operator knew of, or was responsible for, the presence or disposal of the hazardous or toxic substances. The cost of complying with environmental laws could materially adversely affect amounts available for distribution to our stockholders and could exceed the value of all of our facilities. In addition, the presence of hazardous or toxic substances, or the failure of our tenants to properly manage, dispose of or remediate such substances, including medical waste generated by physicians and our other healthcare tenants,

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operators, may adversely affect our tenants or our

Index to Financial Statements

ability to use, sell or rent such property or to borrow using such property as collateral which, in turn, could reduce our revenue and our financing ability. We typically obtain Phase I environmental assessments (or similar studies) on facilities we acquire or develop or on which we make mortgage loans, and intend to obtain on future facilities we acquire. However, even if the Phase I environmental assessment reports do not reveal any material environmental contamination, it is possible that material environmental contamination and liabilities may exist, of which we are unaware.

Although the leases for our facilities and our mortgage loans generally require our operators to comply with laws and regulations governing their operations, including the disposal of medical waste, and to indemnify us for certain environmental liabilities, the scope of their obligations may be limited. We cannot assure you that our tenants would be able to fulfill their indemnification obligations and, therefore, any material violation of environmental laws could have a material adverse affecteffect on us. In addition, environmental laws are constantly evolving, and changes in laws, regulations or policies, or changes in interpretations of the foregoing, could create liabilities where none exist today.

Our interests in facilities through ground leases expose us to the loss of the facility upon breach or termination of the ground lease, and may limit our use of the facility and may result in additional expense to us if our tenants vacate our facility.

We have acquired interests in 33 of our facilities, at least in part, by acquiring leasehold interests in the land on which the facility is located rather than an ownership interest in the property, and we may acquire additional facilities in the future through ground leases. As lessee under ground leases, we are exposed to the possibility of losing the property upon termination, or an earlier breach by us, of the ground lease.lease, which would be a negative impact to our financial condition.  Ground leases may also restrict our use of facilities, which may limit our flexibility in renting the facility and may impede our ability to sell the property.  Finally, if our lease expires or is terminated for whatever reason resulting in the tenant vacating the facility, we would be responsible for the ground lease payments until we found a replacement tenant, which would negatively impact our cash flows and results of operations.

Our acquisitions may not prove to be successful.

We are exposed to the risk that some of our acquisitions may not prove to be successful. We could encounter unanticipated difficulties and expenditures relating to any acquired properties, including contingent liabilities, and acquired properties might require significant management attention that would otherwise be devoted to our ongoing business. In addition, we might be exposed to undisclosed and unknown liabilities related to any acquired properties. If we agree to provide construction funding to an operator/tenant and the project is not completed, we may need to take steps to ensure completion of the project. Moreover, if we issue equity securities or incur additional debt, or both, to finance future acquisitions, it may reduce our per share financial results. These costs may negatively affect our results of operations.

RISKS RELATING TO THE HEALTHCARE INDUSTRY

Reductions inThe continued pressure on fee-for-service reimbursement from third-party payors and the shift towards alternative payment models, could adversely affect the profitability of our tenants and hinder their ability to make payments to us.

Sources of revenue for our tenants and operators may include the Medicare and Medicaid programs, private insurance carriers, and health maintenance organizations, among others. Efforts by such payorsIn addition to ongoing efforts to reduce healthcare costs, could continue, which may result in reductions or slower growth in reimbursement for certain services provided by some of our tenants. In addition, the failure of any of our tenants to comply with various laws and regulations could jeopardize their ability to continue participating in Medicare, Medicaid, and other government-sponsored payment programs.

The U.S. healthcare industry continues to face various challenges, including increased government and private payor pressure on healthcare providers to control or reduce costs. For example, we believe thatshift in our tenants will continue to experience a shift intenants' payor mix away fromfee-for-service payors which would resultresults in an increase in the percentage of revenues attributable to alternative payment models implemented by private and

Index government payors, which can lead to Financial Statements

government payors. CMSreductions in reimbursement for services provided by our tenants. There is particularly focusedcontinued focus on transitioning Medicare from its traditionalfee-for-service model to models that employ one or more capitated, value-based, or bundled payment approaches, and private payors are continuing to explore and implementhave implemented similar types of alternative payment models. Such efforts from private and government payors, in addition to general industry trends, continue to place pressures on our tenants to control healthcare costs. Furthermore, pressures to control healthcare costs and a shift away from traditional health insurance reimbursement have resulted in an increase in the number of patients whose healthcare coverage is provided under managed care plans, such as health maintenance organizations and preferred provider organizations. These shifts place further cost pressures on our tenants. We also continue to believe that, due to the aging of the population and the expansion of governmental payor programs, there will be a marked increase in the number of patients relying on healthcare coverage provided by governmental payors. All of these changes could have a material adverse effect on the financial condition of some or all of our tenants, which could have a material adverse effect on our financial condition and results of operations and could negatively affect our ability to make distributions to our stockholders. In instances where we have an equity investment in our tenants’ operations, in addition to the effect on these tenants’ ability to meet their financial obligations to us, our ownership and investment interests may also be negatively impacted.

CMS’s increased regulatory restrictions on reimbursement for LTACH, and inpatient rehabilitation facilities (“IRFs”IRF”), has reduced reimbursement for some tenants that operate LTACHs and IRFs, and CMS has also begun to implement regulatory restrictions on reimbursement for hospital outpatient departments (“HOPD”), which may alsoHOPD can lead to reduced to reimbursement for our tenants that operate HOPDs.such facilities and departments. CMS is likely to continue exploring other restrictions on

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LTACH, IRF, and HOPD reimbursement and possibly develop more restrictive facility and patient level criteria for these types of facilities or departments. These changes could have a material adverse effect on the financial condition of some of our tenants, which could have a material adverse effect on our financial condition and results of operations and could negatively affect our ability to make distributions to our stockholders.

The Reform Law represented a major shift in the U.S. healthcare industry by, among other things, allowing millions of formerly uninsured individuals to obtain health insurance coverage and by significantly expanding Medicaid. The Reform Law, however, remains controversial, and there are continuingThough efforts to repeal and replace the Reform Law. InLaw may continue in the eventfuture, we believe that certain trends, including, but not limited to, various quality and reimbursement initiatives discussed above, will continue irrespective of whether the Reform Law is repealed thisor replaced, we cannot predict with any certainty or precision what effect a repeal or replacement law would have on the operations of our tenants, but it could have a material adverse effect on the financial condition of some or all of our tenants.

The U.S. healthcare industry is heavily regulatedSignificant regulation and loss of licensure or certification or failure to obtain licensure or certification could negatively impact our tenants' financial condition and results of operations.operations and affect their ability to make payments to us.

The U.S. healthcare industry is highly regulated by federal, state, and local laws (as discussed onpages 10-13) and is directly affected by federal conditions of participation, state licensing requirements, facility inspections, state and federal reimbursement policies, regulations concerning capital and other expenditures, certification requirements and other such laws, regulations, and rules.  As with the U.S. healthcare industry, our tenants in the United Kingdom and Western Europe are also subject in some instances to comparable types of laws, regulations, and rules that affect their ownership and operation of healthcare facilities.  Although our lease and mortgage loan agreements require our tenants/borrowers to comply with applicable laws, and we intend for these facilities to comply with such laws, we do not actively monitor compliance.  Therefore, we cannot offer any assurance that our tenants/borrowers will be found to be in compliance with such, as the same may ultimately be implemented or interpreted.  

We are aware of various federal and state inquiries, investigations, and other proceedings currently affecting several of our tenants and would expect such governmental compliance and enforcement activities to be ongoing at any given time with respect to one or more of our tenants, either on a confidential or public basis. As discussed in further detail below, anAn adverse result to our tenantstenant/borrower in one or more such governmental proceedings may have a material adverse effect on the relevant tenant’stheir operations and financial condition and on its ability to make required lease and/or mortgageloan payments to us. In instances where we have an equity investment in our tenants’ operations,the operator, in addition to the effect on these tenants’/borrowers’ ability to meet their financial obligation to us, our ownership and investment interests may also be negatively impacted.

LicensedIn the U.S., licensed health care facilities must comply with minimum health and safety standards and are subject to survey and inspection by state and federal agencies and their agents or affiliates, including CMS, the Joint Commission, and state departments of health. CMS develops Conditions of Participation and Conditions for Coverage that health care organizations must meet in order to begin and continue participating in the Medicare

Index to Financial Statements

and Medicaid programs and receive payment under such programs. These minimum health and safety standards are aimed at improving quality and protecting the health and safety of beneficiaries, and there are several common criteria that exist across health entities. The failure to comply with any of these standards could jeopardize a healthcare organization’s Medicare certification and, in turn, itsit’s right to receive payment under the Medicare and Medicaid programs.

Further, many hospitals and other institutional providers in the U.S. are accredited by accrediting agencies such as the Joint Commission, a national healthcare accrediting organization. The Joint Commission was created to accredit healthcare organizations that meet its minimum health and safety standards. A national accrediting organization, such as the Joint Commission, enforces standards that meet or exceed such requirements. Surveyors for the Joint Commission, prior to the opening of a facility and approximately every three years thereafter, conduct on site surveys of facilities for compliance with a multitude of patient safety, treatment, and administrative requirements. Facilities may lose accreditation for failure to meet such requirements, which in turn may result in the loss of license or certification including under the Medicare and Medicaid programs. For example, a facility may lose accreditation for failing to maintain proper medication in the operating room to treat potentially fatal reactions to anesthesia or for failure to maintain safe and sanitary medical equipment.

Finally, healthcare facility reimbursement practices and quality of care issues may result in loss of license or certification. For instance, the practice of “upcoding,” whereby services are billed for higher procedure codes than were actually performed, may lead to the revocation of a hospital’s license.license or the imposition of penalties. An event involving poor quality of care, such as that which leads to the serious injury or death of a patient, may also result in loss of license or certification. Prime continues certain litigation against the Service Employees International Union (“SEIU”) relating to allegations that SEIU and other defendants conspired to drive Prime out of certain markets, primarily by lobbying for governmental action relating to alleged fraudulent billing practices. Prime has addressed these fraudulent billing practice allegations publicly and has provided clinical and other data to us refuting these allegations. Prime has also informed us that SEIU regularly attempts to organize certain Prime employees. Prime has also disclosed a complaint filed against it by the U.S. Department of Justice relating to alleged improper admitting practices. Prime has addressed this complaint publicly and denied the allegations.

The failure of any tenanttenant/borrower to comply with such laws, requirements, and regulations resulting in a loss of its license would affect its ability to continue its operation of the facility and would adversely affect the tenant’sits ability to make lease and/or principal and interestloan payments to us. This, in turn, could have a material adverse effect on our financial condition and results of operations and could negatively affect our ability to make distributions to our stockholders. In instances where we have an equity investment in our tenants’ operations,the operator, in addition to the effects on these tenants’/borowers’ ability to meet their financial obligations to us, our ownership and investment interests would be negatively impacted.

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In addition, establishment of healthcare facilities and transfers of operations of healthcare facilities in the U.S. and in the United Kingdom and Western Europe are typically subject to regulatory approvals, not required for establishment, or transfers, of other types of commercial operations and real estate including, but not limited to,such as state certificate of need laws.laws in the U.S. Restrictions and delays in transferring the operations of healthcare facilities, in obtaining new third-party payor contracts, including Medicare and Medicaid provider agreements, and in receiving licensure and certification approval from appropriate state and federal agencies by new tenants, may affect our ability to terminate lease agreements, remove tenants that violate lease terms, and replace existing tenants with new tenants. Furthermore, these matters may affect a new tenant’stenant’s/borrower’s ability to obtain reimbursement for services rendered, which could adversely affect their ability to pay rent to usmake lease and/or loan payments to pay principal and interest on their loans from us. In instances where we have an equity investment in our tenants’ operations,the operator, in addition to the effect on these tenants’/borrowers’ ability to meet their financial obligations to us, our ownership and investment interests may also be negatively impacted.

Index to Financial Statements

Our tenants are subject to fraud and abuse laws, the violation of which by a tenant may jeopardize the tenant’s ability to make payments to us and adversely affect their profitability.

As noted earlier, in the U.S., the federal government and numerous state governments have passed laws and regulations that attempt to eliminate healthcare fraud and abuse by prohibiting business arrangements that induce patient referrals or the ordering of specific ancillary services. In addition, federal and state governments continue to investigate and conduct enforcement activity to detect and eliminate fraud and abuse in the Medicare and Medicaid programs. It is anticipated that theThe trend toward increased investigation and enforcement activity in the areas of fraud and abuse and patient self-referrals willto detect and eliminate fraud and abuse in the Medicare and Medicaid programs is likely to continue in future years. ViolationsAs described above, the penalties for violations of these laws can be substantial and may result in the imposition of criminal and civil penalties, including possible exclusion from federal and state healthcare programs. Imposition of any of these penalties upon any of our tenants could jeopardize a tenant’s ability to operate a facility or to make lease and/or loan payments, thereby potentially adversely affecting us. In instances where we have an equity investment in our tenants’ operations, in addition to the effect on the tenants’ ability to meet their financial obligations to us, our ownership and investment interests may also be negatively impacted.

Some of our tenants have accepted, and prospective tenants may accept, an assignment of the previous operator’s Medicare provider agreement.agreement typically in the case of the acquisition of such previous operator's facility. Such operators and othernew-operator tenants that take assignment of Medicare provider agreements might be subject to liability for federal or state regulatory, civil, and criminal investigations of the previous owner’s operations and claims submissions. While we conduct due diligence in connection with the acquisition of such facilities, theseThese types of issues may not be discovered prior to purchase.purchase or after our tenants commence operations in our facilities. Adverse decisions, fines, or recoupments might negatively impact our tenants’ financial condition, and in turn their ability to make lease and/or loan payments to us. In instances where we have an equity investment in our tenants’ operations, in addition to the effect on these tenants’ ability to meet their financial obligations to us, our ownership and investment interests may also be negatively impacted.

Certain of our lease arrangements may be subject to laws related to fraud and abuse or physician self-referral laws.self-referrals.

Although no such investment exists today, physicianPhysician investment in our operating partnership or our subsidiaries that own our facilities could subject our lease arrangements to scrutiny under fraud and abuse and physician self-referral laws. Under the Stark Law, and its implementing regulations, if our lease arrangements do not satisfy the requirements of an applicable exception, the ability of our tenants to bill for services provided to Medicare beneficiaries pursuant to referrals from physician investors could be adversely impacted and subject us and our tenants to fines, which could impact our tenants’ ability to make lease andand/or loan payments to us. In instances where we have an equity investment in our tenants’ operations, in addition to the effect on the tenants’ ability to meet their financial obligations to us, our ownership and investment interests may also be negatively impacted.

We Therefore, in all cases, we intend to use our good faith efforts to structure our lease arrangements to comply with these laws; however, if we are unable to do so, this failure may restrict our ability to permit physician investment or, where such physicians do participate, may restrict the types of lease arrangements into which we may enter, including our ability to enter into percentage rent arrangements.laws.

We may be required to incur substantial renovation costs to make certain of our healthcare properties suitable for other operators and tenants.

Healthcare facilities are typically highly customized, subject to healthcare-specific building code requirements, and may not be easily adapted tonon-healthcare-related uses. The improvements generally required to conform a property to healthcare use can be costly and at times tenant-specific. A new or replacement operator or tenant may require different features in a property, depending on that operator’s or tenant’s particular business. If a current operator or tenant is unable to pay rent and/or vacates a property, we may incur substantial expenditures to modify a property before we are able to secure another operator or tenant. Also, if the property needs to be renovated to accommodate multiple operators or tenants, we may incur substantial expenditures before we are able tore-lease the space. These expenditures or renovations may have a material adverse effect on our business, results of operations, and financial condition.

Index to Financial Statements

State certificate of need laws may adversely affect our development of facilities and the operations of our tenants.

Certain healthcare facilities in which we invest may also be subject to state laws in the U.S. which require regulatory approval in the form of a certificate of need prior to the transfer of a healthcare facility or prior to initiation of certain projects, including, but not limited to, the establishment of new or replacement facilities, the addition of beds, the addition or expansion of services and certain capital expenditures. State certificate of need laws are not uniform throughout the U.S., are subject to change, and may delay

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developments of facilities or acquisitions or certain other transfers of ownership of facilities.facilities including, but limited to, a delay in obtaining approval of a replacement operator for an existing facility. We cannot predict the impact of state certificate of need laws on any of the preceding activities or on the operations of our tenants. Certificate of need laws often materially impact the ability of competitors to enter into the marketplace of our facilities. In addition, in limited circumstances, loss of state licensure or certification or closure of a facility could ultimately result in loss of authority to operate the facility and requirere-licensure or new certificate of need authorization tore-institute operations. As a result, a portion of the value of the facility may be related to the limitation on new competitors. In the event of a change in the certificate of need laws, this value may markedly change.

RISKS RELATING TO OUR ORGANIZATION AND STRUCTURE

Pursuant to Maryland law, and our charter and bylaws contain provisions whichthat may prevent or deterhave the effect of deterring changes in management and third-party acquisition proposals, that you may believe to bewhich in your best interest,turn could depress the price of Medical Properties common stock or cause dilution.

Our charter contains ownership limitations that may restrict business combination opportunities, inhibit change of control transactions and reduce the value of our common stock. To qualify as a REIT under the Internal Revenue Code of 1986, as amended, or the Code, no more than 50% in value of our outstanding stock, after taking into account options to acquire stock, may be owned, directly or indirectly, by five or fewer persons during the last half of each taxable year. Our charter generally prohibits direct or indirect ownership by any person of more than 9.8% in value or in number, whichever is more restrictive, of outstanding shares of any class or series of our securities, including our common stock. Generally, our common stock owned by affiliated owners will be aggregated for purposes of the ownership limitation. The ownership limitation could have the effect of delaying, deterring or preventing a change in control or other transaction in which holders of common stock might receive a premium for their common stock over the then-current market price or which such holders otherwise might believe to be in their best interests. The ownership limitation provisions also may make our common stock an unsuitable investment vehicle for any person seeking to obtain, either alone or with others as a group, ownership of more than 9.8% of either the value or number of the outstanding shares of our common stock.

Our charter and bylaws contain provisions that may impede third-party acquisition proposals that may be in the best interests of our stockholders.proposals. Our charter and bylaws also provide that our directorsrestrictions on replacing or removing directors. Directors may only be removed by the affirmative vote of the holders oftwo-thirds of our common stock, thatstock. Additionally, stockholders are required to give us advance notice of director nominations and new business to be conducted at our annual meetings of stockholders and that specialnominations. Special meetings of stockholders can only be called by our president, our board of directors or the holders of at least 25% of stock entitled to vote at the meetings. These and other charter and bylaw provisions may delay or prevent a change of control or other transaction in which holders of our common stock might receive a premium for their common stock over the then-current market price or which such holders otherwise might believe to be in their best interests.

Our UPREIT structure may result in conflicts of interest between our stockholders and the holders of our operating partnership units.

We are organized as an umbrella partnership real estate investment trust, “UPREIT”, which means that we hold our assets and conduct substantially all of our operations through an operating limited partnership, and may issue operating partnership units to employees and/or third parties. Persons holding operating partnership units

Index to Financial Statements

would have the right to vote on certain amendments to the partnership agreement of our operating partnership, as well as on certain other matters. Persons holding these voting rights may exercise them in a manner that conflicts with the interests of our stockholders. Circumstances may arise in the future, such as the sale or refinancing of one of our facilities, when the interests of limited partners in our operating partnership conflict with the interests of our stockholders. As the sole member of the general partner of the operating partnership, we have fiduciary duties to the limited partners of the operating partnership that may conflict with fiduciary duties that our officers and directors owe to its stockholders. These conflicts may result in decisions that are not in the best interest of our stockholders.

We rely on information technology in our operations, and any material failure, inadequacy, interruption or security failure of that technology could harm our business.

We rely on information technology networks and systems, including the Internet, to process, transmit and store electronic information, and to manage or support a variety of business processes, including financial transactions and records, and maintaining personal identifying information and tenant and lease data. We purchase or license some of our information technology from vendors, on whom our systems depend. We rely on commercially available systems, software, tools and monitoring to provide security for the processing, transmission and storage of confidential tenant data. Although we have taken steps to protect the security of our information systems and the data maintained in those systems, it is possible that our safety and security measures will not prevent the systems’ improper functioning or the improper access or disclosure of our or our tenant’s information such as in the event of cyber-attacks. Security breaches, including physical or electronicbreak-ins, computer viruses, attacks by hackers and similar breaches, can create system disruptions, shutdowns or unauthorized disclosure of confidential information. The risk of security breaches has generally increased as the number, intensity and sophistication of attacks have increased. In some cases, it may be difficult to anticipate or immediately detect such incidents and the damage they cause. Any failure to maintain proper function, security and

28


availability of our information systems could interrupt our operations, damage our reputation, subject us to liability claims or regulatory penalties and could have a materially adverse effect on our business, financial condition and results of operations.

Changes in accounting pronouncements could adversely affect our operating results, in addition to the reported financial performance of our tenants.

Uncertainties posed by various initiatives of accounting standard-setting by the Financial Accounting Standards Board (“FASB”) and the Securities and Exchange Commission (“SEC”),SEC, which create and interpret applicable accounting standards for U.S. companies (like the new lease accounting standard effective for us starting January 1, 2019), may change the financial accounting and reporting standards or their interpretation and application of these standards that govern the preparation of our financial statements. Proposed changes include, but are not limited to, changes in lease accounting, revenue recognition and the adoption of accounting standards likely to require the increased use of “fair-value” measures.

These changes could have a material impact on our reported financial condition and results of operations. In some cases, we could be required to apply a new or revised standard retroactively, resulting in potentially material restatements of prior period financial statements. Similarly, these changes could have a material impact on our tenants’/borrowers’ reported financial condition or results of operations or could affect our tenants’ preferences regarding leasing real estate.

TAX RISKS ASSOCIATED WITH OUR STATUS AS A REIT

Loss of our tax status as a REIT would have significant adverse consequences to us and the value of our common stock.

We believe that we qualify as a REIT for federal income tax purposes and have elected to be taxed as a REIT under the federal income tax laws commencing with our taxable year that began on April 6, 2004, and

Index to Financial Statements

ended on December 31, 2004. The REIT qualification requirements are extremely complex, and interpretations of the federal income tax laws governing qualification as a REIT are limited. Accordingly, there is no assurance that we will be successful in operating so as to qualify as a REIT. At any time, new laws, regulations, interpretations or court decisions may change the federal tax laws relating to, or the federal income tax consequences of, qualification as a REIT. It is possible that future economic, market, legal, tax or other considerations may cause our board of directors to revoke the REIT election, which it may do without stockholder approval.

If we lose or revoke our REIT status, we will face serious tax consequences that will substantially reduce the funds available for distribution because:

we would not be allowed a deduction for distributions to stockholders in computing our taxable income; therefore, we would be subject to federal income tax at regular corporate rates, and we might need to borrow money or sell assets in order to pay any such tax;

we also could be subject to the federal alternative minimum tax and possibly increased state and local taxes; and

unless we are entitled to relief under statutory provisions, we also would be disqualified from taxation as a REIT for the four taxable years following the year during which we ceased to qualify.

As a result of all these factors, a failure to achieve or a loss or revocation of our REIT status could have a material adverse effect on our financial condition and results of operations and would adversely affect the value of our common stock.

Failure to make required distributions would subject us to tax.

In order to qualify as a REIT, each year we must distribute to our stockholders at least 90% of our REIT taxable income, excluding net capital gains. To the extent that we satisfy the distribution requirement, but distribute less than 100% of our taxable income, we will be subject to federal corporate income tax on our undistributed income. In addition, we will incur a 4% nondeductible excise tax on the amount, if any, by which our distributions in any year are less than the sum of (1) 85% of our ordinary income for that year; (2) 95% of our capital gain net income for that year; and (3) 100% of our undistributed taxable income from prior years.

We may be required to make distributions to stockholders at disadvantageous times or when we do not have funds readily available for distribution. Differences in timing between the recognition of income and the related cash receipts or the effect of required debt amortization payments could require us to borrow money or sell assets to pay out enough of our taxable income to satisfy the distribution requirement and to avoid corporate income tax and the 4% excise tax in a particular year. In the future, we may borrow to pay distributions to our stockholders and the limited partners of our operating partnership. Any funds that we borrow would subject us to interest rate and other market risks.

Complying with REIT requirements may cause us to forego otherwise attractive opportunities.

To qualify as a REIT for U.S. federal income tax purposes, we must continually satisfy tests concerning, among other things, the sources of our income, the nature and diversification of our assets, the amounts we distribute to our stockholders and the ownership of our stock. In order to meet these tests, we may be required to forego attractive business or investment opportunities. Currently, no

29


more than 25%20% of the value of our assets may consist of securities of one or more TRSsTRS and no more than 25% of the value of our assets may consist of securities that are not qualifying assets under the test requiring that 75% of a REIT’s assets consist of real estate and other related assets. In addition, at least 75% of our gross income must be generated from either rents from real estate or interest on loans secured by real estate (i.e. mortgage loans). Further, a TRS may not directly or indirectly operate or manage a healthcare facility. For purposes of this definition a “healthcare facility” means a hospital, nursing facility, assisted living facility, congregate care facility, qualified continuing care facility, or

Index to Financial Statements

other licensed facility which extends medical or nursing or ancillary services to patients and which is operated by a service provider that is eligible for participation in the Medicare program under Title XVIII of the Social Security Act with respect to the facility. Compliance with current and future changes to REIT requirements may limit our flexibility in executing our business plan.

If certain sale-leaseback transactions are not characterized by the Internal Revenue Service (“IRS”) as “true leases,” we may be subject to adverse tax consequences.

We have purchased certain properties and leased them back to the sellers of such properties, and we may enter into similar transactions in the future. We intend for any such sale-leaseback transaction to be structured in a manner that the lease will be characterized as a “true lease,” thereby allowing us to be treated as the owner of the property for U.S. federal income tax purposes. However, depending on the terms of any specific transaction, the IRS might take the position that the transaction is not a “true lease” but is more properly treated in some other manner. In the event any sale-leaseback transaction is challenged and successfullyre-characterized, we might fail to satisfy the REIT asset tests or income test and, consequently could lose our REIT status effective with the year ofre-characterizations.

Transactions with TRSs may be subject to excise tax.

We have historically entered into lease and other transactions with our TRSsTRS and theirits subsidiaries and expect to continue to do so in the future. Under applicable rules, transactions such as leases between our TRSsTRS and theirits parent REIT that are not conducted on a market terms basis may be subject to a 100% excise tax. While we believe that all of our transactions with our TRSsTRS are at arm’s length, imposition of a 100% excise tax could have a material adverse effect on our financial condition and results of operations and could adversely affect the trading price of our common stock.

Loans to our tenants could be characterized as equity, in which case our income from that tenant might not be qualifying income under the REIT rules and we could lose our REIT status.

In connection with the acquisition in 2004 of certain Vibra Healthcare, LLC (“Vibra”) facilities, one of our TRSsTRS made a loan to Vibra to acquire the operations at those Vibra facilities. The acquisition loan bore interest at an annual rate of 10.25%. Our operating partnership loaned the funds to the TRS to make this loan. The loan from our operating partnership to the TRS bore interest at an annual rate of 9.25%.

Like the Vibra loan discussed above, our TRSs haveTRS has made and will make loans to tenants in our facilities to acquire operations or for working capital purposes. The IRS may take the position that certain loans to tenants should be treated as equity interests rather than debt, and that our interest income from such tenant should not be treated as qualifying income for purposes of the REIT gross income tests. If the IRS were to successfully treat a loan to a particular tenant as equity interests, the tenant would be a “related party tenant” with respect to our company and the rent that we receive from the tenant would not be qualifying income for purposes of the REIT gross income tests. As a result, we could be in jeopardy of failing the 75% income test discussed above, which if we did would cause us to lose our REIT status. In addition, if the IRS were to successfully treat a particular loan as interests held by our operating partnership rather than by our TRSs,TRS, we could fail the 5% asset test, and if the IRS further successfully treated the loan as other than straight debt, we could fail the 10% asset test with respect to such interest. As a result of the failure of either test, we could lose our REIT status, which would subject us to corporate level income tax and adversely affect our ability to make distributions to our stockholders.

Certain property transfers may generate prohibited transaction income, resulting in a penalty tax on gain attributable to the transaction.

From time to time, we may transfer or otherwise dispose of some of our properties, including by contributing properties to ourco-investment ventures. Under the Code, any gain resulting from transfers of

Index to Financial Statements

properties we hold as inventory or primarily for sale to customers in the ordinary course of business is treated as income from a prohibited transaction subject to a 100% penalty tax. We do not believe that our transfers or disposals of property or our contributions of properties into ourco-investment ventures are prohibited transactions. However, whether property is held for investment purposes is a question of fact that depends on all the facts and circumstances surrounding the particular transaction. The IRS may contend that certain transfers or dispositions of properties by us or contributions of properties into ourco-investment ventures are prohibited transactions. While we believe that the IRS would not prevail in any such dispute, if the CodeIRS were to argue successfully that a transfer, disposition or contribution of property constituted a

30


prohibited transaction, we would be required to pay a 100% penalty tax on any gain allocable to us from the prohibited transaction. In addition, income from a prohibited transaction might adversely affect our ability to satisfy the income tests for qualification as a REIT.

Changes in U.S. or foreign tax laws, regulations, including changes to tax rates, may adversely affect our results of operations.

We are headquartered in the U.S. with subsidiaries and investments globally and are subject to income taxes in these jurisdictions. Significant judgment is required in determining our provision for income taxes. Although we believe that we have adequately assessed and accounted for our potential tax liabilities, and that our tax estimates are reasonable, there can be no assurance that additional taxes will not be due upon audit of our tax returns or as a result of changes to applicable tax laws. The U.S. government (particularly with the recent presidential election coupled with a Republican-controlled Congress) as well as the governments of many of the countries in which we operate (such as Germany, the United Kingdom, and Luxembourg, which is where our Europe entities are domiciled) are actively discussing changes to the corporate recognition and taxationtaxation. Our future tax expense could be adversely affected by these changes in tax laws or their interpretation, both domestically and internationally. Potential tax reforms being considered by many countries include changes that could impact, among other things, global tax reporting, intercompany transfer pricing arrangements, the definition of worldwide income.taxable permanent establishments, and other legal or financial arrangements.  The nature and timing of any changes to each jurisdiction’s tax laws and the impact on our future tax liabilities both in the U.S. and abroad cannot be predicted with any accuracy but could materially and adversely impact our results of operations and cash flows.

The recently enacted Tax Cuts and Jobs Act is a complex revision to the U.S. federal income tax laws with impacts on different categories of taxpayers and industries, and will require subsequent rulemaking and interpretation in a number of areas. The long-term impact of the Tax Cuts and Jobs Act on the overall economy, government revenues, our tenants, our company, and the real estate industry cannot be reliably predicted at this time. Furthermore, the Tax Cuts and Jobs Act may impact certain of our tenants’ operating results, financial condition, and future business plans. The Tax Cuts and Jobs Act may also result in reduced government revenues, and therefore reduced government spending, which may impact some of our tenants that rely on government funding. There can be no assurance that the Tax Cuts and Jobs Act will not impact our operating results, financial condition, and future business operations.

Dividends payable by REITs do not qualify for the reduced tax rates available for some dividends.

Income from “qualified dividends” payable to U.S. stockholders that are individuals, trusts and estates are generally subject to tax at preferential rates. Dividends payable by REITs, however, generally are not eligible for the preferential tax rates applicable to qualified dividend income. Although these rules do not adversely affect the taxation of REITs or dividends payable by REITs, to the extent that the preferential rates continue to apply to regular corporate qualified dividends, investors who are individuals, trusts and estates may perceive investments in REITs to be relatively less attractive than investments in the stocks ofnon-REIT corporations that pay dividends, which could materially and adversely affect the value of the shares of REITs, including the per share trading price of our capital stock.

The Tax Cuts and Jobs Act provides a deduction to non-corporate taxpayers (e.g., individuals, trusts and estates) of 20% on dividends paid by a REIT that are not classified as capital gains. This provides closer parity between the treatment under the new law of ordinary REIT dividends and qualified dividends. The new law also provides for a maximum individual marginal tax rate on ordinary income, without regard to the effect of this deduction, of 37%. For non-corporate taxpayers, this would reduce the maximum marginal tax rate on ordinary REIT dividends to 33.4% (including the 3.8% Medicare tax that is applied before the 20% deduction.). The new tax law’s 20% deduction on dividends paid by a REIT to non-corporate taxpayers and the reduced individual tax rates are scheduled to sunset for tax years beginning after 2025, absent further legislation.

ITEM 1B.

Unresolved Staff Comments

None.

31

Index to Financial Statements

ITEM 2.

Properties

Properties

At December 31, 2016,2018, our portfolio consisted of 231275 properties: 213254 facilities (of the 219265 facilities that we owned) were in operation and leased to 3029 operators, 1210 assets were in the form of first mortgage loans to four operators, and sixthree properties were under construction. Our owned facilities consisted of 125151 general acute care hospitals, 7598 inpatient rehabilitation hospitals, 1613 LTACHs, and three medical office buildings. The 1210 non-owned facilities consisted of eightsix general acute care facilities, three inpatient rehabilitation hospitals, and one LTACH.

 

   Total
Properties
   Total 2016
Revenue
   Total
Assets (A)
 
   (Dollars in thousands) 

United States:

      

Alabama

   2   $763   $8,614 

Arizona

   13    23,798    286,847(B) 

Arkansas

   1    14,457    90,335(F) 

California

   13    66,197    542,889 

Colorado

   13    12,684    100,298 

Connecticut

   —      90    1,500(D) 

Florida

   1    2,250    25,810 

Idaho

   4    12,581    103,059 

Indiana

   2    4,806    52,003 

Kansas

   3    11,177    98,356 

Louisiana

   5    11,124    128,687(E) 

Massachusetts

   9    26,098    1,250,000 

Michigan

   2    4,367    40,743 

Missouri

   4    19,621    210,921 

Montana

   1    2,589    21,821 

Nevada

   1    9,949    84,601 

New Jersey

   8    39,084    417,436 

New Mexico

   2    6,027    55,960 

Ohio

   2    1,936    20,388(B) 

Oklahoma

   1    12,283    58,743(F) 

Oregon

   2    15,146    133,503 

Pennsylvania

   1    4,492    38,204 

South Carolina

   6    15,618    172,996 

Texas

   58    96,992    877,315(B)(C)(E) 

Utah

   3    9,943    107,151 

Virginia

   1    1,072    10,915 

Washington

   1    5,942    103,168 

West Virginia

   1    2,756    23,792 

Wisconsin

   1    2,936    29,062 

Wyoming

   1    2,754    23,229 

Other Assets

   —      —      27,623 
  

 

 

   

 

 

   

 

 

 

Total United States

   162   $439,532   $5,145,969 

International:

      

Germany

   59   $97,382   $1,098,002 

United Kingdom

   1    3,871    34,861 

Italy

   8    —      89,511(G) 

Spain

   1    352    18,800 

Other Assets

   —      —      31,393 
  

 

 

   

 

 

   

 

 

 

Total International

   69   $101,605   $1,272,567 
  

 

 

   

 

 

   

 

 

 

Total

   231   $541,137   $6,418,536 
  

 

 

   

 

 

   

 

 

 

Index to Financial Statements

 

 

Total

Properties

 

 

Total 2018 Revenue

 

 

Total

Assets(A)

 

 

 

 

(Dollars in thousands)

 

 

United States:

 

 

 

 

 

 

 

 

 

 

 

 

 

Alabama

 

 

2

 

 

$

763

 

 

$

8,614

 

 

Arizona

 

 

16

 

 

 

46,724

 

 

 

483,778

 

(C)

Arkansas

 

 

2

 

 

 

8,196

 

 

 

99,036

 

 

California

 

 

12

 

 

 

61,059

 

 

 

522,753

 

 

Colorado

 

 

13

 

 

 

11,500

 

 

 

91,302

 

 

Connecticut

 

 

 

 

 

90

 

 

 

1,500

 

(D)

Florida

 

 

4

 

 

 

15,643

 

 

 

182,791

 

 

Idaho

 

 

6

 

 

 

19,088

 

 

 

226,990

 

(B)

Indiana

 

 

2

 

 

 

4,754

 

 

 

52,003

 

 

Kansas

 

 

3

 

 

 

11,611

 

 

 

100,156

 

 

Louisiana

 

 

6

 

 

 

13,214

 

 

 

144,964

 

 

Massachusetts

 

 

9

 

 

 

118,155

 

 

 

1,382,799

 

 

Michigan

 

 

2

 

 

 

4,395

 

 

 

40,743

 

 

Missouri

 

 

4

 

 

 

19,767

 

 

 

210,921

 

 

Montana

 

 

1

 

 

 

2,454

 

 

 

17,389

 

 

Nevada

 

 

1

 

 

 

10,175

 

 

 

86,405

 

 

New Jersey

 

 

8

 

 

 

43,906

 

 

 

422,022

 

 

New Mexico

 

 

2

 

 

 

6,097

 

 

 

43,791

 

 

Ohio

 

 

6

 

 

 

13,270

 

 

 

133,243

 

 

Oregon

 

 

1

 

 

 

9,846

 

 

 

110,000

 

 

Pennsylvania

 

 

3

 

 

 

13,641

 

 

 

141,893

 

 

South Carolina

 

 

6

 

 

 

14,086

 

 

 

164,636

 

 

Texas

 

 

60

 

 

 

115,748

 

 

 

1,126,217

 

(C)

Utah

 

 

7

 

 

 

83,335

 

 

 

1,054,539

 

 

Virginia

 

 

1

 

 

 

1,072

 

 

 

10,915

 

 

Washington

 

 

2

 

 

 

10,351

 

 

 

136,600

 

 

West Virginia

 

 

2

 

 

 

6,378

 

 

 

40,220

 

 

Wisconsin

 

 

1

 

 

 

3,051

 

 

 

29,062

 

 

Wyoming

 

 

1

 

 

 

2,612

 

 

 

18,511

 

 

Other assets

 

 

 

 

 

 

 

 

232,973

 

 

Total United States

 

 

183

 

 

$

670,981

 

 

$

7,316,766

 

 

International:

 

 

 

 

 

 

 

 

 

 

 

 

 

Germany

 

 

80

 

 

$

109,202

 

 

$

782,833

 

(E)

United Kingdom

 

 

3

 

 

 

3,813

 

 

 

73,992

 

(B)

Italy

 

 

8

 

 

 

 

 

 

92,683

 

(E)

Spain

 

 

1

 

 

 

526

 

 

 

25,789

 

(E)

Other assets

 

 

 

 

 

 

 

 

551,580

 

 

Total International

 

 

92

 

 

$

113,541

 

 

$

1,526,877

 

 

Total

 

 

275

 

 

$

784,522

 

 

$

8,843,643

 

 

 

(A)

Represents total assets at December 31, 2016.2018.

(B)

Includes development projects still under construction at December 31, 2016.2018.

(C)

Includes

Arizona includes one facility that is vacant at December 31, 2018. Texas includes our Twelve Oaks facility that is 55% occupied.occupied and six facilities that were vacant at December 31, 2018. Our investment in these facilities is less than 1% of total gross investment in the facility is $63 million.assets.

(D)

We do not own any property in this state as of December 31, 2016;2018; however, we hold a $1.5 million note related to a property disposed of in 2015.

32


(E)

Includes revenue in the amount of $10.9 million related to

For Germany, Italy, and Spain, we own 71, eight, and one properties, that were disposed during 2016.

(F)Includes revenue in the amount of $7.3 million related to mortgage loans repaid during 2016.
(G)Includesrespectively, through joint venture arrangements for which our equity investment in eight facilities that is included in otherOther assets on the balance sheet at December 31, 2016.2018.

 

Type of Property

(includes properties subject to leases and mortgage loans)

  Number of
Properties
   Number of
Square

Feet
   Number of
Licensed
Beds(C)
 

General Acute Care Hospitals(A)

   136    20,216,265    11,646 

Inpatient Rehabilitation Hospitals(B)

   78    8,831,567    12,018 

Long-Term Acute Care Hospitals

   17    1,002,664    1,043 
  

 

 

   

 

 

   

 

 

 
   231    30,050,496    24,707 
  

 

 

   

 

 

   

 

 

 

Type of Property

(includes properties subject to leases and mortgage loans)

 

Number of

Properties

 

 

Total

Square

Footage

 

 

Total

Licensed

Beds(A)

 

General Acute Care Hospitals

 

 

160

 

 

 

26,516,886

 

 

 

15,388

 

Inpatient Rehabilitation Hospitals

 

 

101

 

 

 

11,592,283

 

 

 

15,687

 

LTACHs

 

 

14

 

 

 

782,152

 

 

 

814

 

 

 

 

275

 

 

 

38,891,321

 

 

 

31,889

 

 

(A)

One of our general acute care hospitals, currently under development, with 387,500 square feet and 183 beds, is located in Spain. One of our general acute care hospitals, with 69,965 square feet and 28 beds, is located in the United Kingdom. Eight of our general acute care hospitals, with 822,000 square feet and 807 beds, are located in Italy. Two of our general acute care hospitals, with 238,732 square feet and 233 beds, are located in Germany.
(B)57 of our rehabilitation facilities, with 7.8 million square feet and 11,097 beds, are located in Germany.
(C)

Excludes our sixthree facilities that are under development.

The following table shows lease and mortgage loan expirations, for the next 10 years and thereafter, assuming that none of the tenants/borrowers exercise any of their renewal options (dollars in thousands):

 

Total Lease and Mortgage Loan Portfolio(2)

  Total
Leases/Mortgage
Loans
   Base
Rent/
Interest(1)
   % of Total
Base

Rent/Interest
 Total
Square
Footage
   Total
Licensed
Beds
 

 

Total

Leases/

Mortgage

Loans

 

 

 

Annualized

Base

Rent/

Interest(1)

 

 

% of Total

Annualized

Base

Rent/

Interest

 

 

Total

Square

Footage

 

 

Total

Licensed

Beds

 

2017

   —     $—      —     —      —   

2018

   1    2,016    0.4 66,459    62 

2019

   2    5,017    0.9 307,706    306 

 

 

3

 

 

 

$

6,481

 

 

 

1.0

%

 

 

227,066

 

 

 

228

 

2020

   5    10,662    1.9 1,205,908    590 

 

 

1

 

 

 

 

2,073

 

 

 

0.3

%

 

 

47,937

 

 

 

64

 

2021

   3    13,125    2.3 422,679    338 

 

 

1

 

 

 

 

2,250

 

 

 

0.3

%

 

 

95,445

 

 

 

126

 

2022

   15    72,532    12.9 3,543,907    2,571 

 

 

15

 

 

 

 

75,138

 

 

 

11.3

%

 

 

3,310,543

 

 

 

2,552

 

2023

   4    12,630    2.2 912,652    851 

 

 

4

 

 

 

 

13,147

 

 

 

2.0

%

 

 

912,652

 

 

 

823

 

2024

   1    2,237    0.4 183,545    204 

 

 

2

 

 

 

 

5,401

 

 

 

0.8

%

 

 

387,870

 

 

 

374

 

2025

   7    21,927    3.9 1,293,953    812 

 

 

6

 

 

 

 

19,933

 

 

 

3.0

%

 

 

1,299,924

 

 

 

769

 

2026

   5    24,598    4.4 969,349    892 

 

 

5

 

 

 

 

25,789

 

 

 

3.9

%

 

 

948,301

 

 

 

850

 

2027

 

 

1

 

 

 

 

3,051

 

 

 

0.5

%

 

 

102,948

 

 

 

13

 

2028

 

 

5

 

 

 

 

7,155

 

 

 

1.1

%

 

 

194,879

 

 

 

119

 

2029

 

 

19

 

 

 

 

48,902

 

 

 

7.4

%

 

 

2,700,101

 

 

 

1,355

 

Thereafter

   188    396,662    70.7 21,050,715    19,453 

 

 

203

 

 

 

 

453,296

 

 

 

68.4

%

 

 

28,049,629

 

 

 

24,413

 

  

 

   

 

   

 

  

 

   

 

 

Total

   231   $561,406    100.0 29,956,873    26,079 

 

 

265

 

 

 

$

662,616

 

 

 

100.0

%

 

 

38,277,295

 

 

 

31,686

 

  

 

   

 

   

 

  

 

   

 

 

 

(1)

The most recent monthly base rent and mortgage loan interest annualized. This does not include tenant recoveries, additional rents and other lease/loan-related adjustments to revenue (i.e., straight-line rents and deferred revenues).

(2)

Excludes sixIncludes all properties, including 80 properties owned through joint ventures, except eight vacant properties representing less than 1% of our total gross assets, and three facilities that are under development, our Twelve Oaksdevelopment. The schedule also includes one facility in Germany that is not fully occupied, and the nine properties that we own through joint venture arrangements. In addition, the schedulewas acquired in February 2019.

Index to Financial Statements

ITEM 3.

reflects post December 31, 2016 transactions and commitments, including the acquisition of two RCCH facilities and the remaining 14 facilities in Germany — see Note 8 to Item 8 of the Annual Report on

Form 10-KLegal Proceedings for details of our commitments at December 31, 2016.

ITEM 3.Legal Proceedings

From time to time, there are various legal proceedings pending to which we are a party or to which some of our properties are subject to arising in the normal course of business. At this time, we do not believe that the ultimate resolution of these proceedings will have a material adverse effect on our consolidated financial position or results of operations.

ITEM 4.

Mine Safety Disclosures

None.

33


Index to Financial Statements

PART II

ITEM 5.

Market for Registrant’s Common Equity, Related Stockholder Matters, and Issuer Purchases of Equity Securities

(a) Medical Properties’ common stock is traded on the New York Stock Exchange under the symbol “MPW.” The following table sets forth the high and low sales prices for the common stock for the periods indicated, as reported by the New York Stock Exchange Composite Tape, and the dividends per share declared by us with respect to each such period.

 

 

High

 

 

Low

 

 

Dividends

 

  High   Low   Dividends 

Year ended December 31, 2016

      

Year Ended December 31, 2018

 

 

 

 

 

 

 

 

 

 

 

 

First Quarter

  $13.29   $9.61   $0.22 

 

$

13.89

 

 

$

11.82

 

 

$

0.25

 

Second Quarter

   15.50    12.61    0.23 

 

 

14.18

 

 

 

12.25

 

 

 

0.25

 

Third Quarter

   15.92    13.64    0.23 

 

 

15.24

 

 

 

13.79

 

 

 

0.25

 

Fourth Quarter

   15.04    11.54    0.23 

 

 

17.52

 

 

 

13.98

 

 

 

0.25

 

Year ended December 31, 2015

      

Year Ended December 31, 2017

 

 

 

 

 

 

 

 

 

 

 

 

First Quarter

  $15.62   $13.81   $0.22 

 

$

13.86

 

 

$

11.90

 

 

$

0.24

 

Second Quarter

   15.42    13.04    0.22 

 

 

14.22

 

 

 

12.25

 

 

 

0.24

 

Third Quarter

   13.98    10.79    0.22 

 

 

13.54

 

 

 

12.27

 

 

 

0.24

 

Fourth Quarter

   12.21    10.59    0.22 

 

 

14.19

 

 

 

12.89

 

 

 

0.24

 

On February 24, 2017,22, 2019, the closing price for our common stock, as reported on the New York Stock Exchange, was $13.36$18.50 per share. As of February 24, 2017,22, 2019, there were 7578 holders of record of our common stock. This figure does not reflect the beneficial ownership of shares held in nominee name.

To qualify as a REIT, we must distribute at least 90% of our REIT taxable income, excluding net capital gain, as dividends to our stockholders. If dividends are declared in a quarter, those dividends will be paid during the subsequent quarter. We expect to continue the policy of distributing our taxable income through regular cash dividends on a quarterly basis, although there is no assurance as to future dividends because they depend on future earnings, capital requirements, and our financial condition. In addition, our Credit Facility limits the amounts of dividends we can pay — see Note 4 of Item 8 of this Annual Report onForm 10-K for more information.

Recent Sales of Unregistered Securities

As previously disclosed, we issued an aggregate of 10.3 shares of common stock in a private placement on October 7,2016, in connection with our acquisition of the Steward portfolio, for total proceeds of $150 million. The shares were issued pursuant to a Stock Purchase Agreement between us and an affiliate of Cerberus Capital Management (“Cerberus”), the controlling member of Steward. Prior to issuance, Cerberus assigned a portion of its rights to acquire the shares under the Stock Purchase Agreement to certain members of the management of Steward. The private placement was conducted in reliance on the exemption from registration provided by Section 4(a)(2) of the Securities Act.

(b) Not applicable.

(c) None.

34

Index to Financial Statements

The following graph provides comparison of cumulative total stockholder return for the period from December 31, 20112013 through December 31, 2016,2018, among us, the Russell 2000 Index, NAREIT All Equity REIT Index, and SNL US REIT Healthcare Index. The stock performance graph assumes an investment of $100 in us and the three indices, and the reinvestment of dividends. The historical information below is not indicative of future performance.

 

 

  Period Ending 

 

Period Ending

 

Index

  12/31/11   12/31/12   12/31/13   12/31/14   12/31/15   12/31/16 

 

12/31/2013

 

 

12/31/2014

 

 

12/31/2015

 

 

12/31/2016

 

 

12/31/2017

 

 

12/31/2018

 

Medical Properties Trust, Inc.

   100.00    131.19    142.19    170.84    153.28    175.50 

 

 

100.00

 

 

 

120.14

 

 

 

107.79

 

 

 

123.42

 

 

 

148.78

 

 

 

186.02

 

Russell 2000

   100.00    116.35    161.52    169.43    161.95    196.45 

 

 

100.00

 

 

 

104.89

 

 

 

100.26

 

 

 

121.63

 

 

 

139.44

 

 

 

124.09

 

NAREIT All Equity REIT Index

   100.00    119.70    123.12    157.63    162.08    176.07 

 

 

100.00

 

 

 

128.03

 

 

 

131.64

 

 

 

143.00

 

 

 

155.41

 

 

 

149.12

 

SNL US REIT Healthcare

   100.00    120.06    112.53    149.86    138.96    149.27 

 

 

100.00

 

 

 

133.17

 

 

 

123.49

 

 

 

132.65

 

 

 

132.45

 

 

 

140.66

 

The graph and accompanying text shall not be deemed incorporated by reference by any general statement incorporating by reference this Annual Report on Form10-K into any filing under the Securities Act of 1933, as amended, or under the Securities Exchange Act of 1934, as amended.

Index to Financial Statements
35


ITEM 6.

Selected Financial Data

The following tables set forth are selected consolidated financial and operating data for Medical Properties Trust, Inc. and MPT Operating Partnership, L.P. and their respective subsidiaries. You should read the following selected financial data in conjunction with the consolidated historical financial statements and notes thereto of each of Medical Properties Trust, Inc. and MPT Operating Partnership, L.P. and their respective subsidiaries included in Item 8, in this Annual Report onForm 10-K, along with “Management’s Discussion and Analysis of Financial Condition and Results of Operations” included in Item 7, in this Annual Report on Form10-K.

Medical Properties Trust, Inc.

The consolidated operating data and balance sheetssheet data have been derived from our audited consolidated financial statements. As of December 31, 2016,2018, Medical Properties Trust, Inc. had a 99.9% equity ownership interest in the Operating Partnership. Medical Properties Trust, Inc. has no significant operations other than as the sole member of its wholly owned subsidiary, Medical Properties Trust, LLC, which is the sole general partner of the Operating Partnership, and no material assets, other than its direct and indirect investment in the Operating Partnership.

 

   2016(1)  2015(1)  2014(1)  2013(1)  2012(1) 
   (In thousands except per share data) 

OPERATING DATA

      

Total revenue

  $541,137  $441,878  $312,532  $242,523  $198,125 

Real estate depreciation and amortization (expense)

   (94,374  (69,867  (53,938  (36,978  (32,815

Property-related and general and administrative (expenses)

   (51,623  (47,431  (39,125  (32,513  (30,039

Acquisition expenses(2)

   (46,273  (61,342  (26,389  (19,494  (5,420

Impairment (charge)

   (7,229  —     (50,128  —     —   

Gain on sale of real estate and other asset dispositions, net

   61,224   3,268   2,857   7,659   16,369 

Interest and other (expense) income

   (1,618  175   5,183   (4,424  (15,088

Unutilized financing fees/ debt refinancing costs

   (22,539  (4,367  (1,698  —     —   

Interest (expense)

   (159,597  (120,884  (98,156  (66,746  (58,243

Income tax benefit (expense)(3)

   6,830   (1,503  (340  (726  (19
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income from continuing operations

   225,938   139,927   50,798   89,301   72,870 

Income (loss) from discontinued operations

   (1  —     (2  7,914   17,207 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income

   225,937   139,927   50,796   97,215   90,077 

Net income attributable tonon-controlling interests

   (889  (329  (274  (224  (177
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to MPT common stockholders

  $225,048  $139,598  $50,522  $96,991  $89,900 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income from continuing operations attributable to MPT common stockholders per diluted share

  $0.86  $0.63  $0.29  $0.58  $0.54 

Income from discontinued operations attributable to MPT common stockholders per diluted share

   —     —     —     0.05   0.13 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to MPT common stockholders per diluted share

  $0.86  $0.63  $0.29  $0.63  $0.67 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Weighted average number of common shares — diluted

   261,072   218,304   170,540   152,598   132,333 

OTHER DATA

      

Dividends declared per common share

  $0.91  $0.88  $0.84  $0.81  $0.80 

Index to Financial Statements
   December 31, 
   2016(1)  2015(1)  2014(1)  2013(1)  2012(1) 
   (In thousands) 

BALANCE SHEET DATA

      

Real estate assets — at cost

  $4,965,968  $3,924,701  $2,612,291  $2,296,479  $1,591,189 

Real estate accumulated depreciation/amortization

   (325,125  (257,928  (202,627  (159,776  (122,796

Mortgage and other loans

   1,216,121   1,422,403   970,761   549,746   527,893 

Cash and equivalents

   83,240   195,541   144,541   45,979   37,311 

Other assets

   478,332   324,634   195,364   147,915   128,393 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total assets

  $6,418,536  $5,609,351  $3,720,330  $2,880,343  $2,161,990 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Debt, net

  $2,909,341  $3,322,541  $2,174,648  $1,397,329  $1,008,264 

Other liabilities

   255,967   179,545   163,635   138,806   103,912 

Total Medical Properties Trust, Inc. Stockholders’ Equity

   3,248,378   2,102,268   1,382,047   1,344,208   1,049,814 

Non-controlling interests

   4,850   4,997   —     —     —   
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total equity

   3,253,228   2,107,265   1,382,047   1,344,208   1,049,814 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total liabilities and equity

  $6,418,536  $5,609,351  $3,720,330  $2,880,343  $2,161,990 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

 

 

2018

 

 

2017

 

 

2016

 

 

2015

 

 

2014

 

 

 

(In thousands except per share data)

 

OPERATING DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total revenues

 

$

784,522

 

 

$

704,745

 

 

$

541,137

 

 

$

441,878

 

 

$

312,532

 

Interest expense

 

 

(223,274

)

 

 

(176,954

)

 

 

(159,597

)

 

 

(120,884

)

 

 

(98,156

)

Real estate depreciation and amortization expense

 

 

(133,083

)

 

 

(125,106

)

 

 

(94,374

)

 

 

(69,867

)

 

 

(53,938

)

Property-related and general and administrative expenses

 

 

(89,323

)

 

 

(64,410

)

 

 

(51,623

)

 

 

(47,431

)

 

 

(39,125

)

Acquisition costs

 

 

(917

)

 

 

(29,645

)

 

 

(46,273

)

 

 

(61,342

)

 

 

(26,389

)

Gain on sale of real estate and other

 

 

719,392

 

 

 

7,431

 

 

 

61,224

 

 

 

3,268

 

 

 

2,857

 

Impairment charges

 

 

(48,007

)

 

 

 

 

 

(7,229

)

 

 

 

 

 

(50,128

)

Debt refinancing costs

 

 

 

 

 

(32,574

)

 

 

(22,539

)

 

 

(4,367

)

 

 

(1,698

)

Other income (expense)

 

 

10,094

 

 

 

10,432

 

 

 

(1,619

)

 

 

175

 

 

 

5,181

 

Income tax (expense) benefit

 

 

(927

)

 

 

(2,681

)

 

 

6,830

 

 

 

(1,503

)

 

 

(340

)

Net income

 

 

1,018,477

 

 

 

291,238

 

 

 

225,937

 

 

 

139,927

 

 

 

50,796

 

Net income attributable to non-controlling interests

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

 

 

(329

)

 

 

(274

)

Net income attributable to MPT common stockholders

 

$

1,016,685

 

 

$

289,793

 

 

$

225,048

 

 

$

139,598

 

 

$

50,522

 

Net income attributable to MPT common stockholders per

   diluted share

 

$

2.76

 

 

$

0.82

 

 

$

0.86

 

 

$

0.63

 

 

$

0.29

 

Weighted average shares outstanding — diluted

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

 

 

218,304

 

 

 

170,540

 

OTHER DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dividends declared per common share

 

$

1.00

 

 

$

0.96

 

 

$

0.91

 

 

$

0.88

 

 

$

0.84

 

FFO(1)

 

$

485,335

 

 

$

408,512

 

 

$

253,478

 

 

$

205,168

 

 

$

106,682

 

Normalized FFO(1)

 

$

501,004

 

 

$

474,879

 

 

$

334,826

 

 

$

274,805

 

 

$

181,741

 

Normalized FFO per share(1)

 

$

1.37

 

 

$

1.35

 

 

$

1.28

 

 

$

1.26

 

 

$

1.06

 

Cash paid for acquisitions and other related investments

 

$

666,548

 

 

$

2,246,788

 

 

$

1,489,147

 

 

$

1,833,018

 

 

$

767,696

 

 

(1)Cash paid for acquisitions and other related investments totaled $1.5 billion, $1.8 billion, $767.7 million, $654.9 million, and $621.5 million in 2016, 2015, 2014, 2013, and 2012, respectively. The results of operations resulting from these investments are reflected in our consolidated financial statements from the dates invested. See Note 3 in Item 8 of this Annual Report on Form10-K for further information on acquisitions of real estate, new loans, and other investments. We funded these investments generally from issuing common stock, utilizing additional amounts of our revolving facility, incurring additional debt, or from the sale of facilities. See Notes 4, 9, and 3, in Item 8 on this Annual Report on Form10-K for further information regarding our debt, common stock and property disposals, respectively.
(2)Includes $30.1 million, $37.0 million, $5.8 million and $12.0 million in transfer and capital gains taxes in 2016, 2015, 2014 and 2013, respectively, related to our property acquisitions in foreign jurisdictions.
(3)Includes $9.1 million tax benefit generated from the reversal of foreign valuation allowances and acquisition expenses incurred by certain international subsidiaries in 2016.

 

 

December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

 

2015

 

 

2014

 

 

 

(In thousands)

 

BALANCE SHEET DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real estate assets — at cost

 

$

5,952,512

 

 

$

6,642,947

 

 

$

4,965,968

 

 

$

3,924,701

 

 

$

2,612,291

 

Real estate accumulated depreciation/amortization

 

 

(464,984

)

 

 

(455,712

)

 

 

(325,125

)

 

 

(257,928

)

 

 

(202,627

)

Mortgage and other loans

 

 

1,586,520

 

 

 

1,928,525

 

 

 

1,216,121

 

 

 

1,422,403

 

 

 

970,761

 

Cash and cash equivalents

 

 

820,868

 

 

 

171,472

 

 

 

83,240

 

 

 

195,541

 

 

 

144,541

 

Other assets

 

 

948,727

 

 

 

733,056

 

 

 

478,332

 

 

 

324,634

 

 

 

195,364

 

Total assets

 

$

8,843,643

 

 

$

9,020,288

 

 

$

6,418,536

 

 

$

5,609,351

 

 

$

3,720,330

 

Debt, net

 

$

4,037,389

 

 

$

4,898,667

 

 

$

2,909,341

 

 

$

3,322,541

 

 

$

2,174,648

 

Other liabilities

 

 

245,316

 

 

 

286,416

 

 

 

255,967

 

 

 

179,545

 

 

 

163,635

 

Total Medical Properties Trust, Inc. Stockholders’ Equity

 

 

4,547,108

 

 

 

3,820,633

 

 

 

3,248,378

 

 

 

2,102,268

 

 

 

1,382,047

 

Non-controlling interests

 

 

13,830

 

 

 

14,572

 

 

 

4,850

 

 

 

4,997

 

 

 

 

Total equity

 

 

4,560,938

 

 

 

3,835,205

 

 

 

3,253,228

 

 

 

2,107,265

 

 

 

1,382,047

 

Total liabilities and equity

 

$

8,843,643

 

 

$

9,020,288

 

 

$

6,418,536

 

 

$

5,609,351

 

 

$

3,720,330

 

Index to Financial Statements
36


MPT Operating Partnership, L.P.

The consolidated operating data and balance sheetssheet data presented below have been derived from the Operating Partnership’s audited consolidated financial statements.

 

   2016(4)  2015(4)  2014(4)  2013(4)  2012(4) 
   (In thousands except per unit data) 

OPERATING DATA

      

Total revenue

  $541,137  $441,878  $312,532  $242,523  $198,125 

Real estate depreciation and amortization (expense)

   (94,374  (69,867  (53,938  (36,978  (32,815

Property-related and general and administrative (expenses)

   (51,623  (47,431  (39,125  (32,513  (30,039

Acquisition expenses(5)

   (46,273  (61,342  (26,389  (19,494  (5,420

Impairment (charge)

   (7,229  —     (50,128  —     —   

Gain on sale of real estate and other asset dispositions, net

   61,224   3,268   2,857   7,659   16,369 

Interest and other (expense) income

   (1,618  175   5,183   (4,424  (15,088

Unutilized financing fees/ debt refinancing costs

   (22,539  (4,367  (1,698  —     —   

Interest (expense)

   (159,597  (120,884  (98,156  (66,746  (58,243

Income tax benefit (expense)(6)

   6,830   (1,503  (340  (726  (19
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income from continuing operations

   225,938   139,927   50,798   89,301   72,870 

Income (loss) from discontinued operations

   (1  —     (2  7,914   17,207 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income

   225,937   139,927   50,796   97,215   90,077 

Net income attributable tonon-controlling interests

   (889  (329  (274  (224  (177
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income attributable to MPT Operating Partnership, L.P. partners

  $225,048  $139,598  $50,522  $96,991  $89,900 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Income from continuing operations attributable to MPT Operating Partnership, L.P. partners per diluted unit

  $0.86  $0.63  $0.29  $0.58  $0.54 

Income from discontinued operations attributable to MPT Operating Partnership, L.P. partners per diluted unit

   —     —     —     0.05   0.13 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Net income, attributable to MPT Operating Partnership, L.P. partners per diluted unit

  $0.86  $0.63  $0.29  $0.63  $0.67 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Weighted average number of units — diluted

   261,072   218,304   170,540   152,598   132,333 

OTHER DATA

      

Dividends declared per unit

  $0.91  $0.88  $0.84  $0.81  $0.80 

Index to Financial Statements
   December 31, 
   2016(4)  2015(4)  2014(4)  2013(4)  2012(4) 
   (In thousands) 

BALANCE SHEET DATA

      

Real estate assets — at cost

  $4,965,968  $3,924,701  $2,612,291  $2,296,479  $1,591,189 

Real estate accumulated depreciation/amortization

   (325,125  (257,928  (202,627  (159,776  (122,796

Mortgage and other loans

   1,216,121   1,422,403   970,761   549,746   527,893 

Cash and equivalents

   83,240   195,541   144,541   45,979   37,311 

Other assets

   478,332   324,634   195,364   147,915   128,393 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total assets

  $6,418,536  $5,609,351  $3,720,330  $2,880,343  $2,161,990 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Debt, net

  $2,909,341  $3,322,541  $2,174,648  $1,397,329  $1,008,264 

Other liabilities

   255,577   179,155   163,245   138,416   103,522 

Total MPT Operating Partnership, L.P. capital

   3,248,768   2,102,658   1,382,437   1,344,598   1,050,204 

Non-controlling interests

   4,850   4,997   —     —     —   
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total capital

   3,253,618   2,107,655   1,382,437   1,344,598   1,050,204 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

Total liabilities and capital

  $6,418,536  $5,609,351  $3,720,330  $2,880,343  $2,161,990 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

 

 

 

2018

 

 

2017

 

 

2016

 

 

2015

 

 

2014

 

 

 

(In thousands except per unit data)

 

OPERATING DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total revenues

 

$

784,522

 

 

$

704,745

 

 

$

541,137

 

 

$

441,878

 

 

$

312,532

 

Interest expense

 

 

(223,274

)

 

 

(176,954

)

 

 

(159,597

)

 

 

(120,884

)

 

 

(98,156

)

Real estate depreciation and amortization expense

 

 

(133,083

)

 

 

(125,106

)

 

 

(94,374

)

 

 

(69,867

)

 

 

(53,938

)

Property-related and general and administrative expenses

 

 

(89,323

)

 

 

(64,410

)

 

 

(51,623

)

 

 

(47,431

)

 

 

(39,125

)

Acquisition costs

 

 

(917

)

 

 

(29,645

)

 

 

(46,273

)

 

 

(61,342

)

 

 

(26,389

)

Gain on sale of real estate and other

 

 

719,392

 

 

 

7,431

 

 

 

61,224

 

 

 

3,268

 

 

 

2,857

 

Impairment charges

 

 

(48,007

)

 

 

 

 

 

(7,229

)

 

 

 

 

 

(50,128

)

Debt refinancing costs

 

 

 

 

 

(32,574

)

 

 

(22,539

)

 

 

(4,367

)

 

 

(1,698

)

Other income (expense)

 

 

10,094

 

 

 

10,432

 

 

 

(1,619

)

 

 

175

 

 

 

5,181

 

Income tax (expense) benefit

 

 

(927

)

 

 

(2,681

)

 

 

6,830

 

 

 

(1,503

)

 

 

(340

)

Net income

 

 

1,018,477

 

 

 

291,238

 

 

 

225,937

 

 

 

139,927

 

 

 

50,796

 

Net income attributable to non-controlling interests

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

 

 

(329

)

 

 

(274

)

Net income attributable to MPT Operating Partnership partners

 

$

1,016,685

 

 

$

289,793

 

 

$

225,048

 

 

$

139,598

 

 

$

50,522

 

Net income attributable to MPT Operating Partnership partners

   per diluted unit

 

$

2.76

 

 

$

0.82

 

 

$

0.86

 

 

$

0.63

 

 

$

0.29

 

Weighted average units outstanding — diluted

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

 

 

218,304

 

 

 

170,540

 

OTHER DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dividends declared per unit

 

$

1.00

 

 

$

0.96

 

 

$

0.91

 

 

$

0.88

 

 

$

0.84

 

FFO(1)

 

$

485,335

 

 

$

408,512

 

 

$

253,478

 

 

$

205,168

 

 

$

106,682

 

Normalized FFO(1)

 

$

501,004

 

 

$

474,879

 

 

$

334,826

 

 

$

274,805

 

 

$

181,741

 

Normalized FFO per unit(1)

 

$

1.37

 

 

$

1.35

 

 

$

1.28

 

 

$

1.26

 

 

$

1.06

 

Cash paid for acquisitions and other related investments

 

$

666,548

 

 

$

2,246,788

 

 

$

1,489,147

 

 

$

1,833,018

 

 

$

767,696

 

 

 

 

December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

 

2015

 

 

2014

 

 

 

(In thousands)

 

BALANCE SHEET DATA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real estate assets — at cost

 

$

5,952,512

 

 

$

6,642,947

 

 

$

4,965,968

 

 

$

3,924,701

 

 

$

2,612,291

 

Real estate accumulated depreciation/amortization

 

 

(464,984

)

 

 

(455,712

)

 

 

(325,125

)

 

 

(257,928

)

 

 

(202,627

)

Mortgage and other loans

 

 

1,586,520

 

 

 

1,928,525

 

 

 

1,216,121

 

 

 

1,422,403

 

 

 

970,761

 

Cash and cash equivalents

 

 

820,868

 

 

 

171,472

 

 

 

83,240

 

 

 

195,541

 

 

 

144,541

 

Other assets

 

 

948,727

 

 

 

733,056

 

 

 

478,332

 

 

 

324,634

 

 

 

195,364

 

Total assets

 

$

8,843,643

 

 

$

9,020,288

 

 

$

6,418,536

 

 

$

5,609,351

 

 

$

3,720,330

 

Debt, net

 

$

4,037,389

 

 

$

4,898,667

 

 

$

2,909,341

 

 

$

3,322,541

 

 

$

2,174,648

 

Other liabilities

 

 

244,926

 

 

 

286,026

 

 

 

255,577

 

 

 

179,155

 

 

 

163,245

 

Total MPT Operating Partnership, L.P. capital

 

 

4,547,498

 

 

 

3,821,023

 

 

 

3,248,768

 

 

 

2,102,658

 

 

 

1,382,437

 

Non-controlling interests

 

 

13,830

 

 

 

14,572

 

 

 

4,850

 

 

 

4,997

 

 

 

 

Total capital

 

 

4,561,328

 

 

 

3,835,595

 

 

 

3,253,618

 

 

 

2,107,655

 

 

 

1,382,437

 

Total liabilities and capital

 

$

8,843,643

 

 

$

9,020,288

 

 

$

6,418,536

 

 

$

5,609,351

 

 

$

3,720,330

 

(4)

(1)

Cash paid for acquisitions and other related investments totaled $1.5 billion, $1.8 billion, $767.7 million, $654.9 million, and $621.5 million

See section titled “Non-GAAP Financial Measures” in 2016, 2015, 2014, 2013, and 2012, respectively. The results of operations resulting from these investments are reflected in our consolidated financial statements from the dates invested. See Note 3 in Item 8 of this Annual Report on Form10-K for further information on acquisitions of real estate, new loans, and other investments. We funded these investments generally from issuing units, utilizing additional amounts of our revolving facility, incurring additional debt, or from the sale of facilities. See Notes 4, 9, and 3, in Item 8 on this Annual Report on Form10-K for further information regarding our debt, partners’ capital and property disposals, respectively.

(5)Includes $30.1 million, $37.0 million, $5.8 million and $12.0 million in transfer and capital gains taxes in 2016, 2015, 2014 and 2013, respectively, related to our property acquisitions in foreign jurisdictions.
(6)Includes $9.1 million tax benefit generated from the reversal of foreign valuation allowances and acquisition expenses incurred by certain international subsidiaries in 2016.

Index to Financial Statements
ITEM 7.Management’s“Management’s Discussion and Analysis of Financial Condition and Results of OperationsOperations” included in Item 7 of this Annual Report on Form 10-K for an explanation of why these non-GAAP financial measures are useful along with a reconciliation to our GAAP earnings.

37


ITEM 7.

Management’s Discussion and Analysis of Financial Condition and Results of Operations

Unless otherwise indicated, references to “our,” “we” and “us” in this management’s discussion and analysis of financial condition and results of operations refer to Medical Properties Trust, Inc. and its consolidated subsidiaries, including MPT Operating Partnership, L.P.

Overview

We were incorporated in Maryland on August 27, 2003, primarily for the purpose of investing in and owningnet-leased healthcare facilities. We also make real estate mortgage loans and other loans to our tenants. We conduct our business operations in one segment. We currently have healthcare investments in the U.S. and Europe. We have operated as a REIT since April 6, 2004, and accordingly, elected REIT status upon the filing of our calendar year 2004 U.S. federal income tax return. Our existing tenants are, and our prospective tenants will generally be, healthcare operating companies and other healthcare providers that use substantial real estate assets in their operations. We offer financing for these operators’ real estate through 100% lease and mortgage financing and generally seek lease and loan terms on a long-term basis ranging from 10 to 15 years with a series of shorter renewal terms at the option of our tenants and borrowers. We also have included and intend to include in our lease and loan agreements annual contractual minimum rate increases. Our existing portfolio’s minimum escalators generally range from 0.5% to 5%, while a limited number of our properties do not have an escalator. Most3%.  In addition, most of our leases and loans also include rate increases based on the general rate of inflation if greater than the minimum contractual increases. In addition toOnly less than 2% of our properties do not have either a minimum escalator or an escalator based on inflation.  Beyond rent or mortgage interest, our leases and loans typically require our tenants to pay all operating costs and expenses associated with the facility. Some leases also may require our tenants to pay percentage rents, which are based on the tenant’s revenues from their operations. Finally, we may acquire a profits or other equity interest in our tenants that gives us a right to share in the tenant’s income or loss.

We selectively make loans to certain of our operators through our TRSs, which the operators use for acquisitions and working capital. We consider our lending business an important element of our overall business strategy for two primary reasons: (1) it provides opportunities to make income-earning investments that yield attractive risk-adjusted returns in an industry in which our management has expertise, and (2) by making debt capital available to certain qualified operators, we believe we create for our company a competitive advantage over other buyers of, and financing sources for, healthcare facilities.

At December 31, 2016,2018, our portfolio (including real estate assets in joint ventures) consisted of 231275 properties leased or loaned to 3029 operators, of which sixthree are under development and 1210 are in the form of mortgage loans.

2018 Highlights

In 2018, we demonstrated the value of our portfolio through strategic property sales that generated gains exceeding $700 million and cash proceeds of approximately $2 billion. In addition, we generated returns to our shareholders of 25% during 2018, outpacing the returns of several key indexes as noted in Item 5 of this Annual Report on Form 10-K. Our return included an increase in our quarterly dividend to $0.25 per share in 2018 — the fourth year in a row for such an increase. Finally, we improved our liquidity position and leverage metrics during 2018, which puts us in an excellent position for future investment opportunities.

A summary of our 2018 highlights is as follows:

Sold the real estate of 76 properties (71 of which are leased to MEDIAN and were contributed to a joint venture arrangement) and sold our equity interest in Ernest (along with the repayment of all outstanding loans and accrued interest) for a net gain of approximately $720 million, as noted below:

Sold two acute care hospitals in Houston, Texas for a net gain of approximately $100 million;

Sold three long-term acute care hospitals located in California, Texas, and Oregon, for $53 million of cash and resulting in a net gain of $19.1 million;

Sold 71 properties located in Germany for a net gain of approximately €500 million by way of a joint venture arrangement, for which we own a 50% interest; and

Sold our investment in the operations of Ernest and were repaid outstanding loans and accrued interest generating over $176 million in cash.

Acquired the following real estate assets:

Acquired three inpatient rehabilitation hospitals in Germany for a combined purchase price of €17.3 million. These facilities are leased to MEDIAN;

Acquired five acute care hospitals from Steward in exchange for the reduction of $764 million in mortgage loans plus cash, which further increased the strength of our portfolio; and

Acquired an acute care hospital in Pasco, Washington for $17.5 million. This facility is leased to LifePoint.

38


After completing our strategic dispositions, we repaid over $800 million in outstanding revolver debt, resulting in approximately $1.3 billion in available liquidity from the revolving credit facility at December 31, 2018.

Sold 5.6 million shares under our at-the-market equity program, generating proceeds of approximately $95 million.

Successfully re-tenanted nine of the 16 Adeptus transition properties and our Florence facility.

2017 Highlights

In 2017, we invested or committed to invest approximately $2.2 billion in healthcare real estate assets. These significant investments enhanced the size and scale of our healthcare portfolio, while expanding our geographic footprint in the U.S. and extending our lease and mortgage loan maturity schedule. Furthermore, we strategically sold an asset for proceeds totaling $64 million, raised $548 million in proceeds from a successful equity offering, and refinanced approximately $0.6 billion of debt, which strengthened our balance sheet, reduced interest rates, and funded acquisitions. Finally, we increased our dividend to $0.24 per share per quarter in 2017.

A summary of our 2017 highlights is as follows:

Acquired real estate assets, entered into development agreements, entered into leases and made new loan investments, totaling more than $2.2 billion as noted below:

Acquired 17 inpatient rehabilitation hospitals and one acute care hospital in Germany for a combined purchase price of €274 million. These facilities are leased to MEDIAN or its affiliates;

Acquired 15 acute care hospitals, one rehabilitation hospital, and one behavioral health facility, completed mortgage financing on two acute care hospitals, and invested in an additional minority equity contribution in Steward for an aggregate investment of $1.8 billion;

Acquired an acute care hospital in Lewiston, Idaho for $87.5 million. This facility is leased to LifePoint;

Acquired two acute care hospitals located in Wheeling, West Virginia and Martins Ferry, Ohio for an aggregate purchase price of approximately $40 million. We simultaneously leased the facilities to Alecto Healthcare Services LLC (“Alecto”); and

Executed agreements totaling more than $150 million with Circle Health Group and Surgery Partners, Inc. to develop acute care hospitals in Birmingham, England and Idaho Falls, Idaho, respectively.

With these new investments, we expanded our gross assets to $9.5 billion, increased the total number of properties in our portfolio to 275, and increased our total number of beds to more than 32 thousand, as of December 31, 2017.

Sold the real estate of an acute care facility in Muskogee, Oklahoma, for a net gain of $7.4 million.

To fund our over $2.2 billion of asset investments, while lowering our average interest cost, we successfully refinanced approximately $0.6 billion of debt, and generated proceeds of approximately $2.5 billion from the sale of 43.1 million shares in an equity offering and through new issuances of unsecured notes. Details of such activities are as follows:

Replaced our previous unsecured credit facility with a new $1.3 billion unsecured revolving loan facility, a $200 million unsecured term loan facility, and a new €200 million unsecured term loan facility;

Redeemed our 5.750% Senior Unsecured Notes due 2020 using proceeds from our €200 million term loan and cash on hand;

Completed a €500 million senior unsecured notes offering in March 2017 and used a portion of the proceeds to pay off our €200 million term loan;

Completed a $1.4 billion senior unsecured notes offering in September 2017 with a rate of 5.000% and used a portion of the proceeds to redeem our 6.375% Senior Unsecured Notes due 2022;

Prepaid the principal amount of the mortgage loan on our property in Kansas City, Missouri at par in the amount of $12.9 million; and

Completed an underwritten public offering of 43.1 million shares of our common stock, resulting in net proceeds of $548 million, after deducting estimated offering expenses.

With these transactions, our weighted average interest rate at December 31, 2017, improved to 4.42% versus 4.87% at December 31, 2016.

39


2016 Highlights

In 2016, we invested or committed to invest approximately $1.8 billion in healthcare real estate assets. These significant investments enhanced the size and quality of our healthcare portfolio, while improving our tenant concentration and expanding our geographic footprint in the U.S. Furthermore, we strategically sold assets for proceeds totaling more than $800 million, refinanced $1 billion of debt, and sold 82.7 million shares generating proceeds of approximately $1.2 billion in order to strengthen our balance sheet, reduce leverage, and fund acquisitions.

A summary of our 2016 highlights is as follows:

Acquired real estate assets (or committed to acquire real estate assets), entered into development agreements, entered into leases and made new loan investments, totaling more than $1.8 billion as noted below:

Acquired a portfolio of five acute care hospitals and completed mortgage financing on four acute care hospitals in Massachusetts and invested in a minority equity contribution in Steward for an aggregate investment of $1.25 billion;

Acquired 12 inpatient rehabilitation hospitals in Germany for a combined purchase price of €85.2 million and committed €174.6 million to acquire 14 additional inpatient rehabilitation hospitals. These facilities are leased or will be leased to MEDIAN or its affiliates;

Index to Financial Statements
Acquired an acute care hospital in Newark, New Jersey, from Prime for an aggregate purchase price of $63.0 million and committed to advance an additional $30 million to Prime over a three-year period to be used solely for capital additions to the real estate; any such addition will be added to the basis upon which the lessee will pay us rents;

Closed on the final MEDIAN property, as part of the initial MEDIAN transaction in 2015, for a purchase price of €41.6 million. See “2015 Activity” for a description of the initial MEDIAN Transaction;million;

Completed the sale leaseback transaction with Prime converting our existing mortgage loan on three general acute care hospitals and one free-standing emergency department in New Jersey to real estate, for an aggregate investment of $115 million;

Completed the sale leaseback transaction converting the remaining $93.3 million RCCH acquisition loan on the Olympia, Washington property to real estate, including funding an additional $7 million; and

Committed to purchase two acute care hospitals in Washington and Idaho for an aggregate purchase price of $105 million, which will beare leased to RCCH.

After these new investments, our largest tenant made up 17.5% of our gross assets as of December 31, 2016, slightly down from 17.6% as of December 31, 2015.

Sold investments in real estate and equity interests and received payments in full on loans for proceeds of more than $800 million as noted below:

Completed the Capella Healthcare, Inc. (“Capella”) Disposal Transaction (as fully described in Note 3 to Item 8 of this Annual Report on Form10-K) in which we sold our equity investment, received $395 million to settle outstanding acquisition loans and received $210 million in prepayment of two mortgage loans for hospitals in Russellville, Arkansas and Lawton, Oklahoma, resulting in net proceeds of approximately $600 million;

Sold the real estate of five properties (three of which were in Texas and two in Louisiana), received payment in full for outstanding loans, and recovered our investment in operations for proceeds of $71 million, resulting in a net gain of approximately $15 million;

Sold the real estate of a long-term acute care facility in Corinth, Texas, for proceeds of $28 million; and

Sold the real estate of three inpatient rehabilitation hospitals located in Texas, for proceeds of $111.5 million, resulting in a net gain of approximately $45 million.

Refinanced $1 billion of debt and sold 82.7 million shares generating proceeds of approximately $1.2 billion:

Completed a $500 million senior unsecured notes offering in February 2016 and used the proceeds to reduce our outstanding balance on our revolving credit facility;

Completed a $500 million senior unsecured notes offering in July 2016 and used the proceeds to redeem our $450 million 6.875% Senior Unsecured Notes due 2021;

Sold the remaining 14.9 million shares under our January 2014at-the-market equity offering program resulting in net proceeds of approximately $224 million;

Completed an underwritten public offering of 57.5 million shares of our common stock, resulting in net proceeds of $799.5 million, after deducting estimated offering expenses; and

Sold 10.3 million shares of common stock in a private placement, generating total proceeds of $150 million.

With these transactions, our net debt to gross assets at December 31, 2016, improved to 43.1% versus 56.6% at December 31, 2015.40

Index to Financial Statements

2015 Highlights

In 2015, we invested or committed to invest approximately $1.8 billion in healthcare real estate assets. These significant investments greatly strengthened our portfolio through geographic, tenant and property type diversification. We expanded total assets by 51%, increased revenues by 41%, and lowered our general and administrative expense as a percentage of revenue to less than 10%.

A summary of our 2015 highlights is as follows:

Acquired (or committed to acquire) real estate assets, entered into development agreements, entered into leases and made new loan investments, totaling more than $1.8 billion as noted below:

Acquired the original Capella hospital portfolio (now RCCH) including seven acute care hospitals throughout the U.S. and obtained a stake in their operations for a combined total of approximately $900 million. Also, acquired an eighth facility (Kershaw) for $35 million later in the year.

Completed the sale-leaseback transaction (step 2 of the initial transaction in 2014) of 31 MEDIAN facilities in Germany for an aggregate purchase price of €646 million;

Initiated long term relationship with AXA Real Estate Investment Managers toco-invest withAXA-advised accounts for the acquisition of acute care hospitals in Spain and Italy via a joint venture arrangement;

Executed a $19 million agreement to develop an inpatient rehabilitation hospital in Toledo, Ohio, acquired an inpatient rehabilitation facility and a long-term acute care hospital in Lubbock, Texas for an aggregate purchase price of $31.5 million, and acquired an inpatient rehabilitation hospital in Weslaco, Texas for $10.7 million all leased to Ernest;

Completed $30 million mortgage financing to Prime for a general acute care hospital in Port Huron, Michigan and subsequently converted a portion of the loan to real estate for $20 million, which reduced the mortgage loan accordingly;

Provided $100 million mortgage financing to Prime for three general acute care hospitals and one free-standing emergency department in New Jersey and acquired two general acute care hospitals in the Kansas City area for $110 million;

Acquired a266-bed outpatient rehabilitation clinic located in Hannover, Germany from MEDIAN for €18.7 million;

Executed an additional $250 million agreement with Adeptus Health for the development of acute care hospitals and free-standing emergency departments; and

Completed construction and began recording rental income on 17 acute care facilities in Texas, Arizona, and Colorado with Adeptus Health totaling approximately $102.6 million and an acute care facility and a medical office building in Birmingham, Alabama with UAB Medical West totaling $8.6 million.

Sold the real estate of a long-term acute care facility in Luling, Texas, and real estate of six wellness centers in the U.S. for a net gain; and

Increased our senior Credit Facility to $1.95 billion comprised of a $1.3 billion senior unsecured revolving credit facility and a $250 million senior unsecured term loan facility along with a $400 million accordion feature, issued €500 million of unsecured notes, and raised $817 million in equity to fund the acquisition activity mentioned above.

2014 Highlights

In 2014, we invested or committed to invest approximately $1.4 billion in healthcare real estate assets. These significant investments greatly strengthened our portfolio through geographic, tenant and property type diversification.

Index to Financial Statements

A summary of our 2014 highlights is as follows:

Acquired (or committed to acquire) real estate assets, entered into development agreements, entered into leases and made new loan investments, totaling more than $1.4 billion as noted below:

Completed Step 1 of the two step acquisition of 32 MEDIAN facilities for €688 million by loaning €425 million to Waterland Private Equity Fund VC.V.(“Waterland”) and MEDIAN;

Completed the acquisition of three MEDIAN (formally RHM) facilities located in Germany for a transaction valued at approximately €64 million incurring approximately €3 million of transfer and other taxes that have been expensed as acquisition costs;

Acquired an acute care hospital in Fairmont, West Virginia for an aggregate purchase price of $15 million from Alecto Healthcare Services (“Alecto”), made a $5 million working capital loan to the tenant and a commitment to fund up to $5 million in capital improvements;

Acquired an acute care hospital in Sherman, Texas for an aggregate purchase price of $32.5 million from Alecto and funded a $7.5 million working capital loan to the tenant;

Entered the United Kingdom healthcare market by acquiring an acute care hospital in Peasedown St. John, United Kingdom from Circle Health Ltd., through its subsidiary Circle Hospital (Bath) Ltd. valued at approximately £28.3 million incurring approximately £1.1 million of transfer and other taxes that have been expensed as acquisition costs;

Acquired a general acute care hospital and an adjacent parcel of land for an aggregate purchase price of $115 million from a joint venture of LHP Hospital Group, Inc. and Hackensack University Medical Center Mountainside;

Executed an additional $150 million agreement with Adeptus Health for the development of acute care hospitals and free-standing emergency departments; and

Completed construction and began recording rental income on the following facilities:

Northern Utah Rehabilitation Hospital — $19 million inpatient rehabilitation facility located in South Ogden, Utah leased to Ernest;

Oakleaf Surgical Hospital — $30.5 million acute care facility located in Altoona, Wisconsin leased to National Surgical Hospitals; and

Adeptus Health — Completed 17 acute care facilities totaling approximately $80.3 million.

Sold the real estate of La Palma Community Hospital to Prime recognizing a gain on sale of $2.9 million;

Sold the real estate of our Bucks facility pursuant to a purchase option, resulting in a $3.1 million impairment charge;

Restructured our investment in Monroe Hospital by entering into a lease with an affiliate of Prime which had acquired the operations of the facility;

Completed a $1.15 billion senior unsecured credit facility comprised of a $1.025 billion senior unsecured revolving credit facility and a $125 million senior unsecured term loan facility, issued $300 million of unsecured notes, and raised $138 million in equity to fund the acquisition activity mentioned above; and

Received investment grade rating on our unsecured debt ofBBB- and a corporate credit rating upgrade from Standard & Poor’s Ratings Services to BB+.

Critical Accounting Policies

In order to prepare financial statements in conformity with generally accepted accounting principles (“GAAP”) in the U.S., we must make estimates about certain types of transactions and account balances. We

Index to Financial Statements

believe that our estimates of the amount and timing of our revenues, credit losses, fair values (either as part of a purchase price allocation, impairment analysis or in valuing certain of our equity investments), periodic depreciation of our real estate assets, and stock compensation expense, along with our assessment as to whether an entity that we do business with should be consolidated with our results, have significant effects on our financial statements. Each of these items involves estimates that require us to make subjective judgments. We rely on our experience, collect historical and current market data, and develop relevant assumptions to arrive at what we believe to be reasonable estimates. Under different conditions or assumptions, materially different amounts could be reported related to the critical accounting policies described below. In addition, application of these critical accounting policies involves the exercise of judgment on the use of assumptions as to future uncertainties and, as a result, actual results could materially differ from these estimates. See Note 2 to Item 8 of this Annual Report on Form10-K for more information regarding our critical accounting policies and recent accounting developments. Our accounting estimates include the following:

Revenue Recognition:  We receive income from operating leases based on the fixed, minimum required rents (base rents) per the lease agreements. Rent revenue from base rents is recorded on the straight-line method over the terms of the related lease agreements for new leases and the remaining terms of existing leases for those acquired as part of a property acquisition. The straight-line method records the periodic average amount of base rent earned over the term of a lease, taking into account contractual rent adjustments over the lease term. The straight-line method typically has the effect of recording more rent revenue from a lease than a tenant is required to pay early in the term of the lease. During the later parts of a lease term, this effect reverses with less rent revenue recorded than a tenant is required to pay. Rent revenue, as recorded on the straight-line method, in the consolidated statements of income is presented as two amounts: rent billed revenue and straight-line revenue. Rent billed revenue is the amount of base rent actually billed to the customer each period as required by the lease. Straight-line rent revenue is the difference between rent revenue earned based on the straight-line method and the amount recorded as rent billed revenue. We record the difference between base rent revenues earned and amounts due per the respective lease agreements, as applicable, as an increase or decrease to straight-line rent receivable.

Certain leases may provide for additional rents contingent upon a percentage of the tenant’s revenues in excess of specified base amount/threshold (percentage rents). Percentage rents are recognized in the period in which revenue thresholds are met. Rental payments received prior to their recognition as income are classified as deferred revenue. We also receive additional rent (contingent rent) under some leases based on increases in the CPI or where the CPI exceeds the annual minimum percentage increase as stipulated in the lease. Contingent rents are recorded as rent billed revenue in the period earned.

We use direct financing lease (“DFL”) accounting to record rent on certain leases deemed to be financing leases, per accounting rules, rather than operating leases. For leases accounted for as DFLs, future minimum lease payments are recorded as a receivable. The difference between the future minimum lease payments and the estimated residual values less the cost of the properties is recorded as unearned income. Unearned income is deferred and amortized to income over the lease terms to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unearned income.

In instances where we have a profits or equity interest in our tenants’ operations, we record income equal to our percentage interest of the tenants’ profits, as defined in the lease or tenants’ operating agreements, once annual thresholds, if any, are met.

We begin recording base rent income from our development projects when the lessee takes physical possession of the facility, which may be different from the stated start date of the lease. Also, during construction of our development projects, we are generally entitled to accrue rent based on the cost paid during the construction period (construction period rent). We accrue construction period rent as a receivable with a corresponding offset to deferred revenue during the construction period. When the lessee takes physical possession of the facility, we begin recognizing the deferred construction period revenue on the straight-line method over the remaining term of the lease.

Index to Financial Statements

We receive interest income from our tenants/borrowers on mortgage loans, working capital loans, and other long-term loans. Interest income from these loans is recognized as earned based upon the principal outstanding and terms of the loans.

Commitment fees received from lesseelessees for development and leasing services are initially recorded as deferred revenue and recognized as income over the initial term of a lease to produce a constant effective yield on the lease (interest method). Commitment and origination fees from lending services are also recorded as deferred revenue initially and recognized as income over the life of the loan using the interest method.

Investments in Real Estate:  We maintain our investments in real estate at cost, and we capitalize improvements and replacements when they extend the useful life or improve the efficiency of the asset. While our tenants are generally responsible for all operating costs at a facility, to the extent that we incur costs of repairs and maintenance, we expense those costs as incurred. We compute depreciation using the straight-line method over the weighted-averageweighted average useful life of approximately 38.839.2 years for buildings and improvements.

When circumstances indicate a possible impairment of the value of our real estate investments, we review the recoverability of the facility’s carrying value. The review of the recoverability is generally based on our estimate of the future undiscounted cash flows, excluding interest charges, from the facility’s use and eventual disposition. Our forecast of these cash flows considers factors such as expected future operating income, market and other applicable trends, and residual value, as well as the effects of leasing demand, competition and other factors. If impairment exists due to the inability to recover the carrying value of a facility on an undiscounted

41


basis, such as was the case with certain of our MonroeAdeptus transition facilities and Bucks facilitiesfour of our Alecto properties in 2014,2018, an impairment loss is recorded to the extent that the carrying value exceeds the estimated fair value of the facility. We do not believe that the value of any of our facilities was impaired at December 31, 2016;2018; however, given the highly specialized aspects of our properties no assurance can be given that future impairment charges will not be taken.

Acquired Real Estate Purchase Price Allocation: For existing  Since January 1, 2018, with the adoption of ASU No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”), all of our property acquisitions have been accounted for as asset acquisitions. Prior to 2018, properties acquired for leasing purposes we accountwere accounted for such acquisitions based onusing business combination accounting rules. WeUnder either accounting method, we allocate the purchase price of acquired properties to net tangible and identified intangible assets acquired based on their fair values. In making estimates of fair valuesvalue for purposes of allocating purchase prices of acquired real estate, we may utilize a number of sources, including available real estate broker data, independent appraisals that may be obtained in connection with the acquisition or financing of the respective property, internal data from previous acquisitions or developments, and other market data. We also consider information obtained about each property as a result of ourpre-acquisition due diligence, marketing and leasing activities in estimating the fair value of the tangible and intangible assets acquired.

We record above-market and below-marketin-place lease values, if any, for the facilities we own which are based on the present value of the difference between (i) the contractual amounts to be paid pursuant to thein-place leases and (ii) management’s estimate of fair market lease rates for the correspondingin-place leases, measured over a period equal to the remainingnon-cancelable term of the lease. We amortize any resulting capitalized above-market lease values as a reduction of rental income over lease term. We amortize any resulting capitalized below-market lease values as an increase to rental income over the lease term. Because our strategy to a large degree involves the origination and acquisition of long-term lease arrangements at market rates with independent parties, we do not expect the above-market and below-marketin-place lease values to be significant for many of our transactions.

We measure the aggregate value of other lease intangible assets to be acquired based on the difference between (i) the property valued with new orin-place leases adjusted to market rental rates and (ii) the property valued as if vacant when acquired. Management’s estimates of value are made using methods similar to those used by independent appraisers (e.g., discounted cash flow analysis). Factors considered by management in our analysis include an estimate of carrying costs during hypothetical expectedlease-up periods, considering current market conditions, and costs to execute similar leases. We also consider information obtained about each targeted

Index to Financial Statements

facility as a result of ourpre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the intangible assets acquired. In estimating carrying costs, management includes real estate taxes, insurance and other operating expenses and estimates of lost rentals at market rates during the expectedlease-up periods, which we expect to be about six months (based on experience) depending on specific local market conditions. Management also estimates costs to execute similar leases including leasing commissions, legal costs, and other related expenses to the extent that such costs are not already incurred in connection with a new lease origination as part of the transaction.

Other intangible assets acquired may include customer relationship intangible values, which are based on management’s evaluation of the specific characteristics of each prospective tenant’s lease and our overall relationship with that tenant. Characteristics to be considered by management in allocating these values include the nature and extent of our existing business relationships with the tenant, growth prospects for developing new business with the tenant, the tenant’s credit quality, and expectations of lease renewals, including those existing under the terms of the lease agreement, among other factors. At December 31, 2016,2018, we have assigned no value to customer relationship intangibles.

We amortize the value of lease intangibles to expense over the term of the respective leases, which have a weighted average useful life of 17.926.0 years at December 31, 2016.2018. If a lease is terminated early, the unamortized portion of the lease intangible is charged to expense as was the case with our Twelve Oaks property in 2015.expense.

Losses from Rent Receivables:For all leases, we continuously monitor the performance of our existing tenants including, but not limited to: admission levels and surgery/procedure volumes by type; current operating margins; ratio of our tenants’ operating margins both to facility rent and to facility rent plus other fixed costs; trends in revenue, cash collections, and patient mix; and the effect of evolving healthcare regulations on tenants’ profitability and liquidity.

Losses from Operating Lease Receivables: We utilize the information above along with the tenants’ payment and default history in evaluating (on aproperty-by-property basis) whether or not a provision for losses on outstanding rent receivables is needed. A provision for losses on rent receivables (including straight-line rent receivables) is ultimately recorded when it becomes probable that the receivable will not be collected in full. The provision is an amount which reduces the receivable to its estimated net realizable value based on a determination of the eventual amounts to be collected either from the debtor or from existing collateral, if any.

Losses on DFL Receivables: Allowances are established for DFLs based upon an estimate of probable losses on a property-by-property basis. DFLs are impaired when it is deemed probable that we will be unable to collect all amounts due in accordance with the contractual terms of the lease. Like operating lease receivables, the need for an allowance is based upon our assessment of the lessee’s overall financial condition; economic resources and payment record; the prospects for support from any financially responsible

42


guarantors; and, if appropriate, the realizable value of any collateral. These estimates consider all available evidence including the expected future cash flows discounted at the DFL’s effective interest rate, fair value of collateral, and other relevant factors, as appropriate. DFLs are placed onnon-accrual status when we determine that the collectability of contractual amounts is not reasonably assured. If onnon-accrual status, we generally account for the DFLs on a cash basis, in which income is recognized only upon receipt of cash.

Loans: Loans consist of mortgage loans, working capital loans and other long-term loans. Mortgage loans are collateralized by interests in real property. Working capital and other long-term loans are generally collateralized by interests in receivables and corporate and individual guarantees. We record loans at cost. We evaluate the collectability of both interest and principal on aloan-by-loan basis (using the same process as we do for assessing the collectability of rents as discussed above) to determine whether they are impaired. A loan is considered impaired when, based on current information and events, it is probable that we will be unable to collect all amounts due according to the existing contractual terms. When a loan is considered to be impaired, the amount of the allowance is calculated by comparing the recorded investment to either the value determined by

Index to Financial Statements

discounting the expected future cash flows using the loansloan’s effective interest rate or to the fair value of the collateral, if the loan is collateral dependent.

Stock-Based Compensation:During the years ended December 31, 2016, 2015,2018, 2017, and 2014,2016, we recorded $7.9$16.5 million, $11.1$9.9 million, and $9.2$7.9 million, respectively, of expense for share-based compensation related to grants of restricted common stock and other stock-based awards. Starting in 2017, we granted annual performance condition awards that are amortized using the straight-line method over the service period in which the performance conditions as are measured, adjusted for the probability of achieving the performance conditions. Starting in 2010, we granted annual performance-based restricted share awards that vest based on the achievement of certain market conditions as defined by the accounting rules. Typical market conditions for our awards are based on our total shareholder return (factoring in stock price appreciation and dividends paid) including comparisons of our total shareholder returns to an index of other REIT stocks. Because these awards are earned based on the achievement of these market conditions, we must initially evaluate and estimate the probability of achieving these market conditions in order to determine the fair value of the award and over what period we should recognize stock compensation expense. Because of the complexities inherently involved with these awards, we work with an independent consultant to assist us in modeling both the value of the award and the various periods over which each tranche of an award will be earned. We use what is termed a Monte Carlo simulation model, which determines a value and earnings periods based on multiple outcomes and their probabilities. We record expense over the expected or derived vesting periods using the calculated value of the awards. We record expense over these vesting periods even though the awards have not yet been earned and, in fact, may never be earned — such as was the case with our 2014 performance awards in which 500,000 shares were forfeited because the related market conditions were not achieved for the period of January 1, 2014 through December 31, 2016.earned. If awards vest faster than our original estimate, we will record acatch-up of expense, which we did in the 2014 and 2013 fourth quarters due to our 2012 and 2011 stock awards being earned earlier than expected.expense.

Fair Value Option Election: We elected to account for certain investments acquired on February 29, 2012, as part of the Ernest transaction, using the fair value option method, which means we mark these investments to fair market value on a recurring basis. Any changesOn October 4, 2018, we sold our investment in the operations of Ernest and all outstanding acquisition loans and working capital loans were repaid. The only remaining investments measured at fair value of these investments arenon-cash adjustments that will not impact our financial condition or cash flows unless we decided to liquidate these investments.

These investments include the following at December 31, 20162018, are the mortgage loans. See below for these investments carried at fair value for the last two years (in thousands):

 

Asset (Liability)

  Total
Fair Value
 

Mortgage loans

  $112,836 

Acquisition and other loans

   116,298 

Equity investment

   3,300 
  

 

 

 

Total

  $232,434 
  

 

 

 

We measure the estimated fair value of most of these investments utilizing Level 2 and 3 of the fair value hierarchy. Under current accounting guidance, Level 3 represents fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

Asset (Liability)

 

Fair Value

 

 

Original Cost

 

 

Fair Value

 

 

Original Cost

 

Mortgage loans

 

$

115,000

 

 

$

115,000

 

 

$

115,000

 

 

$

115,000

 

Equity investment and other loans

 

 

 

 

 

 

 

 

114,554

 

 

 

118,354

 

Total

 

$

115,000

 

 

$

115,000

 

 

$

229,554

 

 

$

233,354

 

Our mortgage and acquisition loans with Ernest are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. OurPrior to the October 2018 transaction disclosed above, our equity investment in Ernest iswas recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requiresrequired significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classifyclassified the equity investment as Level 3, as we useused certain unobservable inputs to the valuation methodology that arewere significant to the fair value measurement, and the valuation requiresrequired management judgment due to the absence of quoted market prices. For the cash flow model, our observable inputs includeincluded use of a capitalization rate, discount rate (which iswas based on a weighted-

Index to Financial Statements

weighted average cost of capital), and market interest rates, and our unobservable input includesincluded an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at December 31, 2016..

In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections arewere provided by Ernest. However, we will modifymodified such projections (including underlying assumptions used) as needed based on our review and analysis of their historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors including the percent of control, the nature of the underlying investee’s business along with

43


our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To illustrate the effect of movements in the DLOM,

In both 2017 and 2018, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):

Basis Point

Change in

Marketability Discount

  Estimated Increase (Decrease)
In Fair Value
 

+100 basis points

  $(49

- 100 basis points

   49 

Becauserecognized unrealized losses because the fair value of Ernest investments noted above approximate theirwere below our original cost, we did not recognize any unrealized gains/losses during 2016.

In 2015, we held an equity investment in Capella (now RCCH) similar to our Ernest equity investment. We accounted for this investment under the fair value option election as well. Similar to Ernest, we recorded nocost. No unrealized gain/loss on this investmentthe Ernest investments were recorded in 2015 and through April 2016. In April 2016, we sold our Capella equity investment at cost resulting in no recognized gain/loss.years prior to 2017.

Principles of Consolidation:  Property holding entities and other subsidiaries of which we own 100% of the equity or have a controlling financial interest evidenced by ownership of a majority voting interest are consolidated. All inter-company balances and transactions are eliminated. For entities in which we own less than 100% of the equity interest, we consolidate the property if we have the direct or indirect ability to control the entities’ activities based upon the terms of the respective entities’ ownership agreements. For these entities, we record anon-controlling interest representing equity held bynon-controlling interests. interests.

We continually evaluate all of our transactions and investments to determine if they represent variable interests in a variable interest entity. If we determine that we have a variable interest in a variable interest entity, we then evaluate if we are the primary beneficiary of the variable interest entity. The evaluation is a qualitative assessment as to whether we have the ability to direct the activities of a variable interest entity that most significantly impact the entity’s economic performance. We consolidate each variable interest entity in which we, by virtue of or transactions with our investments in the entity, are considered to be the primary beneficiary. At December 31, 20162018 and 2015,2017, we determined that we were not the primary beneficiary of any of our variable interest entitiesentity in which we hold a variable interest because we do not control the activities (such as theday-to-day operations of the hospital) operations) that most significantly impact the economic performance of these entities.

Index to Financial Statements

Disclosure of Contractual Obligations

The following table summarizes known material contractual obligations (including interest) as of December 31, 2016,2018, excluding the impact of subsequent events (amounts in thousands):

 

Contractual Obligations

  Less Than
1 Year
   1-3 Years   3-5 Years   After
5 Years
   Total 

 

Less Than

1 Year

 

 

1-3 Years

 

 

3-5 Years

 

 

After

5 Years

 

 

Total

 

6.375% Senior Unsecured Notes due 2022

  $22,313   $44,625   $44,625   $361,156   $472,719 

5.750% Senior Unsecured Notes due 2020(1)

   12,095    24,189    220,419    —      256,703 

4.000% Senior Unsecured Notes due 2022(1)

   21,034    42,047    42,089    539,104    644,274 

 

$

22,934

 

 

$

45,868

 

 

$

596,284

 

 

$

 

 

$

665,086

 

5.500% Senior Unsecured Notes due 2024

   16,500    33,000    33,000    341,250    423,750 

 

 

16,500

 

 

 

33,000

 

 

 

33,000

 

 

 

308,250

 

 

 

390,750

 

6.375% Senior Unsecured Notes due 2024

   31,875    63,750    63,750    579,688    739,063 

 

 

31,875

 

 

 

63,750

 

 

 

63,750

 

 

 

515,938

 

 

 

675,313

 

3.325% Senior Unsecured Notes due 2025(1)

 

 

19,064

 

 

 

38,128

 

 

 

38,128

 

 

 

611,478

 

 

 

706,798

 

5.250% Senior Unsecured Notes due 2026

   26,906    52,500    52,500    631,250    763,156 

 

 

26,250

 

 

 

52,500

 

 

 

52,500

 

 

 

578,750

 

 

 

710,000

 

Revolving credit facility(2)

   10,190    294,755    —      —      304,945 

Term loans

   7,117    271,617    —      —      278,734 

5.000% Senior Unsecured Notes due 2027

 

 

70,000

 

 

 

140,000

 

 

 

140,000

 

 

 

1,680,000

 

 

 

2,030,000

 

Revolving credit facility(1)(2)

 

 

3,806

 

 

 

32,181

 

 

 

 

 

 

 

 

 

35,987

 

Term loan

 

 

7,888

 

 

 

15,798

 

 

 

200,692

 

 

 

 

 

 

224,378

 

Operating lease commitments(3)

   7,328    14,176    12,968    251,982    286,454 

 

 

6,602

 

 

 

13,745

 

 

 

13,698

 

 

 

198,932

 

 

 

232,977

 

Purchase obligations(4)

   464,592    43,638    —      —      508,230 

 

 

169,341

 

 

 

71,831

 

 

 

 

 

 

 

 

 

241,172

 

  

 

   

 

   

 

   

 

   

 

 

Totals

  $619,950   $884,297   $469,351   $2,704,430   $4,678,028 

 

$

374,260

 

 

$

506,801

 

 

$

1,138,052

 

 

$

3,893,348

 

 

$

5,912,461

 

  

 

   

 

   

 

   

 

   

 

 

 

(1)

Our 5.750% Senior Unsecured Notes due 2020 and 4.000% Senior Unsecured Notes due 2022 and 3.325% Senior Unsecured Notes due 2025 are euro-denominated. A portion of our revolver is British pound-denominated. We used the exchange rate at December 31, 2016, (or 1.0517)2018 (1.1467 for euros and 1.2754 for British pounds) in preparing this table.

(2)

As of December 31, 2016,2018, we have a $1.3 billion revolving credit facility. However, this table assumes the balance outstanding under the revolver and rate in effect at December 31, 20162018 (which was $290$28.1 million as of December 31, 2016)2018) remains in effect through maturity.

(3)

Most of our contractual obligations to make operating lease payments are related to ground leases for which we are reimbursed by our tenants along with corporate office and equipment leases.

(4)

Includes approximately $95.5$94 million of future expenditures related to development projects, a €5.8 million commitment to acquire one MEDIAN facility post December 31, 2018 (including real estate transfer taxes), and future expenditures on commenced capital improvement projects. We have excluded from the table above $135.9 million of capital expenditure commitments in our leases that we are not definitive on the amount, timing, and certainty of funding. However, payment on any of these commitments, if made, would be added to the lease base upon which the lessee will pay us rents.

Off BalanceOff-Balance Sheet Arrangements

We own interests in certain unconsolidated joint ventures as described under Note 3 to Item 8 of this Annual Report on Form10-K. Except in limited circumstances, our risk of loss is limited to our investment in the joint venture and any outstanding receivables. We have no other materialoff-balance sheet arrangements that we expect would materially affect our liquidity and capital resources, except those described above under “Disclosure of Contractual Obligations”.

44


Liquidity and Capital Resources

20162018 Cash Flow Activity

We generated cash of $264.7$449.1 million from operating activities during 2018, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cash on-hand to fund our dividends of $364 million and certain investing activities including the additional funding of our development activities.

In regards to other investing and financing activities in 2018, we did the following:

a)

In 2018, we generated more than $2 billion of cash proceeds from the joint venture transaction with Primotop (which included the disposal of 71 inpatient rehabilitation hospitals in Germany and issuance of secured debt) and the sale of five other acute care and long-term acute care properties. Approximately $580 million was reinvested in the joint venture with Primotop in the form of an equity interest and shareholder loan;

b)

On August 31, 2018, we funded the acquisition of one property in Pasco, Washington for $17.5 million;

c)

On August 28, 2018, we funded the acquisition of three properties in Germany for €17.3 million;

d)

Originated $212 million in mortgage and other loans;

e)

Funded less than $200 million for development and capital improvement projects;

f)

Acquired five facilities operated by Steward by converting the $764.4 million in mortgage loans on the same properties plus cash consideration;

g)

We used the net cash received from property disposals to reduce our revolver by approximately $810 million;

h)

On October 4, 2018, we finalized our recapitalization agreement with Ernest generating $176.3 million (which included the sale of our equity investment in Ernest and repayment in full of non-mortgage loans outstanding plus accrued interest); and

i)

In the fourth quarter of 2018, we sold 5.6 million shares of common stock under our at-the-market equity program generating approximately $95 million.

At December 31, 2018, we had more than $800 million of cash on-hand and availability under our revolving credit facility of nearly $1.3 billion. Subsequent to December 31, 2018, we acquired one inpatient rehabilitation hospital in Germany for €5.8 million including real estate transfer taxes, and entered into definitive agreements to acquire 11 Australian hospitals for approximately $860 million – see Note 13 to Item 8 of this Annual Report on Form 10-K.

2017 Cash Flow Activity

We generated cash of $362 million from operating activities during 2017, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cash on-hand to fund our dividends of $326.7 million and certain investing activities including the additional funding of our development activities.

In regards to other investing and financing activities in 2017, we did the following:

a)

On February 1, 2017, we replaced our previous unsecured credit facility with a new credit facility (“Credit Facility”) resulting in a $50 million reduction in our U.S. dollar term loan and a new €200 million unsecured term loan facility (which was paid off on March 30, 2017).

b)

On March 4, 2017, we redeemed our €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020. We funded this redemption, including the premium and accrued interest, with proceeds from the new €200 million term loan together with cash on hand.

c)

On March 24, 2017, we completed a senior unsecured notes offering for €500 million. We used the net proceeds from this offering to prepay and extinguish the new €200 million term loan with the remainder of the proceeds used to acquire 12 facilities leased to MEDIAN for €146.4 million.

d)

On March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to LifePoint. Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million.

e)

On May 1, 2017, we completed an underwritten public offering of approximately 43.1 million shares of our common stock, resulting in net proceeds of approximately $548 million. We used a portion of these proceeds to acquire eight facilities for $301.3 million (leased to Steward), a facility in Idaho for $87.5 million (leased to LifePoint) and two other facilities for $40 million (leased to Alecto).

f)

On September 7, 2017, we completed a senior unsecured notes offering for $1.4 billion. We used a portion of the net proceeds from the 5.000% Senior Unsecured Notes due 2027 offering to redeem the $350 million aggregate principal amount of our 6.375% Senior Unsecured Notes due 2022, plus a redemption premium, on October 7, 2017. The remaining

45


proceeds, plus borrowings on our revolving credit facility, were used to acquire nine facilities and ancillary properties leased to Steward for $700 million, to make mortgage loans on two properties for $700 million, and to make a $100 million equity investment in Steward.

g)

On September 29, 2017, we prepaid the principal amount of the mortgage loan on our property in Kansas City, Missouri at par in the amount of $12.9 million. To fund such prepayment, including accrued and unpaid interest thereon, we used borrowings from the revolving credit facility.

h)

On November 13, 2017, we entered into a new at-the-market equity program, which gives us the ability to sell up to $750 million of stock with a commission rate of up to 2.0%. We did not sell any shares under this program in 2017.

2016 Cash Flow Activity

We generated cash of $264 million from operating activities during 2016, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cashon-hand to fund our dividends of $218.4 million and certain investing activities including the additional funding of our development activities.

In regards to other financing activities in which we used such net proceeds to ultimately fund our approximate $1.5 billion of acquisitions in 2016 and the remainder of our development activities, we did the following:

 

a)

On February 22, 2016, we completed a senior unsecured notes offering for $500 million.

 

b)

On March 1, 2016, we updated ourat-the-market equity program, which gave us the ability to sell up to $227 million of stock with a commission rate of 1.25%. During 2016, we sold approximately 15 million shares of our common stock under this program, resulting in net proceeds of approximately

Index to Financial Statements
$224 $224 million, after deducting expenses of approximately $2.8 million of commissions. We have no capacity to sell additional shares under thisat-the-market equity offering program.

 

c)

On April 30, 2016, we closed on the Capella Disposal Transaction (as further discussed in Note 3 to Item 8 of this Annual Report on Form10-K) resulting in net proceeds of $550 million along with an additional $50 million once we sold our investment in RegionalCare Hospital Partners, Inc. (“RegionalCare”) bonds in June 2016.

 

d)

On May 23, 2016, we sold our investment in five properties leased and operated by Post Acute Medical (“Post Acute”) for $71 million.

 

e)

On June 17, 2016, we sold our investment in one property leased and operated by Corinth Investor Holdings for $28 million.

 

f)

On July 13, 2016, we completed a new $500 million senior unsecured notes offering. We used the net proceeds from this offering to redeem our $450 million 6.875% Senior Unsecured Notes due 2021, which was completed on August 12, 2016. Net proceeds from the notes offering and redemption approximated $19 million, and we incurred aone-time charge of $22.5 million related to the redemption (see Note 4 to Item 8 of this Annual Report on Form10-K for further details).

 

g)

On July 20, 2016, we sold three facilities leased to HealthSouth Corporation (“HealthSouth”)(now Encompass Health) for $111.5 million.

 

h)

On September 30, 2016, we completed a public offering of 57.5 million shares of our common stock, resulting in net proceeds of $799.5 million, after deducting offering expenses.

 

i)

On October 7, 2016, we sold 10.3 million shares of common stock in a private placement to Cerberus, and certain members of Steward management. We sold these shares at a price per share of $14.50, equal to the public offering price of our September 2016 equity offering, generating total proceeds of $150 million.

j)Subsequent to December 31, 2016, we replaced our credit facility with a new credit facility that includes a $1.3 billion unsecured revolving loan facility, a $200 million unsecured term loan facility, and a €200 million unsecured term loan facility. We plan to use the proceeds of the €200 million unsecured notes along with cash on hand to redeem the 5.750% Senior Unsecured Notes due 2020 in the same principal amounts. On February 2, 2017, we delivered an irrevocable notice of full redemption to the holders of these notes and set a redemption date of March 4, 2017. With the new credit facility and bond redemption, we expect to incur aone-time charge of approximately $13 million in the 2017 first quarter of which $9 million relates to a prepayment penalty. See Note 13 to Item 8 of this Annual Report on Form10-K for further discussion of the subsequent event activities.

2015 Cash Flow Activity

We generated cash of $207.0 million from operating activities during 2015, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cashon-hand to fund our dividends of $183.0 million and certain investing activities including the additional funding of our development activities.

In regards to other financing activities in which we used such net proceeds to ultimately fund our approximate $1.8 billion of acquisitions in 2015 and the remainder of our development activities, we did the following:

a)On August 19, 2015, we completed a public offering of €500 million aggregate principal amount of 4.00% senior unsecured notes. In addition, on September 30, 2015, we entered into an amendment to our amended and restated revolving credit and term loan agreement, dated as of June 19, 2014. The amendment, among other things, increased our revolver availability to $1.3 billion and increased borrowings under our term loan by $125 million.

Index to Financial Statements
b)On August 11, 2015, we completed an underwritten public offering of 28.75 million shares of our common stock, resulting in net proceeds of approximately $337 million, after deducting estimated offering expenses.

c)On January 14, 2015, we completed an underwritten public offering of 34.5 million shares of our common stock, resulting in net proceeds of approximately $480 million, after deducting estimated offering expenses.

2014 Cash Flow Activity

We generated cash of $150.4 million from operating activities during 2014, primarily consisting of rent and interest from mortgage and other loans, which with cashon-hand, was principally used to fund our dividends of $144.4 million and certain of our investing activities including the additional funding of our development properties.

In regards to other financing activities in which we used such net proceeds to ultimately fund our $767.7 million of acquisitions in 2014 and to fund other investment activities, we did the following:

a)On March 11, 2014, we completed an underwritten public offering of 7.7 million shares of our common stock, resulting in net proceeds of approximately $100 million, after deducting estimated offering expenses. We also granted the underwriters a30-day option to purchase up to an additional 1.2 million shares of common stock. The option, which was exercised in full, closed on April 8, 2014 and resulted in additional net proceeds of approximately $16 million.

b)On April 17, 2014, we completed a $300 million senior unsecured notes offering.

c)On October 17, 2014, we entered into an amendment to our revolving credit and term loan agreement to increase the aggregate committed size of the facility to $1.15 billion with an additional $400 million accordion available increasing the total aggregate capacity to $1.55 billion. The amendment also increased the alternative currency sublimit under the facility to €500 million and amended certain covenants in order to permit us to consummate and finance the MEDIAN transaction.

d)We established anat-the-market equity offering program in January 2014, which gave us the ability to sell up to $250 million in shares. In 2014, we sold 1.7 million shares resulting in net proceeds of $22.6 million.

Debt Restrictions and CovenantsREIT Requirements

Our debt facilities impose certain restrictions on us, including, but not limited to, restrictions on our ability to: incur debt; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreement governing our Credit Facility limits the amount of dividends we can pay to 95% of normalized adjusted funds from operations,NAFFO, as defined in the agreements, on a rolling four quarter basis. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of funds from operations, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, unsecured leverage ratio, consolidated adjusted net worth, and unsecured interest coverage ratio. This facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the facility, the entire outstanding balance may become immediately due and payable. At December 31, 2016,2018, we were in compliance with all such financial and operating covenants.

46

Index to Financial Statements

In order for us to continue to qualify as a REIT we are required to distribute annual dividends equal to a minimum of 90% of our REIT taxable income, computed without regard to the dividends paid deduction and our net capital gains. See section titled “Distribution Policy” within this Item 7 of this Annual Report onForm 10-K for further information on our dividend policy along with the historical dividends paid on a per share basis.

Short-term Liquidity Requirements:

As of February 24, 2017,22, 2019, we have less than $0.4 million inno debt principal payments due in 20172019 — see debt maturity schedule below. At February 24, 2017,22, 2019, our availability under our revolving credit facility plus cashon-hand (after adjusting for the redemption of the €200 million 5.750% Senior Unsecured Notes due 2020) approximated $1.2$2 billion. We believe this liquidity andalong with our current monthly cash receipts from rent and loan interest, quarterly distributions from our joint venture arrangements and availability under our at-the-market equity program is sufficient to fund our operations, debt and interest obligations, our purchase obligations as disclosed in the “Contractual Obligations” schedule earlier along with our recent commitment to acquire 11 properties in Australia for approximately $860 million, and dividends in order to comply with REIT requirements for the next twelve months.

Long-term Liquidity Requirements:

As of February 24, 2017, after adjusting for the new credit facility and notes redemption discussed above,22, 2019, we have less than $15 million inno debt and principal paymentpayments due between now and January 2020.2021 when our revolving credit facility, with a current outstanding amount of $28.1 million, comes due (which can be extended by one year). With our liquidity as of February 24, 201722, 2019 of approximately $1.2$2 billion, along with our current monthly cash receipts from rent and loan interest, quarterly distributions from our joint venture arrangements and availability under our at-the-market equity program, we believe we have the liquidity available for us to fund our operations, debt and interest obligations, dividends in order to comply with REIT requirements, and our purchase obligations included in the “Contractual Obligations” schedule foralong with our recent commitment to acquire the foreseeable future.Australian portfolio.

However, in order to fund our investment strategies andadditional investments and/or to fund debt maturities coming due in later years, we believe the following sources of capital are generally available in the market and we may need to access one or a combination of them:

the following sources of capital:

amending or entering into new bank term loans,

issuancesale of new USD or EUR denominated debt securities, including senior unsecured notes,equity securities;

placing new secured loans on real estate located inoutside the U.S. and/;

amending or Europe,

entering into joint venture arrangements,new bank term loans;

issuing of new USD or other currency denominated debt securities, including senior unsecured notes; and/or

proceeds from strategic property sales, and/orsales.

sale of equity securities.

However, there is no assurance that conditions will be favorable for such possible transactions or that our plans will be successful.

Principal payments due on our debt (which is adjusted for the closing of the February 1, 2017 credit facility and the redemption of the €200 million 5.750% Senior Unsecured Notes due 2020 and exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in($ amounts in thousands):

 

2017

  $320 

2018

   12,781 

2019

   —   

 

$

 

2020

   210,340 

 

 

 

2021

   340,000 

 

 

28,059

 

2022

 

 

773,350

 

2023

 

 

 

Thereafter

   2,375,850 

 

 

3,273,350

 

  

 

 

Total

  $2,939,291 

 

$

4,074,759

 

  

 

 

Index to Financial Statements

Results of Operations

Our operating results may vary significantly fromyear-to-year due to a variety of reasons including acquisitions made during the year, incremental revenues and expenses from acquisitions made in the prior year, revenues and expenses from completed development properties, property disposals, annual escalation provisions, foreign currency exchange rate changes, new or amended debt agreements, issuances of shares through an equity offering, impact from accounting changes, etc. Thus, our operating results for the current year are not necessarily indicative of the results that may be expected in future years.

47


Year Ended December 31, 20162018 Compared to the Year Ended December 31, 20152017

Net income for the year ended December 31, 2016,2018, was $225.0 million$1.02 billion compared to net income of $139.6$289.8 million for the year ended December 31, 2015.2017. This increase is primarily due to additional revenue generated from our new investments and from completed development projects, $61.2the approximate $720 million of gains on the sales of real estate recognized in 2018 from the disposal of five properties in the U.S. and other disposals, and a $15 million reductionthe joint venture transaction with Primotop described in acquisition expenses, partially offset by higher debt refinancing costs and interest expense in 2016.Note 3 to Item 1 of this Annual Report on Form 10-K. FFO, after adjusting for certain items (as more fully described in Reconciliationthe section titled “Non-GAAP Financial Measures” in “Management’s Discussion and Analysis ofNon-GAAP Financial Measures)Condition and Results of Operations” in Item 7 of this Annual Report on Form 10-K), was $334.8$501.0 million, or $1.28$1.37 per diluted share for 20162018 as compared to $274.8$474.9 million, or $1.26$1.35 per diluted share for 2015, a 2% increase on a per share basis.2017. This 5.5% increase in FFO per sharedollars is primarily due to additionalthe increase in revenue from new investments, partially offset by the loss of income from properties disposed of in 2016, higher interest costsacquisitions and an increase in the number of shares outstandingcompleted development projects during 2016 to fund such new investments.2018 and 2017.

A comparison of revenues for the years ended December 31, 20162018 and 20152017 is as follows (dollar amounts in thousands):

 

  2016     2015     Change 
  (Dollar amounts in thousands) 

 

2018

 

 

 

 

 

 

2017

 

 

 

 

 

 

Change

 

Rent billed

  $327,269    60.5 $247,604    56.0 $79,665 

 

$

473,343

 

 

 

60.3

%

 

$

435,782

 

 

 

61.8

%

 

$

37,561

 

Straight-line rent

   41,067    7.6 23,375    5.3 17,692 

 

 

74,741

 

 

 

9.5

%

 

 

65,468

 

 

 

9.3

%

 

 

9,273

 

Income from direct financing leases

   64,307    11.9 58,715    13.3 5,592 

 

 

73,983

 

 

 

9.5

%

 

 

74,495

 

 

 

10.6

%

 

 

(512

)

Interest and fee income

   108,494    20.0 112,184    25.4 (3,690

 

 

162,455

 

 

 

20.7

%

 

 

129,000

 

 

 

18.3

%

 

 

33,455

 

  

 

   

 

  

 

   

 

  

 

 

Total revenues

  $541,137    100.0 $441,878    100.0 $99,259 

 

$

784,522

 

 

 

100.0

%

 

$

704,745

 

 

 

100.0

%

 

$

79,777

 

  

 

   

 

  

 

   

 

  

 

 

Our total revenuerevenues for 2016 is2018 are up $99.3$79.8 million or 22.5%11.3% over the prior year. This increase is made up of the following:

Operating lease revenue (including rent billed and straight-line rent) — up $97.4$46.8 million over the prior year of which $0.2$60 million is incremental revenue from acquisitions primarily due to the Steward and MEDIAN acquisitions in 2017 and 2018, $24.6 million is from ourrent recorded on the new Steward leases that converted from mortgage loans in 2018, $11 million is incremental revenue from capital additions, $3.7 million is incremental revenue from development properties that were placed in service, and approximately $5.8 million is from favorable foreign currency fluctuations. These increases are partially offset by approximately $31.4 million of lower revenue as 71 revenue producing properties were contributed to the joint venture transaction with Primotop on August 31, 2018, along with approximately $16 million of lower revenue and approximately $11.2 million of higher straight-line rent write-offs in 2018 associated with other disposals and loss of revenue from certain properties vacated during 2018 - see Note 3 to Item 8 of this Annual Report on Form 10-K for additional information.

Income from direct financing leases — down $0.5 million over the prior year, of which $1.2 million is from net revenue earned in 2017 but not in 2018 on the Boise lease that converted from DFL to operating lease accounting classification upon execution of the new lease with the Vibra/Ernest joint venture and by the write-off of $1.5 million of DFL unbilled interest associated with the same transaction. The impact was partially offset by $1.9 million of incremental revenue from acquisitions made in 2017 and $0.3 million is from annual escalationescalations of rental rates in accordance with provisions in our leases, $69.6leases.

Interest and fee income — up $33.5 million over the prior year of which $51.1 million is from incremental revenue from new loans (primarily the $700 million of Steward mortgage loans in 2017) and $0.7 million is from our annual escalations in interest rates in accordance with loan provisions. These increases are partially offset by $15.7 million of lower interest revenue related to certain Steward loans that were converted to fee simple assets in 2018 and $4.1 million of lower revenue related to the Ernest acquisition loan repayment discussed in Note 3 to Item 8 of this Annual Report on Form 10-K.

Interest expense for 2018 and 2017 totaled $223.3 million and $177.0 million, respectively. Although our debt balance at December 31, 2018 is lower than the prior year with the paydown of our revolver from the proceeds of asset disposals, our average debt balance for 2018 was higher than 2017 due to the issuance of the $1.4 billion bonds in September 2017. Our weighted average interest rate was 4.6% for 2018, consistent with 4.6% in 2017. See Note 4 in Item 8 to this Annual Report on Form 10-K for further information on our debt activities.

Real estate depreciation and amortization during 2018 was $133.1 million compared to $125.1 million in 2017 primarily due to the incremental depreciation/amortization from the facilities acquired (particularly the Steward and MEDIAN facilities acquired in 2017) and the development properties completed in 2017 and 2018.

Property expenses for 2018 increased $3.4 million compared to 2017 primarily due to the growth of our business internationally along with expense from certain properties vacated during 2018. See Note 3 to Item 8 of this Annual Report on Form 10-K for more details, including the successful re-tenanting of many of these facilities.

48


General and administrative expenses in 2018 totaled $80.1 million, which is 10.2% of revenues, up from 8.3% of revenues in the prior year. General and administrative expenses as a percentage of revenues was higher during 2018 due to our adoption of ASU 2017-01, as more fully explained in Note 2 to Item 8 of this Annual Report on Form 10-K and the impact on revenues from the joint venture transaction with Primotop on August 31, 2018. Excluding the $6.2 million of higher expense due to the accounting change and adjusting for the revenues included in joint ventures, general and administrative expenses represented 9.0% of adjusted revenues in 2018. On a dollar basis (exclusive of the accounting change impact), general and administrative expenses were up $15.3 million from the prior year due to travel, compensation expenses, and costs associated with expanding our team at our European office, which are all up as a result of the growth and expansion of our company.

Acquisition costs decreased from $29.6 million in 2017 to $0.9 million in 2018. The acquisition costs in 2017 primarily related to real estate transfer taxes on the MEDIAN acquisition. Beginning in 2018, all third party transaction costs directly related to acquisitions are now capitalized due to the adoption of ASU 2017-01.  However, we did incur $0.9 million in the current period related to the settlement of contingencies involving acquisitions that occurred prior to the adoption of ASU 2017-01.

During the year ended December 31, 2018, we sold one acute care property (operated by Steward), three long-term acute care properties (operated by Vibra), 71 inpatient rehabilitation hospitals (operated by MEDIAN) by way of a joint venture arrangement, and one general acute care hospital located in Texas (operated by North Cypress), resulting in a total net gain of $719.4 million. During the year ended December 31, 2017, we sold one LifePoint property resulting in a $7.4 million gain.

In 2018, we had a $48 million adjustment to lower the carrying value of the real estate to fair value on seven of our transitioning Adeptus Health facilities and four of our Alecto facilities – see Note 3 to Item 8 of this Annual Report on Form 10-K for further details. We did not have any impairment charges in 2017.

During 2017, we incurred $32.6 million of debt refinancing charges related to the replacement of our credit facility, the payoff of our €200 million term loan, the payoff of our €200 million euro bonds, the prepayment of our $350 million senior unsecured notes, and structuring and underwriting fees associated with the termination of the short-term loan commitment we made in anticipation of the Steward transaction in 2017. We did not have any similar charges during the year ended December 31, 2018.

Other income of $10.1 million in 2018, which was basically flat with 2017, is primarily made up of our earnings from equity interests in real estate joint ventures and in the operations of our tenants along with any foreign currency transaction gains/losses.  Between the two years, the negative impact from the Ernest disposal transaction on other income was almost entirely offset by the income generated from the joint venture with Primotop.

We recognize income tax expense related to our taxable REIT subsidiary (“TRS”) and the local, state and foreign jurisdictions in which we operate. Income tax expense for 2018 was $0.9 million as compared to $2.7 million for 2017. The decrease in tax expense is primarily due to the release of $4.4 million in valuation allowances previously recorded on our federal and state deferred tax assets at our TRS. The tax benefit from the valuation allowance release was partially offset by increases in income tax expense on earnings from our foreign investments. For more detailed information, see Note 5 to Item 8 of this Annual Report on Form 10-K.

Year Ended December 31, 2017 Compared to the Year Ended December 31, 2016

Net income for the year ended December 31, 2017, was $289.8 million compared to net income of $225.0 million for the year ended December 31, 2016. This increase is primarily due to additional revenue generated from the MEDIAN, Steward, and LifePoint investments made in late 2016 and throughout 2017 and incremental revenue from completed development projects, partially offset by higher depreciation expense from such new investments, approximately $54 million in higher gains on sale of properties during 2016, and higher interest expense in 2017 primarily due to the $1.4 billion 5.000% Senior Unsecured Notes due 2027. FFO, after adjusting for certain items (as more fully described in the section titled “Non-GAAP Financial Measures” in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Item 7 of this Annual Report on Form 10-K), was $474.9 million, or $1.35 per diluted share for 2017 as compared to $334.8 million, or $1.28 per diluted share for 2016. This 41.8% increase in FFO dollars is primarily due to the increase in revenue from acquisitions and completed development projects during 2017, while FFO per share is only a 5% increase in 2017 compared to prior year due to more shares outstanding from the September 2016 and May 2017 equity offerings.

A comparison of revenues for the years ended December 31, 2017 and 2016 is as follows (dollar amounts in thousands):

 

 

2017

 

 

 

 

 

 

2016

 

 

 

 

 

 

Change

 

Rent billed

 

$

435,782

 

 

 

61.8

%

 

$

327,269

 

 

 

60.5

%

 

$

108,513

 

Straight-line rent

 

 

65,468

 

 

 

9.3

%

 

 

41,067

 

 

 

7.6

%

 

$

24,401

 

Income from direct financing leases

 

 

74,495

 

 

 

10.6

%

 

 

64,307

 

 

 

11.9

%

 

$

10,188

 

Interest and fee income

 

 

129,000

 

 

 

18.3

%

 

 

108,494

 

 

 

20.0

%

 

$

20,506

 

Total revenues

 

$

704,745

 

 

 

100.0

%

 

$

541,137

 

 

 

100.0

%

 

$

163,608

 


Our total revenue for 2017 is up $163.6 million or 30.2% over the prior year. This increase is made up of the following:

Operating lease revenue (including rent billed and straight-line rent) — up $132.9 million over the prior year of which $1.0 million is from annual escalations of rental rates in accordance with provisions in our leases, $120.3 million is incremental revenue from acquisitions made inafter December 31, 2016, (including $15.0 million related to Steward), $20.2$16.7 million is incremental revenue from development properties that were completed and put into service in 2016 and 2015, and $2.12017, $3.1 million is incremental revenue from capital additions at ourmade to existing facilities during 2016. The increase is also attributablein 2017 and 2016, $5.6 million relates to $15.0 million earned on our Capella properties after lease reclassificationthe conversion of certain LifePoint facilities in April 2016 from DFL todirect financing leases into operating lease accounting as part of the April 29, 2016 amendments.leases, and favorable foreign currency fluctuations. These increases are partially offset by $10.3$9.8 million of lower revenues fromrevenue related to dispositions and $4.8 million of higher straight-line rent write-offs in 2017 related to Adeptus Health and the 2016 dispositions.sale of our Muskogee property.

Income from direct financing leases — up $5.6$10.2 million over the prior year of which $0.8 million is from annual escalationescalations of rental rates in accordance with provisions in our leases, and $6.7$4.8 million is from incremental revenue from acquisitions made after December 31, 2016, and $9.8 million relates to the conversion of certain Prime facilities in 2016. This increase is also attributableOctober 2016 from mortgage loans to $0.3 million of incremental revenue on the Capella properties prior to lease reclassification. The increase wasdirect financing leases. These increases were partially offset by $5.2 million of net revenue earned in 2016 but not in 2017 from those LifePoint facilities that converted from direct financing leases into operating leases in the $2.6first half of 2016.

Interest from loans — up $20.5 millionwrite-off over the prior year of DFLnon-cash incomewhich $1.5 million is from annual escalations in connectioninterest rates in accordance with loan provisions and $47.6 million is incremental revenue from new loans (primarily Steward mortgage loans made in October 2016 and September 2017). These increases were partially offset by $21.8 million in less interest revenue earned in 2017 from loans that were repaid in 2016 (primarily from the Capella lease reclassification (seeDisposal Transaction as noted in Note 3 toof Item 8 of this Annual Report on Form10-K 10-K) and $7.0 million of lower interest revenue related to the conversion of certain Prime facilities, valued at approximately $100 million, from mortgage loans to direct financing leases in October 2016.

Interest expense for details).

Interest2017 and fee income —2016 totaled $177.0 million and $159.6 million, respectively. Our average debt balance for 2017 was higher than 2016 due to the continued growth of the company; however, its impact on interest expense was partially offset by lower interest rates. Our weighted average interest rate was 4.6% for 2017, down $3.7 million over the prior year, which was attributable to $22.9 millionfrom 4.9% in interest earned in 2015 from loans that were converted to real estate on or before December 31, 2016,2016.

Index to Financial Statements

in connection with the MEDIAN Transaction and $1.1 million related to loan pay downs in 2016. The decrease was partially offset by $18.0 million of additional interest from other loans made during 2016, including the Prime mortgage loans, $2.1 million of interest on the Capella mortgage and acquisition loans that were outstanding longer in 2016 than in 2015, and $0.4 million in annual escalation provisions of our loans.

Real estate depreciation and amortization during 20162017 was $94.4$125.1 million compared to $69.9$94.4 million in 20152016 primarily due to the incremental depreciation/amortization from the facilities acquired in 20162017 and the development properties completed in 20152016 and 2016. In the 2016 second quarter, we accelerated the amortization of the lease intangible asset related to our Corinth facility resulting in $1.1 million of additional expense. This was offset by a similar $1.1 million of expense in 2015 to accelerate the amortization of lease intangible assets associated with Twelve Oaks, Luling, and Healthtrax properties.2017.

Property expenses for 2016 decreased $1.12017 increased $3 million compared to 2015. This decrease is2016 primarily due to the growth of our business internationally. In addition, property expenses for 2016 were lower than normal due to the reimbursement of $0.8 million from the tenant of our Twelve Oaks facility for property expenses incurred in previous periods.

Acquisition expenses decreased from $61.3 million in 2015 to $46.3 million in 2016 primarily as a result of $31.7 million in lower real estate transfer taxes associated with our international acquisitions. This decrease was partially offset by $24.8 million of acquisition expenses incurred in 2016 associated with contingent consideration adjustments involving the seller’s capital gains taxes on our MEDIAN transaction in 2015.

General and administrative expenses in 20162017 totaled $48.9$58.6 million, which is 9.0%8.3% of revenues, down from 9.9%9.0% of revenues in the prior year. The decline in general and administrative expenses as a percentage of revenues is primarily due to our business model as we can generally increase our revenues significantly without increasing our headcounthead count and related expense at the same rate. On a dollar basis, general and administrative expenses were up $5.3$9.7 million from the prior year due primarily to higherincreases in travel, international administrative expenses,administration, costs associated with opening/maintaining a European office, compensation related to increased headcount and public company board expenses.

Acquisition costs decreased from $46.3 million in 2016 to a lesser extent personnel and travel costs, which are up$29.6 million in 2017 primarily as a result of the growth and expansion$24.8 million of our company.

Interest expense foracquisition expenses incurred in 2016 and 2015 totaled $159.6 million and $120.9 million, respectively. This increase is related to higher average debt balances in the current year associated with our 4.000% Senior Unsecured Notes due 2022 entered into in August 2015 and our 6.375% Senior Unsecured Notes due 2024 entered into in February 2016 and our expanded credit facility. In addition, we incurred $1.7 million in additional interest expense in 2016 betweencontingent consideration adjustments involving the time we issued the $500 million 5.250% Senior Unsecured Notes due 2026 in July 2016 and when we were able to redeem the $450 million 6.875% Senior Unsecured Notes due 2021 in August 2016. Our weighted average interest rate was 4.9% for 2016, up from 4.3% in 2015 due to more permanent debt financing in 2016 and higher LIBOR rates. See Note 4 to our consolidated financial statements in Item 8 to this Annual Report on Form10-K for further informationseller’s capital gains taxes on our debt activities.MEDIAN transaction in 2015.

During the year ended December 31, 2017, we sold the Muskogee, Oklahoma facility resulting in a net gain on sale of real estate of $7.4 million, while in 2016, we had various dispositions resulting in a net gain on sale of real estate and other asset dispositions of $61.2 million and impairment charges of $7.2 million (see Note 3 to Item 8 of this Annual Report on Form10-K for further details).

Earnings from our equity interests declined from $2.8 million of income in the 2015 to a loss of $1.1 million in 2016. The loss in 2016 includes approximately $5.4 million ofone-time acquisition expenses, representing our share of such expenses incurred by our Italian joint venture to acquire its eight hospital properties. Excluding these acquisition expenses, our earnings from our equity interest would have been $4.3 million, an increase over 2015 due to $3.4 million of income from our Italian joint venture (no such income was recorded in 2015).million.

With the redemption of the $450 million in senior unsecured notes, we incurred $22.5 million in debt refinancing charges ($15.5 million of which was a redemption premium) during 2016. During 2015,2017, we incurred $4.4$32.6 million of debt refinancing charges primarily related to the replacement of our credit facility, the payoff of our €200 million term loan, the payoff of our €200 million euro bonds, the prepayment of our $350 million senior unsecured notes, and structuring and underwriting fees associated with the bridgetermination of the short-term loan entered into ascommitment we made in anticipation of the Steward transaction in 2017.

Other income (expense) primarily included our earnings from equity investments and foreign currency gain/losses. Earnings from our equity interests increased from a back stoploss of $1.1 million in 2016 to income of $10.1 million in 2017. The loss in 2016 included

50


approximately $5.4 million of one-time acquisition expenses, representing our share of such expenses incurred by our Italian joint venture to acquire its eight hospital properties. The remaining difference of $5.8 million was from additional income related to our increased ownership in and improved operating results of the operator of our Hoboken facility, along with additional income from our IMED Group investment in which the underlying facility began operations on financing the original Capella acquisition.March 31, 2017.

Index to Financial Statements

Income tax expense includes U.S. federal and state income taxes on our TRS, entities, as well asnon-U.S. income based taxes and withholding taxes on certain investments located in jurisdictions outside the U.S. The provision for income taxes was an expense of $2.7 million for 2017 compared to a benefit of $6.8 million for 2016 compared to expense of $1.5 million for 2015. As discussed in Note 5 to Item 8 of this Annual Report on Form10-K, the2016. The income tax benefit recognized for 2016 was primarily due to acquisition costs associated with our European investments (approximately $5.1 million) and the release of valuation allowances on foreign deferred tax assets of approximately $4 million. The reversal

Non-GAAP Financial Measures

We consider non-GAAP financial measures to be useful supplemental measures of our operating performance. A non-GAAP financial measure is a measure of financial performance, financial position or cash flows that excludes or includes amounts that are not so excluded from or included in the valuation allowances onmost directly comparable measure calculated and presented in accordance with GAAP. Described below are the non-GAAP financial measures used by management to evaluate our operating performance and that we consider most useful to investors, together with reconciliations of these foreign deferred tax assets is expected to result in higher income tax expense related to our European investments in future periods. We continue to reflect a valuation allowance against our U.S. and certain foreign net deferred tax assets at December 31, 2016.

Year Ended December 31, 2015 Comparedmeasures to the Year Ended December 31, 2014most directly comparable GAAP measures.

Net income for the year ended December 31, 2015, was $139.6 million compared to net income of $50.5 million for the year ended December 31, 2014. This increase is primarily due to additional income generated from our 2015 acquisitionsFunds From Operations and from completed development projects. In addition, we incurred $50.1 million of impairment charges in 2014 — see Note 3 to Item 8 of this Annual Report on Form10-K for further details. FFO, after adjusting for certain items (as more fully described in “Reconciliation ofNon-GAAP Financial Measures”), was $274.8 million, or $1.26 per diluted share for 2015 as compared to $181.7 million, or $1.06 per diluted share for 2014, a 19% increase on a per share basis. This increase in FFO was primarily due to the increase in revenue from acquisitions and the completion of development projects during 2015.

A comparison of revenues for the years ended December 31, 2015 and 2014 is as follows (dollar amounts in thousands):

   2015      2014      Change 
   (Dollar amounts in thousands) 

Rent billed

  $247,604    56.0 $187,018    59.9 $60,586 

Straight-line rent

   23,375    5.3  13,507    4.3  9,868 

Income from direct financing leases

   58,715    13.3  49,155    15.7  9,560 

Interest and fee income

   112,184    25.4  62,852    20.1  49,332 
  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

 

Total revenues

  $441,878    100.0 $312,532    100.0 $129,346 
  

 

 

   

 

 

  

 

 

   

 

 

  

 

 

 

Our total revenue for 2015 is up $129.3 million or 41.4% over the prior year. This increase is made up of the following:

Operating lease revenue (including rent billed and straight-line rent) — up $70.5 million over the prior year of which $0.4 million is from our annual escalation provisions in our leases, $69.6 million is from incremental revenue from acquisitions made in 2015, $16.4 million is incremental revenue from development properties that were completed and put into service in 2015, and $2.0 million is net incremental revenue from properties where we changed operators and began recording straight-line rent on the respective leases. This increase is partially offset by $12.7 million attributable to the decline in the euro and a $3.1 million write-off of straight-line rent related to our Luling and Twelve Oaks properties. In addition, approximately $2.7 million of base rents were recorded in 2014 related to our disposed properties but none was recorded in 2015.

Income from direct financing leases — up $9.6 million over the prior year of which $1.0 million is from annual escalation provisions in our leases and $8.5 million is from incremental revenue from acquisitions made in 2015.

Interest and fee income — up $49.3 million over the prior period of which $1.8 million is from our annual escalation provisions in our loans and $52.6 million is primarily from new loans, partially offset by $0.1 million due to the repayment of loans in 2015 and $5.0 million attributable to the decline in the euro.

Index to Financial Statements

Real estate depreciation and amortization during 2015 was $69.9 million compared to $53.9 million in 2014 primarily due to the incremental depreciation/amortization from the facilities acquired in 2015 and the development properties completed in 2014 and 2015. In addition, we accelerated the related lease intangible of our Twelve Oaks, Luling, and Healthtrax properties resulting in an additional $1.1 million of expense in 2015.

During 2014, we recorded a $3.1 million real estate impairment charge on our Bucks facility and a $47.0 million impairment charge on our Monroe facility — see Note 3 to Item 8 of this Annual Report on Form10-K for further details.

Acquisition expenses increased from $26.4 million in 2014 to $61.3 million in 2015 primarily as a result of the completion of the MEDIAN and Capella acquisitions. Included in the 2015 and 2014 acquisition expenses are $37.0 million and $5.8 million, respectively, of real estate transfer taxes associated with our international properties.

General and administrative expenses in 2015 totaled $43.6 million, which is 9.9% of revenues, down from 11.9% of revenues in the prior year. The decline in general and administrative expenses as a percentage of revenue is primarily due to our business model as we can generally increase our revenue significantly without increasing our headcount and related expense at the same rate. On a dollar basis, general and administrative expenses were up $6.4 million from the prior year due to higher compensation expense, travel and international administrative expenses, which are up as a result of the growth and expansion of our company.

Interest expense for 2015 and 2014 totaled $120.9 million and $98.2 million, respectively. This increase is related to higher average debt balances in the current year associated with our 5.500% Senior Unsecured Notes due 2024 (entered into in April 2014), our 4.000% Senior Unsecured Notes due 2022 and the expansion of our credit facility in 2015. Our weighted average interest rate was 4.3% for 2015, down from 5.4% in 2014, due to the issuance of our 4.000% Senior Unsecured Notes due 2022 and a higher outstanding balance on the revolving credit facility in 2015.

With the expansion of our credit facility in 2015, along with a bridge loan entered into in the 2015 third quarter to fund the Capella transaction, we incurred $4.4 million of unutilized financing fees/debt refinancing costs compared to $1.7 million in 2014.

Gain on sale of real estate increased slightly from 2014 due to the $1.7 million and $1.5 million gains on the Healthrax and Luling property sales in 2015, respectively, compared to the $2.9 million gain on the La Palma property sale in 2014.

Earnings from equity and other interests increased slightly from 2014 due to increased investee earnings, partially offset by lower income from our interest in Bucks as the property was sold in August 2014 — this interest generated about $1 million of income annually.

Other income (expense) was down $5.2 million in 2015 primarily due to $4.9 million of foreign currency transaction gains in 2014.

Income tax expense was $1.5 million for 2015 — up from $0.3 million in 2014, primarily due to the increase in income in certain of our European entities.

Reconciliation ofNon-GAAP Financial MeasuresNormalized Funds From Operations

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.

Index to Financial Statements

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 ornon-core events or activities or accounting changes that, if not noted, would make comparison to prior period results and market expectations potentially 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 financial performance or to cash flow from operating activities (computed in accordance with GAAP) as an indicator of our liquidity.

51

Index to Financial Statements

The following table presents a reconciliation of net income attributable to MPT common stockholders to FFO and normalized FFO for the years ended December 31, 2018, 2017, 2016, 2015, and 2014, ($ amounts in thousands except per share data):

 

   For the Year Ended 
   December 31,
2016
  December 31,
2015
  December 31,
2014
 

FFO information:

    

Net income attributable to MPT common stockholders

  $225,048  $139,598  $50,522 

Participating securities’ share in earnings

   (559  (1,029  (895
  

 

 

  

 

 

  

 

 

 

Net income, less participating securities’ share in earnings

  $224,489  $138,569  $49,627 

Depreciation and amortization

   96,157   69,867   53,938 

Gain on sale of real estate

   (67,168  (3,268  (2,857

Real estate impairment charge

   —     —     5,974 
  

 

 

  

 

 

  

 

 

 

Funds from operations

  $253,478  $205,168  $106,682 

Write-off of straight line rent and other

   3,063   3,928   2,818 

Transaction costs fromnon-real estate dispositions

   5,944   —     —   

Acquisition expenses, net of tax benefit

   46,529   61,342   26,389 

Release of valuation allowance

   (3,956  —     —   

Impairment charges

   7,229   —     44,154 

Unutilized financing fees/ debt refinancing costs

   22,539   4,367   1,698 
  

 

 

  

 

 

  

 

 

 

Normalized funds from operations attributable to MPT common stockholders

  $334,826  $274,805  $181,741 
  

 

 

  

 

 

  

 

 

 

Per diluted share data:

    

Net income, less participating securities’ share in earnings

  $0.86  $0.63  $0.29 

Depreciation and amortization

   0.37   0.32   0.31 

Gain on sale of real estate

   (0.26  (0.01  (0.01

Real estate impairment charge

   —     —     0.04 
  

 

 

  

 

 

  

 

 

 

Funds from operations

  $0.97  $0.94  $0.63 

Write-off of straight line rent and other

   0.01   0.02   0.02 

Transaction costs fromnon-real estate dispositions

   0.02   —     —   

Acquisition expenses, net of tax benefit

   0.18   0.28   0.15 

Release of valuation allowance

   (0.02  —     —   

Impairment charges

   0.03   —     0.26 

Unutilized financing fees/ debt refinancing costs

   0.09   0.02   —   
  

 

 

  

 

 

  

 

 

 

Normalized funds from operations attributable to MPT common stockholders

  $1.28  $1.26  $1.06 
  

 

 

  

 

 

  

 

 

 

 

 

For the Year Ended December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

 

2015

 

 

2014

 

 

 

(In thousands except per unit data)

 

FFO Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to MPT common stockholders

 

$

1,016,685

 

 

$

289,793

 

 

$

225,048

 

 

$

139,598

 

 

$

50,522

 

Participating securities’ share in earnings

 

 

(3,685

)

 

 

(1,409

)

 

 

(559

)

 

 

(1,029

)

 

 

(895

)

Net income, less participating securities’ share in earnings

 

$

1,013,000

 

 

$

288,384

 

 

$

224,489

 

 

$

138,569

 

 

$

49,627

 

Depreciation and amortization

 

 

143,720

 

 

 

127,559

 

 

 

96,157

 

 

 

69,867

 

 

 

53,938

 

Gain on sale of real estate

 

 

(719,392

)

 

 

(7,431

)

 

 

(67,168

)

 

 

(3,268

)

 

 

(2,857

)

Real estate impairment charges

 

 

48,007

 

 

 

 

 

 

 

 

 

 

 

 

5,974

 

Funds from operations

 

$

485,335

 

 

$

408,512

 

 

$

253,478

 

 

$

205,168

 

 

$

106,682

 

Write-off of straight line rent and other

 

 

18,002

 

 

 

5,340

 

 

 

3,063

 

 

 

3,928

 

 

 

2,818

 

Debt refinancing costs

 

 

 

 

 

32,574

 

 

 

22,539

 

 

 

4,367

 

 

 

1,698

 

Release of income tax valuation allowance

 

 

(4,405

)

 

 

 

 

 

(3,956

)

 

 

 

 

 

 

Acquisition and other transaction costs, net of tax benefit

 

 

2,072

 

 

 

28,453

 

 

 

52,473

 

 

 

61,342

 

 

 

26,389

 

Non-real estate impairment charges

 

 

 

 

 

 

 

 

7,229

 

 

 

 

 

 

44,154

 

Normalized funds from operations

 

$

501,004

 

 

$

474,879

 

 

$

334,826

 

 

$

274,805

 

 

$

181,741

 

Per diluted share data

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income, less participating securities’ share in earnings

 

$

2.76

 

 

$

0.82

 

 

$

0.86

 

 

$

0.63

 

 

$

0.29

 

Depreciation and amortization

 

 

0.39

 

 

 

0.37

 

 

 

0.37

 

 

 

0.32

 

 

 

0.31

 

Gain on sale of real estate

 

 

(1.96

)

 

 

(0.02

)

 

 

(0.26

)

 

 

(0.01

)

 

 

(0.01

)

Real estate impairment charges

 

 

0.13

 

 

 

 

 

 

 

 

 

 

 

 

0.04

 

Funds from operations

 

$

1.32

 

 

$

1.17

 

 

$

0.97

 

 

$

0.94

 

 

$

0.63

 

Write-off of straight line rent and other

 

 

0.05

 

 

 

0.01

 

 

 

0.01

 

 

 

0.02

 

 

 

0.02

 

Debt refinancing costs

 

 

 

 

 

0.09

 

 

 

0.09

 

 

 

0.02

 

 

 

 

Release of income tax valuation allowance

 

 

(0.01

)

 

 

 

 

 

(0.02

)

 

 

 

 

 

 

Acquisition and other transaction costs, net of tax benefit

 

 

0.01

 

 

 

0.08

 

 

 

0.20

 

 

 

0.28

 

 

 

0.15

 

Non-real estate impairment charges

 

 

 

 

 

 

 

 

0.03

 

 

 

 

 

 

0.26

 

Normalized funds from operations

 

$

1.37

 

 

$

1.35

 

 

$

1.28

 

 

$

1.26

 

 

$

1.06

 

IndexTotal Gross Assets (and Total Pro Forma Gross Assets)

Total gross assets is total assets before accumulated depreciation/amortization and assumes all real estate binding commitments on new investments at December 31, 2018 and unfunded amounts on development deals and commenced capital improvement projects are fully funded, and assumes cash on hand is used in these transactions. Total pro forma gross assets is total gross assets plus our Australian commitment announced on January 31, 2019. We believe total gross assets and total pro forma gross assets is useful to Financial Statements

investors as it provides a more current view of our portfolio and allows for a better understanding of our concentration levels as our binding commitments close and our other commitments are fully funded. The following table presents a reconciliation of total assets to total gross assets and total pro forma gross assets (in thousands):


 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

Total Assets

 

$

8,843,643

 

 

$

9,020,288

 

Add:

 

 

 

 

 

 

 

 

Binding real estate commitments on new

   investments(1)

 

 

6,596

 

 

 

17,500

 

Unfunded amounts on development deals and

   commenced capital improvement projects(2)

 

 

229,979

 

 

 

154,184

 

Accumulated depreciation and amortization

 

 

464,984

 

 

 

455,712

 

Incremental gross assets of our joint ventures(3)

 

 

375,544

 

 

 

 

Less:

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

 

(236,575

)

 

 

(171,472

)

Total Gross Assets

 

$

9,684,171

 

 

$

9,476,212

 

 

 

 

 

 

 

 

 

 

Australian commitment, net of cash(4)

 

 

374,276

 

 

 

 

Total Pro Forma Gross Assets

 

$

10,058,447

 

 

$

9,476,212

 

(1)

The 2018 column reflects our commitment to acquire a facility in Germany post December 31, 2018. The 2017 column reflects a commitment to acquire a LifePoint facility post December 31, 2017.

(2)

Includes $94.1 million and $137.4 million of unfunded amounts on ongoing development projects and $135.9 million and $16.8 million of unfunded amounts on capital improvement projects and development projects that have commenced rent, as of December 31, 2018 and 2017, respectively.

(3)

Adjustment needed to reflect our share of our joint venture's gross assets.

(4)

The 2018 column reflects our commitment made on January 31, 2019 to acquire 11 facilities in Australia for approximately $860 million less cash available at December 31, 2018.  

Adjusted Revenues

Adjusted revenues are total revenues adjusted for our pro rata portion of similar revenues in our 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. The following table presents a reconciliation of total revenues to total adjusted revenues (in thousands):

 

 

For the Year Ended

December 31, 2018

 

Total revenues

 

$

784,522

 

Revenue from real estate properties owned through joint venture arrangements

 

 

32,343

 

Total adjusted revenues

 

$

816,865

 

Distribution Policy

We have elected to be taxed as a REIT commencing with our taxable year that began on April 6, 2004 and ended on December 31, 2004. To qualify as a REIT, we must meet a number of organizational and operational requirements, including a requirement that we distribute at least 90% of our REIT taxable income, excluding net capital gain, to our stockholders. It is our current intention to comply with these requirements and maintain such status going forward.

53


The table below is a summary of our distributions declared for the three year period ended December 31, 2016:2018:

 

Declaration Date

  

Record Date

  

Date of Distribution

  Distribution per Share 

November 10, 2016

  

December 8, 2016

  

January 12, 2017

  $0.23 

August 18, 2016

  

September 15, 2016

  

October 13, 2016

  $0.23 

May 19, 2016

  

June 16, 2016

  

July 14, 2016

  $0.23 

February 19, 2016

  

March 17, 2016

  

April 14, 2016

  $0.22 

November 12, 2015

  

December 10, 2015

  

January 14, 2016

  $0.22 

August 20, 2015

  

September 17, 2015

  

October 15, 2015

  $0.22 

May 14, 2015

  

June 11, 2015

  

July 9, 2015

  $0.22 

February 23, 2015

  

March 12, 2015

  

April 9, 2015

  $0.22 

November 13, 2014

  

December 4, 2014

  

January 8, 2015

  $0.21 

August 21, 2014

  

September 18, 2014

  

October 15, 2014

  $0.21 

May 15, 2014

  

June 12, 2014

  

July 10, 2014

  $0.21 

February 21, 2014

  

March 14, 2014

  

April 11, 2014

  $0.21 

Declaration Date

 

Record Date

 

Date of Distribution

 

Distribution per Share

 

November 15, 2018

 

December 13, 2018

 

January 10, 2019

 

$

0.25

 

August 16, 2018

 

September 13, 2018

 

October 11, 2018

 

$

0.25

 

May 24, 2018

 

June 14, 2018

 

July 12, 2018

 

$

0.25

 

February 15, 2018

 

March 15, 2018

 

April 12, 2018

 

$

0.25

 

November 9, 2017

 

December 7, 2017

 

January 11, 2018

 

$

0.24

 

August 17, 2017

 

September 14, 2017

 

October 12, 2017

 

$

0.24

 

May 25, 2017

 

June 15, 2017

 

July 14, 2017

 

$

0.24

 

February 16, 2017

 

March 16, 2017

 

April 13, 2017

 

$

0.24

 

November 10, 2016

 

December 8, 2016

 

January 12, 2017

 

$

0.23

 

August 18, 2016

 

September 15, 2016

 

October 13, 2016

 

$

0.23

 

May 19, 2016

 

June 16, 2016

 

July 14, 2016

 

$

0.23

 

February 19, 2016

 

March 17, 2016

 

April 14, 2016

 

$

0.22

 

On February 16, 2017,14, 2019, we announced that our Board of Directors declared a regular quarterly cash dividend of $0.24$0.25 per share of common stock to be paid on April 13, 2017,11, 2019, to stockholders of record on March 16, 2017.14, 2019.

We intend to pay to our stockholders, within the time periods prescribed by the Code, all or substantially all of our annual REIT taxable income, including taxable gains from the sale of real estate and recognized gains on the sale of securities. It is our policy to make sufficient cash distributions to stockholders in order for us to maintain our status as a REIT under the Code and to avoid corporate income and excise taxes on undistributed income. However, our Credit Facility limits the amounts of dividends we can pay — see Note 4 to our consolidated financial statements in Item 8 to this Annual Report onForm 10-K for further information.

Index to Financial Statements

ITEM 7A.

Quantitative and Qualitative Disclosures about Market Risk

Market risk includes risks that arise from changes in interest rates, foreign currency exchange rates, commodity prices, equity prices and other market changes that affect market sensitive instruments. We seek to mitigate the effects of fluctuations in interest rates by matching the terms of new investments with new long-term fixed rate borrowings to the extent possible. We may or may not elect to use financial derivative instruments to hedge interest rate or foreign currency exposure. For interest rate hedging, these decisions are principally based on our policy to match our variable rate investments with comparable borrowings, but are also based on the general trend in interest rates at the applicable dates and our perception of the future volatility of interest rates. For foreign currency, these decisions are principally based on how our investments are financed, the long-term nature of our investments, the need to repatriate earnings back to the U.S. and the general trend in foreign currency exchange rates.

In addition, the value of our facilities will be subject to fluctuations based on changes in local and regional economic conditions and changes in the ability of our tenants to generate profits, all of which may affect our ability to refinance our debt if necessary. The changes in the value of our facilities would be impacted also by changes in “cap” rates, which is measured by the current base rent divided by the current market value of a facility.

Our primary exposure to market risks relates to fluctuations in interest rates and foreign currency. The following analyses present the sensitivity of the market value, earnings and cash flows of our significant financial instruments to hypothetical changes in interest rates and exchange rates as if these changes had occurred. The hypothetical changes chosen for these analyses reflect our view of changes that are reasonably possible over aone-year period. These forward looking disclosures are selective in nature and only address the potential impact from these hypothetical changes. They do not include other potential effects which could impact our business as a result of changes in market conditions. In addition, they do not include measures we may take to minimize our exposure such as entering into future interest rate swaps to hedge against interest rate increases on our variable rate debt.

Interest Rate Sensitivity

For fixed rate debt, interest rate changes affect the fair market value but do not impact net income to common stockholders or cash flows. Conversely, for floating rate debt, interest rate changes generally do not affect the fair market value but do impact net income to common stockholders and cash flows, assuming other factors are held constant. At December 31, 2016,2018, our outstanding debt totaled $2.9$4.0 billion, which consisted of fixed-rate debt of $2.4$3.8 billion and variable rate debt of $0.5$0.2 billion. If market interest rates increase byone-percent, 1%, the fair value of our debt at December 31, 20162018 would decrease by approximately $5.8$10.3 million. Changes in the fair value of our fixed rate debt will not have any impact on us unless we decided to repurchase the debt in the open markets.

If market rates of interest on our variable rate debt increase by 1%, the increase in annual interest expense on our variable rate debt would decrease future earnings and cash flows by $0.1 million per year. If market rates of interest on our variable rate debt

54


decrease by 1%, the decrease in interest expense on our variable rate debt would increase future earnings and cash flows by $0.1 million per year. This assumes that the average amount outstanding under our variable rate debt for a year is $0.5$0.2 billion, the balance of our revolver and term loan at December 31, 2016.2018.

Foreign Currency Sensitivity

With our investments in Germany, the United Kingdom, Spain, and Italy, we are subject to fluctuations in the euro and British pound to U.S. dollar currency exchange rates. Increases or decreases in the value of the euro to U.S. dollar and the British pound to U.S. dollar exchange rates may impact our financial condition and/or our results of operations. Based solely on our 2018 operating results for 2016 and excluding the gain on an annualized basis,sale of real estate as part of the joint venture transaction with Primotop, if the euro exchange rate were to change by 5%, our net income and FFO would change by approximately $2 million and $3.5 million.million, respectively. Based solely on our 2018 operating results, for 2016 and on an annualized basis, if the British pound exchange rate were to change by 5%, our net income and FFO would change by approximately $0.1 million and less than $0.2 million.million, respectively.

Index to Financial Statements

ITEM 8.

Financial Statements and Supplementary Data

Report of Independent Registered Public Accounting Firm

To the Board of Directors and Stockholders

of Medical Properties Trust, Inc.:

In our opinion,Opinions on the Financial Statements and Internal Control over Financial Reporting

We have audited the accompanying consolidated financial statements listed in the index appearing under Item 15(a) present fairly, in all material respects, the financial positionbalance sheets of Medical Properties Trust, Inc. and its subsidiaries at(the “Company”) as of December 31, 20162018 and December 31, 2015,2017, and the resultsrelated consolidated statements of their operationsnet income, comprehensive income, equity and their cash flows for each of the three years in the period ended December 31, 20162018, including the related notes and financial statement schedules as listed in the index appearing under Item 15(a) (collectively referred to as the “consolidated financial statements”).  We also have audited the Company's internal control over financial reporting as of December 31, 2018, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).  

In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of the Company as of December 31, 2018 and December 31, 2017, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2018 in conformity with accounting principles generally accepted in the United States of America. In addition, in our opinion, the financial statement schedules listed in the index under Item 15(a) present fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements.  Also in our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2016,2018, based on criteria established inInternal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). COSO.

Basis for Opinions

The Company’sCompany's management is responsible for these consolidated financial statements, and financial statement schedules, for maintaining effective internal control over financial reporting, and for its assessment of the effectiveness of internal control over financial reporting, included in Management’sManagement's Report on Internal Control over Financial Reporting appearing under Item 9a.9A.  Our responsibility is to express opinions on thesethe Company’s consolidated financial statements on the financial statement schedules, and on the Company’sCompany's internal control over financial reporting based on our integrated audits.  We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) ("PCAOB") and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States).PCAOB.  Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud, and whether effective internal control over financial reporting was maintained in all material respects.

Our audits of the consolidated financial statements included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due to error or fraud, and performing procedures that respond to those risks.  Such procedures included examining, on a test basis, evidence supportingregarding the amounts and disclosures in the consolidated financial statements, assessingstatements.  Our audits also included evaluating the accounting principles used and significant estimates made by management, andas well as evaluating the overall presentation of the consolidated financial statement presentation.statements.  Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk.  Our audits also included performing such other procedures as we considered necessary in the circumstances. We believe that our audits provide a reasonable basis for our opinions.

Definition and Limitations of Internal Control over Financial Reporting

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles.  A company’s internal control over financial reporting includes those policies and procedures that (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements.  Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

/s/ PricewaterhouseCoopers LLP

Birmingham, ALAlabama

March 1, 2017

2019

Index to Financial Statements
We have served as the Company’s auditor since 2008.

56


Report of Independent Registered Public Accounting Firm

To the Partners

of MPT Operating Partnership, L.P.:

In our opinion,Opinions on the Financial Statements and Internal Control over Financial Reporting

We have audited the accompanying consolidated financial statements listed in the index appearing under Item 15(a) present fairly, in all material respects, the financial positionbalance sheets of MPT Operating Partnership, L.P. and its subsidiaries at(the “Company”) as of December 31, 20162018 and December 31, 2015,2017, and the resultsrelated consolidated statements of their operationsnet income, comprehensive income, capital and their cash flows for each of the three years in the period ended December 31, 20162018, including the related notes and financial statement schedules as listed in the index appearing under Item 15(a) (collectively referred to as the “consolidated financial statements”).  We also have audited the Company's internal control over financial reporting as of December 31, 2018, based on criteria established in Internal Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).  

In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of the Company as of December 31, 2018 and December 31, 2017, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2018 in conformity with accounting principles generally accepted in the United States of America. In addition, in our opinion, the financial statement schedules listed in the index under Item 15(a) present fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements.  Also in our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2016,2018, based on criteria established inInternal Control—Control - Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). COSO.

Basis for Opinions

The Company’sCompany's management is responsible for these consolidated financial statements, and financial statement schedules, for maintaining effective internal control over financial reporting, and for its assessment of the effectiveness of internal control over financial reporting, included in Management’sManagement's Report on Internal Control over Financial Reporting appearing under Item 9a.9A.  Our responsibility is to express opinions on thesethe Company’s consolidated financial statements on the financial statement schedules, and on the Company’sCompany's internal control over financial reporting based on our integrated audits.  We are a public accounting firm registered with the Public Company Accounting Oversight Board (United States) ("PCAOB") and are required to be independent with respect to the Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and Exchange Commission and the PCAOB.

We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States).PCAOB.  Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement, whether due to error or fraud, and whether effective internal control over financial reporting was maintained in all material respects.  

Our audits of the consolidated financial statements included performing procedures to assess the risks of material misstatement of the consolidated financial statements, whether due to error or fraud, and performing procedures that respond to those risks.  Such procedures included examining, on a test basis, evidence supportingregarding the amounts and disclosures in the consolidated financial statements, assessingstatements.  Our audits also included evaluating the accounting principles used and significant estimates made by management, andas well as evaluating the overall presentation of the consolidated financial statement presentation.statements.  Our audit of internal control over financial reporting included obtaining an understanding of internal control over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk.  Our audits also included performing such other procedures as we considered necessary in the circumstances. We believe that our audits provide a reasonable basis for our opinions.

Definition and Limitations of Internal Control over Financial Reporting

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles.  A company’s internal control over financial reporting includes those policies and procedures that (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements.  Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

/s/ PricewaterhouseCoopers LLP

Birmingham, ALAlabama

March 1, 2017

2019

Index to Financial Statements
We have served as the Company’s auditor since 2008.

57


MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Balance Sheets

  December 31, 

 

December 31,

 

  2016 2015 

 

2018

 

 

2017

 

  (Amounts in thousands,
except for per share data)
 

 

(Amounts in thousands,

except for per share data)

 

ASSETSASSETS 

 

 

 

 

 

 

 

 

Real estate assets

   

 

 

 

 

 

 

 

 

Land

  $417,368  $315,787 

 

$

547,894

 

 

$

639,626

 

Buildings and improvements

   3,550,674  2,675,803 

 

 

4,233,255

 

 

 

4,667,150

 

Construction in progress and other

   53,648  49,165 

Construction in progress

 

 

84,172

 

 

 

47,695

 

Intangible lease assets

   296,176  256,950 

 

 

403,138

 

 

 

443,134

 

Real estate held for sale

 

 

 

 

 

146,615

 

Net investment in direct financing leases

   648,102  626,996 

 

 

684,053

 

 

 

698,727

 

Mortgage loans

   1,060,400  757,581 

 

 

1,213,322

 

 

 

1,778,316

 

  

 

  

 

 

Gross investment in real estate assets

   6,026,368  4,682,282 

 

 

7,165,834

 

 

 

8,421,263

 

Accumulated depreciation

   (292,786 (232,675

 

 

(414,331

)

 

 

(406,855

)

Accumulated amortization

   (32,339 (25,253

 

 

(50,653

)

 

 

(48,857

)

  

 

  

 

 

Net investment in real estate assets

   5,701,243  4,424,354 

 

 

6,700,850

 

 

 

7,965,551

 

Cash and cash equivalents

   83,240  195,541 

 

 

820,868

 

 

 

171,472

 

Interest and rent receivables

   57,698  46,939 

 

 

25,855

 

 

 

78,970

 

Straight-line rent receivables

   116,861  82,155 

 

 

220,848

 

 

 

185,592

 

Other loans

   155,721  664,822 

 

 

373,198

 

 

 

150,209

 

Other assets

   303,773  195,540 

 

 

702,024

 

 

 

468,494

 

  

 

  

 

 

Total Assets

  $6,418,536  $5,609,351 

 

$

8,843,643

 

 

$

9,020,288

 

  

 

  

 

 
LIABILITIES AND EQUITYLIABILITIES AND EQUITY 

 

 

 

 

 

 

 

 

Liabilities

   

 

 

 

 

 

 

 

 

Debt, net

  $2,909,341  $3,322,541 

 

$

4,037,389

 

 

$

4,898,667

 

Accounts payable and accrued expenses

   207,711  137,356 

 

 

204,325

 

 

 

211,188

 

Deferred revenue

   19,933  29,358 

 

 

13,467

 

 

 

18,178

 

Lease deposits and other obligations to tenants

   28,323  12,831 

 

 

27,524

 

 

 

57,050

 

  

 

  

 

 

Total Liabilities

   3,165,308  3,502,086 

 

 

4,282,705

 

 

 

5,185,083

 

Commitments and Contingencies

   

 

 

 

 

 

 

 

 

Equity

   

 

 

 

 

 

 

 

 

Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding

   —     —   

 

 

 

 

 

 

Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding — 320,514 shares at December 31, 2016 and 236,744 shares at December 31, 2015

   321  237 

Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding —

370,637 shares at December 31, 2018 and 364,424 shares at December 31, 2017

 

 

371

 

 

 

364

 

Additionalpaid-in capital

   3,775,336  2,593,827 

 

 

4,442,948

 

 

 

4,333,027

 

Distributions in excess of net income

   (434,114 (418,650

Retained earnings (deficit)

 

 

162,768

 

 

 

(485,932

)

Accumulated other comprehensive loss

   (92,903 (72,884

 

 

(58,202

)

 

 

(26,049

)

Treasury shares, at cost

   (262 (262

 

 

(777

)

 

 

(777

)

  

 

  

 

 

Total Medical Properties Trust, Inc. Stockholders’ Equity

   3,248,378  2,102,268 

 

 

4,547,108

 

 

 

3,820,633

 

Non-controlling interests

   4,850  4,997 

 

 

13,830

 

 

 

14,572

 

  

 

  

 

 

Total Equity

   3,253,228  2,107,265 

 

 

4,560,938

 

 

 

3,835,205

 

  

 

  

 

 

Total Liabilities and Equity

  $6,418,536  $5,609,351 

 

$

8,843,643

 

 

$

9,020,288

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

58


Index to Financial Statements

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Net Income

 

  For the Years Ended December 31, 

 

For the Years Ended December 31,

 

  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

  

(Amounts in thousands,

except for per share data)

 

 

(Amounts in thousands,

except for per share data)

 

Revenues

    

 

 

 

 

 

 

 

 

 

 

 

 

Rent billed

  $327,269  $247,604  $187,018 

 

$

473,343

 

 

$

435,782

 

 

$

327,269

 

Straight-line rent

   41,067  23,375  13,507 

 

 

74,741

 

 

 

65,468

 

 

 

41,067

 

Income from direct financing leases

   64,307  58,715  49,155 

 

 

73,983

 

 

 

74,495

 

 

 

64,307

 

Interest and fee income

   108,494  112,184  62,852 

 

 

162,455

 

 

 

129,000

 

 

 

108,494

 

  

 

  

 

  

 

 

Total revenues

   541,137  441,878  312,532 

 

 

784,522

 

 

 

704,745

 

 

 

541,137

 

Expenses

    

 

 

 

 

 

 

 

 

 

 

 

 

Interest

 

 

223,274

 

 

 

176,954

 

 

 

159,597

 

Real estate depreciation and amortization

   94,374  69,867  53,938 

 

 

133,083

 

 

 

125,106

 

 

 

94,374

 

Impairment charges

   7,229   —    50,128 

Property-related

   2,712  3,792  1,851 

 

 

9,237

 

 

 

5,811

 

 

 

2,712

 

Acquisition expenses

   46,273  61,342  26,389 

General and administrative

   48,911  43,639  37,274 

 

 

80,086

 

 

 

58,599

 

 

 

48,911

 

  

 

  

 

  

 

 

Total operating expenses

   199,499  178,640  169,580 
  

 

  

 

  

 

 

Operating income

   341,638  263,238  142,952 

Acquisition costs

 

 

917

 

 

 

29,645

 

 

 

46,273

 

Total expenses

 

 

446,597

 

 

 

396,115

 

 

 

351,867

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income (expense)

    

 

 

 

 

 

 

 

 

 

 

 

 

Interest expense

   (159,597 (120,884 (98,156

Gain on sale of real estate and other asset dispositions, net

   61,224  3,268  2,857 

Earnings from equity and other interests

   (1,116 2,849  2,559 

Unutilized financing fees/ debt refinancing costs

   (22,539 (4,367 (1,698

Other income (expense)

   (502 (2,674 2,624 

Income tax benefit (expense)

   6,830  (1,503 (340

Gain on sale of real estate and other, net

 

 

719,392

 

 

 

7,431

 

 

 

61,224

 

Impairment charges

 

 

(48,007

)

 

 

 

 

 

(7,229

)

Debt refinancing costs

 

 

 

 

 

(32,574

)

 

 

(22,539

)

Other

 

 

10,094

 

 

 

10,432

 

 

 

(1,619

)

Total other income (expense)

 

 

681,479

 

 

 

(14,711

)

 

 

29,837

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net other expenses

   (115,700 (123,311 (92,154

Income before income tax

 

 

1,019,404

 

 

 

293,919

 

 

 

219,107

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income from continuing operations

   225,938  139,927  50,798 

Loss from discontinued operations

   (1  —    (2

Income tax (expense) benefit

 

 

(927

)

 

 

(2,681

)

 

 

6,830

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

   225,937  139,927  50,796 

 

 

1,018,477

 

 

 

291,238

 

 

 

225,937

 

Net income attributable tonon-controlling interests

   (889 (329 (274

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

  

 

  

 

  

 

 

Net income attributable to MPT common stockholders

  $225,048  $139,598  $50,522 

 

$

1,016,685

 

 

$

289,793

 

 

$

225,048

 

  

 

  

 

  

 

 

Earnings per share — basic

    

 

 

 

 

 

 

 

 

 

 

 

 

Income from continuing operations attributable to MPT common stockholders

  $0.86  $0.64  $0.29 

Income from discontinued operations attributable to MPT common stockholders

   —     —     —   
  

 

  

 

  

 

 

Net income attributable to MPT common stockholders

  $0.86  $0.64  $0.29 

 

$

2.77

 

 

$

0.82

 

 

$

0.86

 

  

 

  

 

  

 

 

Weighted average shares outstanding — basic

   260,414   217,997   169,999 

 

 

365,364

 

 

 

349,902

 

 

 

260,414

 

  

 

  

 

  

 

 

Earnings per share — diluted

    

 

 

 

 

 

 

 

 

 

 

 

 

Income from continuing operations attributable to MPT common stockholders

  $0.86  $0.63  $0.29 

Income from discontinued operations attributable to MPT common stockholders

   —     —     —   
  

 

  

 

  

 

 

Net income attributable to MPT common stockholders

  $0.86  $0.63  $0.29 

 

$

2.76

 

 

$

0.82

 

 

$

0.86

 

  

 

  

 

  

 

 

Weighted average shares outstanding — diluted

   261,072   218,304   170,540 

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

  

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

59


Index to Financial Statements

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Comprehensive Income

 

  For the Years
Ended December 31,
 

 

For the Years Ended December 31,

 

(In thousands)  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

Net income

  $225,937  $139,927  $50,796 

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Other comprehensive income (loss):

    

 

 

 

 

 

 

 

 

 

 

 

 

Unrealized gain on interest rate swap

   2,904  3,139  2,964 

Foreign currency translation loss

   (22,923 (54,109 (15,937
  

 

  

 

  

 

 

Unrealized (loss) gain on interest rate swap

 

 

(3,317

)

 

 

 

 

 

2,904

 

Foreign currency translation (loss) gain

 

 

(28,836

)

 

 

66,854

 

 

 

(22,923

)

Total comprehensive income

   205,918  88,957  37,823 

 

 

986,324

 

 

 

358,092

 

 

 

205,918

 

Comprehensive income attributable tonon-controlling interests

   (889 (329 (274

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

  

 

  

 

  

 

 

Comprehensive income attributable to MPT common stockholders

  $205,029  $88,628  $37,549 

 

$

984,532

 

 

$

356,647

 

 

$

205,029

 

  

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

Index to Financial Statements


MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Equity

For the Years Ended December 31, 2016, 20152018, 2017 and 20142016

(Amounts in thousands, except per share data)

 

 

Preferred

 

 

Common

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Preferred Common Additional
Paid-in
Capital
  Distributions
in Excess
of Net
Income
  Accumulated
Other
Comprehensive
Loss
  Treasury
Stock
  Non-
Controlling
Interests
  Total
Equity
 

 

Shares

 

 

Par

Value

 

 

Shares

 

 

Par

Value

 

 

Additional

Paid-in

Capital

 

 

Retained

Earnings

(Deficit)

 

 

Accumulated

Other

Comprehensive

Loss

 

 

Treasury

Shares

 

 

Non-

Controlling

Interests

 

 

Total

Equity

 

 Shares Par
Value
 Shares Par
Value
 

Balance at December 31, 2013

  —    $—    161,310  $161  $1,618,054  $(264,804 $(8,941 $(262 $—    $1,344,208 
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income

  —     —     —     —     —    50,522   —     —    274  50,796 

Unrealized gain on interest rate swap

  —     —     —     —     —     —    2,964   —     —    2,964 

Foreign currency translation loss

  —     —     —     —     —     —    (15,937  —     —    (15,937

Stock vesting and amortization of stock-based compensation

  —     —    777   —    9,165   —     —     —     —    9,165 

Distributions tonon-controlling interests

  —     —     —     —     —     —     —     —    (274 (274

Proceeds from offering (net of offering costs)

  —     —    10,656  11  138,162   —     —     —     —    138,173 

Dividends declared ($0.84 per common share)

  —     —     —     —     —    (147,048  —     —     —    (147,048
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Balance at December 31, 2014

  —    $—    172,743  $172  $1,765,381  $(361,330 $(21,914 $(262 $—    $1,382,047 
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income

  —     —     —     —     —    139,598   —     —    329  139,927 

Sale ofnon-controlling interests

  —     —     —     —     —     —     —     —    5,000  5,000 

Unrealized gain on interest rate swap

  —     —     —     —     —     —    3,139   —     —    3,139 

Foreign currency translation loss

  —     —     —     —     —     —    (54,109  —     —    (54,109

Stock vesting and amortization of stock-based compensation

  —     —    751  2  11,120   —     —     —     —    11,122 

Distributions tonon-controlling interests

  —     —     —     —     —     —     —     —    (332 (332

Proceeds from offering (net of offering costs)

  —     —    63,250  63  817,326   —     —     —     —    817,389 

Dividends declared ($0.88 per common share)

  —     —     —     —     —    (196,918  —     —     —    (196,918
 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Balance at December 31, 2015

  —    $—    236,744  $237  $2,593,827  $(418,650 $(72,884 $(262 $4,997  $2,107,265 

 

 

 

 

$

 

 

 

236,744

 

 

$

237

 

 

$

2,593,827

 

 

$

(418,650

)

 

$

(72,884

)

 

$

(262

)

 

$

4,997

 

 

$

2,107,265

 

 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income

  —     —     —     —     —    225,048   —     —    889  225,937 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

225,048

 

 

 

 

 

 

 

 

 

889

 

 

 

225,937

 

Unrealized gain on interest rate swap

  —     —     —     —     —     —    2,904   —     —    2,904 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2,904

 

 

 

 

 

 

 

 

 

2,904

 

Foreign currency translation loss

  —     —     —     —     —     —    (22,923  —     —    (22,923

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(22,923

)

 

 

 

 

 

 

 

 

(22,923

)

Stock vesting and amortization of stock-based compensation

  —     —    1,021  1  7,941   —     —     —     —    7,942 

 

 

 

 

 

 

 

 

1,021

 

 

 

1

 

 

 

7,941

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7,942

 

Distributions tonon-controlling interests

  —     —     —     —     —     —     —     —    (1,036 (1,036

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1,036

)

 

 

(1,036

)

Proceeds from offering (net of offering costs)

  —     —    82,749  83  1,173,568   —     —     —     —    1,173,651 

 

 

 

 

 

 

 

 

82,749

 

 

 

83

 

 

 

1,173,568

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1,173,651

 

Dividends declared ($0.91 per common share)

  —     —     —     —     —    (240,512  —     —     —    (240,512

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(240,512

)

 

 

 

 

 

 

 

 

 

 

 

(240,512

)

 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Balance at December 31, 2016

  —    $—    320,514  $321  $3,775,336  $(434,114 $(92,903 $(262 $4,850  $3,253,228 

 

 

 

 

$

 

 

 

320,514

 

 

$

321

 

 

$

3,775,336

 

 

$

(434,114

)

 

$

(92,903

)

 

$

(262

)

 

$

4,850

 

 

$

3,253,228

 

 

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

  

 

 

Net income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

289,793

 

 

 

 

 

 

 

 

 

1,445

 

 

 

291,238

 

Sale of non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10,000

 

 

 

10,000

 

Foreign currency translation gain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

66,854

 

 

 

 

 

 

 

 

 

66,854

 

Stock vesting and amortization of stock-based

compensation

 

 

 

 

 

 

 

 

785

 

 

 

 

 

 

9,949

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9,949

 

Treasury shares acquired (41,270 shares)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(515

)

 

 

 

 

 

(515

)

Distributions to non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1,723

)

 

 

(1,723

)

Proceeds from offering (net of offering costs)

 

 

 

 

 

 

 

 

43,125

 

 

 

43

 

 

 

547,742

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

547,785

 

Dividends declared ($0.96 per common share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(341,611

)

 

 

 

 

 

 

 

 

 

 

 

(341,611

)

Balance at December 31, 2017

 

 

 

 

$

 

 

 

364,424

 

 

$

364

 

 

$

4,333,027

 

 

$

(485,932

)

 

$

(26,049

)

 

$

(777

)

 

$

14,572

 

 

$

3,835,205

 

Net income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1,016,685

 

 

 

 

 

 

 

 

 

1,792

 

 

 

1,018,477

 

Cumulative effect of change in accounting principles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1,938

 

 

 

 

 

 

 

 

 

 

 

 

1,938

 

Unrealized loss on interest rate swap

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3,317

)

 

 

 

 

 

 

 

 

(3,317

)

Foreign currency translation loss

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(28,836

)

 

 

 

 

 

 

 

 

(28,836

)

Stock vesting and amortization of stock-based

compensation

 

 

 

 

 

 

 

 

599

 

 

 

1

 

 

 

16,504

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16,505

 

Redemption of MOP units

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(816

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(816

)

Distributions to non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2,534

)

 

 

(2,534

)

Proceeds from offering (net of offering costs)

 

 

 

 

 

 

 

 

5,614

 

 

 

6

 

 

 

94,233

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

94,239

 

Dividends declared ($1.00 per common share)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(369,923

)

 

 

 

 

 

 

 

 

 

 

 

(369,923

)

Balance at December 31, 2018

 

 

 

 

$

 

 

 

370,637

 

 

$

371

 

 

$

4,442,948

 

 

$

162,768

 

 

$

(58,202

)

 

$

(777

)

 

$

13,830

 

 

$

4,560,938

 

See accompanying notes to consolidated financial statements.

Index to Financial Statements

61


MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Consolidated Statements of Cash Flows

 

 For the Years Ended December 31, 

 

For the Years Ended December 31,

 

 2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

 (Amounts in thousands) 

 

(Amounts in thousands)

 

Operating activities

   

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 $225,937  $139,927  $50,796 

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Adjustments to reconcile net income to net cash provided by operating activities:

   

 

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

 97,601  71,827  55,162 

 

 

141,492

 

 

 

131,979

 

 

 

97,601

 

Amortization of deferred financing costs and debt discount

 7,613  6,085  5,105 

 

 

7,363

 

 

 

6,521

 

 

 

7,613

 

Direct financing lease interest accretion

 (9,120 (8,032 (6,701

 

 

(9,783

)

 

 

(9,933

)

 

 

(9,120

)

Straight-line rent revenue

 (41,567 (26,187 (16,325

 

 

(90,811

)

 

 

(70,808

)

 

 

(41,567

)

Share-based compensation

 7,942  11,122  9,165 

 

 

16,505

 

 

 

9,949

 

 

 

7,942

 

Gain from sale of real estate and other asset dispositions, net

 (61,224 (3,268 (2,857

Gain from sale of real estate and other, net

 

 

(719,392

)

 

 

(7,431

)

 

 

(61,224

)

Impairment charges

 7,229   —    50,128 

 

 

48,007

 

 

 

 

 

 

7,229

 

Straight-line rent and otherwrite-off

 3,063  2,812  2,818 

 

 

18,002

 

 

 

5,340

 

 

 

3,063

 

Unutilized financing fees/ debt refinancing costs

 22,539  4,367  1,698 

Debt refinancing costs

 

 

 

 

 

32,574

 

 

 

22,539

 

Other adjustments

 3,563  (6,334 (1,178

 

 

(3,768

)

 

 

(1,204

)

 

 

3,563

 

Decrease (increase) in:

   

Interest and rent receivable

 (13,247 (5,599 (3,856

Changes in:

 

 

 

 

 

 

 

 

 

 

 

 

Interest and rent receivables

 

 

46,498

 

 

 

(21,116

)

 

 

(13,247

)

Other assets

 (18,357 (8,297 764 

 

 

(18,051

)

 

 

(5,318

)

 

 

(19,202

)

Accounts payable and accrued expenses

 41,583  26,540  6,209 

 

 

(5,596

)

 

 

2,494

 

 

 

41,583

 

Deferred revenue

 (8,872 2,033  (485

 

 

145

 

 

 

(2,050

)

 

 

(8,872

)

 

 

  

 

  

 

 

Net cash provided by operating activities

 264,683  206,996  150,443 

 

 

449,088

 

 

 

362,235

 

 

 

263,838

 

Investing activities

   

 

 

 

 

 

 

 

 

 

 

 

 

Cash paid for acquisitions and other related investments

 (1,682,409 (2,218,869 (767,696

 

 

(1,430,995

)

 

 

(2,246,788

)

 

 

(1,682,409

)

Net proceeds from sale of real estate

 198,767  19,175  34,649 

 

 

1,513,666

 

 

 

64,362

 

 

 

198,767

 

Principal received on loans receivable

 906,757  771,785  11,265 

 

 

885,917

 

 

 

8,480

 

 

 

906,757

 

Investment in loans receivable

 (109,027 (354,001 (12,782

 

 

(212,002

)

 

 

(19,338

)

 

 

(109,027

)

Construction in progress and other

 (171,209 (146,372 (102,333

 

 

(53,967

)

 

 

(73,812

)

 

 

(171,209

)

Investment in unsecured senior notes

 (50,000  —     —   

 

 

 

 

 

 

 

 

(50,000

)

Proceeds from sale of unsecured notes

 50,000   —     —   

 

 

 

 

 

 

 

 

50,000

 

Other investments, net

 (69,423 (17,339 (13,126

 

 

(138,441

)

 

 

(94,970

)

 

 

(69,423

)

 

 

  

 

  

 

 

Net cash used for investing activities

 (926,544 (1,945,621 (850,023

Net cash provided by (used for) investing activities

 

 

564,178

 

 

 

(2,362,066

)

 

 

(926,544

)

Financing activities

   

 

 

 

 

 

 

 

 

 

 

 

 

Proceeds from term debt

 1,000,000  681,000  425,000 

 

 

759,735

 

 

 

2,355,280

 

 

 

1,000,000

 

Payments of term debt

 (575,299 (283 (100,266

 

 

 

 

 

(1,038,221

)

 

 

(575,299

)

Payment of deferred financing costs

 (15,468 (7,686 (14,496

 

 

 

 

 

(32,794

)

 

 

(15,468

)

Revolving credit facilities, net

 (810,000 509,415  490,625 

 

 

(811,718

)

 

 

550,415

 

 

 

(810,000

)

Distributions paid

 (218,393 (182,980 (144,365

 

 

(363,906

)

 

 

(326,729

)

 

 

(218,393

)

Lease deposits and other obligations to tenants

 14,557  (10,839 7,892 

 

 

(20,606

)

 

 

27,525

 

 

 

14,557

 

Proceeds from sale of common shares, net of offering costs

 1,173,651  817,389  138,173 

 

 

94,239

 

 

 

547,785

 

 

 

1,173,651

 

Other financing activities

 (16,485 (5,326  —   

 

 

(3,614

)

 

 

(12,984

)

 

 

(16,485

)

 

 

  

 

  

 

 

Net cash provided by financing activities

 552,563  1,800,690  802,563 
 

 

  

 

  

 

 

Increase in cash and cash equivalents for the year

 (109,298 62,065  102,983 

Net cash (used for) provided by financing activities

 

 

(345,870

)

 

 

2,070,277

 

 

 

552,563

 

Increase (decrease) in cash, cash equivalents, and restricted cash for the year

 

 

667,396

 

 

 

70,446

 

 

 

(110,143

)

Effect of exchange rate changes

 (3,003 (11,065 (4,421

 

 

(17,218

)

 

 

16,920

 

 

 

(3,003

)

Cash and cash equivalents at beginning of year

 195,541  144,541  45,979 
 

 

  

 

  

 

 

Cash and cash equivalents at end of year

 $83,240  $195,541  $144,541 
 

 

  

 

  

 

 

Interest paid, including capitalized interest of $2,320 in 2016, $1,425 in 2015, and $1,860 in 2014

 $138,770  $107,228  $91,890 

Supplemental schedule ofnon-cash investing activities:

   

Mortgage loan issued from sale of real estate

 $—    $—    $12,500 

Increase in development project construction costs incurred, not paid

 15,857  2,684   —   

Cash, cash equivalents and restricted cash at beginning of year

 

 

172,247

 

 

 

84,881

 

 

 

198,027

 

Cash, cash equivalents, and restricted cash at end of year

 

$

822,425

 

 

$

172,247

 

 

$

84,881

 

Interest paid, including capitalized interest of $1,480 in 2018, $840 in 2017,

and $2,320 in 2016

 

$

221,779

 

 

$

149,798

 

 

$

138,770

 

Supplemental schedule ofnon-cash financing activities:

   

 

 

 

 

 

 

 

 

 

 

 

 

Dividends declared, not paid

 $74,521  $52,402  $38,461 

 

$

95,419

 

 

$

89,403

 

 

$

74,521

 

Cash, cash equivalents and restricted cash are comprised of the following:

 

 

 

 

 

 

 

 

 

 

 

 

Beginning of period:

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

171,472

 

 

$

83,240

 

 

$

195,541

 

Restricted cash, included in Other assets

 

 

775

 

 

 

1,641

 

 

 

2,486

 

 

$

172,247

 

 

$

84,881

 

 

$

198,027

 

End of period:

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

820,868

 

 

$

171,472

 

 

$

83,240

 

Restricted cash, included in Other assets

 

 

1,557

 

 

 

775

 

 

 

1,641

 

 

$

822,425

 

 

$

172,247

 

 

$

84,881

 

See accompanying notes to consolidated financial statements.

62


Index to Financial Statements

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Consolidated Balance Sheets

 

  December 31, 

 

December 31,

 

  2016 2015 

 

2018

 

 

2017

 

  (Amounts in thousands,
except for per unit data)
 

 

(Amounts in thousands,

except for per unit data)

 

ASSETSASSETS 

 

 

 

 

 

 

 

 

Real estate assets

   

 

 

 

 

 

 

 

 

Land

  $417,368  $315,787 

 

$

547,894

 

 

$

639,626

 

Buildings and improvements

   3,550,674  2,675,803 

 

 

4,233,255

 

 

 

4,667,150

 

Construction in progress and other

   53,648  49,165 

Construction in progress

 

 

84,172

 

 

 

47,695

 

Intangible lease assets

   296,176  256,950 

 

 

403,138

 

 

 

443,134

 

Real estate held for sale

 

 

 

 

 

146,615

 

Net investment in direct financing leases

   648,102  626,996 

 

 

684,053

 

 

 

698,727

 

Mortgage loans

   1,060,400  757,581 

 

 

1,213,322

 

 

 

1,778,316

 

  

 

  

 

 

Gross investment in real estate assets

   6,026,368  4,682,282 

 

 

7,165,834

 

 

 

8,421,263

 

Accumulated depreciation

   (292,786 (232,675

 

 

(414,331

)

 

 

(406,855

)

Accumulated amortization

   (32,339 (25,253

 

 

(50,653

)

 

 

(48,857

)

  

 

  

 

 

Net investment in real estate assets

   5,701,243  4,424,354 

 

 

6,700,850

 

 

 

7,965,551

 

Cash and cash equivalents

   83,240  195,541 

 

 

820,868

 

 

 

171,472

 

Interest and rent receivables

   57,698  46,939 

 

 

25,855

 

 

 

78,970

 

Straight-line rent receivables

   116,861  82,155 

 

 

220,848

 

 

 

185,592

 

Other loans

   155,721  664,822 

 

 

373,198

 

 

 

150,209

 

Other assets

   303,773  195,540 

 

 

702,024

 

 

 

468,494

 

  

 

  

 

 

Total Assets

  $6,418,536  $5,609,351 

 

$

8,843,643

 

 

$

9,020,288

 

  

 

  

 

 
LIABILITIES AND CAPITALLIABILITIES AND CAPITAL 

 

 

 

 

 

 

 

 

Liabilities

   

 

 

 

 

 

 

 

 

Debt, net

  $2,909,341  $3,322,541 

 

$

4,037,389

 

 

$

4,898,667

 

Accounts payable and accrued expenses

   132,868  84,628 

 

 

108,574

 

 

 

121,465

 

Deferred revenue

   19,933  29,358 

 

 

13,467

 

 

 

18,178

 

Lease deposits and other obligations to tenants

   28,323  12,831 

 

 

27,524

 

 

 

57,050

 

Payable due to Medical Properties Trust, Inc.

   74,453  52,338 

 

 

95,361

 

 

 

89,333

 

  

 

  

 

 

Total Liabilities

   3,164,918  3,501,696 

 

 

4,282,315

 

 

 

5,184,693

 

Commitments and Contingencies

   

 

 

 

 

 

 

 

 

Capital

   

 

 

 

 

 

 

 

 

General partner — issued and outstanding — 3,204 units at December 31, 2016 and 2,363 units at December 31, 2015

   33,436  21,773 

General partner — issued and outstanding — 3,706 units at December 31, 2018 and 3,644 units at December 31, 2017

 

 

46,084

 

 

 

38,489

 

Limited Partners:

   

 

 

 

 

 

 

 

 

Common units — issued and outstanding — 317,310 units at December 31, 2016 and 234,381 units at December 31, 2015

   3,308,235  2,153,769 

LTIP units — issued and outstanding — 292 units at December 31, 2016 and December 31, 2015

   —     —   

Common units — issued and outstanding — 366,931 units at December 31,

2018 and 360,780 units at December 31, 2017

 

 

4,559,616

 

 

 

3,808,583

 

LTIP units — issued and outstanding — 232 units at December 31, 2018 and

292 units December 31, 2017

 

 

 

 

 

 

Accumulated other comprehensive loss

   (92,903 (72,884

 

 

(58,202

)

 

 

(26,049

)

  

 

  

 

 

Total MPT Operating Partnership, L.P. capital

   3,248,768  2,102,658 

 

 

4,547,498

 

 

 

3,821,023

 

Non-controlling interests

   4,850  4,997 

 

 

13,830

 

 

 

14,572

 

  

 

  

 

 

Total Capital

   3,253,618  2,107,655 

 

 

4,561,328

 

 

 

3,835,595

 

  

 

  

 

 

Total Liabilities and Capital

  $6,418,536  $5,609,351 

 

$

8,843,643

 

 

$

9,020,288

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

63


Index to Financial Statements

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Consolidated Statements of Net Income

 

  For the Years Ended December 31, 

 

For the Years Ended December 31,

 

  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

  (Amounts in thousands,
except for per unit data)
 

 

(Amounts in thousands,

except for per unit data)

 

Revenues

    

 

 

 

 

 

 

 

 

 

 

 

 

Rent billed

  $327,269  $247,604  $187,018 

 

$

473,343

 

 

$

435,782

 

 

$

327,269

 

Straight-line rent

   41,067  23,375  13,507 

 

 

74,741

 

 

 

65,468

 

 

 

41,067

 

Income from direct financing leases

   64,307  58,715  49,155 

 

 

73,983

 

 

 

74,495

 

 

 

64,307

 

Interest and fee income

   108,494  112,184  62,852 

 

 

162,455

 

 

 

129,000

 

 

 

108,494

 

  

 

  

 

  

 

 

Total revenues

   541,137  441,878  312,532 

 

 

784,522

 

 

 

704,745

 

 

 

541,137

 

Expenses

    

 

 

 

 

 

 

 

 

 

 

 

 

Interest expense

 

 

223,274

 

 

 

176,954

 

 

 

159,597

 

Real estate depreciation and amortization

   94,374  69,867  53,938 

 

 

133,083

 

 

 

125,106

 

 

 

94,374

 

Property-related

 

 

9,237

 

 

 

5,811

 

 

 

2,712

 

General and administrative

 

 

80,086

 

 

 

58,599

 

 

 

48,911

 

Acquisition costs

 

 

917

 

 

 

29,645

 

 

 

46,273

 

Total expenses

 

 

446,597

 

 

 

396,115

 

 

 

351,867

 

 

 

 

 

 

 

 

 

 

 

 

 

Other income (expense)

 

 

 

 

 

 

 

 

 

 

 

 

Gain on sale of real estate and other, net

 

 

719,392

 

 

 

7,431

 

 

 

61,224

 

Impairment charges

   7,229   —    50,128 

 

 

(48,007

)

 

 

 

 

 

(7,229

)

Property-related

   2,712  3,792  1,851 

Acquisition expenses

   46,273  61,342  26,389 

General and administrative

   48,911  43,639  37,274 

Debt refinancing costs

 

 

 

 

 

(32,574

)

 

 

(22,539

)

Other

 

 

10,094

 

 

 

10,432

 

 

 

(1,619

)

Total other income (expense)

 

 

681,479

 

 

 

(14,711

)

 

 

29,837

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total operating expense

   199,499  178,640  169,580 

Income before income tax

 

 

1,019,404

 

 

 

293,919

 

 

 

219,107

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Operating income

   341,638  263,238  142,952 

Other income (expense)

    

Interest expense

   (159,597 (120,884 (98,156

Gain on sale of real estate and other asset dispositions, net

   61,224  3,268  2,857 

Earnings from equity and other interests

   (1,116 2,849  2,559 

Unutilized financing fees/ debt refinancing costs

   (22,539 (4,367 (1,698

Other income (expense)

   (502 (2,674 2,624 

Income tax benefit (expense)

   6,830  (1,503 (340
  

 

  

 

  

 

 

Net other expenses

   (115,700 (123,311 (92,154
  

 

  

 

  

 

 

Income from continuing operations

   225,938  139,927  50,798 

Loss from discontinued operations

   (1  —    (2

Income tax (expense) benefit

 

 

(927

)

 

 

(2,681

)

 

 

6,830

 

  

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

   225,937  139,927  50,796 

 

 

1,018,477

 

 

 

291,238

 

 

 

225,937

 

Net income attributable tonon-controlling interests

   (889 (329 (274

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

  

 

  

 

  

 

 

Net income attributable to MPT Operating Partnership partners

  $225,048  $139,598  $50,522 

 

$

1,016,685

 

 

$

289,793

 

 

$

225,048

 

  

 

  

 

  

 

 

Earnings per unit — basic

    

 

 

 

 

 

 

 

 

 

 

 

 

Income from continuing operations attributable to MPT Operating Partnership partners

  $0.86  $0.64  $0.29 

Income from discontinued operations attributable to MPT Operating Partnership partners

   —     —     —   
  

 

  

 

  

 

 

Net income attributable to MPT Operating Partnership partners

  $0.86  $0.64  $0.29 

 

$

2.77

 

 

$

0.82

 

 

$

0.86

 

  

 

  

 

  

 

 

Weighted average units outstanding — basic

   260,414   217,997   169,999 

 

 

365,364

 

 

 

349,902

 

 

 

260,414

 

  

 

  

 

  

 

 

Earnings per unit — diluted

    

 

 

 

 

 

 

 

 

 

 

 

 

Income from continuing operations attributable to MPT Operating Partnership partners

  $0.86  $0.63  $0.29 

Income from discontinued operations attributable to MPT Operating Partnership partners

   —     —     —   
  

 

  

 

  

 

 

Net income attributable to MPT Operating Partnership partners

  $0.86  $0.63  $0.29 

 

$

2.76

 

 

$

0.82

 

 

$

0.86

 

  

 

  

 

  

 

 

Weighted average units outstanding — diluted

   261,072   218,304   170,540 

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

  

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

64


Index to Financial Statements

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Consolidated Statements of Comprehensive Income

 

  For the Years
Ended December 31,
 

 

For the Years Ended December 31,

 

(In thousands)  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

Net income

  $225,937  $139,927  $50,796 

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Other comprehensive income (loss):

    

 

 

 

 

 

 

 

 

 

 

 

 

Unrealized gain on interest rate swap

   2,904  3,139  2,964 

Foreign currency translation loss

   (22,923 (54,109 (15,937
  

 

  

 

  

 

 

Unrealized (loss) gain on interest rate swap

 

 

(3,317

)

 

 

 

 

 

2,904

 

Foreign currency translation (loss) gain

 

 

(28,836

)

 

 

66,854

 

 

 

(22,923

)

Total comprehensive income

   205,918  88,957  37,823 

 

 

986,324

 

 

 

358,092

 

 

 

205,918

 

Comprehensive income attributable tonon-controlling interests

   (889 (329 (274

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

  

 

  

 

  

 

 

Comprehensive income attributable to MPT Operating Partnership partners

  $205,029  $88,628  $37,549 

 

$

984,532

 

 

$

356,647

 

 

$

205,029

 

  

 

  

 

  

 

 

See accompanying notes to consolidated financial statements.

Index to Financial Statements

65


MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Consolidated Statements of Capital

For the Years Ended December 31, 2016, 20152018, 2017 and 20142016

(Amounts in thousands, except per unit data)

 

 

General

 

 

Limited Partners

 

 

Accumulated

 

 

 

 

 

 

 

 

 

  General
Partner
  Limited Partners Accumulated
Other
Comprehensive
Loss
  Non-
Controlling
Interests
  Total
Capital
 

 

Partner

 

 

Common

 

 

LTIPs

 

 

Other

 

 

Non-

 

 

 

 

 

 Common LTIPs 

 

Units

 

 

Unit

Value

 

 

Units

 

 

Unit

Value

 

 

Units

 

 

Unit

Value

 

 

Comprehensive

Loss

 

 

Controlling

Interests

 

 

Total

Capital

 

  Units   Unit
Value
 Units   Unit
Value
 Units   Unit
Value
 

Balance at December 31, 2013

   1,608   $13,541  159,702   $1,339,998  292   $—    $(8,941 $—    $1,344,598 
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Balance at December 31, 2015

 

 

2,363

 

 

$

21,773

 

 

 

234,381

 

 

$

2,153,769

 

 

 

292

 

 

$

 

 

$

(72,884

)

 

$

4,997

 

 

$

2,107,655

 

Net income

   —      508   —      49,769   —      245   —    274  50,796 

 

 

 

 

 

2,251

 

 

 

 

 

 

222,797

 

 

 

 

 

 

 

 

 

 

 

 

889

 

 

 

225,937

 

Unrealized gain on interest rate swap

   —      —     —      —     —      —    2,964   —    2,964 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2,904

 

 

 

 

 

 

2,904

 

Foreign currency translation loss

   —      —     —      —     —      —    (15,937  —    (15,937

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(22,923

)

 

 

 

 

 

(22,923

)

Unit vesting and amortization of unit-based compensation

   8    92  769    9,073   —      —     —     —    9,165 

 

 

10

 

 

 

80

 

 

 

1,011

 

 

 

7,862

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7,942

 

Distributions tonon- controlling interests

   —      —     —      —     —      —     —    (274 (274

Distributions to non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1,036

)

 

 

(1,036

)

Proceeds from offering (net of offering costs)

   106    1,382  10,550    136,791   —      —     —     —    138,173 

 

 

831

 

 

 

11,737

 

 

 

81,918

 

 

 

1,161,914

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1,173,651

 

Distributions declared ($0.84 per unit)

   —      (1,468  —      (145,335  —      (245  —     —    (147,048
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Balance at December 31, 2014

   1,722   $14,055  171,021   $1,390,296  292   $—    $(21,914 $—    $1,382,437 
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Distributions declared ($0.91 per unit)

 

 

 

 

 

(2,405

)

 

 

 

 

 

(238,107

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(240,512

)

Balance at December 31, 2016

 

 

3,204

 

 

$

33,436

 

 

 

317,310

 

 

$

3,308,235

 

 

 

292

 

 

$

 

 

$

(92,903

)

 

$

4,850

 

 

$

3,253,618

 

Net income

   —      1,399   —      138,199   —      —     —    329  139,927 

 

 

 

 

 

2,898

 

 

 

 

 

 

286,895

 

 

 

 

 

 

 

 

 

 

 

 

1,445

 

 

 

291,238

 

Sale ofnon-controlling interests

   —      —     —      —     —      —     —    5,000  5,000 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10,000

 

 

 

10,000

 

Unrealized gain on interest rate swap

   —      —     —      —     —      —    3,139   —    3,139 

Foreign currency translation gain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

66,854

 

 

 

 

 

 

66,854

 

Unit vesting and amortization of unit-based

compensation

 

 

9

 

 

 

99

 

 

 

776

 

 

 

9,850

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9,949

 

Treasury units acquired (41,270 units)

 

 

 

 

 

(6

)

 

 

 

 

 

(509

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(515

)

Distributions to non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1,723

)

 

 

(1,723

)

Proceeds from offering (net of offering costs)

 

 

431

 

 

 

5,478

 

 

 

42,694

 

 

 

542,307

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

547,785

 

Distributions declared ($0.96 per unit)

 

 

 

 

 

(3,416

)

 

 

 

 

 

(338,195

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(341,611

)

Balance at December 31, 2017

 

 

3,644

 

 

$

38,489

 

 

 

360,780

 

 

$

3,808,583

 

 

 

292

 

 

$

 

 

$

(26,049

)

 

$

14,572

 

 

$

3,835,595

 

Net income

 

 

 

 

 

10,167

 

 

 

 

 

 

1,006,518

 

 

 

 

 

 

 

 

 

 

 

 

1,792

 

 

 

1,018,477

 

Cumulative effect of change in accounting principles

 

 

 

 

 

19

 

 

 

 

 

 

1,919

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1,938

 

Unrealized loss on interest rate swap

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3,317

)

 

 

 

 

 

(3,317

)

Foreign currency translation loss

   —      —     —      —     —      —    (54,109  —    (54,109

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(28,836

)

 

 

 

 

 

(28,836

)

Unit vesting and amortization of unit-based compensation

   8    111  743    11,011   —      —     —     —    11,122 

 

 

6

 

 

 

165

 

 

 

593

 

 

 

16,340

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16,505

 

Distributions tonon- controlling interests

   —      —     —      —     —      —     —    (332 (332

Conversion of LTIP units to common units

 

 

 

 

 

 

 

 

60

 

 

 

 

 

 

(60

)

 

 

 

 

 

 

 

 

 

 

 

 

Redemption of common units

 

 

 

 

 

 

 

 

(60

)

 

 

(816

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(816

)

Distributions to non-controlling interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2,534

)

 

 

(2,534

)

Proceeds from offering (net of offering costs)

   633    8,175  62,617    809,214   —      —     —     —    817,389 

 

 

56

 

 

 

942

 

 

 

5,558

 

 

 

93,297

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

94,239

 

Distributions declared ($0.88 per unit)

   —      (1,967  —      (194,951  —      —     —     —    (196,918
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Balance at December 31, 2015

   2,363   $21,773  234,381   $2,153,769  292   $—    $(72,884 $4,997  $2,107,655 
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Net income

   —      2,251   —      222,797   —      —     —    889  225,937 

Unrealized gain on interest rate swap

   —      —     —      —     —      —    2,904   —    2,904 

Foreign currency translation loss

   —      —     —      —     —      —    (22,923  —    (22,923

Unit vesting and amortization of unit-based compensation

   10    80  1,011    7,862   —      —     —     —    7,942 

Distributions tonon- controlling interests

   —      —     —      —     —      —     —    (1,036 (1,036

Proceeds from offering (net of offering costs)

   831    11,737  81,918    1,161,914   —      —     —     —    1,173,651 

Distributions declared ($0.91 per unit)

   —      (2,405  —      (238,107  —      —     —     —    (240,512
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Balance at December 31, 2016

   3,204   $33,436  317,310   $3,308,235  292   $—    $(92,903 $4,850  $3,253,618 
  

 

   

 

  

 

   

 

  

 

   

 

  

 

  

 

  

 

 

Distributions declared ($1.00 per unit)

 

 

 

 

 

(3,698

)

 

 

 

 

 

(366,225

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(369,923

)

Balance at December 31, 2018

 

 

3,706

 

 

$

46,084

 

 

 

366,931

 

 

$

4,559,616

 

 

 

232

 

 

$

 

 

$

(58,202

)

 

$

13,830

 

 

$

4,561,328

 

See accompanying notes to consolidated financial statements.

Index to Financial Statements

66


MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Consolidated Statements of Cash Flows

 

  For the Years Ended December 31, 

 

For the Years Ended December 31,

 

  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

  (Amounts in thousands) 

 

(Amounts in thousands)

 

Operating activities

    

 

 

 

 

 

 

 

 

 

 

 

 

Net income

  $225,937  $139,927  $50,796 

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Adjustments to reconcile net income to net cash provided by operating activities:

    

 

 

 

 

 

 

 

 

 

 

 

 

Depreciation and amortization

   97,601  71,827  55,162 

 

 

141,492

 

 

 

131,979

 

 

 

97,601

 

Amortization of deferred financing costs and debt discount

   7,613  6,085  5,105 

 

 

7,363

 

 

 

6,521

 

 

 

7,613

 

Direct financing lease interest accretion

   (9,120 (8,032 (6,701

 

 

(9,783

)

 

 

(9,933

)

 

 

(9,120

)

Straight-line rent revenue

   (41,567 (26,187 (16,325

 

 

(90,811

)

 

 

(70,808

)

 

 

(41,567

)

Unit-based compensation

   7,942  11,122  9,165 

 

 

16,505

 

 

 

9,949

 

 

 

7,942

 

Gain from sale of real estate and other asset dispositions, net

   (61,224 (3,268 (2,857

Gain from sale of real estate and other, net

 

 

(719,392

)

 

 

(7,431

)

 

 

(61,224

)

Impairment charges

   7,229   —    50,128 

 

 

48,007

 

 

 

 

 

 

7,229

 

Straight-line rent and otherwrite-off

   3,063  2,812  2,818 

 

 

18,002

 

 

 

5,340

 

 

 

3,063

 

Unutilized financing fees/ debt refinancing costs

   22,539  4,367  1,698 

Debt refinancing costs

 

 

 

 

 

32,574

 

 

 

22,539

 

Other adjustments

   3,563  (6,334 (1,178

 

 

(3,768

)

 

 

(1,204

)

 

 

3,563

 

Decrease (increase) in:

    

Interest and rent receivable

   (13,247 (5,599 (3,856

Changes in:

 

 

 

 

 

 

 

 

 

 

 

 

Interest and rent receivables

 

 

46,498

 

 

 

(21,116

)

 

 

(13,247

)

Other assets

   (18,357 (8,297 764 

 

 

(18,051

)

 

 

(5,318

)

 

 

(19,202

)

Accounts payable and accrued expenses

   41,583  26,540  6,209 

 

 

(5,596

)

 

 

2,494

 

 

 

41,583

 

Deferred revenue

   (8,872 2,033  (485

 

 

145

 

 

 

(2,050

)

 

 

(8,872

)

  

 

  

 

  

 

 

Net cash provided by operating activities

   264,683  206,996  150,443 

 

 

449,088

 

 

 

362,235

 

 

 

263,838

 

Investing activities

    

 

 

 

 

 

 

 

 

 

 

 

 

Cash paid for acquisitions and other related investments

   (1,682,409 (2,218,869 (767,696

 

 

(1,430,995

)

 

 

(2,246,788

)

 

 

(1,682,409

)

Net proceeds from sale of real estate

   198,767  19,175  34,649 

 

 

1,513,666

 

 

 

64,362

 

 

 

198,767

 

Principal received on loans receivable

   906,757  771,785  11,265 

 

 

885,917

 

 

 

8,480

 

 

 

906,757

 

Investment in loans receivable

   (109,027 (354,001 (12,782

 

 

(212,002

)

 

 

(19,338

)

 

 

(109,027

)

Construction in progress and other

   (171,209 (146,372 (102,333

 

 

(53,967

)

 

 

(73,812

)

 

 

(171,209

)

Investment in unsecured senior notes

   (50,000  —     —   

 

 

 

 

 

 

 

 

(50,000

)

Proceeds from sale of unsecured senior notes

   50,000   —     —   

 

 

 

 

 

 

 

 

50,000

 

Other investments, net

   (69,423 (17,339 (13,126

 

 

(138,441

)

 

 

(94,970

)

 

 

(69,423

)

  

 

  

 

  

 

 

Net cash used for investing activities

   (926,544 (1,945,621 (850,023

Net cash provided by (used for) investing activities

 

 

564,178

 

 

 

(2,362,066

)

 

 

(926,544

)

Financing activities

    

 

 

 

 

 

 

 

 

 

 

 

 

Proceeds from term debt

   1,000,000  681,000  425,000 

 

 

759,735

 

 

 

2,355,280

 

 

 

1,000,000

 

Payments of term debt

   (575,299 (283 (100,266

 

 

 

 

 

(1,038,221

)

 

 

(575,299

)

Payment of deferred financing costs

   (15,468 (7,686 (14,496

 

 

 

 

 

(32,794

)

 

 

(15,468

)

Revolving credit facilities, net

   (810,000 509,415  490,625 

 

 

(811,718

)

 

 

550,415

 

 

 

(810,000

)

Distributions paid

   (218,393 (182,980 (144,365

 

 

(363,906

)

 

 

(326,729

)

 

 

(218,393

)

Lease deposits and other obligations to tenants

   14,557  (10,839 7,892 

 

 

(20,606

)

 

 

27,525

 

 

 

14,557

 

Proceeds from sale of units, net of offering costs

   1,173,651  817,389  138,173 

 

 

94,239

 

 

 

547,785

 

 

 

1,173,651

 

Other financing activities

   (16,485 (5,326  —   

 

 

(3,614

)

 

 

(12,984

)

 

 

(16,485

)

  

 

  

 

  

 

 

Net cash provided by financing activities

   552,563  1,800,690  802,563 
  

 

  

 

  

 

 

Increase in cash and cash equivalents for the year

   (109,298 62,065  102,983 

Net cash (used for) provided by financing activities

 

 

(345,870

)

 

 

2,070,277

 

 

 

552,563

 

Increase (decrease) in cash, cash equivalents and restricted cash for the year

 

 

667,396

 

 

 

70,446

 

 

 

(110,143

)

Effect of exchange rate changes

   (3,003 (11,065 (4,421

 

 

(17,218

)

 

 

16,920

 

 

 

(3,003

)

Cash and cash equivalents at beginning of year

   195,541  144,541  45,979 
  

 

  

 

  

 

 

Cash and cash equivalents at end of year

  $83,240  $195,541  $144,541 
  

 

  

 

  

 

 

Interest paid, including capitalized interest of $2,320 in 2016, $1,425 in 2015, and $1,860 in 2014

  $138,770  $107,228  $91,890 

Supplemental schedule ofnon-cash investing activities:

    

Mortgage loan issued from sale of real estate

  $—    $—    $12,500 

Increase in development project construction costs incurred, not paid

   15,857  2,684   —   

Cash, cash equivalents and restricted cash at beginning of year

 

 

172,247

 

 

 

84,881

 

 

 

198,027

 

Cash, cash equivalents and restricted cash at end of year

 

$

822,425

 

 

$

172,247

 

 

$

84,881

 

Interest paid, including capitalized interest of $1,480 in 2018, $840 in 2017,

and $2,320 in 2016

 

$

221,779

 

 

$

149,798

 

 

$

138,770

 

Supplemental schedule ofnon-cash financing activities:

    

 

 

 

 

 

 

 

 

 

 

 

 

Dividends declared, not paid

  $74,521  $52,402  $38,461 

 

$

95,419

 

 

$

89,403

 

 

$

74,521

 

Cash, cash equivalents and restricted cash are comprised of the following:

 

 

 

 

 

 

 

 

 

 

 

 

Beginning of period:

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

171,472

 

 

$

83,240

 

 

$

195,541

 

Restricted cash, included in Other assets

 

 

775

 

 

 

1,641

 

 

 

2,486

 

 

$

172,247

 

 

$

84,881

 

 

$

198,027

 

End of period:

 

 

 

 

 

 

 

 

 

 

 

 

Cash and cash equivalents

 

$

820,868

 

 

$

171,472

 

 

$

83,240

 

Restricted cash, included in Other assets

 

 

1,557

 

 

 

775

 

 

 

1,641

 

 

$

822,425

 

 

$

172,247

 

 

$

84,881

 

See accompanying notes to consolidated financial statements.


Index to Financial Statements

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Notes To Consolidated Financial Statements

1. Organization

Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the General Corporation Law of Maryland for the purpose of engaging in the business of investing in, owning, and leasing healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., through which we conduct all of our operations, was formed in September 2003. Through another wholly-owned subsidiary, Medical Properties Trust, LLC, we are the sole general partner of the Operating Partnership. At present, we directly own substantially all of the limited partnership interests in the Operating Partnership and have elected to report our required disclosures and that of the Operating Partnership on a combined basis, except where material differences exist.

We have operated as a REITreal estate investment trust (“REIT”) since April 6, 2004, and accordingly, elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will generally not be subject to United States (“U.S.”) federal income tax, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income.

Our primary business strategy is to acquire and develop real estate and improvements, primarily for long-term lease to providers of healthcare services such as operators of general acute care hospitals, inpatient physical rehabilitation hospitals, long-term acute care hospitals, surgery centers, centers for treatment of specific conditions such as cardiac, pulmonary, cancer, and neurological hospitals, and other healthcare-oriented facilities. We also make mortgage and other loans to operators of similar facilities. In addition, we may obtain profits or equity interests in our tenants, from time to time, in order to enhance our overall return. We manage our business as a single business segment. All of our properties are located in the U.S. and Europe.

2. Summary of Significant Accounting Policies

Use of Estimates: The preparation of financial statements in conformity with accounting principles generally accepted in the U.S. requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Principles of Consolidation: Property holding entities and other subsidiaries of which we own 100% of the equity or have a controlling financial interest evidenced by ownership of a majority voting interest are consolidated. All inter-company balances and transactions are eliminated. For entities in which we own less than 100% of the equity interest, we consolidate the property if we have the direct or indirect ability to control the entities’ activities based upon the terms of the respective entities’ ownership agreements. For these entities, we record anon-controlling interest representing equity held bynon-controlling interests. interests.

We continually evaluate all of our transactions and investments to determine if they represent variable interests in a variable interest entity (“VIE”). If we determine that we have a variable interest in a VIE, we then evaluate if we are the primary beneficiary of the VIE. The evaluation is a qualitative assessment as to whether we have the ability to direct the activities of a VIE that most significantly impact the entity’s economic performance. We consolidate each VIE in which we, by virtue of or transactions with our investments in the entity, are considered to be the primary beneficiary.

Index to Financial Statements

At December 31, 2016,2018, we had loans and/or equity investments in certain VIEs, which are also tenants of our facilities, (including but not limited to Ernest and Vibra).facilities. We have determined that we are not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at December 31, 20162018 (in thousands):

 

VIE

Type

  Maximum Loss
Exposure(1)
   Asset Type
Classification
   Carrying
Amount(2)
 

 

Maximum Loss

Exposure(1)

 

 

Asset Type

Classification

 

Carrying

Amount(2)

 

Loans, net

  $316,179    Mortgage and other loans   $235,613 

Equity investments

  $13,223    Other assets   $140 

 

$

17,187

 

 

Other assets

 

$

 

 

(1)

Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities.

Our maximum loss exposure related to our equity investment in VIEs represent the current carrying values of such investment plus any other related assets (such as rent receivables) less any liabilities.

(2)

Carrying amount reflects the net book value of our loan or equity interest only in the VIE.

For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as theday-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance. As of December 31, 2016,2018, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which it could be exposed to further losses (e.g., cash short falls).

68


Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower.

See Note 3 and 10 for additional description of the nature, purpose and activities of some of our VIEs and interests therein.

Investments in Unconsolidated Entities:Investments in entities in which we have the ability to significantly influence (but not control) are typically accounted for by the equity method.method, such as our joint venture with Primotop as discuss in Note 3. Under the equity method of accounting, our share of the investee’s earnings or losses are included in the other income line of our consolidated statements of net income, andincome. Except for our joint venture with Primotop, we have elected to record our share of such investee’s earnings or losses on a90-day lag basis. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the interest in the investee entity. Subsequently, our investments are increased/decreased by our share in the investees’ earningsearnings/losses and decreased by cash distributions from our investees. To the extent that our cost basis is different from the basis reflected at the investee entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the investee.

Investments in entities in which we do not control nor do we have the ability to influence (such as our investments in Steward and MEDIAN) are accounted for using the cost method. The initial carrying value of such investments is based on the amount paid to purchase the interest in the investee entity. No income is recorded on our cost method investments until distributions are received.

We evaluate our equity and cost method investments for impairment based upon a comparison of the fair value of the equity method investment to its carrying value, when impairment indicators exist. If we determine a decline in the fair value of an investment in an unconsolidated investee entity below its carrying value is other-than-temporary, anand impairment is recorded.

Investments in entities in which we do not control nor do we have the ability to significantly influence and for which there is no readily determinable fair value (such as our investments in Steward Health Care System LLC (“Steward”) and Median Kliniken S.á.r.l. (“MEDIAN”)) are accounted for at cost, less any impairment, plus or minus changes resulting from observable price changes in orderly transactions involving the investee.

Cash and Cash Equivalents: Certificates of deposit, short-term investments with original maturities of three months or less and money-market mutual funds are considered cash equivalents. The majority of our cash and cash equivalents are held at major commercial banks, which at times may exceed the Federal Deposit Insurance Corporation limit. We have not experienced any losses to date on our invested cash. Cash and cash equivalents which have been restricted as to its use are recorded in other assets.

Index to Financial Statements

Revenue Recognition: We receive income from operating leases based on the fixed, minimum required rents (base rents) per the lease agreements. Rent revenue from base rents is recorded on the straight-line method over the terms of the related lease agreements for new leases and the remaining terms of existing leases for those acquired as part of a property acquisition. The straight-line method records the periodic average amount of base rent earned over the term of a lease, taking into account contractual rent increases over the lease term. The straight-line method typically has the effect of recording more rent revenue from a lease than a tenant is required to pay early in the term of the lease. During the later parts of a lease term, this effect reverses with less rent revenue recorded than a tenant is required to pay. Rent revenue, as recorded on the straight-line method, in the consolidated statements of net income is presented as two amounts: rent billed and straight-line revenue. Rent billed revenue is the amount of base rent actually billed to the customerour tenants each period as required by the lease. Straight-line rent revenue is the difference between rent revenue earned based on the straight-line method and the amount recorded as rent billed revenue. We record the difference between base rent revenues earned and amounts due per the respective lease agreements, as applicable, as an increase or decrease to straight-line rent receivable.

Certain leases may provide for additional rents contingent upon a percentage of the tenant’s revenue in excess of specified base amounts/thresholds (percentage rents). Percentage rents are recognized in the period in which revenue thresholds are met. Rental payments received prior to their recognition as income are classified as deferred revenue. We also receive additional rent (contingent rent) under some leases based on increases in the CPIconsumer price index (“CPI”) or when the CPI exceeds the annual minimum percentage increase as stipulated in the lease. Contingent rents are recorded as rent billed revenue in the period earned. Rental payments received prior to their recognition as income are classified as deferred revenue.

We use DFLdirect financial lease (“DFL”) accounting to record rent on certain leases deemed to be financing leases, per accounting rules, rather than operating leases. For leases accounted for as DFLs, the future minimum lease payments are recorded as a receivable. The difference between the future minimum lease payments and the estimated residual values less the cost of the properties is recorded as unearned income. Unearned income is deferred and amortized to income over the lease terms to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unearned income.

In instances where we have a profits or equity interest in our tenants’ operations, we record income equal to our percentage interest of the tenants’ profits, as defined in the lease or tenants’ operating agreements, once annual thresholds, if any, are met.

We begin recording base rent income from our development projects when the lessee takes physical possession of the facility, which may be different from the stated start date of the lease. Also, during construction of our development projects, we are generallymay be entitled to accrue rent based on the cost paid during the construction period (construction period rent). We accrue construction period rent as a receivable with a corresponding offset to deferred revenue during the construction period. When the lessee takes physical possession of the facility, we begin recognizing the deferred construction period revenue on the straight-line method over the remaining term of the lease.

We receive interest income from our tenants/borrowers on mortgage loans, working capital loans, and other long-term loans. Interest income from these loans is recognized as earned based upon the principal outstanding and terms of the loans.

Commitment fees received from lessees for development and leasing services are initially recorded as deferred revenue and recognized as income over the initial term of a lease to produce a constant effective yield on the lease (interest method). Commitment

69


and origination fees from lending services are also recorded as deferred revenue initially and recognized as income over the life of the loan using the interest method.

Tenant payments for certain taxes, insurance, and other operating expenses related to our facilities (most of which are paid directly by our tenants to the government or appropriate third party vendor) are recorded net of the respective expense as generally our leases are“triple-net” “triple-net” leases, with terms requiring such expenses to be

Index to Financial Statements

paid by our tenants. Failure on the part of our tenants to pay such expense or to pay late would result in a violation of the lease agreement, which could lead to an event of default, if not cured.

In regards to property disposals, starting January 1, 2018, we account for such transactions pursuant to ASU No. 2014-09, “Revenue from Contracts with Customers,” (“ASU 2014-09”). Under this guidance, we recognize a sale of real estate when control has been transferred to the buyer and collection of the sales price is probable. Prior to 2018, we could not recognize a sale if we had continuing involvement in the real estate. Upon adoption of the new accounting guidance, we recorded a $2 million adjustment to retained earnings to fully recognize a gain on real estate sold in prior years that was required to be deferred under old accounting guidance.

Acquired Real Estate Purchase Price Allocation: For existing  Since January 1, 2018 with adoption of ASU No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”), all of our property acquisitions have been accounted for as asset acquisitions. Prior to 2018, properties acquired for leasing purposes we accountwere accounted for such acquisitions based onusing business combination accounting rules. WeThe primary impact to us from this change in accounting is the capitalization of third party transaction costs that are directly related to the acquisition as these costs were expensed under business combination accounting rules. Under either accounting method, we allocate the purchase price of acquired properties to net tangible and identified intangible assets acquired based on their fair values. In making estimates of fair values for purposes of allocating purchase prices of acquired real estate, we may utilize a number of sources, from time to time, including available real estate broker data, independent appraisals that may be obtained in connection with the acquisition or financing of the respective property, internal data from previous acquisitions or developments, and other market data. We also consider information obtained about each property as a result of ourpre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the tangible and intangible assets acquired.

We measure the aggregate value of lease intangible assets acquired based on the difference between (i) the property valued with new orin-place leases adjusted to market rental rates and (ii) the property valued as if vacant. Management’s estimates of value are made using methods similar to those used by independent appraisers (e.g., discounted cash flow analysis). Factors considered by management in our analysis include an estimate of carrying costs during hypothetical expectedlease-up periods, considering current market conditions, and costs to execute similar leases. We also consider information obtained about each targeted facility as a result of ourpre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the intangible assets acquired. In estimating carrying costs, management includes real estate taxes, insurance and other operating expenses and estimates of lost rentals at market rates during the expectedlease-up periods, which we expect to be about six months depending on specific local market conditions. Management also estimates costs to execute similar leases including leasing commissions, legal costs, and other related expenses to the extent that such costs are not already incurred in connection with a new lease origination as part of the transaction.

We record above-market and below-marketin-place lease values, if any, for our facilities, which are based on the present value of the difference between (i) the contractual amounts to be paid pursuant to thein-place leases and (ii) management’s estimate of fair market lease rates for the correspondingin-place leases, measured over a period equal to the remainingnon-cancelable term of the lease. We amortize any resulting capitalized above-market lease values as a reduction of rental income over the lease term. We amortize any resulting capitalized below-market lease values as an increase to rental income over the lease term.

Other intangible assets acquired may include customer relationship intangible values which are based on management’s evaluation of the specific characteristics of each prospective tenant’s lease and our overall relationship with that tenant. Characteristics to be considered by management in allocating these values include the nature and extent of our existing business relationships with the tenant, growth prospects for developing new business with the tenant, the tenant’s credit quality and expectations of lease renewals, including those existing under the terms of the lease agreement, among other factors.

We amortize the value of these intangible assets to expense over the term of the respective leases. If a lease is terminated early, the unamortized portion of the lease intangibles are charged to expense.

Goodwill:Goodwill is deemed to have an indefinite economic life and is not subject to amortization. Goodwill is tested annually for impairment and is tested for impairment more frequently if events and circumstances indicate that the asset might be impaired. The impairment testing involves atwo-step approach. The first step determines if goodwill is impaired by comparing the fair value of the reporting unit as a whole to its book value. If a deficiency exists, the second step measures the amount of the impairment loss as the difference between the implied fair value of goodwill and its carrying value.

Real Estate and Depreciation: Real estate, consisting of land, buildings and improvements, are maintained at cost. Although typically paid by our tenants, any expenditure for ordinary maintenance and repairs that we pay

Index to Financial Statements

are expensed to operations as incurred. Significant renovations and improvements which improve and/or extend the useful life of the asset are capitalized and depreciated over their estimated useful lives. We record impairment losses on long-lived assets used in operations when events and circumstances indicate that the assets might be impaired and the undiscounted cash flows estimated to be generated by those assets, including an estimated liquidation amount, during the expected holding periods are less than the carrying amounts of those assets. Impairment losses are measured as the difference between carrying value and fair value of the assets. For assets held for sale, we cease recording depreciation expense and adjust the assets’ value to the lower of its carrying value or fair value, less cost of disposal. Fair value is

70


based on estimated cash flows discounted at a risk-adjusted rate of interest. We classify real estate assets as held for sale when we have commenced an active program to sell the assets, and in the opinion of management, it is probable the asset will be sold within the next 12 months.

Construction in progress includes the cost of land, the cost of construction of buildings, improvements and fixed equipment, and costs for design and engineering. Other costs, such as interest, legal, property taxes and corporate project supervision, which can be directly associated with the project during construction, are also included in construction in progress. We commence capitalization of costs associated with a development project when the development of the future asset is probable and activities necessary to get the underlying property ready for its intended use have been initiated. We stop the capitalization of costs when the property is substantially complete and ready for its intended use.

Depreciation is calculated on the straight-line method over the estimated useful lives of the related real estate and other assets. Our weighted-averageweighted average useful lives at December 31, 20162018 are as follows:

 

Buildings and improvements

38.8

39.2 years

Tenant lease intangibles

23.9

26.0 years

Leasehold improvements

17.9

16.4 years

Furniture, equipment and other

9.5

9.8 years

Losses from Rent Receivables: For all leases, we continuously monitor the performance of our existing tenants including, but not limited to: admission levels and surgery/procedure volumes by type; current operating margins; ratio of our tenants’ operating margins both to facility rent and to facility rent plus other fixed costs; trends in cash collections; trends in revenue and patient mix; and the effect of evolving healthcare regulations on tenants’ profitability and liquidity.

Losses from Operating Lease Receivables: We utilize the information above along with the tenant’s payment and default history in evaluating (on aproperty-by-property basis) whether or not a provision for losses on outstanding rent receivables is needed. A provision for losses on rent receivables (including straight-line rent receivables) is ultimately recorded when it becomes probable that the receivable will not be collected in full. The provision is an amount which reduces the receivable to its estimated net realizable value based on a determination of the eventual amounts to be collected either from the debtor or from existing collateral, if any.

Losses on DFL Receivables: Allowances are established for DFLs based upon an estimate of probable losses on aproperty-by-property basis. DFLs are impaired when it is deemed probable that we will be unable to collect all amounts due in accordance with the contractual terms of the lease. Like operating lease receivables, the need for an allowance is based upon our assessment of the lessee’s overall financial condition; economic resources and payment record; the prospects for support from any financially responsible guarantors; and, if appropriate, the realizable value of any collateral. These estimates consider all available evidence including the expected future cash flows discounted at the DFL’s effective interest rate, fair value of collateral, and other relevant factors, as appropriate. DFLs are placed onnon-accrual status when we determine that the collectability of contractual amounts is not reasonably assured. If onnon-accrual status, we generally account for the DFLs on a cash basis, in which income is recognized only upon receipt of cash.

Index to Financial Statements

Loans: Loans consist of mortgage loans, working capital loans and other long-term loans. Mortgage loans are collateralized by interests in real property. Working capital and other long-term loans are generally collateralized by interests in receivables and corporate and individual guarantees. We record loans at cost. We evaluate the collectability of both interest and principal on aloan-by-loan basis (using the same process as we do for assessing the collectability of rents) to determine whether they are impaired. A loan is considered impaired when, based on current information and events, it is probable that we will be unable to collect all amounts due according to the existing contractual terms. When a loan is considered to be impaired, the amount of the allowance is calculated by comparing the recorded investment to either the value determined by discounting the expected future cash flows using the loan’s effective interest rate or to the fair value of the collateral, if the loan is collateral dependent. If a loan is deemed to be impaired, we generally place the loan onnon-accrual status and record interest income only upon receipt of cash.

Earnings Per Share/Units: Basic earnings per common share/unit is computed by dividing net income applicable to common shares/units by the weighted number of shares/units of common stock/units outstanding during the period. Diluted earnings per common share/units is calculated by including the effect of dilutive securities.

Our unvested restricted stock/unit awards containnon-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. These participating securities are included in the earnings allocation in computing both basic and diluted earnings per common share/unit.

Income Taxes: We conduct our business as a REIT under Sections 856 through 860 of the Code.Internal Revenue Code of 1986, as amended (“the Code”). To qualify as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to stockholders at least 90% of our REIT’s ordinary taxable income. As a REIT, we generally pay little U.S.

71


federal and state income tax because of the dividends paid deduction that we are allowed to take. If we fail to qualify as a REIT in any taxable year, we will then be subject to U.S. federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost, unless the IRSInternal Revenue Service grants us relief under certain statutory provisions. Such an event could materially adversely affect our net income and net cash available for distribution to stockholders. However, we intend to operate in such a manner so that we will remain qualified as a REIT for U.S. federal income tax purposes.

Our financial statements include the operations of TRSs, includinga taxable REIT subsidiary (“TRS”), MPT Development Services, Inc. (“MDS”), alongand with many other entities, which are single member LLCs that are disregarded for tax purposes and are reflected in the tax returns of MDS. Our TRS entities areMDS is not entitled to a dividends paid deduction and areis subject to U.S. federal, state, and local income taxes. Our TRS entities areMDS is authorized to provide property development, leasing, and management services for third-party owned properties, and they maywe will make non-mortgage loans to and/or investments in our lessees.lessees through this entity.

With the property acquisitions and investments in Europe, we are subject to income taxes internationally. However, we do not expect to incur any additional income taxes in the U.S. as such income from our international properties will flowflows through our REIT income tax returns. For our TRS and international subsidiaries, we determine deferred tax assets and liabilities based on the differences between the financial reporting and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Any increase or decrease in our deferred tax receivables/assets/liabilities that results from a change in circumstances and that causes us to change our judgment about expected future tax consequences of events, is reflected in our tax provision when such changes occur. Deferred income taxes also reflect the impact of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of our deferred tax assets will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about the realizability ofour ability to realize the related deferred tax asset, is reflected in our tax provision when such changes occur.

Index to Financial Statements

The calculation of our tax liabilities involveincome taxes involves dealing with uncertainties in the application of complex tax laws and regulations in a multitude of jurisdictions across our global operations. AAn income tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, on the basis of technical merits. However, if a more likely than not position cannot be reached, we record a liability as an off-set to the tax benefit and adjust the liabilities when our judgment changes as a result of the evaluation of new information not previously available. Because of the complexity of some of these uncertainties, the ultimate resolution may result in a payment that is materially different from our current estimate of the uncertain tax position liabilities. These differences will be reflected as increases or decreases to income tax expense in the period in which new information is available.

Stock-Based Compensation: We adopted the 2013 Equity Incentive Plan (the “Equity Incentive Plan”) during the second quarter of 2013. Awards of restricted stock, stock options and other equity-based awards with service conditions are amortized to compensation expense over the vesting periods (typically three years), using the straight-line method. Awards that contain market conditions are amortized to compensation expense over the derived vesting periods, which correspond to the periods over which we estimate the awards will be earned, which generally range from three to five years, using the straight-line method. Awards with performance conditions are amortized using the straight-line method over the service period in which the performance conditions are measured, adjusted for the probability of achieving the performance conditions. Forfeitures of stock-based awards are recognized as they occur.

Deferred Costs: Costs incurred that directly relate to the offerings of stock are deferred and netted against proceeds received from the offering. Leasing commissions and other leasing costs directly attributable to tenant leases are capitalized as deferred leasing costs and amortized on the straight-line method over the terms of the related lease agreements. Costs identifiable with loans made to borrowers are capitalized and recognized as a reduction in interest income over the life of the loan.

Deferred Financing Costs: We amortize deferredgenerally capitalize financing costs incurred in connection with anticipatednew financings and refinancings of debt. These costs are amortized over the lives of the related debt as an addition to interest expense. For debt with defined principalre-payment terms, the deferred costs are amortized to produce a constant effective yield on the debt (interest method) and are included within Debt, net on our consolidated balance sheets. For debt without defined principal repayment terms, such as our revolving credit agreements,facility, the deferred costs are amortized on the straight-line method over the term of the debt and are included as a component of Other Assetsassets on our consolidated balance sheets.

Foreign Currency Translation and Transactions:Certain of our international subsidiaries’ functional currencies are the local currencies of their respective countries. We translate the results of operations of our foreign subsidiaries into U.S. dollars using average rates of exchange in effect during the period, and we translate balance sheet accounts using exchange rates in effect at the end of the period. We record resulting currency translation adjustments in accumulated other comprehensive income (loss), a component of stockholders’ equity on our consolidated balance sheets.

72


Certain of our U.S. subsidiaries will enter into short-term and long-term transactions denominated in a foreign currency from time to time. Gains or losses resulting from these foreign currency transactions are translated into U.S. dollars at the rates of exchange prevailing at the dates of the transactions. The effects of transaction gains or losses on our short-term transactions are included in other income in the consolidated statements of income, while the translation effects on our long-term investments are recorded in accumulated other comprehensive income (loss) on our consolidated balance sheets.

Derivative Financial Investments and Hedging Activities:  During our normal course of business, we may use certain types of derivative instruments for the purpose of managing interest rate and/or foreign currency risk. We record our derivative and hedging instruments at fair value on the balance sheet. Changes in the estimated fair value of derivative instruments that are not designated as hedges or that do not meet the criteria for hedge

Index to Financial Statements

accounting are recognized in earnings. For derivatives designated as cash flow hedges, the change in the estimated fair value of the effective portion of the derivative is recognized in accumulated other comprehensive income (loss), on our consolidated balance sheets, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings. For derivatives designated as fair value hedges, the change in the estimated fair value of the effective portion of the derivatives offsets the change in the estimated fair value of the hedged item, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings.

To qualify for hedge accounting, we formally document all relationships between hedging instruments and hedged items, as well as our risk management objective and strategy for undertaking the hedge prior to entering into a derivative transaction. This process includes specific identification of the hedging instrument and the hedge transaction, the nature of the risk being hedged and how the hedging instrument’s effectiveness in hedging the exposure to the hedged transaction’s variability in cash flows attributable to the hedged risk will be assessed. Both at the inception of the hedge and on an ongoing basis, we assess whether the derivatives that are used in hedging transactions are highly effective in offsetting changes in cash flows or fair values of hedged items. In addition, for cash flow hedges, we assess whether the underlying forecasted transaction will occur. We discontinue hedge accounting if a derivative is not determined to be highly effective as a hedge or that it is probable that the underlying forecasted transaction will not occur.

Fair Value Measurement: We measure and disclose the estimated fair value of financial assets and liabilities utilizing a hierarchy of valuation techniques based on whether the inputs to a fair value measurement are considered to be observable or unobservable in a marketplace. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect our market assumptions. This hierarchy requires the use of observable market data when available. These inputs have created the following fair value hierarchy:

Level 1 — quoted prices for identical instruments in active markets;

Level 1 — quoted prices foridenticalinstruments in active markets;

Level 2 — quoted prices for similar instruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

Level 2 — quoted prices forsimilarinstruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers areunobservable.

We measure fair value using a set of standardized procedures that are outlined herein for all assets and liabilities which are required to be measured at their estimated fair value on either a recurring ornon-recurring basis. When available, we utilize quoted market prices from an independent third party source to determine fair value and classify such items in Level 1. In some instances where a market price is available, but the instrument is in an inactive orover-the-counter market, we apply the dealer (market maker) pricing estimate and classify the asset or liability in Level 2.

If quoted market prices or inputs are not available, fair value measurements are based upon valuation models that utilize current market or independently sourced market inputs, such as interest rates, option volatilities, credit spreads, market capitalization rates, etc. Items valued using such internally-generated valuation techniques are classified according to the lowest level input that is significant to the fair value measurement. As a result, the asset or liability could be classified in either Level 2 or 3 even though there may be some significant inputs that are readily observable. Internal fair value models and techniques used by us include discounted cash flow and Monte Carlo valuation models. We also consider our counterparty’s and own credit risk on derivatives and other liabilities measured at their estimated fair value.

Fair Value Option Election: For our equity interest in Ernest along with any related loans (as more fully described in(all of which other than the mortgage loans were sold or paid off on October 4, 2018 - see Note 3 and 10)for more details), we have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. Other than the Capella equity investment held at December 31, 2015, weWe have not made a similar election for other existing equity interestinterests or loans.

loans that existed at December 31, 2018.

IndexReclassifications: Certain amounts in the consolidated financial statements for prior periods have been reclassified to Financial Statements
conform to the current period presentation.

73


Recent Accounting Developments:

Revenue from Contracts with Customers

In May 2014, the FASB issued Accounting Standards Update (“ASU”)No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. Entities may use a full retrospective approach or report the cumulative effect as of the date of adoption. On April 1, 2015, the FASB proposed deferring the effective date of this standard by one year to December 15, 2017, for annual reporting periods beginning after that date. The FASB also proposed permitting early adoption of the standard, but not before the original effective date of December 15, 2016. We do not expect this standard to have a significant impact on our financial results, as a substantial portion of our revenue consists of rental income from leasing arrangements, which are specifically excluded from ASUNo. 2014-09.

Leases

In February 2016, the FASB issuedASU 2016-02, “Leases”, which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either financefinancing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight linestraight-line basis over the term of the lease. A lessee is also required to record aright-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. The ASU is not effective for us until January 1, 2019, with early adoption permitted. We are continuing to evaluate this standard and the impact to us from both a lessor and lessee perspective.

Measurement of Credit Losses on Financial Instruments

In June 2016,July 2018, the FASB issued ASU2016-13, “Measurement of Credit Losses on Financial Instruments” 2018-11, “Leases (Topic 842): Targeted Improvements” (“ASU 2018-11”), which is intendedallowing companies to improve financial reporting by requiring timely recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets not recorded at fair value based on historical experience, current conditions, and reasonable and supportable forecasts. The ASU will be required to be implemented throughrecord a cumulative-effectcumulative adjustment to retained earnings asin the period of adoption rather than requiring the beginningrestatement of the first reporting period in which the amendments are effective. The ASUprior periods.

This standard is not effective for us untilon January 1, 2019. We do have leases in which we are the lessee, including ground leases, on which certain of our facilities reside, along with corporate office and equipment leases. Although we do not expect any change in the current operating lease classification of these leases, we will record a right-of-use asset and a lease liability on our balance sheet upon adoption of this ASU to have a significant impact on our consolidated financial statements.

Classification of Certain Cash Receipts and Cash Payments

In August 2016, the FASB issued ASUNo. 2016-15, “Classification of Certain Cash Receipts and Cash Payments”,standard, which clarifies the classification within the statement of cash flows for certain transactions, including debt extinguishment costs,zero-coupon debt, contingent consideration related to business combinations, insurance proceeds, equity method distributions and beneficial interests in securitizations. The standard also clarifies that cash flows with aspects of multiple classes of cash flows or that cannot be separated by source or use should be classified based on the activity that is likelywe estimate to be between $80 million to $90 million with any difference recorded as a cumulative adjustment in equity. From a lessor perspective, we do not expect any change in the predominant source or usecurrent classification and accounting of cash flowsour existing leases. However, we do expect certain non-lease components (such as certain operating expenses that we pay and our tenants reimburse us for the item. This guidance is effective for us starting January 1, 2018; however, we believepursuant to our current cash flow presentation is generally consistent with this standard.

Clarifying the Definition of a Business

In January 2017, the FASB issued ASUNo. 2017-01, “Clarifying the Definition of a Business” (“ASU2017-01”). The amendments in ASU2017-01 provide an initial screen“triple-net” leases) to determine if substantially allbe recorded gross versus net of the fair

Index to Financial Statements

value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, in which case, the transaction would be accounted for as an asset acquisition. In addition, ASU2017-01 clarifies the requirements for a set of activities to be considered a business and narrows the definition of an output. ASU2017-01 is effective for fiscal years, and interim periods within, beginning after December 15, 2017. Early adoption is permitted. A reporting entity must apply the amendments in ASU2017-01 using a prospective approach. Uponrespective expenses upon adoption of this standard in 2019 in accordance with ASU2017-01, No. 2014-09, “Revenue from Contracts with Customers (Topic 606)”. For those operating expenses that our tenants pay directly to third parties pursuant to our leases, we expectwill continue to recognizepresent on a majority of our real estate acquisitions as asset transactions rather than business combinations which will result in the capitalization of related third party transaction costs.

Reclassifications and Revisions:

Certain amounts in the consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.net basis.

3. Real Estate Activities

Acquisitions

For the years ended December 31, 2018, 2017, and Loans Receivable

Acquisitions

We2016, we acquired the following assets:

 

  2016 2015 2014 

 

2018

 

 

2017

 

 

2016

 

  (in thousands) 

 

(in thousands)

 

Assets Acquired

  

 

 

 

 

 

 

 

 

 

 

 

 

Land

  $91,176  $120,746  $22,569 

 

$

71,880

 

 

$

240,993

 

 

$

91,071

 

Building

   654,772  741,935  241,242 

 

 

686,739

 

 

 

985,219

 

 

 

655,324

 

Intangible lease assets — subject to amortization (weighted average useful life of 28.5 years in 2016, 30.0 years in 2015 and 18.2 years in 2014)

   94,614  176,383  22,513 

Intangible lease assets — subject to amortization

(weighted average useful life of 27.9 years in 2018,

27.7 years in 2017, and 28.5 years in 2016)

 

 

90,651

 

 

 

181,004

 

 

 

94,167

 

Net investments in direct financing leases

   178,000  174,801   —   

 

 

 

 

 

40,450

 

 

 

178,000

 

Mortgage loans

   600,000  380,000   —   

 

 

 

 

 

700,000

 

 

 

600,000

 

Other loans

   —    523,605  447,664 

 

 

336,458

 

 

 

 

 

 

 

Equity investments and other assets

   70,166  101,716  33,708 

 

 

245,267

 

 

 

100,000

 

 

 

70,166

 

Liabilities assumed

   (6,319 (317  —   

 

 

 

 

 

(878

)

 

 

(6,319

)

  

 

  

 

  

 

 

Total assets acquired

  $1,682,409  $2,218,869  $767,696 

 

$

1,430,995

 

 

$

2,246,788

 

 

$

1,682,409

 

Loans repaid(1)

   (193,262 (385,851  —   

 

 

(764,447

)

 

 

 

 

 

(193,262

)

  

 

  

 

  

 

 

Total net assets acquired

  $1,489,147  $1,833,018  $767,696 

 

$

666,548

 

 

$

2,246,788

 

 

$

1,489,147

 

  

 

  

 

  

 

 

 

(1)

$93.3 million

The 2018 column includes $0.8 billion of loans advanced to Steward in 2016 and repaid in 2018 as part of sale leaseback conversion described below. The 2016 column includes $93.3 million of loans advanced to Capella(2) in 2015 and repaid in 2016 as a part of the Capella transaction and(2), along with $100.0 million of loans advanced to Prime Healthcare Services, Inc. (“Prime”) in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey. $385.9 million loans advanced

(2)

In 2018, LifePoint Health, Inc. (“LifePoint”) merged with RCCH, who acquired Capella Healthcare, Inc. (“Capella”) in 2016.  Any reference to MEDIAN in 2014 and repaid in 2015 as a part ofeither LifePoint, RCCH, or Capella represent the MEDIAN transaction.same entity.

Purchase price allocations attributable74


2018 Activity

Joint Venture Transaction

On August 31, 2018, we completed a joint venture arrangement with Primotop Holdings S.à.r.l. (“Primotop”) pursuant to acquisitionswhich we contributed 71 of our post-acute hospitals in Germany, with an aggregate fair value of €1.635 billion, for a 50% interest, while Primotop contributed cash for its 50% interest in the joint venture. As part of the transaction, we received an aggregate amount of approximately €1.14 billion, from the proceeds of the cash contributed by Primotop and the secured debt financing placed on the joint venture’s real estate (as more fully discussed in Note 4), and we recognized an approximate €500 million gain on sale. Our interest in the joint venture is made duringup of a 50% equity investment valued at approximately €210 million, which is being accounted for under the equity method of accounting, and a €290 million shareholder loan (with terms identical to Primotop’s shareholder loan).

Other Transactions

On August 31, 2018, we acquired an acute care facility in Pasco, Washington for $17.5 million. The property is leased to RCCH, pursuant to the existing long-term master lease entered into with RCCH in April 2016.

On August 28, 2018, we acquired three inpatient rehabilitation hospitals in Germany for €17.3 million (including real estate transfer taxes). These hospitals are part of a four-hospital portfolio that we agreed to purchase for an aggregate amount of €23 million (including real estate transfer taxes) in June 2018 – see Note 13 for an update on the final property in this portfolio. The properties are leased to MEDIAN, pursuant to a new 27-year master lease with annual escalators at the greater of 1% or 70% of the change in German CPI.

During 2018, we acquired the fee simple real estate of five general acute care hospitals, four of which are located in Massachusetts and one located in Texas, from Steward Health Care System LLC (“Steward”) in exchange for the reduction of $764.4 million of mortgage loans made to Steward in October 2016 fourth quarterand March 2018, along with additional cash consideration. These properties are preliminary. When all relevant informationbeing leased to Steward pursuant to the original master lease from October 2016 that had an initial 15-year term with three five-year extension options, plus CPI increases.

2017 Activity

Steward Transactions

On September 29, 2017, we acquired, from IASIS Healthcare LLC (“IASIS”), a portfolio of ten acute care hospitals and one behavioral health facility, along with ancillary land and buildings, that are located in Arizona, Utah, Texas, and Arkansas. The portfolio is obtained, resulting changes, if any, to our provisionalnow operated by Steward which separately completed its acquisition of the operations of IASIS on September 29, 2017. Our investment in the portfolio includes the acquisition of eight acute care hospitals and one behavioral health facility for approximately $700 million, the making of $700 million in mortgage loans on two acute care hospitals, and a $100 million minority equity contribution in Steward, for a combined investment of approximately $1.5 billion.

On May 1, 2017, we acquired eight hospitals previously affiliated with Community Health Systems, Inc. in Florida, Ohio, and Pennsylvania for an aggregate purchase price allocation will be adjusted to reflect new information obtained about the facts and circumstances that existed asof $301.3 million.

See “2016 Activity — Acquisition of Steward Portfolio” below for details of the respective acquisition dates that, if known, would have affectedmaster lease and mortgage loan terms.

MEDIAN Transactions

On November 29, 2017, we acquired three rehabilitation hospitals in Germany for an aggregate purchase price of €80 million. The facilities are leased to affiliates of MEDIAN, pursuant to a new long-term master lease. The lease began on November 30, 2017, and the measurementterm is for 27 years (ending in November 2044). The lease provides for increases in rent at the greater of one percent or 70% of the amounts recognizedchange in German CPI.

During the third quarter of 2017, we acquired two rehabilitation hospitals in Germany for an aggregate purchase price of €39.2 million, in addition to 11 rehabilitation hospitals in Germany that we acquired in the second quarter of 2017 for an aggregate purchase price of €127 million. These 13 properties are leased to affiliates of MEDIAN, pursuant to a third master lease entered into in 2016. (See “2016 Activity” below for details of this master lease.) These acquisitions are the final properties of the portfolio of 20 properties in Germany that we agreed to acquire in July 2016 for €215.7 million, of which seven properties totaling €49.5 million closed in December 2016.

On June 22, 2017, we acquired an acute care hospital in Germany for a purchase price of €19.4 million, of which €18.6 million was paid upon closing with the remainder being paid over four years. This property is leased to affiliates of MEDIAN, pursuant to an existing master lease agreement that ends in December 2042 with annual escalators at the greater of one percent or 70% of the change in German CPI.

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On January 30, 2017, we acquired an inpatient rehabilitation hospital in Germany for €8.4 million. This acquisition was the final property to close as part of those dates.the six hospital portfolio that we agreed to buy in September 2016 for an aggregate amount of €44.1 million. This property is leased to affiliates of MEDIAN pursuant to the original long-term master lease agreement reached with MEDIAN in 2015.

Other Transactions

On June 1, 2017, we acquired the real estate assets of Ohio Valley Medical Center, a 218-bed acute care hospital located in Wheeling, West Virginia, and the East Ohio Regional Hospital, a 139-bed acute care hospital in Martins Ferry, Ohio, from Ohio Valley Health Services, a not-for-profit entity in West Virginia, for an aggregate purchase price of approximately $40 million. We simultaneously leased the facilities to Alecto Healthcare Services LLC (“Alecto”), pursuant to a lease with a 15-year initial term with 2% annual minimum rent increases and three 5-year extension options. The facilities are cross-defaulted and cross-collateralized with our other hospitals currently operated by Alecto. With these acquisitions, we also obtained a 20% interest in the operator of these facilities.

On May 1, 2017, we acquired the real estate of St. Joseph Regional Medical Center, a 145-bed acute care hospital in Lewiston, Idaho for $87.5 million. This facility is leased to RCCH, pursuant to the existing long-term master lease entered into with RCCH in April 2016.

2016 Activity

Acquisition of Steward Portfolio

On October 3, 2016, we closed on a portfolio of nine acute care hospitals in Massachusetts operated by Steward. Our investment in the portfolio includesincluded the acquisition of five hospitals for $600 million, the making of

Index to Financial Statements

$600 $600 million in mortgage loans on four facilities, and a $50 million minority equity contribution in Steward, for a combined investment of $1.25 billion. The five facilities acquired are being leased to Steward under a master lease agreement that has a15-year term (ending October 31, 2031) with three5-year extension options, plus annual inflation-based escalators. The terms of the mortgage loan are substantially similar to the master lease.

Other Acquisitions

From October 27, 2016 to December 31, 2016, we acquired 12 rehabilitation hospitals in Germany for an aggregate purchase price to us of €85.2 million. Of these acquisitions, five properties (totaling €35.7€35.6 million) are leased to affiliates of MEDIAN, pursuant to a master lease agreement reached with MEDIAN in 2015. (See “2015 Activity” below for further details of this master lease). The remaining seven properties (totaling €49.5 million) are leased to affiliates of MEDIAN, pursuant to a third master lease that has terms similar to the original master lease in 2015.2015 with a fixed 27-year lease term ending in August 2043.

On October 21, 2016, we acquired three general acute care hospitals and one free-standing emergency department and health center in New Jersey from Prime (as originally contemplated in the agreements) by reducing the $100 million mortgage loan made in September 2015 and advancing an additional $15 million. We are leasing these properties to Prime pursuant to a fifth master lease, which has a15-year initial term (ending in May 2031) with three five-year extension options, plus consumer-price indexed increases.

On July 22, 2016, we acquired an acute care facility in Olympia, Washington in exchange for a $93.3 million loan and an additional $7 million in cash, as contemplated in the initial Capella acquisition transaction in 2015. The terms of the Olympia lease are substantially similar to those of the master lease with Capella post lease amendment. See the Capella Disposal Transaction under the subheading “Disposals” below for further details on the terms of the Capellathese leases.

On June 22, 2016, we closed on the final property of the initial MEDIAN transaction that began in 2014 for a purchase price of € 41.6€41.6 million. See “2015 and 2014 Activity” for a description of the initial MEDIAN Transaction.

On May 2, 2016, we acquired an acute care hospital in Newark, New Jersey for an aggregate purchase price of $63 million leased to Prime pursuant to the fifth master lease. Furthermore, we committed to advance an additional $30 million to Prime over a three-year period to be used solely for capital additions to the real estate; any such addition will be added to the basisbase upon which the lessee will pay us rents. None of the additional $30 million has been funded to date.


Development Activities

From the respective acquisition dates in 2016 through year-end, the properties acquired during2018 Activity

During the year ended December 31, 2016, contributed $37.42018, we completed the construction on Ernest Flagstaff. This $25.5 million inpatient rehabilitation facility located in Flagstaff, Arizona opened on March 1, 2018 and $31.7 million of revenue and income (excluding related acquisition expenses), respectively, for the year ended December 31, 2016. In addition, we incurred $12.1 million of acquisition-related costs on the 2016 acquisitions for the year ended December 31, 2016.

2015 Activity

Acquisition of Capella Portfolio

In July 2015, we entered into definitive agreementsis being leased to acquire a portfolio of seven acute care hospitals owned and operated by Capella for a combined purchase price and investment of approximately $900 million, adjusted for any cash on hand. The transaction included our investments in seven acute care hospitals (two of which were in the form of mortgage loans) for an aggregate investment of approximately $600 million, an acquisition loan for approximately $290 million and a 49% equity interest in the ongoing operator of the facilities.

In conjunction with the acquisition, MPT Camaro Opco, LLC, a wholly-owned subsidiary of MDS, formed a joint venture limited liability company, Capella Health Holdings, LLC (“Capella Holdings”), with an entity affiliated with the senior management of Capella (“ManageCo”). MPT Camaro Opco, LLC held 49% of the equity interests in Capella Holdings and the ManageCo held the remaining 51%. Capella and its operating subsidiaries were managed and operated by ManageCoErnest pursuant to the terms of one or more management

Index to Financial Statements

agreements, the terms of which included base management fees payable to ManageCo and incentive payments tied to agreed benchmarks. Pursuant to the limited liability company agreement of Capella Holdings, ManageCo and MPT Camaro Opco, LLC shared profits and distributions from Capella Holdings according to a distribution waterfall under which, if certain benchmarks were met, after taking into account interest paid on the acquisition loan, ManageCo and MPT Camaro Opco, LLC shared in cash generated by Capella Holdings in a ratio of 35% to ManageCo and 65% to MPT Camaro Opco, LLC. The limited liability company agreement provided that ManageCo managed Capella Holdings and MPT Camaro Opco, LLC had no management authority or control except for certain protective rights consistent with a passive ownership interest, such as a limited right to approve certain components of the annual budgets and the right to approve extraordinary transactions.

On August 31, 2015, we closed on six of the seven Capella properties, two of which were in the form of mortgage loans. We closed on the seventh property on July 22, 2016 (as discussed above). We entered into a master lease, a stand-alone lease, and mortgage loans for the acquired properties providing for15-yearwith terms with four5-year extension options, plus consumer price-indexed increases, limited to a 2% floor and a 4% ceiling annually. The acquisition loan had a15-year term and carried a fixed interest rate of 8%.

On October 30, 2015, we acquired an additional acute hospital in Camden, South Carolina for an aggregate purchase price of $25.8 million. We leased this hospital to Capella pursuantsimilar to the 2015original master lease. In connection with the transaction, we funded an additional acquisition loan to Capella of $9.2 million.

See the Capella Disposal Transaction under the subheading “Disposals” below for an update to this transaction.

MEDIAN Transaction2017 Activity

During early 2015,2017, we made additional loans (as part ofcompleted construction and began recording rental income on the initial MEDIAN transaction discussed below under “2014 Activity”following facilities:

Adeptus Health, Inc. (“Adeptus Health”) of— We completed four acute care facilities for this tenant during 2017 totaling approximately € 240$68 million on behalf of MEDIAN, to complete step one of a two step process to acquire the healthcare real estate of MEDIAN. On April 29, 2015, we entered into a series of definitive agreements with MEDIAN to complete step two, which involved the acquisition of the real estate assets of 32 hospitals owned by MEDIAN for an aggregate purchase price of approximately € 688 million. Upon acquisition, each property became subject to a master lease between us and MEDIAN providing for the leaseback of the property to MEDIAN. The master lease had an initial term of 27 years and provided for annual escalations of rent at the greater of one percent or 70% of the German consumer price index.

At each closing, the purchase price for each facility was reduced and offset against the interim loans made to affiliates of Waterland and MEDIAN and against the amount of any debt assumed or repaid by us in connection with the closing. As part of this transaction, we incurred approximately $37 million of real estate transfer tax in 2015. As of December 31, 2015, we had closed on 31 of the 32 properties for an aggregate amount of € 646 million, and we had no loans outstanding to MEDIAN.development costs.

Other Acquisitions

On December 3, 2015, we acquired a266-bed outpatient rehabilitation clinicIMED Group (“IMED”) — Our general acute facility located in Hannover, Germany from MEDIAN (formally RHM) for €18.7 million. Upon acquisition, the facility was leased back under the initial master lease with MEDIAN in 2013, providing for a remaining term of 25 years at that time and annual rent increases of 2.0% inValencia, Spain opened on March 31, 2017, and 0.5% thereafter. On December 31, 2020 and every three years thereafter, rent will also be increased to reflect 70% of cumulative increases in the German CPI.

On November 18, 2015, we acquired seven acute care hospitals and a freestanding clinic in northern Italy for an aggregate purchase price to us of approximately €90 million. The acquisition was effected through a newly-formed joint venture between us and affiliates of AXA Real Estate, in which we own a 50% interest. The facilities areis being leased to an Italian acute care hospital operator,IMED pursuant to a long-term master lease. We are accounting30-year lease that provides for our 50% interestquarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020. Our ownership in this joint venture under the equity method.

Index to Financial Statements

On September 30, 2015, we provided a $100 million mortgage financing to Prime for three general acute care hospitals and one free-standing emergency department and health center in New Jersey. The loan had a five-year term and provided for consumer-priced indexed interest increases, subject to a floor. As previously noted above, we acquired these facilities in October 2016 by reducing the mortgage loan and advancing an additional $15 million.

On September 9, 2015, we acquired the real estate of a general acute care hospital under development located in Valencia, Spain. The acquisition wasfacility is effected through a newly-formed joint venture between us and clients of AXA Real Estate, in which we will own a 50% interest. Our expected share of the aggregate purchase and development cost of this facility is approximately €21 million.

In April 2017, we completed the acquisition of the long leasehold interest of a development site in Birmingham, England from the Circle Health Group (“Circle”) (the tenant of our existing site in Bath, England) for a purchase price of £2.7 million. Simultaneously with the acquisition, we entered into contracts with the property landlord and Circle committing us to construct an acute care hospital on the site and have subsequently added a rehabilitation facility to the development. Our total development costs for both facilities are anticipated to be approximately £50 million. Circle is €21.4contracted to enter into a lease of the hospital following completion of construction for an initial 15-year term with rent to be calculated based on our total development costs.

On December 19, 2017, we entered into an agreement to finance the development of and lease an acute care hospital in Idaho Falls, Idaho, for $113.5 million. Upon completion, theThis facility will be leased to a Spanish operator of acute care hospitals,Surgery Partners, Inc. (“Surgery Partners”) pursuant to a long-term lease. We expect construction to be complete on this facility in the second quarter of 2017.lease upon completion.

On August 31, 2015, we closed on a $30 million mortgage loan transaction with Prime for the acquisition of Lake Huron Medical Center, a144-bed general acute care hospital located in Port Huron, Michigan. The loan provided for consumer-priced indexed interest increases, subject to a floor. The mortgage loan had a five-year term with conversion rights to our standard sale leaseback agreement, which we exercised on December 31, 2015, when we acquired the real estate of Lake Huron Medical Center for $20 million, which reduced the mortgage loan accordingly. The facility is being leased to Prime under our master lease agreement.

On June 16, 2015, we acquired the real estate of two facilities in Lubbock, Texas, a60-bed inpatient rehabilitation hospital and a37-bed LTACH, for an aggregate purchase price of $31.5 million. We entered into a20-year lease with Ernest for the rehabilitation hospital, which provides for three five-year extension options, and separately entered into a lease with Ernest for the long-term acute care hospital that has a final term ending December 31, 2034. In connection with the transaction, we funded an acquisition loan to Ernest of approximately $12.0 million. Ernest operates the rehabilitation hospital in a joint venture with Covenant Health System. Effective July 18, 2016, we amended the lease of the rehabilitation hospital to include the long-term acute care hospital. Ernest’s plans are to convert the long-term acute care facility into a rehabilitation facility by the second quarter of 2017.

On February 27, 2015, we acquired an inpatient rehabilitation hospital in Weslaco, Texas for $10.7 million. We have leased this hospital to Ernest pursuant to the 2012 master lease, which had a remaining17-year fixed term at that time and three extension options of five years each. This lease provides for consumer-priced-indexed annual rent increases, subject to a floor and a cap. In addition, we funded an acquisition loan in the amount of $5 million.

On February 13, 2015, we acquired two general acute care hospitals in the Kansas City area for $110 million. Prime is the tenant and operator pursuant to a new master lease that has similar terms and security enhancements as the other master lease agreements entered into in 2013. This master lease has a10-year initial fixed term with two extension options of five years each. The lease provides for consumer-price-indexed annual rent increases, subject to a specified floor. In addition, we funded a mortgage loan in the amount of $40 million, which has a10-year term.

From the respective acquisition dates in 2015 through that year end, the properties and mortgage loans acquired in 2015 contributed $102.7 million and $87.7��million of revenue and income (excluding related acquisition expenses), respectively, for the year ended December 31, 2015. In addition, we incurred $58 million of acquisition related costs on the 2015 acquisitions for the year ended December 31, 2015.

2014 Activity

MEDIAN Transaction

On October 15, 2014, we entered into definitive agreements pursuant to which we would acquire substantially all the real estate assets of MEDIAN. The transaction was structured using a two step process in

Index to Financial Statements

partnership with affiliates of Waterland. In the first step, an affiliate of Waterland acquired 94.9% of the outstanding equity interest in MEDIAN pursuant to a stock purchase agreement with MEDIAN’s current owners. We indirectly acquired the remaining 5.1% of the outstanding equity interest and provided or committed to provide interim acquisition loans to Waterland and MEDIAN in aggregate amounts of approximately €425 million, of which €349 million had been advanced at December 31, 2014. These interim loans bore interest at a rate similar to the initial lease rate under the planned sale and leaseback transactions. See “2015 and 2016 Activity” for an update on the second step of this transaction — the sale-leaseback of the real estate.

Other Acquisitions

In the fourth quarter of 2014, we acquired three RHM (now MEDIAN) rehabilitation facilities in Germany for an aggregate purchase price of € 63.6 million (approximately $81 million based on currency exchange rates at that time) including approximately € 3.0 million (or approximately $3.6 million) of transfer and other taxes that have been expensed as acquisition costs. These facilities included: Bad Mergentheim (211 beds), Bad Tolz (248 beds), and Bad Liebenstein (271 beds). All three properties are included under our initial master lease agreement with MEDIAN in 2013.

On October 31, 2014, we acquired a237-bed acute care hospital, associated medical office buildings, and a behavioral health facility in Sherman, Texas for $32.5 million. Alecto is the tenant and operator pursuant to a15-year lease agreement with three five-year extension options. In addition, we funded a working capital loan of $7.5 million, and we obtained a 20% interest in the operator of the facility.

On September 19, 2014, we acquired an acute care hospital in Fairmont, West Virginia for an aggregate purchase price of $15 million from Alecto. The facility was simultaneously leased back to the seller under a15-year initial term with three five-year extension options. In addition, we made a $5 million working capital loan to the tenant with a five year term and a commitment to fund up to $5 million in capital improvements. Finally, we obtained a 20% interest in the operator of this facility.

On July 1, 2014, we acquired an acute care hospital in Peasedown St. John, United Kingdom from Circle Health Ltd. (“Circle”), through its subsidiary Circle Hospital (Bath) Ltd. The sale/leaseback transaction, excluding any transfer taxes, was valued at approximately £28.3 million (or approximately $48.0 million based on exchange rates at that time). The lease has an initial term of15-years with a tenant option to extend the lease for an additional 15 years. The lease includes annual rent increases, which will equal the year-over-year change in the retail price index with a floor of 2% and a cap of 5%. With the transaction, we incurred approximately £1.1 million (approximately $1.9 million) of transfer and other taxes that have been expensed as acquisition costs.

On March 31, 2014, we acquired a general acute care hospital and an adjacent parcel of land for an aggregate purchase price of $115 million from a joint venture of LHP Hospital Group, Inc. and Hackensack University Medical Center Mountainside. The facility was simultaneously leased back to the seller under a lease with a15-year initial term with a3-year extension option, followed by a further12-year extension option at fair market value. The lease provides for consumer price-indexed annual rent increases, subject to a specified floor and ceiling. The lease includes a customary right of first refusal with respect to a subsequent proposed sale of the facility.

From the respective acquisition dates in 2014 through that year end, the 2014 acquisitions contributed $12.4 million and $8.7 million of revenue and income (excluding related acquisition and financing expenses) for the period ended December 31, 2014. In addition, we incurred $26.4 million of acquisition related expenses in 2014, of which $25.2 million (including $5.8 million in transfer taxes as part of our MEDIAN and Circle transactions) related to acquisitions consummated as of December 31, 2014.

Index to Financial Statements

Pro Forma Information

The following unaudited supplemental pro forma operating data is presented below as if each acquisition was completed on January 1, 2015 and January 1, 2014 for the year ended December 31, 2016 and 2015, respectively. The unaudited supplemental pro forma operating data is not necessarily indicative of what the actual would have been assuming the transactions had been completed as set forth above, nor do they purport to represent our results of operations for future periods (in thousands, except per share/unit amounts).

   For the Year Ended
December 31,
(Unaudited)
 
   2016   2015 

Total revenues

  $627,583   $624,443 

Net income

   310,019    306,756 

Net income per share/unit

  $0.97   $0.96 

Development Activities

2016 Activity

During 2016, we completed construction and began recording rental income on the following facilities:

Adeptus Health — We completed 19 acute care facilities for this tenant during 2016. These facilities are leased pursuant to the master leases entered into in both 2014 and 2015 and are cross-defaulted with each other and with the original master lease executed in 2013.2016 totaling $136.6 million.

Ernest Toledo — This $18.4 million inpatient rehabilitation facility located in Toledo, Ohio opened on April 1, 2016 and is being leased to Ernest pursuant to the original 2012 master lease.

On August 23, 2016, we entered into an agreement to finance the development of and lease an inpatient rehabilitation facility in Flagstaff, Arizona, for $28.1 million, which will be leased to Ernest pursuant to a stand-alone lease, which has terms generally similar to the original master lease. The facility is expected to be completed in the third quarter of 2017.

2015 Activity

During 2015, we completed construction and began recording rental income on the following facilities:

Adeptus Health — We completed 17 acute care facilities for this tenant during 2015 totaling $102.6 million. Fourteen of these facilities are leased pursuant to the master lease entered into in 2014 and are cross-defaulted with the original master lease executed with Adeptus Health in 2013. Three properties are leased pursuant to the master lease entered into in 2015 and are cross-defaulted with the master leases entered into in 2014 and 2013.

UAB Medical West — This $8.6 million acute care facility and medical office building located in Birmingham, Alabama is leased to Medical West, an affiliate of The University of Alabama at Birmingham, for 15 years and contains four renewal options of five years each. The rent increases 2% annually.

In April 2015, we executed an agreement with Adeptus Health that provides for the acquisition and development of general acute care hospitals and free standing emergency facilities with an aggregate commitment of $250 million. These facilities will be leased to Adeptus Health pursuant to the terms of the 2014 and 2015 master lease agreements that have a15-year initial term with three extension options of five years each that provide for annual rent increases based on changes in the CPI with a 2% minimum. With this commitment, along with similar agreements entered into in 2014 and 2013, we have committed to fund up to $500 million in acute care facilities with Adeptus Health. At December 31, 2016, we have 54 completed and open facilities and five still under construction. See table below for an update on our remaining commitments to Adeptus Health.

Index to Financial Statements

2014 Activity

During 2014, we completed construction and began recording rental income on the following facilities:

Northern Utah Rehabilitation Hospital — This $19 million inpatient rehabilitation facility located in South Ogden, Utah is leased to Ernest pursuant to the 2012 master lease.

Oakleaf Surgical Hospital — This approximately $30 million acute care facility located in Altoona, Wisconsin. This facility is leased to National Surgical Hospitals for 15 years and contains two renewal options of five years each plus an additional option for nearly another five years, and the rent increases annually based on changes in the consumer price-index.

Adeptus Health — We completed 17 acute care facilities for this tenant during 2014 totaling approximately $83.0 million. These facilities are leased pursuant to the master lease entered into in 2013.

See table below for a status update onsummary of our current development projects (in thousands):

Property

 

Commitment

 

 

Costs

Incurred as of

December 31, 2018

 

 

Estimated Rent

Commencement

Date

Circle Health (Birmingham, England)

 

$

43,288

 

 

$

28,881

 

 

2Q 2019

Circle Health Rehabilitation (Birmingham, England)

 

 

21,505

 

 

 

9,081

 

 

3Q 2019

Surgery Partners (Idaho Falls, Idaho)

 

 

113,468

 

 

 

46,210

 

 

1Q 2020

 

 

$

178,261

 

 

$

84,172

 

 

 

 

Operator

  Commitment   Costs
Incurred
as of
12/31/16
   Estimated
Completion
Date
 

Adeptus Health

  $5,848   $2,710    1Q 2017 

Adeptus Health

   67,185    44,948    2Q 2017 

Ernest Health

   28,067    4,342    4Q 2017 

Adeptus Health

   7,804    1,648    1Q 2018 

Adeptus Health

   53,866    —      Various 
  

 

 

   

 

 

   
  $162,770   $53,648   
  

 

 

   

 

 

   

Disposals

20162018 Activity

Capella Disposal TransactionOn October 4, 2018, we finalized a recapitalization agreement in which we sold our investment in the operations of Ernest and were repaid for our outstanding acquisition loans, working capital loans, and any unpaid interest.  Total proceeds received from this transaction approximated $176 million.  We retained ownership of the real estate and secured mortgage loans of our Ernest properties.  

On August 31, 2018, we completed the previously described joint venture arrangement with Primotop, in which we contributed the real estate of 71 of our post-acute hospitals in Germany, with a fair value of approximately €1.635 billion, resulting in a gain of approximately €500 million.  See “2018 Activity” in this Note 3 for further details on this transaction.

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On August 31, 2018, we sold a general acute care hospital located in Houston, Texas that was leased and operated by North Cypress for $148 million.  The transaction resulted in a gain on sale of $102.4 million, which was partially offset by a net $2.5 million non-cash charge to revenue to write-off related straight-line rent receivables.

On June 4, 2018, we sold three long-term acute care hospitals located in California, Texas, and Oregon, that were leased and operated by Vibra Healthcare, LLC (“Vibra”), which included our equity investment in operations of the Texas facility. Total proceeds from the transaction were $53.3 million in cash, a mortgage loan in the amount of $18.3 million, and a $1.5 million working capital loan.  The transaction resulted in a gain on real estate of $24.2 million, which was partially offset by a $5.1 million non-cash charge to revenue to write-off related straight-line rent receivables.

On March 21, 1, 2018, we sold the real estate of St. Joseph Medical Center in Houston, Texas, for approximately $148 million to Steward. In return, we received a mortgage loan equal to the purchase price, with such loan secured by the underlying real estate. The mortgage loan had terms consistent with the other mortgage loans in the Steward portfolio. This transaction resulted in a gain of $1.5 million, offset by a $1.7 million non-cash charge to revenue to write-off related straight-line rent receivables on this property.  

Summary of Operations for Disposed Assets in 2018

The properties sold during 2018 did not meet the definition of discontinued operations. However, the following represents the operating results (excluding the St. Joseph sale in March 2018) from these properties for the periods presented (in thousands):

 

 

For the Year Ended

December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

Revenues

 

$

88,838

 

 

$

132,039

 

 

$

109,544

 

Real estate depreciation and amortization

 

 

(15,849

)

 

 

(31,870

)

 

 

(26,410

)

Property-related expenses

 

 

(531

)

 

 

(404

)

 

 

(45

)

Other income (expense) (1)

 

 

709,717

 

 

 

(14,168

)

 

 

(23,937

)

Income from real estate dispositions, net

 

$

782,175

 

 

$

85,597

 

 

$

59,152

 

(1)

Includes approximately $720 million of gains on sale for the twelve months ended December 31, 2018.

2017 Activity

On March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to RCCH. Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million, partially offset by a $0.6 million non-cash charge to revenue to write-off related straight-line rent receivables on this property. The sale of Muskogee facility was not a strategic shift in our operations and therefore the results of the Muskogee operations were not reclassified to discontinued operations.

2016 we entered into definitive agreementsActivity

Capella Disposal Transaction

Effective April 30, 2016, our investment in the operator of Capella merged with RegionalCare Hospital Partners, Inc. (“RegionalCare”), an affiliate of certain funds managed by affiliates of Apollo Global Management, LLC (together with its consolidated subsidiaries, “Apollo”(“Apollo”), under which our investment in the operations of Capella would be merged with RegionalCare, formingto form RCCH.

On April 29, 2016, this transaction closed and funded, effective April 30, 2016. As part of the transaction, we received net proceeds of approximately $550 million including approximately $492 million for our equity investment and loans made as part of the original Capella acquisition that closed on August 31, 2015. In addition, we received $210 million in prepayment of two mortgage loans for hospitals in Russellville, Arkansas, and Lawton, Oklahoma that we made to subsidiaries of Capella in connection with the original Capella transaction on August 31, 2015.transaction. We made a new $93.3 million loan for a hospital property in Olympia, Washington (whichthat was subsequently converted to real estate on July 22, 2016 as previously disclosed).2016. Additionally, we and an Apollo affiliate invested $50 million each in unsecured senior notes issued by RegionalCare, which we sold to a large institution on June 20, 2016 at par. The proceeds from this transaction represented the recoverability of our investment in full, except for transaction costs incurred of $6.3 million.

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We maintained our ownership of five Capella hospitals in Hot Springs, Arkansas; Camden, South Carolina; Hartsville, South Carolina; Muskogee, Oklahoma; and McMinnville, Oregon. Pursuant to the transaction described above, the underlying leases, one of which is a master lease covering all but one property was amended to shorten the initial fixed lease term (to 13.5 years for the master lease and 11.5 years for the other stand-alone lease) , increase the security deposit, and eliminate the lessees’ purchase option provisions. Due to this lease amendment, we reclassified the lease of the properties under the master lease from a DFL to an operating lease. This reclassification resulted in awrite-off of $2.6 million inof unbilled DFL rent receivables in the 2016 second quarter.

2016.

Index to Financial Statements

Post Acute Transaction

On May 23, 2016, we sold five properties (three of which were in Texas and two in Louisiana) that were leased and operated by Post Acute.Acute Medical. As part of this transaction, our outstanding loans of $4 million were paid in full, and we recovered our investment in the operations. Total proceeds from this transaction were $71 million, resulting in a net gain of approximately $15 million.

Corinth Transaction

On June 17, 2016, we sold the Atrium Medical Center real estate located in Corinth, Texas, which was leased and operated by Corinth Investor Holdings. Total proceeds from the transaction were $28 million, resulting in a gain on the sale of real estate of approximately $8 million. This gain on real estate was offset by approximately $9 million ofnon-cash charges that included thewrite-off of our investment in the operations of the facility, straight-line rent receivables, and a lease intangible.

HealthSouthEncompass Health Transaction

On July 20, 2016, we sold three inpatient rehabilitation hospitals located in Texas and operated by HealthSouthEncompass Health for $111.5 million, resulting in a net gain of approximately $45 million.

Summary of Operations for Disposed Assets in 2016

The properties sold during 2016 did not meet the definition of discontinued operations. However, the following represents the operating results (excluding gain on sale, transaction costs, and impairment or othernon-cash charges) from these properties (excluding loans repaid in the Capella Disposal Transaction) for the periods presented (in thousands):

 

  For the Year Ended December 31, 
  2016   2015   2014 

 

For

the Year Ended

December 31, 2016

 

Revenues

  $7,851   $18,112   $18,225 

 

$

8,350

 

Real estate depreciation and amortization

   (1,754   (3,795   (3,789

 

 

(2,870

)

Property-related expenses

   (114   (121   (60

 

 

(113

)

Other income (expense)

   (23   1,079    462 
  

 

   

 

   

 

 

Other income(1)

 

 

60,283

 

Income from real estate dispositions, net

  $5,960   $15,275   $14,838 

 

$

65,650

 

  

 

   

 

   

 

 

2015 Activity

(1)

Includes approximately $60 million of net gains on sale for the year ended December 31, 2016.

On July 30, 2015, we sold a long-term acute care facility in Luling, Texas for approximately $9.7 million, resulting in a gain of $1.5 million. Due to this sale, we wrote off $0.9 million of straight-line receivables. On August 5, 2015, we sold six wellness centers in the U.S. for total proceeds of approximately $9.5 million (of which $1.5 million is in the form of a promissory note), resulting in a gain of $1.7 million. Due to this sale, we wrote off $0.9 million of billed rent receivables. With these disposals, we accelerated the amortization of the related lease intangible assets resulting in approximately $0.7 million of additional expense.

The sale of the Luling facility and the six wellness centers were not strategic shifts in our operations, and therefore the results of operations related to these facilities were not reclassified as discontinued operations.

2014 Activity

On December 31, 2014, we sold our La Palma facility for $12.5 million, resulting in a gain of $2.9 million. Due to this sale, wewrote-off $1.3 million of straight-line rent receivables.

Index to Financial Statements

On May 20, 2014, the tenant of our Bucks facility gave notice of their intent to exercise the lease’s purchase option. Pursuant to this purchase option, the tenant acquired the facility on August 6, 2014 for $35 million. We wrote down this facility to fair market value less cost to sell, resulting in a $3.1 million real estate impairment charge in the 2014 second quarter.

The sale of the Bucks and La Palma facilities was not a strategic shift in our operations, and therefore the results of the Bucks and La Palma operations were not reclassified as discontinued operations.

Intangible Assets

At December 31, 20162018 and 2015,2017, our intangible lease assets were $296.2$403.1 million ($263.8352.5 million, net of accumulated amortization) and $257.0$443 million ($231.7394 million, net of accumulated amortization), respectively.

We recorded amortization expense related to intangible lease assets of $17.6 million, $15.8 million, and $13.4 million $9.1 million,in 2018, 2017, and $7.0 million in 2016, 2015, and 2014, respectively, and expect to recognize amortization expense from existing lease intangible assets as follows (amounts in thousands):

 

For the Year Ended December 31:

    

 

 

 

 

2017

  $22,130 

2018

   22,069 

2019

   22,021 

 

$

16,687

 

2020

   21,818 

 

 

16,507

 

2021

   21,751 

 

 

16,493

 

2022

 

 

16,479

 

2023

 

 

16,413

 

As of December 31, 2016,2018, capitalized lease intangibles have a weighted average remaining life of 22.126.0 years.

79


Leasing Operations

All of ourAt December 31, 2018, leases are accounted for as operating leases, except we are accounting foron two Alecto facilities, 15 Ernest facilities and ten Prime facilities are accounted for as DFLs.

The components of our net investment in DFLs consisted of the following (in thousands):

 

  As of December 31,
2016
   As of December 31,
2015
 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

Minimum lease payments receivable

  $2,207,625   $2,587,912 

 

$

2,091,504

 

 

$

2,294,081

 

Estimated residual values

   407,647    393,097 

 

 

424,719

 

 

 

448,339

 

Less unearned income

   (1,967,170   (2,354,013

 

 

(1,832,170

)

 

 

(2,043,693

)

  

 

   

 

 

Net investment in direct financing leases

  $648,102   $626,996 

 

$

684,053

 

 

$

698,727

 

  

 

   

 

 

Minimum rental payments due to us in future periodsover the remaining lease term under operating leases and DFLs which havenon-cancelable terms extending beyond one year at December 31, 2016,2018, are as follows (amounts in thousands):

 

 

Total Under

Operating Leases

 

 

Total Under

DFLs

 

 

Total

 

  Total Under
Operating Leases
   Total Under
DFLs
   Total 

2017

  $386,058   $62,419   $448,477 

2018

   388,808    63,668    452,476 

2019

   392,577    64,941    457,518 

 

$

433,542

 

 

$

64,971

 

 

$

498,513

 

2020

   395,339    66,240    461,579 

 

 

437,025

 

 

 

66,270

 

 

 

503,295

 

2021

   400,607    67,565    468,172 

 

 

445,598

 

 

 

67,595

 

 

 

513,193

 

2022

 

 

450,592

 

 

 

68,947

 

 

 

519,539

 

2023

 

 

457,732

 

 

 

70,326

 

 

 

528,058

 

Thereafter

   7,077,794    1,673,600    8,751,394 

 

 

9,612,430

 

 

 

1,544,035

 

 

 

11,156,465

 

  

 

   

 

   

 

 

 

$

11,836,919

 

 

$

1,882,144

 

 

$

13,719,063

 

  $9,041,183   $1,998,433   $11,039,616 
  

 

   

 

   

 

 

Index to Financial Statements

Adeptus Health

On November 1, 2016, Adeptus Health announced their 2016 third quarter results showing– Transition Properties

2018 Activity

As noted in previous filings, effective October 2, 2017, we had 16 properties transitioning away from Adeptus Health in stages over a declinetwo year period as part of Adeptus Health’s confirmed plan of reorganization under Chapter 11 of the Bankruptcy Code. Through December 31, 2018, Adeptus Health vacated and stopped making rent payments on 14 properties. As a result of the shortening of our lease term on these properties, we accelerated the amortization of the straight-line rent receivables resulting in net income overa reduction of straight-line rent revenue by $6.1 million in 2018. Of the prior yearother two properties, one will be transitioned away from Adeptus Health on October 1, 2019 and disclosing collection issues associatedone has been re-leased by Adeptus Health.

In August and early October 2018, we re-leased three of the vacant facilities in the Houston market and five in the San Antonio market, respectively, to Steward at rates consistent with a third party billing agent among other things.that of the previous Adeptus Health lease. At December 31, 2016,2018, our investment in the remaining seven transition facilities (that have not been re-leased) approximates less than 0.5% of our total assets. Although we have no outstanding receivables due from this tenant. Furthermore,expect to re-tenant and/or sell the remaining seven facilities in the near future, we lowered the carrying value of the six remaining vacant facilities by $18 million to fair value during 2018, based on market data received during the year.

2017 Activity

On December 7, 2017, we announced that UCHealth Partners LLC (“UCHealth”), an affiliate of University of Colorado Hospital, had acquired all of Adeptus Health’s Colorado joint venture interests, assuming the existing master lease of 11 of our free standing emergency facilities. The 11 facilities that are now master leased to UCHealth affiliates had a gross investment of approximately $60 million. The master lease was amended to provide a new 15-year initial term effective January 1, 2018 with three five-year renewal options, while retaining annual escalation provisions of the increase in the CPI with a 2% minimum.

On April 4, 2017, we announced that our Louisiana freestanding emergency facilities then-operated by Adeptus Health is current(with a total budgeted investment of approximately $25 million) had been re-leased to Ochsner Clinic Foundation (“Ochsner”), a health care system in the New Orleans area. We incurred a non-cash charge of $0.5 million to write-off the straight-line rent receivables associated with the previous Adeptus Health lease on these properties. On October 18, 2017, Ochsner agreed to an amended and restated lease that provided for initial terms of 15 years with a 9.2% average minimum lease rate based on our total development and construction cost, as well as the addition of three five-year renewal options.

80


Gilbert and Florence Facilities

In the first quarter of 2018, we terminated the lease at our Gilbert and Florence, Arizona facilities due to the tenant not meeting its rent obligations to us through February 2017. In addition, we currently hold letters of credit approximating $12.4 million. At December 31, 2016, we have approximately $400 million invested in 59 properties (including five properties still under development) that are leased, pursuant to master lease agreements, to Adeptus Health, along with additional funding commitments as disclosed earlier. This investment represents approximately 7% of our total assets at December 31, 2016. At December 31, 2016, we believe this investment is fully recoverable; however, no assurances can be made that we will not have any impairment charges related to this investment in the future.

Hoboken Facility

In the 2015 third quarter, a subsidiary of the operator of our Hoboken facility acquired 10% of our subsidiary that owns the real estate for $5 million, which is reflected in thenon-controlling interest line of our consolidated balance sheets.

Twelve Oaks Facility

In the third quarter of 2015, we sent notice of termination of the lease to the tenant at our Twelve Oaks facility.lease. As a result of the lease terminating, we recorded a charge of $1.9$1.1 million to reserve against the straight-line rent receivables. In addition, we accelerated the amortization of the related lease intangible asset resultingreceivables in $0.5 million of additional expense during 2015. ThisFebruary 2018. On April 25, 2018, this former tenant has continuedfiled for involuntary bankruptcy. On December 14, 2018, the Florence facility was re-leased to occupySteward pursuant to our original master lease with them with a term to begin in the facility. During the thirdfirst quarter of 2016, the tenant paid us approximately $2.5 million representing substantially all of amounts owed to us2019. At December 31, 2018, any outstanding receivables on Florence and agreed to general terms of a new lease, which we expect to execute in 2017. The tenant is current on all of its obligations to us through February 2017.Gilbert were completely reserved. Although no assurances can be made that we will not have any impairment charges in the future, we believe our real estate investment in Twelve Oaksthe Gilbert facility (less than 0.2% of total assets at December 31, 20162018) is fully recoverable.

Monroe FacilityAlecto Healthcare facilities

During 2014, the previous operator of our Monroe facility continued to underperform and became further behind on payments to us as required by the real estate lease agreement and working capital loan agreement. In August 2014, this operator filed for bankruptcy. Based on these developments and the fair value of our real estate and the underlying collateral of our loan (using Level 2 inputs), we recorded a $47.0 million impairment charge in 2014. Effective December 31, 2014, the bankruptcy court approved the purchase by Prime of the assets of the prior operator. Prime leases the facility from us pursuant to terms under an existing master lease. Prime has been current on its rent since lease inception. At December 31, 2016,2018, we own four acute care facilities that are leased to Alecto and have a mortgage loan on a fifth property.  With the continued softening in the markets and the overall decline in the operating results of the facility tenant, we lowered the carrying value of the four owned properties by $30 million to fair value. At December 31, 2018, our total investment in Monroethese properties is approximately $36 million, which we believe is fully recoverable.less than 1 % of our total assets.

Loans

The following is a summary of our loans ($ amounts in thousands):

 

  As of December 31, 2016 As of December 31, 2015 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

  Balance   Weighted Average
Interest Rate
 Balance   Weighted Average
Interest Rate
 

 

Balance

 

 

Weighted Average

Interest Rate

 

 

Balance

 

 

Weighted Average

Interest Rate

 

Mortgage loans

  $1,060,400    8.8 $757,581    9.5

 

$

1,213,322

 

 

 

8.8

%

 

$

1,778,316

 

 

 

8.3

%

Acquisition loans

   121,464    13.7 610,469    9.1

 

 

3,454

 

 

 

10.8

%

 

 

118,448

 

 

 

13.8

%

Working capital and other loans

   34,257    9.0 54,353    10.2

 

 

369,744

 

 

 

5.4

%

 

 

31,760

 

 

 

7.6

%

  

 

    

 

   

 

$

1,586,520

 

 

 

 

 

 

$

1,928,524

 

 

 

 

 

  $1,216,121    $1,422,403   
  

 

    

 

   

Index to Financial Statements

Our mortgage loans cover 1210 of our properties with four operators. The increasedecrease in mortgage loans relates to the use of Steward mortgage loans made to Steward totaling $600 million for four properties in October 2016, partially offset byfund the repayment of two loans for $210 million by RCCH (formally Capella) and the conversion of a $100 million mortgage loan to Prime into a sale/leasebackacquisition of the property — See “2016 Activity”related fee simple real estate as more fully described in this note under sub-caption “Acquisitions”.

Upon the Disposalfinalization of the Ernest recapitalization agreement on October 4, 2018, we sold our investment in the operations of Ernest, and Acquisition sections for more details.all outstanding acquisition loans and unpaid interest with Ernest were repaid (which made up the majority of the acquisition loan balance in 2017). The remaining acquisition loan balance is our outstanding loan with Vibra, which will mature in 2020.

Other loans typically consist of loans to our tenants for acquisitions and working capital purposes. At Decemberpurposes and includes our shareholder loan made to the joint venture with Primotop on August 31, 2016, acquisition loans include our $115 million of loans to Ernest. The Capella acquisition loans of approximately $489 million at December 31, 2015 were paid2018 (as more fully described above in full during 2016 — See “2016 Activity” under the Disposal section for more details.

On March 1, 2012, pursuant to our convertible note agreement, we converted $1.7 million of our $5.0 million convertible note into a 9.9% equity interestthis Note 3) in the operatoramount of our Hoboken University Medical Center facility. On October 1, 2016, we converted the remaining $3.3 million of our convertible note into a 15.1% of equity interest in the operator for a total 25% equity interest in the operator.€290 million.

Concentration of Credit Risks

Revenue by Operator

(Dollar amountsWe monitor concentration risk in thousands)

   For the Years Ended December 31, 
   2016  2015 

Operators (A)

  Total
Revenue
   Percentage of
Total Revenue
  Total
Revenue
   Percentage of
Total Revenue
 

Prime

  $120,558    22.3 $104,325    23.6

MEDIAN

   93,425    17.3  78,540    17.8

Ernest

   67,742    12.5  61,988    14.0

RCCH

   52,720    9.7  28,567    6.4

Other operators

   206,692    38.2  168,458    38.2
  

 

 

   

 

 

  

 

 

   

 

 

 

Total

  $541,137    100.0 $441,878    100.0
  

 

 

   

 

 

  

 

 

   

 

 

 

(A) Steward is not included herein asseveral ways due to the Steward transaction closed on October 3, 2016.

Revenue by U.S. State and Country

(Dollar amounts in thousands)

   For the Years Ended December 31, 
   2016  2015 

U.S. States and Other Countries

  Total
Revenue
   Percentage of
Total Revenue
  Total
Revenue
   Percentage of
Total Revenue
 

Texas

  $96,992    17.9 $87,541    19.8

California

   66,197    12.2  66,120    15.0

New Jersey

   39,084    7.2  27,688    6.3

Massachusetts

   26,098    4.8  69    0.0

Arizona

   23,798    4.4  21,188    4.8

Other States

   187,363    34.7  156,256    35.3
  

 

 

   

 

 

  

 

 

   

 

 

 

Total U.S.

  $439,532    81.2 $358,862    81.2

Germany

  $97,382    18.0 $78,540    17.8

United Kingdom, Italy, and Spain

   4,223    0.8  4,476    1.0
  

 

 

   

 

 

  

 

 

   

 

 

 

Total International

  $101,605    18.8 $83,016    18.8
  

 

 

   

 

 

  

 

 

   

 

 

 

Total

  $541,137    100.0 $441,878    100.0
  

 

 

   

 

 

  

 

 

   

 

 

 

Index to Financial Statements

From an asset perspective, approximately 80%nature of our totalreal estate assets that are vital to the communities in the U.S., while 20% reside in Europe (primarily Germany) aswhich they are located and given our history of December 31, 2016, consistentbeing able to replace inefficient operators of our facilities if needed, with December 31, 2015.more effective operators:

1)

Facility concentration – At December 31, 2018, we had no investment of any single property greater than 4.2% of our total assets, which is consistent with December 31, 2017.

2)

Operator concentration – For the year ended December 31, 2018, revenue from Steward, Prime, MEDIAN, and Ernest represented 39%, 16%, 13% and 8%, respectively. In comparison, these operators represented 27%, 18%, 14% and 10%, respectively, for the year ended December 31, 2017.

3)

Geographic concentration – At December 31, 2018, investments in the U.S. and Europe represented approximately 80% and 20%, respectively, of our total assets, which is consistent with December 31, 2017.

4)

Facility type concentration – For the year ended December 31, 2018, approximately 76% of our revenues are from our general acute care facilities, while rehabilitation and long-term acute care facilities make up 20% and 4%, respectively. In comparison, general acute care, rehabilitation, and long –term acute care facilities made up 69%, 25%, and 6%, respectively, for the year ended December 31, 2017.

81


Related Party Transactions

Lease and interest revenue earned from tenants in which we have or had an equity interest in during the year were $501.4 million, $422.4 million, and $282.9 million $215.4 millionin 2018, 2017, and $101.8 million in 2016, 2015 and 2014, respectively.

4. Debt

The following is a summary of debt ($ amounts in thousands):

 

   As of December 31, 
   2016   2015 

Revolving credit facility

  $290,000   $1,100,000 

Term loans

   263,101    263,400 

Senior Unsecured Notes due 2016

   —      125,000 

6.875% Senior Unsecured Notes due 2021

   —      450,000 

6.375% Senior Unsecured Notes due 2022:

    

Principal amount

   350,000    350,000 

Unamortized premium

   1,814    2,168 
  

 

 

   

 

 

 
   351,814    352,168 

5.750% Senior Unsecured Notes due 2020 (A)

   210,340    217,240 

4.000% Senior Unsecured Notes due 2022 (A)

   525,850    543,100 

5.500% Senior Unsecured Notes due 2024

   300,000    300,000 

6.375% Senior Unsecured Notes due 2024

   500,000    —   

5.250% Senior Unsecured Notes due 2026

   500,000    —   
  

 

 

   

 

 

 
  $2,941,105   $3,350,908 

Debt issue costs, net

   (31,764   (28,367
  

 

 

   

 

 

 
  $2,909,341   $3,322,541 
  

 

 

   

 

 

 

 

 

As of December 31,

2018

 

 

As of December 31,

2017

 

Revolving credit facility(A)

 

$

28,059

 

 

$

840,810

 

Term loans

 

 

200,000

 

 

 

200,000

 

4.000% Senior Unsecured Notes due 2022(B)

 

 

573,350

 

 

 

600,250

 

5.500% Senior Unsecured Notes due 2024

 

 

300,000

 

 

 

300,000

 

6.375% Senior Unsecured Notes due 2024

 

 

500,000

 

 

 

500,000

 

3.325% Senior Unsecured Notes due 2025(B)

 

 

573,350

 

 

 

600,250

 

5.250% Senior Unsecured Notes due 2026

 

 

500,000

 

 

 

500,000

 

5.000% Senior Unsecured Notes due 2027

 

 

1,400,000

 

 

 

1,400,000

 

 

 

$

4,074,759

 

 

$

4,941,310

 

Debt issue costs, net

 

 

(37,370

)

 

 

(42,643

)

 

 

$

4,037,389

 

 

$

4,898,667

 

(A)

Includes £22 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

(B)

These notes are Euro-denominated and reflect the exchange rate at December 31, 2018 and December 31, 2017, respectively.

As of December 31, 2016,2018, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows ($ amounts in thousands):

 

2017

  $320 

2018

   302,781 

2019

   250,000 

 

$

 

2020

   210,340 

 

 

 

2021

   —   

 

 

28,059

 

2022

 

 

773,350

 

2023

 

 

 

Thereafter

   2,175,850 

 

 

3,273,350

 

  

 

 

Total

  $2,939,291 

 

$

4,074,759

 

  

 

 

 

(A)These notes are Euro-denominated and reflect the exchange rates at December 31, 2016 and 2015, respectively.

Revolving Credit Facility

On June 19,February 1, 2017, we replaced our previous unsecured credit facility (which we had entered into in 2014 we closed on the Credit Facility for $900 million.and amended in 2015) with a new revolving credit and term loan agreement (the “Credit Facility”). The Credit Facility was comprised ofnew agreement included a $775 million senior$1.3 billion unsecured revolving creditloan facility (the “Revolving credit facility”) and(same amount as the previous revolving loan facility), a $125$200 million senior unsecured term loan facility (the “Term Loan”). The Credit Facility had an accordion feature that allowed us to expand($50 million lower than the size of the facility by up to $250 million through increases to the Revolving credit facility, Term

Index to Financial Statements

Loan, both or as a separateprevious term loan tranche. The Credit Facility replaced our previous $400 million unsecured revolving credit facilityfacility), and $100a new €200 million unsecured term loan. This transaction resulted in a refinancing charge of approximately $0.3 million in the 2014 second quarter.

On October 17, 2014, we entered into an amendment to our Credit Facility to exercise the $250 million accordion on the Revolving creditloan facility. This amendment increased the Credit Facility to $1.15 billion and added aThe new accordion feature that allowed us to expand our credit facility by another $400 million.

On August 4, 2015, we entered into an amendment to our Revolving credit facility and Term Loan agreement to further increase the current aggregate committed size to $1.25 billion and amend certain covenants in order to permit us to consummate and finance the acquisition of Capella.

On September 30, 2015, we further amended our Credit Facility to, among other things, increase the aggregate commitment under our Revolving credit facility to $1.3 billion and increase the Term Loan portion to $250 million. In addition, this amendment included a new accordion feature that allowed us to expand the Credit Facility by another $400 million for a total commitment of $1.95 billion. This amendment resulted in a $0.1 million expense in the 2015 third quarter.

The Revolving creditunsecured revolving loan facility matures in June 2018February 2021 and can be extended for an additional 12 months at our option. The Revolving credit facility’s interest rate$200 million unsecured term loan facility matures on February 1, 2022, and the €200 million unsecured term loan facility had a maturity date of January 31, 2020; however, it was originally setpaid off on March 30, 2017 — see below. The term loan and/or revolving loan commitments may be increased in an aggregate amount not to exceed $500 million.

At our election, loans under the Credit Facility may be made as (1) the higher of the “prime rate”, federal funds rate plus 0.50%,either ABR Loans or Eurodollar rate plus 1.00%, plusLoans. The applicable margin for term loans that are ABR Loans is adjustable on a spread that was adjustablesliding scale from 0.70%0.00% to 1.25%0.95% based on our current total leverage, or (2) LIBOR pluscredit rating. The applicable margin for term loans that are Eurodollar Loans is adjustable on a spread that was adjustablesliding scale from 1.70%0.90% to 2.25%1.95% based on our current total leverage. In additioncredit rating. The applicable margin for revolving loans that are ABR Loans is adjustable on a sliding scale from 0.00% to interest expense, we were required0.65% based on our current credit rating. The applicable margin for revolving loans that are Eurodollar Loans is adjustable on a sliding scale from 0.875% to pay a quarterly1.65% based on our current credit rating. The commitment fee is adjustable on a sliding scale from 0.125% to 0.30% based on our current credit rating and is payable on the undrawn portion of the revolving credit facility, ranging from 0.25% to 0.35% per year.

In November 2014, we received an upgrade to our credit rating resulting in an improvement in our interest rate spreads and commitment fee rates. Effective December 10, 2014, the Revolving credit facility’s interest rate is (1) the higher of the “prime rate”, federal funds rate plus 0.50%, or Eurodollar rate plus 1.00% plus a fixed spread of 0.40% or (2) LIBOR plus a fixed spread of 1.40%. In regards to commitment fees, we now pay based on the total facility at a rate of 0.30% per year.

At December 31, 2016 and 2015, we had $290 million and $1.1 billion, respectively, outstanding on the Revolving creditloan facility.

At December 31, 2016,2018 and 2017, we had $28.1 million and $840.8 million, respectively, outstanding on the revolving credit facility. At December 31, 2018, our availability under our Revolvingrevolving credit facility was $1$1.27 billion. The weighted average interest rate on this facility was 2.0%2.7% and 1.7%2.4% for 20162018 and 2015,2017, respectively.

See Note 13 for subsequent event activity impacting our Credit Facility.82


Term Loans

As noted above in the Revolving Credit Facility section, we closed on the Term Loan for $125 million in the second quarter of 2014. Furthermore, as noted above, we amended the credit facility to increase the Term Loan portion to $250 million in the third quarter of 2015. The Term Loan matures in June 2019. The Term Loan’s initial interest rate was (1) the higher of the “prime rate”, federal funds rate plus 0.50%, or Eurodollar rate plus 1.00%, plus a spread that was adjustable from 0.60% to 1.20% based on current total leverage, or (2) LIBOR plus a spread that was adjustable from 1.60% to 2.20% based on current total leverage. With the upgrade to our credit rating as discussed above, the Term Loan’s interest rate, effective December 10, 2014, improved to (1) the higher of the “prime rate”, federal funds rate plus 0.50%, or Euro dollar rate plus 1.00% plus a fixed spread of 0.65%, or (2) LIBOR plus a fixed spread of 1.65%. At December 31, 20162018 and 2015,2017, the interest rate in effect on the Term Loan was 2.36% and 2.05%, respectively.

Index to Financial Statements

In connection with our acquisition of the Northland LTACH Hospital on February 14, 2011, we assumed a $14.6 million mortgage. The Northland mortgage loan requires monthly principal and interest payments based on a30-year amortization period. The Northland mortgage loan has a fixed interest rate of 6.2%, matures on January 1, 2018 and can be prepaid, subject to a certain prepayment premium. At December 31, 2016, the remaining balance on this term loan was $13.1 million. The loan is collateralized by the real estate of the Northland LTACH Hospital, which had a net book value of $16.4 million3.89% and $16.9 million at December 31, 2016 and 2015,2.98%, respectively.

See Note 13 for subsequent activity impacting our Credit Facility.

Senior Unsecured Notes due 2016

During 2006, we issued $125.0 million of senior unsecured notes (the “Senior Unsecured Notes due 2016”). One of the issuances of the Senior Unsecured Notes due 2016 totaling $65.0 million paid interest quarterly at a floating annual rate of three-month LIBOR plus 2.30% and could be called at par value by us at any time. This portion of the Senior Unsecured Notes due 2016 matured in July 2016. The remaining issuances of Senior Unsecured Notes due 2016 paid interest quarterly at a floating annual rate of three-month LIBOR plus 2.30% and could also be called at par value by us at any time. These remaining notes matured in October 2016.

During the second quarter 2010, we entered into an interest rate swap to manage our exposure to variable interest rates by fixing $65 million of our $125 million Senior Unsecured Notes due 2016, which started July 31, 2011 (date on which the interest rate turned variable) through maturity date (or July 2016), at a rate of 5.507%. We also entered into an interest rate swap to fix $60 million of our Senior Unsecured Notes due 2016 which started October 31, 2011 (date on which the related interest rate turned variable) through the maturity date (or October 2016) at a rate of 5.675%. At December 31, 2015, the fair value of the interest rate swaps was $2.9 million, which is reflected in accounts payable and accrued expenses on the consolidated balance sheets. These interest rate swaps expired in 2016 in connection with the maturity of the related notes. We accounted for our interest rate swaps as cash flow hedges. We did not have any hedge ineffectiveness from inception of our interest rate swaps through their expiration in 2016; and therefore, there was no income statement effect recorded during the years ended December 31, 2016, 2015, and 2014.

6.875% Senior Unsecured Notes due 2021

On April 26, 2011, we closed on a private placement of $450 million senior notes (the “6.875% Senior Unsecured Notes due 2021”) to qualified institutional buyers in reliance on Rule 144A under the Securities Act. The notes were subsequently registered under the Securities Act pursuant to an exchange offer. Interest on the notes was payable semi-annually on May 1 and November 1 of each year. The notes paid interest in cash at a rate of 6.875% per year, would have matured on May 1, 2021, and offered a redemption option to redeem some or all of the notes at a premium, plus accrued and unpaid interest to, but not including, the redemption date.

On July 22, 2016, we used the net proceeds from the 5.250% Senior Unsecured Notes due 2026 offering (see discussion below for further details on these notes) to redeem our $450 million 6.875% Senior Unsecured Notes due 2021. This redemption resulted in a $22.5 million debt refinancing charge during the 2016 third quarter, consisting of a $15.5 million redemption premium along with thewrite-off of deferred debt issuance costs associated with the redeemed notes.

6.375% Senior Unsecured Notes due 2022

On February 17, 2012, we completed a $200 million offering of senior unsecured notes (“6.375% Senior Unsecured Notes due 2022”), and on August 20, 2013, we completed a $150 million tack on to the notes. These 6.375% Senior Unsecured Notes due 2022 accrue interest at a fixed rate of 6.375% per year and mature on February 15, 2022. The 2013 tack on offering, was issued at a premium (price of 102%), resulting in an effective

Index to Financial Statements

rate of 5.998%. Interest on these notes is payable semi-annually on February 15 and August 15 of each year. We may redeem some or all of the notes at a premium that will decrease over time, plus accrued and unpaid interest to, but not including, the redemption date. In the event of a change of control, each holder of the 6.375% Senior Unsecured Notes due 2022 may require us to repurchase some or all of its notes at a repurchase price equal to 101% of the aggregate principal amount plus accrued and unpaid interest to the date of purchase.

5.750% Senior Unsecured Notes due 2020

On October 10, 2013, we completed a €200 million offering of senior unsecured notes (“5.750% Senior Unsecured Notes due 2020”). Interest on the notes is payable semi-annually on April 1 and October 1 of each year. The 5.750% Senior Unsecured Notes due 2020 pay interest in cash at a rate of 5.750% per year. The notes mature on October 1, 2020. We may redeem some or all of the notes at any time at a “make-whole” redemption price that will decrease over time. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase. See Note 13 for subsequent event activity related to these notes.

4.000% Senior Unsecured Notes due 2022

On August 19, 2015, we completed a €500 million senior unsecured notes offering (“4.000% Senior Unsecured Notes due 2022”). Interest on the notes is payable annually on August 19 of each year. The notes pay interest in cash at a rate of 4.00%4.000% per year. The notes mature on August 19, 2022. We may redeem some or all of the 4.000% Senior Unsecured Notes due 2022 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 4.000% Senior Unsecured Notes due 2022 are fully and unconditionally guaranteed on an unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of the purchase.

5.500% Senior Unsecured Notes due 2024

On April 17, 2014, we completed a $300 million senior unsecured notes offering (“5.500% Senior Unsecured Notes due 2024”). Interest on the notes is payable semi-annually on May 1 and November 1 of each year. The notes pay interest in cash at a rate of 5.50%5.500% per year. The notes mature on May 1, 2024. We may redeem some or all of the notes at any time prior to May 1, 2019 at a “make-whole” redemption price. On or after May 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to May 1, 2017, we may redeem up to 35% of the aggregate principal amount of the notes using the proceeds of one or more equity offerings. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

6.375% Senior Unsecured Notes due 2024

On February 22, 2016, we completed a $500 million senior unsecured notes offering (“6.375% Senior Unsecured Notes due 2024”). Interest on the notes is payable on March 1 and September 1 of each year. Interest on the notes is paid in cash at a rate of 6.375% per year. The notes mature on March 1, 2024. We may redeem some or all of the notes at any time prior to March 1, 2019 at a “make whole” redemption price. On or after March 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to March 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 106.375%

Index to Financial Statements

of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

3.325% Senior Unsecured Notes due 2025

On March 24, 2017, we completed a €500 million senior unsecured notes offering (“3.325% Senior Unsecured Notes due 2025”). Interest on the notes is payable annually on March 24 of each year. The notes pay interest in cash at a rate of 3.325% per year. The notes mature on March 24, 2025. We may redeem some or all of the 3.325% Senior Unsecured Notes due 2025 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be equal to 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest up to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 3.325% Senior Unsecured Notes due 2025 are fully and unconditionally guaranteed on a senior unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest up to, but excluding, the date of the purchase.

5.250% Senior Unsecured Notes due 2026

On July 22, 2016, we completed a $500 million senior unsecured notes offering (“5.250% Senior Unsecured Notes due 2026”). Interest on the notes is payable on February 1 and August 1 of each year, commencing on February 1, 2017.year. Interest on the notes is to be paid in cash at a rate of 5.25%5.250% per year. The notes mature on August 1, 2026. We may redeem some or all of the notes at any time prior to August 1, 2021 at a “make whole” redemption price. On or after August 1, 2021, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to August 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 105.25%105.250% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

83


5.000% Senior Unsecured Notes due 2027

On September 7, 2017, we completed a $1.4 billion senior unsecured notes offering (“5.000% Senior Unsecured Notes due 2027”). Interest on the notes is payable on April 15 and October 15 of each year. The notes pay interest in cash at a rate of 5.000% per year. The notes mature on October 15, 2027. We may redeem some or all of the notes at any time prior to October 15, 2022 at a “make whole” redemption price. On or after October 15, 2022, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to October 15, 2020, we may redeem up to 40% of the notes at a redemption price equal to 105% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

With the completion of the 5.000% Senior Unsecured Notes due 2027 offering in 2017, we canceled a $1.0 billion term loan facility commitment from J.P. Morgan Chase Bank, N.A. that we received to assist in funding the September 2017 Steward Transaction.

Other FinancingActivity

2018

In preparation of the joint venture with Primotop described under “2018 Activity” in Note 3, we issued secured debt on August 3, 2018, resulting in gross proceeds of €655 million. Provisions of the secured debt included a term of seven years and a swapped fixed rate of approximately 2.3%. Subsequently, on August 31, 2018, the secured debt was contributed along with the related real estate of 71 properties to form the joint venture.

2017

In connection with our acquisition of the Northland LTACH Hospital on February 14, 2011, we assumed a $14.6 million mortgage. The Northland mortgage loan required monthly principal and interest payments based on a 30-year amortization period. The Northland mortgage loan had a fixed interest rate of 6.2%, a maturity date of January 1, 2018 and could be prepaid, without penalty within 120 days of the term of the loan. On September 29, 2017, we prepaid the principal amount of this mortgage loan at par in the amount of $12.9 million.

On February 17, 2012, we completed a $200 million offering of senior unsecured notes (“6.375% Senior Unsecured Notes due 2022”), and on August 20, 2013, we completed a $150 million tack on to the notes. These 6.375% Senior Unsecured Notes due 2022 accrued interest at a fixed rate of 6.375% per year and had a maturity date of February 15, 2022. The 2013 tack on offering, was issued at a premium (price of 102%), resulting in an effective rate of 5.998%. On October 7, 2017, we redeemed these notes and incurred an $11.2 million redemption premium.

On October 10, 2013, we completed a €200 million offering of senior unsecured notes (“5.750% Senior Unsecured Notes due 2020”). The 5.750% Senior Unsecured Notes due 2020 paid interest in cash at a rate of 5.750% per year. The notes had a maturity date of October 1, 2020. On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020 and incurred a redemption premium of approximately $9 million.

Debt Refinancing Costs

2017

With the replacement of our previous credit facility, the early redemption of the 5.750% Senior Unsecured Notes due 2020 and the 6.375% Senior Unsecured Notes due 2022, the payoff of our €200 million euro term loan, the cancellation of the $1.0 billion term loan facility commitment, and the payment of our $12.9 million mortgage loan, we incurred a charge of $32.6 million (including redemption premiums and accelerated amortization of deferred debt issuance cost and commitment fees) during the year ended December 31, 2017.

2016

On July 27, 2015,22, 2016, we received a commitmentused the net proceeds from the 5.250% Senior Unsecured Notes due 2026 offering to provide aredeem $450 million of senior unsecured bridge loan facilitynotes that had an original maturity date in 2021. This redemption resulted in a $22.5 million debt refinancing charge, consisting of a $15.5 million redemption premium and the original principal amountwrite-off of $1.0 billion to fund the acquisition of Capella pursuant to a commitment letter from JPMorgan Chase Bank, N.A. and Goldman, Sachs & Co. Funding under the bridge facility was not necessary as we funded the acquisition through a combination of an equitydeferred debt issuance and other borrowings. We incurred and expensed certain customary structuring and underwriting fees of $3.9 million in the 2015 third quarter related to the bridge commitment.costs.

Covenants

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets;

84


and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. Through 2016,2018, the dividend restriction was 95% of normalized adjusted FFO.NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of FFO,NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. This Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At December 31, 2016,2018, we were in compliance with all such financial and operating covenants.

Index to Financial Statements

5. Income Taxes

Medical Properties Trust, Inc.

We have maintained and intend to maintain our election as a REIT under the Code of 1986, as amended.Code. To qualify as a REIT, we must meet a number of organizational and operational requirements, including a requirement to distribute at least 90% of our taxable income to our stockholders. As a REIT, we generally will not be subject to U.S. federal income tax if we distribute 100% of our taxable income to our stockholders and satisfy certain other requirements. Incomerequirements; instead, income tax is paid directly by our stockholders on the dividends distributed to them. If our taxable income exceeds our dividends in a tax year, REIT tax rules allow us to designate dividends from the subsequent tax year in order to avoid current taxation on undistributed income. If we fail to qualify as a REIT in any taxable year, we will be subject to federal income taxes at regular corporate rates, including any applicable alternative minimum tax. Taxable income fromnon-REIT activities managed through our TRSsTRS is subject to applicable U.S. federal, state and local income taxes. Our international subsidiaries are also subject to income taxes in the jurisdictions in which they operate.

From our TRSsTRS and our foreign operations, income tax expense (benefit) expense were as follows (in thousands):

 

 

For the Years Ended December 31,

 

  For the years ended December 31, 

 

2018

 

 

2017

 

 

2016

 

  2016       2015       2014     

Current income tax expense:

      

Current income tax (benefit) expense:

 

 

 

 

 

 

 

 

 

 

 

 

Domestic

  $42   $147   $114 

 

$

(125

)

 

$

(41

)

 

$

42

 

Foreign

   1,856    1,614    225 

 

 

3,294

 

 

 

3,062

 

 

 

1,856

 

  

 

   

 

   

 

 
   1,898    1,761    339 

 

 

3,169

 

 

 

3,021

 

 

 

1,898

 

Deferred income tax (benefit) expense:

      

 

 

 

 

 

 

 

 

 

 

 

 

Domestic

   147    (360   (23

 

 

(3,713

)

 

 

(233

)

 

 

147

 

Foreign

   (8,875   102    24 

 

 

1,471

 

 

 

(107

)

 

 

(8,875

)

  

 

   

 

   

 

 

 

 

(2,242

)

 

 

(340

)

 

 

(8,728

)

   (8,728   (258   1 
  

 

   

 

   

 

 

Income tax (benefit) expense

  $(6,830  $1,503   $340 
  

 

   

 

   

 

 

Income tax expense (benefit)

 

$

927

 

 

$

2,681

 

 

$

(6,830

)

A reconciliation of the income tax expense (benefit) at the statutory income tax rate and the effective tax rate for income before income taxes for the years ended December 31, 2018, 2017, and 2016 is as follows (in thousands):

 

 

2018

 

 

2017

 

 

2016

 

Income before income tax

 

$

1,019,404

 

 

$

293,919

 

 

$

219,107

 

Income tax at the U.S. statutory federal rate (21% in 2018 and 35% in

   2017 and 2016)

 

 

214,075

 

 

 

102,872

 

 

 

76,687

 

Increase (decrease) resulting from:

 

 

 

 

 

 

 

 

 

 

 

 

Foreign rate differential

 

 

(2,643

)

 

 

(2,326

)

 

 

1,434

 

State income taxes, net of federal benefit

 

 

379

 

 

 

 

 

 

66

 

U.S. earnings not subject to federal income tax

 

 

(208,472

)

 

 

(98,026

)

 

 

(84,927

)

Equity investments

 

 

(46

)

 

 

3,293

 

 

 

4,297

 

Change in valuation allowance

 

 

(2,668

)

 

 

(5,391

)

 

 

(6,104

)

Other items, net

 

 

302

 

 

 

2,259

 

 

 

1,717

 

Total income tax expense (benefit)

 

$

927

 

 

$

2,681

 

 

$

(6,830

)

85


The foreign provision (benefit) for income taxes is based on foreign lossprofit before income taxes of $23.5$18.6 million in 20162018 as compared with foreign losslosses before income taxes of $29.4$(0.1) million in 2015,2017, and foreign loss before income taxes of $7.5$(23.5) million in 2014.2016.

The domestic provision (benefit) for income taxes is based on a lossincome before income taxes of $1.4$8.0 million in 20162018 from our taxable REIT subsidiariesTRS as compared with income before income taxes of $7.1$13.9 million in 2015,2017, and a loss before income taxes of $20.9$(1.4) million in 2014.2016.

Index to Financial Statements

At December 31, 20162018 and 2015,2017, components of our deferred tax assets and liabilities were as follows (in thousands):

 

 

2018

 

 

2017

 

  2016   2015 

Deferred tax liabilities:

    

Property and equipment

  $(3,781  $(1,636

Unbilled rent

   (7,045   (4,495

Partnership investments

   (5,103   (3,362

Other

   (6,757   (6,141
  

 

   

 

 

Total deferred tax liabilities

  $(22,686  $(15,634

Deferred tax assets:

    

 

 

 

 

 

 

 

 

Operating loss and interest deduction carry forwards

  $28,289   $19,016 

 

$

21,984

 

 

$

24,580

 

Other

   10,085    10,314 

 

 

277

 

 

 

504

 

  

 

   

 

 

Total deferred tax assets

   38,374    29,330 

 

 

22,261

 

 

 

25,084

 

Valuation allowance

   (15,975   (23,005

 

 

(3,444

)

 

 

(11,101

)

  

 

   

 

 

Total net deferred tax assets

  $22,399   $6,325 

 

$

18,817

 

 

$

13,983

 

  

 

   

 

 

Net deferred tax (liability)

  $(287  $(9,309
  

 

   

 

 

Deferred tax liabilities:

 

 

 

 

 

 

 

 

Property and equipment

 

$

(12,359

)

 

$

(4,336

)

Net unbilled revenue

 

 

(1,633

)

 

 

(6,113

)

Partnership investments

 

 

 

 

 

(2,099

)

Other

 

 

(300

)

 

 

(1,320

)

Total deferred tax liabilities

 

 

(14,292

)

 

 

(13,868

)

Net deferred tax asset (liability)

 

$

4,525

 

 

$

115

 

At December 31, 2016,2018, our U.S. net operating losses (“NOLs”) consisted of $60$78.3 million of federal NOLs and $113.5$99.9 million of state NOLs available as offsets to future years’ taxable income. We have federal and state capital loss carryforwards of $8.1 million. The NOLs primarily expire between 20212022 and 2035 and the capital loss carryforward expires in 2022.2036. We have alternative minimum tax credits of $0.3$0.1 million as of December 31, 2016, which may2018.  To the extent these alternative minimum tax credits exceed regular tax liability in tax years 2019 through 2021, 50% of the excess credit are refundable.  Any remaining alternative minimum tax credit will be carried forward indefinitely.refunded in 2022. At December 31, 2016,2018, we had foreign NOLs of $13.3$8.6 million that may be carried forward indefinitely.

Valuation Allowance

The valuation allowance disclosed in the table above relates to foreign and domestic net operating loss carryforwards and other net deferred tax assets that may not be realized. As of each reporting date, we consider all new evidence that could impact the future realization of our deferred tax assets.  In the evaluation of the need for a valuation allowance on the U.S.our deferred income tax assets, we consideredconsider all available positive and negative evidence, including scheduled reversals of deferred income tax liabilities, carryback of future period losses to prior periods, projected future taxable income, tax planning strategies and recent financial performance. Based on

During the fourth quarter of 2018, we released $4.4 million of valuation allowances previously recorded against our review of all positive and negative evidence, including a three year U.S. cumulativepre-tax loss, we concluded that a valuation allowance should remain against those deferred income tax assets that are not expected to be realized through future sources of taxable income generated from scheduled reversals of deferred income tax liabilities. As a result, a valuation allowance continues to be recorded to reflect the portion of the U.S. federal and state net deferred incometax assets.  We now expect these domestic deferred tax assets that are not likelywill be fully utilized to be realized based upon all available evidence. If we later determine that we will more likely than not realize all, or a portion, of the deferredoffset taxable income tax assets, we willin future years.  The decision to reverse the valuation allowance was due to improved operating income in our TRS resulting in a three-year cumulative income position at the end of 2018 and future period. All future reversals of the valuation allowance would resultyear taxable income projected in a tax benefit in the period recognized.our forecasts.

We also evaluated the need for a valuation allowance on our foreign deferred income tax assets. In doing so, we considered all available evidence to determine whether it is more likely than not that the foreign deferred income tax assets will be realized. When comparing 2016 results to prior periods,Based on our review of all positive and negative evidence, we notedconcluded that a significant increase in positive evidence, which included a strong positive trend in foreign earnings and forecasted foreign income projections in 2017 and future periods. For instance, several of our initial foreign subsidiaries achieved a cumulativepre-tax income position as of the 2016 fourth quarter, and we expect the majority of our remaining foreign subsidiaries to be in a cumulativepre-tax income position within the next12-18 months. Current year earnings resulted in the use of $2 million of beginning of the year valuation allowances on deferred tax assets which offset corresponding current tax expense. The positive evidence noted above resulted in our conclusion to make a one-time release of $4 million of thepartial valuation allowance on ourshould remain against certain foreign deferred income tax assets in the 2016 fourth quarter. We also noted that sufficient objective positive evidence didare not exist for a portion of foreign deferred income tax assets at December 31, 2016 dueexpected to the lack ofbe realized through future sources of taxable income to utilize thesegenerated from scheduled reversals of deferred income tax assets. A valuation allowance of $2.2 million has remained to reserve against these foreign deferred tax assets.liabilities and forecasted taxable income from operating activity.

We have no material uncertain tax position liabilities and related interest or penalties recorded at December 31, 2016.

2018.

Index to Financial Statements

A reconciliation of the income tax (benefit) expense at the statutory income tax rate and the effective tax rate for income from continuing operations before income taxes for the years ended December 31, 2016, 2015, and 2014 is as follows (in thousands):REIT Status

   2016   2015   2014 

Income from continuing operations(before-tax)

  $219,108   $141,430   $51,138 

Income tax at the US statutory federal rate (35%)

   76,688    49,501    17,898 

Increase (decrease) resulting from:

      

Rate differential

   1,434    5,047    1,145 

State income taxes, net of federal benefit

   66    (601   (337

Dividends paid deduction

   (84,927   (57,109   (27,873

Equity investments

   4,297    —      —   

Change in valuation allowance

   (6,104   6,174    8,988 

Other items, net

   1,716    (1,509   519 
  

 

 

   

 

 

   

 

 

 

Total income tax (benefit) expense

  $(6,830  $1,503   $340 
  

 

 

   

 

 

   

 

 

 

We have met the annual REIT distribution requirements by payment of at least 90% of our estimated taxable income in 2016, 2015,2018, 2017, and 2014.2016. Earnings and profits, which determine the taxability of such distributions, will differ from net income reported for financial reporting purposes due primarily to differences in cost basis, differences in the estimated useful lives used to compute depreciation, and differences between the allocation of our net income and loss for financial reporting purposes and for tax reporting purposes.

86


A schedule of per share distributions we paid and reported to our stockholders is set forth in the following:

 

  For the Years Ended December 31, 

 

For the Years Ended December 31,

 

  2016   2015   2014 

 

2018

 

 

2017

 

 

2016

 

Common share distribution

  $0.900000   $0.870000   $0.840000 

 

$

0.990000

 

 

$

0.950000

 

 

$

0.900000

 

Ordinary income

   0.619368    0.769535    0.520692 

 

 

0.438792

 

 

 

0.655535

 

 

 

0.619368

 

Capital gains(1)

   0.102552    —      0.000276 

 

 

0.551208

 

 

 

0.021022

 

 

 

0.102552

 

Unrecaptured Sec. 1250 gain

   0.045432    —      0.000276 

 

 

0.132280

 

 

 

0.004647

 

 

 

0.045432

 

Section 19A Dividends

 

 

0.438792

 

 

 

 

 

 

 

Return of capital

   0.178080    0.100465    0.319032 

 

 

 

 

 

0.273443

 

 

 

0.178080

 

 

(1)

Capital gains include unrecaptured Sec. 1250 gains.

MPT Operating Partnership, L.P.

As a partnership, the allocated share of income of the Operating Partnership is included in the income tax returns of the general and limited partners. Accordingly, no accounting for income taxes is generally required for such income of the Operating Partnership. However, the Operating Partnership has formed TRSsa TRS on behalf of Medical Properties Trust, Inc., which areis subject to U.S. federal, state and local income taxes at regular corporate rates, and its international subsidiaries are subject to income taxes in the jurisdictions in which they operate. See discussion above under Medical Properties Trust, Inc. for more details of income taxes associated with our TRSsTRS and international operations.

Index to Financial Statements

6. Earnings Per Share/Unit

Medical Properties Trust, Inc.

Our earnings per share were calculated based on the following (amounts in thousands):

 

   For the Years Ended December 31, 
   2016  2015  2014 

Numerator:

    

Income from continuing operations

  $225,938  $139,927  $50,798 

Non-controlling interests’ share in continuing operations

   (889  (329  (274

Participating securities’ share in earnings

   (559  (1,029  (894
  

 

 

  

 

 

  

 

 

 

Income from continuing operations, less participating securities’ share in earnings

   224,490   138,569   49,630 

Income (loss) from discontinued operations attributable to MPT common stockholders

   (1  —     (2
  

 

 

  

 

 

  

 

 

 

Net income, less participating securities’ share in earnings

  $224,489  $138,569  $49,628 
  

 

 

  

 

 

  

 

 

 

Denominator:

    

Basic weighted-average common shares

   260,414   217,997   169,999 

Dilutive potential common shares

   658   307   541 
  

 

 

  

 

 

  

 

 

 

Diluted weighted-average common shares

   261,072   218,304   170,540 
  

 

 

  

 

 

  

 

 

 

 

 

For the Years Ended December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

Numerator:

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Non-controlling interests’ share in earnings

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

Participating securities’ share in earnings

 

 

(3,685

)

 

 

(1,409

)

 

 

(559

)

Net income, less participating securities’ share in

   earnings

 

$

1,013,000

 

 

$

288,384

 

 

$

224,489

 

Denominator:

 

 

 

 

 

 

 

 

 

 

 

 

Basic weighted average common shares

 

 

365,364

 

 

 

349,902

 

 

 

260,414

 

Dilutive potential common shares

 

 

907

 

 

 

539

 

 

 

658

 

Diluted weighted average common shares

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

MPT Operating Partnership, L.P.

Our earnings per unit were calculated based on the following (amounts in thousands):

 

   For the Years Ended December 31, 
   2016  2015  2014 

Numerator:

    

Income from continuing operations

  $225,938  $139,927  $50,798 

Non-controlling interests’ share in continuing operations

   (889  (329  (274

Participating securities’ share in earnings

   (559  (1,029  (894
  

 

 

  

 

 

  

 

 

 

Income from continuing operations, less participating securities’ share in earnings

   224,490   138,569   49,630 

Income (loss) from discontinued operations attributable to MPT Operating Partnership partners

   (1  —     (2
  

 

 

  

 

 

  

 

 

 

Net income, less participating securities’ share in earnings

  $224,489  $138,569  $49,628 
  

 

 

  

 

 

  

 

 

 

Denominator:

    

Basic weighted-average units

   260,414   217,997   169,999 

Dilutive potential units

   658   307   541 
  

 

 

  

 

 

  

 

 

 

Diluted weighted-average units

   261,072   218,304   170,540 
  

 

 

  

 

 

  

 

 

 

 

 

For the Years Ended December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

Numerator:

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

$

1,018,477

 

 

$

291,238

 

 

$

225,937

 

Non-controlling interests’ share in earnings

 

 

(1,792

)

 

 

(1,445

)

 

 

(889

)

Participating securities’ share in earnings

 

 

(3,685

)

 

 

(1,409

)

 

 

(559

)

Net income, less participating securities’ share in

   earnings

 

$

1,013,000

 

 

$

288,384

 

 

$

224,489

 

Denominator:

 

 

 

 

 

 

 

 

 

 

 

 

Basic weighted average units

 

 

365,364

 

 

 

349,902

 

 

 

260,414

 

Dilutive potential units

 

 

907

 

 

 

539

 

 

 

658

 

Diluted weighted average units

 

 

366,271

 

 

 

350,441

 

 

 

261,072

 

87


7. Stock Awards

Stock Awards

Our Equity Incentive Plan authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units and awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 8,196,770 shares of common stock for awards under the Equity Incentive Plan and 5,265,916976,073 shares remain available for future stock awards as of December 31, 2016.2018. The Equity Incentive Plan contains a limit of 5,000,000 shares as the maximum number of shares of common stock that may be awarded to

Index to Financial Statements

an individual in any fiscal year. Awards under the Equity Incentive Plan are subject to forfeiture due to termination of employment prior to vesting.vesting and/or from not achieving the respective performance/market conditions on performance-based awards. In the event of a change in control, outstanding and unvested options will immediately vest, unless otherwise provided in the participant’s award or employment agreement, and restricted stock, restricted stock units, deferred stock units and other stock-based awards will vest if so provided in the participant’s award agreement. The term of the awards is set by the Compensation Committee, though Incentive Stock Options may not have terms of more than ten years. Forfeited awards are returned to the Equity Incentive Plan and are then available to bere-issued as future awards. For each share of common stock issued by Medical Properties Trust, Inc. pursuant to its Equity Incentive Plan, the Operating Partnership issues a corresponding number of Operating Partnership units.

The following awards have been granted pursuant to our Equity Incentive Plan (and its predecessor plan):Plan:

Restricted Equity Awards

These stock-based awards are in the form of service-based awards and performance awards based on either company-specific performance hurdles or certain market conditions.

Service-Based Awards

The service-based awards vest as the employee provides the required service (typically three to five years). Service based awards are valued at the average price per share of common stock on the date of grant. Dividends are generally paid on these awards prior to vesting. See table below for a summary of activity involving service-based awards.

Performance-Based Awards

In 2016, 2015,2018, 2017, and 2014,2016, the Compensation Committee granted performance — basedperformance-based awards to employees which vest based on us achieving certain total shareholder returns or comparisons of our total shareholder returns to peer total return indices.employees. Generally, dividends are not paid on performance awards until the award is earned. See below for details of such performance award grants:

2018 performance awards — The 2018 performance awards were granted in three parts:

1)

Certain 2018 performance awards (target number) were granted based on the achievement of specific performance thresholds as set by our compensation committee. However, more or less shares than the target number of shares were allowed to be earned based on our performance. The pre-established performance thresholds for 2018 were as follows:

a)

Approximately 40% of the target shares can be earned based on our return on equity (“ROE”), as defined by our compensation committee, over the period from January 1, 2018 through December 31, 2020, with the opportunity to earn one-third of the award in any one year. If our ROE was 12.5% or less for the performance period, 50% of these shares would be earned; if our ROE was at least equal to 13.0%, 100% of these shares would be earned; and, if our ROE was greater than or equal to 13.5%, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance in 2018, one-third of the target shares was earned at 200%.

b)

Approximately 40% of the target shares can be earned based on our earnings before interest expense, taxes, depreciation and amortization all in accordance with GAAP adjusted for other certain items (or “EBITDA”) as defined by our compensation committee, for the year ending December 31, 2020, with the opportunity to earn one-third of the award in any one year. If our EBITDA is at least equal to $720 million for either of the 2018 or 2019 years, or $775 million for 2020, 50% of these shares would be earned; if our EBITDA is at least equal to $740 million for either of the 2018 or 2019 years or $800 million for 2020, 100% of these shares would be earned; and, if our EBITDA is at least equal to $760 million for either of the 2018 or 2019 years or $825 million for 2020, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance, one-third of the target shares was earned at 200%.

c)

Approximately 20% of the target shares can be earned based on our completed acquisitions ("Acquisitions") as defined by our compensation committee, over the period from January 1, 2018 through December 31, 2020, with

88


the opportunity to earn one-third of the award in any one year. If our Acquisitions were at least equal to $500 million for either of the 2018 or 2019 years or $1.5 billion for the cumulative three-year period; 50% of these shares would be earned; if our Acquisitions were at least equal to $750 million for either of the 2018 or 2019 years or $2.25 billion for the cumulative three-year period, 100% of these shares would be earned; and, if our Acquisitions were at least equal to $1.0 billion for either the 2018 or 2019 years or $3.0 billion for the cumulative three-year period, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. Based on performance, 73% of the target shares available in the first year of the measurement period was earned.

At the end of each of the performance periods, any earned shares during such period will vest on January 1 of the following calendar year.

2)

Certain 2018 performance awards were subject to a modifier (which increases or decreases the actual shares earned in each performance period) based on how our total shareholder return compared to the SNL U.S. REIT Healthcare Index (“SNL Index”). If our total shareholder return is in the 75th percentile of the SNL Index, the number of earned shares under this award is increased by 25%, if our total shareholder return is in the 55th percentile of the SNL Index, the number of earned shares under this award had no change; and, if our total shareholder return is in the 35th percentile of the SNL Index, the number of earned shares under this award is decreased by 25%. For 2018, our total shareholder return was in the 95th percentile of the SNL index.

In 2018, 508,566 shares were earned but not vested, and 2,000 shares were forfeited. At December 31, 2018, we have 1,238,748 of 2018 performance awards remaining to be earned.

2017 performance awards — The 2017 performance awards were granted in three parts:

1)

Certain 2017 performance awards (target number) were granted based on the achievement of specific performance thresholds as set by our compensation committee for the one-year performance period of 2017. However, more or less shares than the target number of shares were allowed to be earned based on our performance. The pre-established performance thresholds for 2017 were as follows:

a)

Approximately 42% of the target shares were earned based on the achievement of a one-year total shareholder return as compared to the SNL Index over the period from January 1, 2017 through December 31, 2017. If the shareholder return was equal to the SNL Index minus 3% for the one-year period, 50% of these shares would be earned; while, if shareholder return was greater than or equal to the SNL Index plus 3%, 200% of these target shares would be earned. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of three years.

b)

Approximately 47% of the target shares were earned based on our return on equity (“ROE”), as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our ROE was at least equal to 12.5% for the one-year period, 50% of these shares would be earned; and, if our ROE was greater than or equal to 13.5%, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

c)

Approximately 11% of the target shares were earned based on general and administrative expenses (“G&A”) as a percentage of revenue, as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our G&A as a percentage of revenue was no more than 10% for the one-year period, 50% of these shares would be earned; while, if our G&A as a percentage of revenue was 9% or less, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

At the end of the one-year performance period, all earned shares will vest in equal annual amounts on January 1, 2018, 2019, and 2020.

2)

Certain other 2017 performance awards were based on the achievement of a multi-year cumulative total shareholder return as compared to pre-established returns set by our compensation committee. If the cumulative shareholder return from January 1, 2017 through December 31, 2019 is 27% or greater, then 30% of these shares will be earned (“2019 award”). If the cumulative shareholder return from January 1, 2017 through December 31, 2020 is 36% or greater, then 30% of these shares may be earned (“2020 award”). However, the maximum percentage cumulatively earned in connection with both the 2019 award and the 2020 award shall not exceed 30% of the total award. If the cumulative shareholder return from

89


January 1, 2017 through December 31, 2021 is 45% or greater, then all remaining shares will be earned. At the end of each of the performance periods, any earned shares during such period will vest on January 1 of the following calendar year. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.9%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 5 years.

3)

The final portion of our 2017 performance awards will be earned if our total shareholder return outpaces that of the SNL Index over the cumulative period from January 1, 2017 to December 31, 2019. Our total shareholder return must be within 3% of the SNL Index to earn the minimum number of shares under this award; while, it must exceed the SNL Index by 3% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2020, 2021, and 2022. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.5%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 3 years.

In 2018, 396,142 shares were earned but not vested, and 3,750 performance awards were forfeited. In 2017, 596,472 shares were earned but not vested, and 14,000 performance awards were forfeited. At December 31, 2018, we have 1,125,281 of 2017 performance awards remaining to be earned.

2016 performance awards — The 2016 performance awards were granted in two parts:

 

1)

One-half of the 2016 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2016 to December 31, 2018. The minimum total shareholder return needed to earn a portion of this award iswas 27.0% with 100% of the award earned if our total shareholder return reachesreached 35.0%. If any shares areShares earned from this award the shares will vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rates of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

2)The remainder of the 2016 performance awards will be earned if our total shareholder return outpaces that of the MSCI U.S. REIT Index (“Index”) over the cumulative period from January 1, 2016 to December 31, 2018. Our total shareholder return must be within 3% of the Index to earn the minimum number of shares under this award, while it must exceed the Index by 3% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

No 2016 performance awards were earned and vested in 2016, and 2,400 performance awards were forfeited in 2016. At December 31, 2016, we have 797,404 of 2016 performance awards remaining to be earned.

2015 performance awards — The 2015 performance awards were granted in three parts:

 

1)

2)

Approximately 40%

The remainder of the 20152016 performance awards were based on us achieving a simple 9.0% annualto be earned if our total shareholder return. Forreturn outpaced that of the three-yearMSCI U.S. REIT Index (“MSCI Index”) over the cumulative period from January 1, 2015 through2016 to December 31, 2017,one-third of the awards will be earned annually (until the award is fully earned) if a 9.0%2018. Our total shareholder return is achieved. If total shareholder return does not reach 9.0%needed to be within 3% of the MSCI Index to earn the minimum number of shares under this award, while it had to exceed the MSCI Index by 3% to earn 100% of the award. Shares earned from this award vest in a particular year, shares for that year can be earned in a future period (during the three-year period) if the cumulative total shareholder return is equal to or greater than a 9.0% annual return for such cumulative period.amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the datedates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%1.0%; expected volatility of 20%24.4%; expected dividend yield of 7.2%; and expected service period of 3 years.

Index to Financial Statements
2)Approximately 30% of the 2015 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2015 to December 31, 2017. The minimum total shareholder return needed to earn a portion of this award is 27.0% with 100% of the award earned if our total shareholder return reaches 35.0%. If any shares are earned from this award, the shares will vest in equal annual amounts on December 31, 2017, 2018, and 2019. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%; expected volatility of 20%; expected dividend yield of 7.2%7.0%; and expected service period of 5 years.

3)The remainder of the 2015 performance awards will be earned if our total shareholder return outpaces the Index over the cumulative period from January 1, 2015 to December 31, 2017. Our total shareholder return must exceed that of the Index to earn the minimum number of shares under this award, while it must exceed the Index by 6% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on December 31, 2017, 2018, and 2019. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%; expected volatility of 20%; expected dividend yield of 7.2%; and expected service period of 5 years.

In 2018, 779,004 shares were earned but not vested, while no shares were forfeited. In 2017 and 2016, 98,526no shares were earned and vested, while 16,000 and 66,792 performance2,400 awards were forfeited in 2016. No 2015 performance awards were earned and vested in 2015, and 4,500 performance awards were forfeited in 2015. At December 31, 2016, we have 702,070 of 2015 performance awards remaining to be earned.

2014 performance awards — The 2014 performance awards were granted in three parts:

1)Approximately 40% of the 2014 performance awards were based on us achieving a simple 9.0% annual total shareholder return. For the five-year period from January 1, 2014 through December 31, 2018,one-third of the awards will be earned annually (until the award is fully earned) if a 9.0% total shareholder return is achieved. If total shareholder return does not reach 9.0% in a particular year, shares for that year can be earned in a future period (during the five-year period) if the cumulative total shareholder return is equal to or greater than a 9.0% annual return for such cumulative period. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.7%; expected volatility of 27%; expected dividend yield of 8.0%; and expected service period of 3 years.

2)Approximately 30% of the 2014 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2014 to December 31, 2016. The minimum total shareholder return needed to earn a portion of this award is 27.0% with 100% of the award earned if our total shareholder return reaches 35.0%. If any shares are earned from this award, the shares will vest in equal annual amounts on December 31, 2016, 2017 and 2018. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 0.8%; expected volatility of 27%; expected dividend yield of 8.0%; and expected service period of 5 years.

3)The remainder of the 2014 performance awards were to be earned if our total shareholder return outpaced that of the Index over the cumulative period from January 1, 2014 to December 31, 2016. Our total shareholder return must exceed that of the Index to earn the minimum number of shares under this award, while it must exceed the Index by 6% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on December 31, 2016, 2017, and 2018. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 0.8%; expected volatility of 27%; expected dividend yield of 8.0%; and expected service period of 5 years.

In 2014 and 2016, 108,261 and 99,959 shares were earned and vested under the 2014 performance awards, respectively. No such awards were earned and vested in 2015. In 2016, 500,000 shares, which

Index to Financial Statements

related to the latter two parts of the award as described above, were forfeited as the three-year cumulative total shareholder return hurdles from January 1, 2014 to December 31, 2016 were not met. An additional 72,003 performance shares were forfeited prior to the measurement date in 2016. At December 31, 2016, we have 99,935 of 2014 performance awards remaining to be earned.

The following summarizes restricted equity award activity in 20162018 and 20152017 (which includes awards granted in 2018, 2017, 2016, 2015, 2014, and any applicable prior years), respectively:

For the Year Ended December 31, 2016:2018:

 

 

Vesting Based

on Service

 

 

Vesting Based on

Market/Performance

Conditions

 

 

 

Shares

 

 

Weighted Average

Value at Award Date

 

 

Shares

 

 

Weighted Average

Value at Award Date

 

Nonvested awards at beginning of the year

 

 

276,280

 

 

$

12.68

 

 

 

2,676,755

 

 

$

7.86

 

Awarded

 

 

958,480

 

 

$

14.31

 

 

 

1,750,834

 

 

$

11.61

 

Vested

 

 

(307,275

)

 

$

12.92

 

 

 

(288,404

)

 

$

11.25

 

Forfeited

 

 

(3,637

)

 

$

13.05

 

 

 

(5,750

)

 

$

9.35

 

Nonvested awards at end of year

 

 

923,848

 

 

$

14.29

 

 

 

4,133,435

 

 

$

9.21

 

90

   Vesting Based on Service   Vesting Based on Market/
Performance
Conditions
 
   Shares  Weighted Average
Value at Award Date
   Shares  Weighted Average
Value at Award Date
 

Nonvested awards at beginning of the year

   509,634  $13.25    2,331,152  $6.38 

Awarded

   254,574  $13.07    799,804  $7.30 

Vested

   (349,356 $13.07    (671,983 $6.50 

Forfeited

   (67,724 $13.06    (647,298 $6.28 
  

 

 

    

 

 

  

Nonvested awards at end of year

   347,128  $13.35    1,811,675  $6.78 
  

 

 

    

 

 

  

For the Year Ended December 31, 2015:2017:

 

 

Vesting Based

on Service

 

 

Vesting Based on

Market/Performance

Conditions

 

 

 

Shares

 

 

Weighted Average

Value at Award Date

 

 

Shares

 

 

Weighted Average

Value at Award Date

 

Nonvested awards at beginning of the year

 

 

347,128

 

 

$

13.35

 

 

 

1,811,675

 

 

$

6.78

 

Awarded

 

 

249,841

 

 

$

12.40

 

 

 

1,741,003

 

 

$

8.21

 

Vested

 

 

(304,613

)

 

$

12.86

 

 

 

(491,071

)

 

$

6.84

 

Forfeited

 

 

(16,076

)

 

$

12.75

 

 

 

(384,852

)

 

$

5.65

 

Nonvested awards at end of year

 

 

276,280

 

 

$

12.68

 

 

 

2,676,755

 

 

$

7.86

 

 

   Vesting Based
on Service
   Vesting Based on
Market/Performance
Conditions
 
   Shares  Weighted Average
Value at Award Date
   Shares  Weighted Average
Value at Award Date
 

Nonvested awards at beginning of the year

   452,263  $12.11    2,428,518  $5.81 

Awarded

   407,969  $13.94    871,888  $6.62 

Vested

   (343,904 $12.56    (406,970 $4.94 

Forfeited

   (6,694 $13.08    (562,284 $5.33 
  

 

 

    

 

 

  

Nonvested awards at end of year

   509,634  $13.25    2,331,152  $6.38 
  

 

 

    

 

 

  

The value of stock-based awards is charged to compensation expense over the vestingservice periods. InFor the years ended December 31, 2016, 2015,2018, 2017, and 2014,2016, we recorded $7.9$16.5 million, $11.1$9.9 million, and $9.2$7.9 million, respectively, ofnon-cash compensation expense. The remaining unrecognized cost from restricted equity awards at December 31, 2016,2018, is $12.4$34.9 million, which will be recognized over a weighted average period of 2.782.1 years. Restricted equity awards that vested in 2016, 2015,2018, 2017, and 20142016, had a value of $12.7$8.4 million, $10.2$10.4 million, and $10.2$12.7 million, respectively.

8. Commitments and Contingencies

Commitments

On July 20, 2016, we entered into definitive agreements to acquire 20 rehabilitation hospitals in Germany for an aggregate purchase price to us of approximately €215.7 million. Upon closing, the facilities will be leased to affiliates of MEDIAN, pursuant to a new master lease with a term of approximately 27 years. Closing of the transaction, which began during the fourth quarter of 2016, is subject to customary real estate, regulatory and other closing conditions. As discussed in Note 3, we have closed seven of the 20 facilities in the amount of €49.5 million on December 31, 2016.

Index to Financial Statements

On September 9, 2016, we entered into definitive agreements to acquire six rehabilitation hospitals in Germany for an aggregate purchase price to us of approximately €44.1 million. Upon closing, the facilities will be leased to affiliates of MEDIAN, pursuant to the existing long-term master lease. Closing of the transaction, which began during the fourth quarter of 2016, is subject to customary real estate, regulatory and other closing conditions. As discussed in Note 3, we have closed on five of the six facilities in the amount of €35.7 million as of December 31, 2016. We closed on the final property on January 27, 2017, in the amount of €8.4 million.

On September 28, 2016, we entered into definitive agreements to acquire two acute care hospitals in Washington and Idaho for an aggregate purchase price to us of approximately $105 million. Upon closing, the facilities will be leased to RCCH, pursuant to the current master lease. Closing of the transaction, which is expected to be completed in the first half of 2017, is subject to customary real estate, regulatory and other closing conditions.

Operating leases, in which we are the lessee, primarily consist of ground leases on which certain of our facilities or other related property reside along with corporate office and equipment leases. The ground leases are long-term leases (almost all having terms of 30 years or more), some of which contain escalation provisions and one contains a purchase option. Properties subject to these ground leases are subleased to our tenants.tenants except for three Adeptus transition properties. Lease and rental expense (which is recorded on the straight-line method) for 2018, 2017, and 2016 2015was $9.4 million, $9.8 million, and 2014, respectively, were $6.8 million, $4.6 million, and $2.3 million,respectively, which was offset by sublease rental income of $4.3 million, $6.6 million, and $4.2 million, $2.3 million,for 2018, 2017, and $0.3 million for 2016, 2015, and 2014, respectively.

Fixed minimum payments due over the remaining lease term under non-cancelable operating leases withnon-cancelable terms of more than one year and amounts to be received in the future fromnon-cancelable subleases over their remaining lease term at December 31, 20162018 are as follows: (amounts in thousands)

 

 

Fixed

minimum

payments

 

 

Amounts to

be received

from

subleases

 

 

Net

payments

 

 

  Fixed
minimum
payments
   Amounts to
be received
from
subleases
   Net
payments
 

2017

  $7,328   $(4,725  $2,603 

2018

   7,249    (4,731   2,518 

2019

   6,925    (4,755   2,170 

 

$

6,602

 

 

$

(3,284

)

 

$

3,318

 

 

2020

   6,944    (4,860   2,084 

 

 

6,903

 

 

 

(3,458

)

 

 

3,445

 

 

2021

   6,024    (4,966   1,058 

 

 

6,841

 

 

 

(3,551

)

 

 

3,290

 

 

2022

 

 

6,838

 

 

 

(3,632

)

 

 

3,206

 

 

2023

 

 

6,861

 

 

 

(3,636

)

 

 

3,225

 

 

Thereafter

   251,981    (249,662   2,319 

 

 

198,932

 

 

 

(93,586

)

 

 

105,346

 

(1)

  

 

   

 

   

 

 

 

$

232,977

 

 

$

(111,147

)

 

$

121,830

 

 

  $286,451   $(273,699  $12,752 
  

 

   

 

   

 

 

(1)

Reflects certain ground leases, in which we are the lessee, that have longer initial fixed terms than our existing sublease to our tenants. However, we would expect to either renew the related sublease, enter into a lease with a new tenant or early terminate the ground lease to reduce or avoid any significant impact from such ground leases.

Contingencies

We are a party to various legal proceedings incidental to our business. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to these proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

91


9. Common Stock/Partner’s Capital

Medical Properties Trust, Inc.

2018 Activity

In the 2018 fourth quarter, we sold 5.6 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $95 million.

2017 Activity

On May 1, 2017, we completed an underwritten public offering of 43.1 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 5.6 million shares) of our common stock, resulting in net proceeds of approximately $548 million, after deducting offering expenses.

On November 13, 2017, we entered into a new at-the-market equity offering program, which gives us the ability to sell up to $750 million of stock with a commission rate up to 2.0%. During 2017, we did not sell any shares of our common stock under this program.

2016 Activity

On October 7, 2016, we sold 10.3 million shares of common stock in a private placement to an affiliate of Cerberus, the controlling member of Steward, and certain members of Steward management. We sold these shares at a price per share of $14.50, equal to the public offering price of our September 2016 equity offering, generating total proceeds of $150 million.

Index to Financial Statements

On September 30, 2016, we completed an underwritten public offering of 57.5 million shares (including the exercise of the underwriters’30-day option to purchase an additional 7.5 million shares) of our common stock, resulting in net proceeds of $799.5 million, after deducting estimated offering expenses.

On March 1, 2016, we updated ourat-the-market equity offering program, which gave us the ability to sell up to $227 million of stock with a commission rate of 1.25%. During 2016, we sold approximately 15 million shares of our common stock under thisa previously existing at-the-market equity offering program (that ended in 2016), resulting in net proceeds of approximately $224 million, after deducting approximately $2.8 million of commissions. We have no capacity to sell additional shares under thisat-the-market equity offering program.

2015 Activity

On August 11, 2015, we completed an underwritten public offering of 28.75 million shares (including the exercise of the underwriters’30-day option to purchase an additional 3.8 million shares) of our common stock, resulting in net proceeds of approximately $337 million, after deducting estimated offering expenses.

On August 4, 2015, we filed Articles of Amendment to our charter with the Maryland State Department of Assessments and Taxation increasing the number of authorized shares of common stock, par value $0.001 per share available for issuance from 250,000,000 to 500,000,000.

On January 14, 2015, we completed an underwritten public offering of 34.5 million shares (including the exercise of the underwriters’30-day option to purchase an additional 4.5 million shares) of our common stock, resulting in net proceeds of approximately $480 million, after deducting estimated offering expenses.

MPT Operating Partnership, L.P.

TheAt December 31, 2018 the Operating Partnership is made up of a general partner, Medical Properties Trust, LLC (“General Partner”) and limited partners, including the Company (which owns 100% of the General Partner) and threetwo other partners. By virtue of its ownership of the General Partner, the Company has a 99.9% ownership interest in Operating Partnership via its ownership of all the common units. The remaining ownership interest is held by the two employees and one director via their ownership of LTIP units. These LTIP units were issued pursuant to the 2007 Multi-Year Incentive Plan, which is now part of the Equity Incentive Plan discussed in Note 7 and once vested in accordance with their award agreement, may be converted to common units per the Second Amended and Restated Agreement of Limited Partnership of MPT Operating Partnership, L.P. (“Operating Partnership Agreement”).

In regards to distributions, the Operating Partnership shall distribute cash at such times and in such amounts as are determined by the General Partner in its sole and absolute discretion, to common unit holders who are common unit holders on the record date. However, per the Operating Partnership Agreement, the General Partner shall use its reasonable efforts to cause the Operating Partnership to distribute amounts sufficient to enable the Company to pay stockholder dividends that will allow the Company to (i) meet its distribution requirement for qualification as a REIT and (ii) avoid any U.S. federal income or excise tax liability imposed by the Code, other than to the extent the Company elects to retain and pay income tax on its net capital gain. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for distribution purposes.

The Operating Partnership’s net income will generally be allocated first to the General Partner to the extent of any cumulative losses and then to the limited partners in accordance with their respective percentage interests in the common units issued by the Operating Partnership. Any losses of the Operating Partnership will generally be allocated first to the limited partners until their capital account is zero and then to the General Partner. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for purposes of income and loss allocations. Limited partners have the right to require the Operating Partnership to redeem part or all of their common units. It is at the Operating Partnership’s discretion to redeem such common units for cash

Index to Financial Statements

based on the fair market value of an equivalent number of shares of the Company’s common stock at the time of redemption or, alternatively, redeem the common units for shares of the Company’s common stock on aone-for-one basis, subject to adjustment in the event of stock splits, stock dividends, or similar events. In order for LTIP units to be redeemed, they must first be converted to common units and then must wait two years from the issuance of the LTIP units to be redeemed.redeemed, and then converted to common units. In 2018, approximately 60 thousand LTIP units were converted to common units and then redeemed for approximately $0.8 million of cash.

92


For each share of common stock issued by Medical Properties Trust, Inc., the Operating Partnership issues a corresponding number of operating partnership units.

10. Fair Value of Financial Instruments

We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents, and accounts payable and accrued expenses approximate their fair values. Included in our accounts payable and accrued expenses at December 31, 2015, were our interest rate swaps, which were recorded at fair value based on Level 2 observable market assumptions using standardized derivative pricing models. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as discounting the estimated future cash flows using the current rates at which similar receivables would be made to others with similar credit ratings and for the same remaining maturities. The fair value of our mortgage and working capital loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes, using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our Revolvingrevolving credit facility and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt.

Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):

 

  December 31,
2016
   December 31,
2015
 

 

December 31, 2018

 

 

December 31, 2017

 

Asset (Liability)

  Book
Value
   Fair
Value
   Book
Value
   Fair
Value
 

 

Book

Value

 

 

Fair

Value

 

 

Book

Value

 

 

Fair

Value

 

Interest and rent receivables

  $57,698   $57,707   $46,939   $46,858 

 

$

25,855

 

 

$

24,942

 

 

$

78,970

 

 

$

78,028

 

Loans(1)

   986,987    1,017,428    508,851    543,859 

 

 

1,471,520

 

 

 

1,490,758

 

 

 

1,698,471

 

 

 

1,722,101

 

Debt, net

   (2,909,341   (2,966,759   (3,322,541   (3,372,773

 

 

(4,037,389

)

 

 

(3,947,795

)

 

 

(4,898,667

)

 

 

(5,073,707

)

 

(1)

Excludes loans related to Ernest and Capella (2015 only) since theythat are recorded at fair value as discussed below.– see below for further details.

Items Measured at Fair Value on a Recurring Basis

Our equity interest in Ernest Capella (2015 only) and related loans, as discussedwhich we sold or were repaid in Note 2, are beingfull (other than our mortgage loans) on October 4, 2018, were measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method. We have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other equity interests or loans inexisting at December 31, 2018 or prior to 2016.December 31, 2017.

Index to Financial Statements

At December 31, 2016,2018 and 2017, the amounts recorded under the fair value option method were as follows (in thousands):

 

 

As of December 31, 2018

 

 

As of December 31, 2017

 

 

Asset Type

Asset (Liability)

 

Fair Value

 

 

Original

Cost

 

 

Fair Value

 

 

Original

Cost

 

 

Classification

Mortgage loans

 

$

115,000

 

 

$

115,000

 

 

$

115,000

 

 

$

115,000

 

 

Mortgage loans

Equity investment and other loans

 

 

 

 

 

 

 

 

114,554

 

 

 

118,354

 

 

Other loans/other assets

 

 

$

115,000

 

 

$

115,000

 

 

$

229,554

 

 

$

233,354

 

 

 

 

Asset (Liability)

  Fair
Value
   Cost   Asset Type
Classification

Mortgage loan

  $112,836   $112,836   Mortgage loans

Acquisition and other loans

   116,298    116,298   Other loans

Equity investment

   3,300    3,300   Other assets
  

 

 

   

 

 

   
  $232,434   $232,434   
  

 

 

   

 

 

   

At December 31, 2015, the amounts recorded under the fair value option method were as follows (in thousands):

 

Asset (Liability)

  Fair
Value
   Cost   Asset Type
Classification
 

Mortgage loan

  $310,000   $310,000    Mortgage loans 

Acquisition and other loans

   603,552    603,552    Other loans 

Equity investment

   7,349    7,349    Other assets 
  

 

 

   

 

 

   
  $920,901   $920,901   
  

 

 

   

 

 

   

Our mortgage and other loans (for 2017 only) with Ernest and Capella (2015 only) are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investmentsinvestment in Ernest and Capella (2015 only) arewas recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classifyclassified the equity investmentsinvestment as Level 3, as we useused certain unobservable inputs to the valuation methodology that arewere significant to the fair value measurement, and the valuation requiresrequired management judgment due to the absence of quoted market prices. For these cash flow models, our observable inputs includeincluded use of a capitalization rate, discount rate (which is based on a weighted-averageweighted average cost of capital), and market interest rates, and our unobservable input includesincluded an adjustment for a DLOMmarketability discount (“DLOM”) on our equity investment of 40% at December 31, 2016.2018.

In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections are provided by Ernest and Capella (2015 only), respectively. However, we will modify such projections (including underlying assumptions used) as needed based on our review and analysis of their historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.93


In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors including the percent of control, the nature of the underlying investee’s business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):

Basis Point

Change in

Marketability Discount

  Estimated Increase (Decrease)
In Fair Value
 

+100 basis points

  $(49

- 100 basis points

   49

Index to Financial Statements

Because the fair value of Ernest and Capella (2015 only) investments noted above approximate theirwas below our original cost, we recognized an unrealized loss during 2018 (before selling our investment) and 2017. We did not recognize any unrealized gains/losses during 2016, 2015, or 2014. To date, we have not received any distribution payments from our equity investmenton the Ernest investments in Ernest. In regards to the Capella investment, we sold this investment in 2016 at our original cost (see Note 3 for further details of this disposal).2016.

11. Other Assets

The following is a summary of our other assets (in thousands):

 

  At December 31, 

 

At December 31,

 

  2016   2015 

 

2018

 

 

2017

 

Debt issue costs, net(1)

  $4,478   $7,628 

 

$

4,793

 

 

$

7,093

 

Equity investments

   177,430    129,337 

 

 

520,058

 

 

 

288,398

 

Other corporate assets

   77,580    31,547 

 

 

115,416

 

 

 

117,827

 

Prepaids and other assets

   44,285    27,028 

 

 

61,757

 

 

 

55,176

 

  

 

   

 

 

Total other assets

  $303,773   $195,540 

 

$

702,024

 

 

$

468,494

 

  

 

   

 

 

 

(1)

Relates to Revolvingrevolving credit facility

Equity investments have increased over the prior year primarily due to our new investment in Steward€210 million joint venture arrangement with Primotop — see Note 3 for further details. Other corporate assets include leasehold improvements associated with our corporate office space,offices, furniture and fixtures, equipment, software, deposits, etc. Included in prepaids and other assets is prepaid insurance, prepaid taxes, goodwill (2017 only), deferred income tax assets (net of valuation allowances, if any), and lease inducements made to tenants, among other items.

Summarized Financial Information for Significant Investees

The following table presents financial information as of and for the year ended December 31, 2018 for the joint venture arrangement with Primotop in which we made an equity method investment in and advances to on August 31, 2018 (in thousands):

 

 

2018

 

Revenue

 

$

42,526

 

Net income

 

$

6,009

 

 

 

 

 

 

Assets

 

$

2,018,496

 

Liabilities

 

$

1,553,191

 

12. Quarterly Financial Data (unaudited)

Medical Properties Trust, Inc.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 20162018 and 2015:2017: (amounts in thousands, except for per share data)

 

  For the Three Month Periods in 2016 Ended 

 

For the Three Month Periods in 2018 Ended

 

  March 31   June 30   September 30   December 31 

 

March 31

 

 

June 30

 

 

September 30

 

 

December 31

 

Revenues

  $134,999   $126,300   $126,555   $153,283 

 

$

205,046

 

 

$

201,902

 

 

$

196,996

 

 

$

180,578

 

Income from continuing operations

   58,226    53,924    70,543    43,245 

Net income

   58,225    53,924    70,543    43,245 

 

 

91,043

 

 

 

112,017

 

 

 

736,476

 

 

 

78,941

 

Net income attributable to MPT common stockholders

   57,927    53,724    70,358    43,039 

 

 

90,601

 

 

 

111,567

 

 

 

736,034

 

 

 

78,483

 

Net income attributable to MPT common stockholders per share — basic

  $0.24   $0.23   $0.29   $0.13 

 

$

0.25

 

 

$

0.30

 

 

$

2.01

 

 

$

0.21

 

Weighted average shares outstanding — basic

   237,510    238,082    246,230    319,833 

 

 

364,882

 

 

 

364,897

 

 

 

365,024

 

 

 

366,655

 

Net income attributable to MPT common stockholders per share — diluted

  $0.24   $0.22   $0.28   $0.13 

 

$

0.25

 

 

$

0.30

 

 

$

2.00

 

 

$

0.21

 

Weighted average shares outstanding — diluted

   237,819    239,008    247,468    319,994 

 

 

365,343

 

 

 

365,541

 

 

 

366,467

 

 

 

367,732

 

 

   For the Three Month Periods in 2015 Ended 
   March 31   June 30   September 30   December 31 

Revenues

  $95,961   $99,801   $114,570   $131,546 

Income from continuing operations

   35,976    22,489    23,123    58,339 

Net income

   35,976    22,489    23,123    58,339 

Net income attributable to MPT common stockholders

   35,897    22,407    23,057    58,237 

Net income attributable to MPT common stockholders per share — basic

  $0.18   $0.11   $0.10   $0.24 

Weighted average shares outstanding — basic

   202,958    208,071    223,948    237,011 

Net income attributable to MPT common stockholders per share —diluted

  $0.17   $0.11   $0.10   $0.24 

Weighted average shares outstanding — diluted

   203,615    208,640    223,948    237,011 

94


 

 

For the Three Month Periods in 2017 Ended

 

 

 

March 31

 

 

June 30

 

 

September 30

 

 

December 31

 

Revenues

 

$

156,397

 

 

$

166,807

 

 

$

176,580

 

 

$

204,961

 

Net income

 

 

68,185

 

 

 

73,796

 

 

 

76,881

 

 

 

72,376

 

Net income attributable to MPT common stockholders

 

 

67,970

 

 

 

73,415

 

 

 

76,464

 

 

 

71,944

 

Net income attributable to MPT common stockholders

   per share — basic

 

$

0.21

 

 

$

0.21

 

 

$

0.21

 

 

$

0.19

 

Weighted average shares outstanding — basic

 

 

321,057

 

 

 

349,856

 

 

 

364,315

 

 

 

364,382

 

Net income attributable to MPT common stockholders

   per share —diluted

 

$

0.21

 

 

$

0.21

 

 

$

0.21

 

 

$

0.19

 

Weighted average shares outstanding — diluted

 

 

321,423

 

 

 

350,319

 

 

 

365,046

 

 

 

364,977

 

Index to Financial Statements

MPT Operating Partnership, L.P.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 20162018 and 2015:2017: (amounts in thousands, except for per unit data)

 

  For the Three Month Periods in 2016 Ended 

 

For the Three Month Periods in 2018 Ended

 

  March 31   June 30   September 30   December 31 

 

March 31

 

 

June 30

 

 

September 30

 

 

December 31

 

Revenues

  $134,999   $126,300   $126,555   $153,283 

 

$

205,046

 

 

$

201,902

 

 

$

196,996

 

 

$

180,578

 

Income from continuing operations

   58,226    53,924    70,543    43,245 

Net income

   58,225    53,924    70,543    43,245 

 

 

91,043

 

 

 

112,017

 

 

 

736,476

 

 

 

78,941

 

Net income attributable to MPT Operating Partnership partners

   57,927    53,724    70,358    43,039 

 

 

90,601

 

 

 

111,567

 

 

 

736,034

 

 

 

78,483

 

Net income attributable to MPT Operating Partnership partners per unit — basic

  $0.24   $0.23   $0.29   $0.13 

 

$

0.25

 

 

$

0.30

 

 

$

2.01

 

 

$

0.21

 

Weighted average units outstanding — basic

   237,510    238,082    246,230    319,833 

 

 

364,882

 

 

 

364,897

 

 

 

365,024

 

 

 

366,655

 

Net income attributable to MPT Operating Partnership partners per unit — diluted

  $0.24   $0.22   $0.28   $0.13 

 

$

0.25

 

 

$

0.30

 

 

$

2.00

 

 

$

0.21

 

Weighted average units outstanding — diluted

   237,819    239,008    247,468    319,994 

 

 

365,343

 

 

 

365,541

 

 

 

366,467

 

 

 

367,732

 

 

  For the Three Month Periods in 2015 Ended 

 

For the Three Month Periods in 2017 Ended

 

  March 31   June 30   September 30   December 31 

 

March 31

 

 

June 30

 

 

September 30

 

 

December 31

 

Revenues

  $95,961   $99,801   $114,570   $131,546 

 

$

156,397

 

 

$

166,807

 

 

$

176,580

 

 

$

204,961

 

Income from continuing operations

   35,976    22,489    23,123    58,339 

Net income

   35,976    22,489    23,123    58,339 

 

 

68,185

 

 

 

73,796

 

 

 

76,881

 

 

 

72,376

 

Net income attributable to MPT Operating Partnership partners

   35,897    22,407    23,057    58,237 

 

 

67,970

 

 

 

73,415

 

 

 

76,464

 

 

 

71,944

 

Net income attributable to MPT Operating Partnership partners per unit — basic

  $0.18   $0.11   $0.10   $0.24 

 

$

0.21

 

 

$

0.21

 

 

$

0.21

 

 

$

0.19

 

Weighted average units outstanding — basic

   202,958    208,071    223,948    237,011 

 

 

321,057

 

 

 

349,856

 

 

 

364,315

 

 

 

364,382

 

Net income attributable to MPT Operating Partnership partners per unit — diluted

  $0.17   $0.11   $0.10   $0.24 

 

$

0.21

 

 

$

0.21

 

 

$

0.21

 

 

$

0.19

 

Weighted average units outstanding — diluted

   203,615    208,640    223,948    237,011 

 

 

321,423

 

 

 

350,319

 

 

 

365,046

 

 

 

364,977

 

13. Subsequent Events

On February 1, 2017,January 31, 2019, we replaced our Credit Facility withentered into definitive agreements to acquire a new revolving credit and term loan agreement. The new agreement includes a $1.3 billion unsecured revolving loan facility, a $200 million unsecured term loan facility, and a €200 million unsecured term loan facility. The new unsecured revolving loan facility matures in February 2021 and can be extendedportfolio of eleven Australian hospitals currently operated by Healthscope Ltd. (“Healthscope”) for an additional 12 months ataggregate purchase price of approximately $859 million. Upon closing, these facilities will be leased to Healthscope pursuant to master lease agreements that have an average initial term of 20 years with annual fixed escalations and multiple extension options. In a related transaction, Brookfield Business Partners L.P. together with its institutional partners (“Brookfield”) has agreed to acquire up to 100% of Healthscope’s outstanding shares. Closing of our option. The $200 million unsecured term loan facility matures on February 1, 2022acquisition, which is expected to be completed in the second quarter of 2019, is subject to Healthscope shareholder approval, customary real estate and regulatory approvals, the €200 million unsecured term loan facility matures on January 31, 2020,successful completion of the Brookfield transactions, and can be extendedother closing conditions.

As discussed in Note 3, in June 2018, we agreed to purchase a four-hospital portfolio from MEDIAN for an additional 12 months at our option. The commitment fee on the total facility is paid at a rate of 0.25%. The term loan and/or revolving loan commitments may be increased in an aggregate amount notof €23 million (including real estate transfer taxes) for which we closed on three of the properties in 2018. The properties are leased to exceed $500 million.

At our election, loans under the new credit facility may be made as either ABR Loans or Eurodollar Loans. The applicable margin for term loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.95% based on our current credit rating. The applicable margin for term loans that are Eurodollar Loans is adjustable on a sliding scale from 0.90% to 1.95% based on our current credit rating. The applicable margin for revolving loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.65% based on our current credit rating. The applicable margin for revolving loans that are Eurodollar Loans is adjustable on a sliding scale from 0.875% to 1.65% based on our current credit rating. The facility fee is adjustable on a sliding scale from 0.125% to 0.30% based on our current credit rating and is payableaffiliates of MEDIAN. On February 6, 2019, we closed on the revolving loan facility.

Index to Financial Statements

On February 2, 2017, we delivered an irrevocable notice of full redemption to the holderslast of the €200four inpatient rehabilitation hospitals in Germany for €5.8 million aggregate principal amount of our 5.750% Senior Notes due 2020 and set a redemption date of March 4, 2017. To fund such redemption, including any premium and accrued interest, we plan to use the proceeds of the new euro term loan together with cash on hand.(including real estate transfer taxes).

With the new revolving credit facility and term loans along with the redemption of the 5.750% Senior Notes due 2020, we expect to incur aone-time debt refinancing charge of approximately $13 million in the 2017 first quarter (of which approximately $9 million relates to the redemption premium).95

Index to Financial Statements

ITEM 9.

Changes in and DisagreementsDisagreements With AccountantsAccountants on Accounting and Financial Disclosure

None.

ITEM 9A.

Controls and Procedures

Medical Properties Trust, Inc.

(a)Evaluation of Disclosure Controls and Procedures. As required by Rule13a-15(b), under the Securities Exchange Act of 1934, as amended, we have carried out an evaluation, under the supervision and with the participation of management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as of the end of the period covered by this report. Based on the foregoing, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective in timely alerting them to materialproviding reasonable assurance that information required to be disclosed by us in the reports that we file withor submit under the SEC.Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms.

(b)Management’s Report on Internal Control over Financial Reporting. The management of Medical Properties Trust, Inc. has prepared the consolidated financial statements and other information in our Annual Report in accordance with accounting principles generally accepted in the United States of America and is responsible for its accuracy.accuracy and completeness. The financial statements necessarily include amounts that are based on management’s best estimates and judgments. In meeting its responsibility, management relies on internal accounting and related control systems. The internal control systems are designed to ensure that transactions are properly authorized and recorded in our financial records and to safeguard our assets from material loss or misuse. Such assurance cannot be absolute because of inherent limitations in any internal control system.

Management of Medical Properties Trust, Inc. is responsible for establishing and maintaining adequate internal control over financial reporting as defined in Rule13a-15(f) of the Securities Exchange Act of 1934. Our internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles.

Because of inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

In connection with the preparation of our annual financial statements, management has undertaken an assessment of the effectiveness of our internal control over financial reporting as of December 31, 2016.2018. The assessment was based upon the framework described in the “Integrated Control-Integrated Framework” issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”) based on criteria established inInternal ControlIntegrated Framework (2013). Management’s assessment included an evaluation of the design of internal control over financial reporting and testing of the operational effectiveness of internal control over financial reporting. We have reviewed the results of the assessment with the Audit Committee of our Board of Directors.

Based on our assessment under the criteria set forth in COSO, management has concluded that, as of December 31, 2016,2018, Medical Properties Trust, Inc. maintained effective internal control over financial reporting.

The effectiveness of our internal control over financial reporting as of December 31, 2016,2018, has been audited by PricewaterhouseCoopers LLP, an independent registered public accounting firm, as stated in their report which appears herein.

(c)Changes in Internal Controls over Financial Reporting. There has been no change in Medical Properties Trust, Inc.’s internal control over financial reporting during our most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

Index to Financial Statements

MPT Operating Partnership, L.P.

(a)Evaluation of Disclosure Controls and Procedures. As required by Rule13a-15(b), under the Securities Exchange Act of 1934, as amended, we have carried out an evaluation, under the supervision and with the participation of management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as of the end of the period covered by this report. Based on the foregoing, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective in timely alerting them to materialproviding reasonable assurance that information required to be disclosed by us in the reports that we file withor submit under the SEC.Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms.

(b)Management’s Report on Internal Control over Financial Reporting. The management of MPT Operating Partnership, L.P. has prepared the consolidated financial statements and other information in our Annual Report in accordance with accounting

96


principles generally accepted in the United States of America and is responsible for its accuracy.accuracy and completeness. The financial statements necessarily include amounts that are based on management’s best estimates and judgments. In meeting its responsibility, management relies on internal accounting and related control systems. The internal control systems are designed to ensure that transactions are properly authorized and recorded in our financial records and to safeguard our assets from material loss or misuse. Such assurance cannot be absolute because of inherent limitations in any internal control system.

Management of MPT Operating Partnership, L.P. is responsible for establishing and maintaining adequate internal control over financial reporting as defined in Rule13a-15(f) of the Securities Exchange Act of 1934. Our internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles.

Because of inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

In connection with the preparation of our annual financial statements, management has undertaken an assessment of the effectiveness of our internal control over financial reporting as of December 31, 2016.2018. The assessment was based upon the framework described in the “Integrated Control-Integrated Framework” issued by COSO based on criteria established inInternal ControlIntegrated Framework (2013). Management’s assessment included an evaluation of the design of internal control over financial reporting and testing of the operational effectiveness of internal control over financial reporting. We have reviewed the results of the assessment with the Audit Committee of our Board of Directors.

Based on our assessment under the criteria set forth in COSO, management has concluded that, as of December 31, 2016,2018, MPT Operating Partnership, L.P. maintained effective internal control over financial reporting.

The effectiveness of our internal control over financial reporting as of December 31, 2016,2018, has been audited by PricewaterhouseCoopers LLP, an independent registered public accounting firm, as stated in their report which appears herein.

(c)Changes in Internal Controls over Financial Reporting. There has been no change in MPT Operating Partnership, L.P.’s internal control over financial reporting during our most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

ITEM 9B.

Other Information

None.

97


Index to Financial Statements

PART III

ITEM 10.

Directors, Executive Officers and Corporate Governance

The information required by this Item 10 is incorporated by reference to our definitive Proxy Statement for the 20172019 Annual Meeting of Stockholders, which will be filed by us with the Commission not later than April 30, 2017.2019.

ITEM 11.

Executive Compensation

The information required by this Item 11 is incorporated by reference to our definitive Proxy Statement for the 20172019 Annual Meeting of Stockholders, which will be filed by us with the Commission not later than April 30, 2017.2019.

ITEM 12.

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

The information required by this Item 12 is incorporated by reference to our definitive Proxy Statement for the 20172019 Annual Meeting of Stockholders, which will be filed by us with the Commission not later than April 30, 2017.2019.

ITEM 13.

Certain Relationships and Related Transactions, and Director Independence

The information required by this Item 13 is incorporated by reference to our definitive Proxy Statement for the 20172019 Annual Meeting of Stockholders, which will be filed by us with the Commission not later than April 30, 2017.2019.

ITEM 14.

Principal Accountant Fees and Services

The information required by this Item 14 is incorporated by reference to our definitive Proxy Statement for the 20172019 Annual Meeting of Stockholders, which will be filed by us with the Commission not later than April 30, 2017.2019.


Index to Financial Statements

PART IV

 

ITEM 15.

Exhibits and Financial Statement Schedules

(a) Financial Statements and Financial Statement Schedules

Index of Financial Statements of Medical Properties Trust, Inc. and MPT Operating Partnership, L.P. which are included in Part II, Item 8 of this Annual Report onForm 10-K:

 

Report of Independent Registered Public Accounting Firm

Medical Properties Trust, Inc.

69

56

MPT Operating Partnership, L.P.

70

57

Medical Properties Trust, Inc.

Consolidated Balance Sheets as of December 31, 20162018 and 20152017

71

58

Consolidated Statements of Net Income for the Years Ended December  31, 2016, 20152018, 2017 and 20142016

72

59

Consolidated Statements of Comprehensive Income for the Years Ended December 31, 2016, 2015,2018, 2017 and 20142016

73

60

Consolidated Statements of Equity for the Years Ended December  31, 2016, 20152018, 2017 and 20142016

74

61

Consolidated Statements of Cash Flows for the Years Ended December  31, 2016, 20152018, 2017 and 20142016

75

62

MPT Operating Partnership, L.P.

Consolidated Balance Sheets as of December 31, 20162018 and 20152017

76

63

Consolidated Statements of Net Income for the Years Ended December  31, 2016, 20152018, 2017 and 20142016

77

64

Consolidated Statements of Comprehensive Income for the Years Ended December 31, 2016, 2015,2018, 2017 and 20142016

78

65

Consolidated Statements of Capital for the Years Ended December  31, 2016, 20152018, 2017 and 20142016

79

66

Consolidated Statements of Cash Flows for the Years Ended December  31, 2016, 2015,2018, 2017 and 20142016

80

67

Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.

Notes to Consolidated Financial Statements

81

68

Financial Statement Schedules

Schedule II — Valuation and Qualifying Accounts for the Years Ended December 31, 2018, 2017 and 2016

133

108

Schedule III — Real Estate and Accumulated Depreciation at December 31, 2018 with reconciliations for the years ended December 31, 2018, 2017 and 2016

134

109

Schedule IV — Mortgage Loans on Real Estate at December 31, 2018 with reconciliations for the years ended December 31, 2018, 2017 and 2016

143

114

Index to Financial Statements
99


(b) Exhibits

 

Exhibit


Number

Exhibit Title

  3.1(1)

Medical Properties Trust, Inc. Second Articles of Amendment and Restatement

  3.2(3)

Articles of Amendment of Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.

  3.3(6)

Articles of Amendment of Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.

  3.4(19)

Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.

  3.5(32)

Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.

  3.6(33)

Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.

  3.7(2)

Medical Properties Trust, Inc. Second Amended and Restated Bylaws

  3.8(32)

Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.

  3.9(40)

Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.

  3.10(41)

Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.

  3.11(46)

Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.

  4.1(1)

Form of Common Stock Certificate

  4.2(4)

Indenture, dated July 14, 2006, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and the Wilmington Trust  Company, as trustee

  4.3(9)

Indenture, dated as of April  26, 2011, Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust Company, as Trustee.

  4.4(26)

First Supplemental Indenture to 2011 Indenture, dated as of August 10, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.5(26)

Second Supplemental Indenture to 2011 Indenture, dated as of October 3, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.6(26)

Third Supplemental Indenture to 2011 Indenture, dated as of December 2, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.7(26)

Fourth Supplemental Indenture to 2011 Indenture, dated as of January 19, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.8(26)

Fifth Supplemental Indenture to 2011 Indenture, dated as of April 9, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.9(26)

Sixth Supplemental Indenture to 2011 Indenture, dated as of June 27, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.10(26)

  4.10(26)

Seventh Supplemental Indenture to 2011 Indenture, dated as of July 31, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.11(26)

Eighth Supplemental Indenture to 2011 Indenture, dated as of September 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.12(26)

Ninth Supplemental Indenture to 2011 Indenture, dated as of December 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.13(26)

Tenth Supplemental Indenture to 2011 Indenture, dated as of June 27, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

100


Exhibit
Number

Exhibit Title

  4.14(26)

Eleventh Supplemental Indenture to 2011 Indenture, dated as of August 8, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.15(26)

Twelfth Supplemental Indenture to 2011 Indenture, dated as of October 30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.16(26)

Thirteenth Supplemental Indenture to 2011 Indenture, dated as of December 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.17(31)

Fourteenth Supplemental Indenture to 2011 Indenture, dated as of March 31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.18(27)

Fifteenth Supplemental Indenture to 2011 Indenture, dated as of June 30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.19(31)

Sixteenth Supplemental Indenture to 2011 Indenture, dated as of October 3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.20(20)

Indenture, dated as of February 17, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.21(23)

First Supplemental Indenture to 2012 Indenture, dated as of April 9, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.22(23)

Second Supplemental Indenture to 2012 Indenture, dated as of June 27, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.23(23)

Third Supplemental Indenture to 2012 Indenture, dated as of July 31, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.24(23)

Fourth Supplemental Indenture to 2012 Indenture, dated as of September 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.25(23)

  4.25(23)

Fifth Supplemental Indenture to 2012 Indenture, dated as of December 26, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.26(23)

Sixth Supplemental Indenture to 2012 Indenture, dated as of June 27, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.27(23)

Seventh Supplemental Indenture to 2012 Indenture, dated as of August 8, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.28(24)

Eighth Supplemental Indenture to 2012 Indenture, dated as of August 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.29(26)

Ninth Supplemental Indenture to 2012 Indenture, dated as of October 30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.30(26)

Tenth Supplemental Indenture to 2012 Indenture, dated as of December 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

101


Exhibit
Number

Exhibit Title

  4.31(28)

Eleventh Supplemental Indenture to 2012 Indenture, dated as of March 31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.32(27)

Twelfth Supplemental Indenture to 2012 Indenture, dated as of June 30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.33(31)

Thirteenth Supplemental Indenture to 2012 Indenture, dated as of October 3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.34(25)

Indenture, dated as of October  10, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.35(25)

First Supplemental Indenture to 2013 Indenture, dated as of October  10, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.36(26)

Second Supplemental Indenture to 2013 Indenture, dated as of October  30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.37(26)

Third Supplemental Indenture to 2013 Indenture, dated as of December  20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.38(28)

Fourth Supplemental Indenture to 2013 Indenture, dated as of March  31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.39(29)

Fifth Supplemental Indenture to 2013 Indenture, dated as of April  17, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.40(27)

  4.40(27)

Sixth Supplemental Indenture to 2013 Indenture, dated as of June  30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.41(31)

Seventh Supplemental Indenture to 2013 Indenture, dated as of October  3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

  4.42(34)

Eighth Supplemental Indenture to 2013 Indenture, dated as of August  19, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, Wilmington trust, N.A., as Trustee, Deutsche Bank Trust company Americas, as Paying Agent, and Deutsche Bank Luxembourg S.A., as Registrar and Transfer Agent.

  4.43(36)

Ninth Supplemental Indenture, dated as of February  22, 2016, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as trustee.Trustee.

  4.44(39)

Tenth Supplemental Indenture, dated as of July  22, 2016, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as trustee.Trustee.

10.2(8)

  4.45(42)

Eleventh Supplemental Indenture, dated as of March  24, 2017, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as Trustee, Deutsche Bank Trust Company Americas, as Paying Agent, Registrar and Transfer Agent.

  4.46(45)

Twelfth Supplemental Indenture, dated as of September  21, 2017, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as trustee.

10.1(11)

Second Amended and Restated Agreement of Limited Partnership of MPT Operating Partnership, L.P.

10.2*

Medical Properties Trust, Inc. 2013 Equity Incentive Plan (This document is being refiled to correct a scrivener’s error.)

102


Exhibit
Number

Exhibit Title

10.3(7)

Form of Stock Option Award

10.4(7)

Form of Restricted Stock Award

10.5(7)

Form of Deferred Stock Unit Award

10.6(1)

Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated September 10, 2003

10.7(1)

First Amendment to Employment Agreement between Registrant and Edward K. Aldag, Jr., dated March 8, 2004

10.8(1)

Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated September 10, 2003

10.9(1)

Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated September 10, 2003

10.10(1)

Form of Indemnification Agreement between Medical Properties Trust, Inc. and executive officers and directors

10.11(11)

Form of Medical Properties Trust, Inc. 2007 Multi-Year Incentive Plan Award Agreement (LTIP Units)

10.12(11)

Form of Medical Properties Trust, Inc. 2007 Multi-Year Incentive Plan Award Agreement (Restricted Shares)

10.13(16)

Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated September  29, 2006

10.14(16)

First Amendment to Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated September 29, 2006

10.15(16)

First Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated September 29, 2006

10.16(17)

Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated January 1, 2008

Index to Financial Statements

Exhibit

Number

Exhibit Title

10.17(17)

10.17(17)

Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated January 1, 2009

10.18(17)

Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Richard S. Hamner, dated January 1, 2008

10.19(17)

Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated January 1, 2009

10.20(17)

Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated January 1, 2008

10.21(17)

Fourth Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated January  1, 2009

10.22(9)

Amended and Restated Revolving Credit and Term Loan Agreement, dated as of April  26, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., KeyBank National Association as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent

10.23(30)

Amended and Restated Revolving Credit and Term Loan Agreement, dated as of June  19, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.

10.24(31)

First Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of October  17, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.

10.25(35)

Second Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of August  4, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.

10.26(35)

Third Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of September  30, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.

10.27(19)

Master Sublease Agreement between certain subsidiaries of MPT Development Services, Inc. as Lessor, and certain subsidiaries of Ernest Health, Inc., as Lessee.

103


Exhibit
Number

Exhibit Title

10.28(22)

Master Lease Agreement I between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment and Master Lease Agreement II between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment.

10.29(33)

Form of Master Lease Agreement between certain subsidiaries of MPT Operating Partnership, L.P., as Lessor, and MEDIAN Kliniken S.a.r.l. and certain of its subsidiaries, as Lessee, and related first and second amendments.

10.30(37)

Master Lease Agreement between certain subsidiaries of MPT Development Services, Inc., as Lessor, and certain subsidiaries of Capella Holdings, Inc., as Lessee.

10.31(37)

Joinder and Amendment to Master Lease Agreement between certain subsidiaries of MPT Development Services, Inc., as Lessor, and certain subsidiaries of Capella Holdings, Inc., as Lessee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

10.32(38)

10.32(38)

Amended and Restated Master Lease Agreement between certain subsidiaries of MPT Operating Partnership, L.P., as lessor and certain subsidiaries of Capella Holdings, Inc., as lessee.

10.33*

10.33(42)

Master Lease Agreement by and among certain subsidiaries of MPT Operating Partnership, L.P. as Lessor and certain subsidiaries of Steward Health Care System LLC, Lessee.

10.34*

10.34(42)

Real Estate Loan Agreement by and among certain subsidiaries of MPT Operating Partnership, L.P. as Lessor and certain subsidiaries of Steward Health Care System LLC, Lessee.

10.35*

10.35(42)

Amended and Restated Revolving Credit and Term Loan Agreement, dated as of February  1, 2017, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.

12.1*

10.36(44)

Statement re Computation

IASIS (Project Ignite) Master Agreement, dated as of RatiosMay  18, 2017, by and among Steward Health Care System LLC and subsidiaries of MPT Operating Partnership, L.P.

21.1*

10.37(44)

Real Property Asset Purchase Agreement, dated as of May  18, 2017, by and among IASIS Healthcare Corporation, as “IASIS”, and subsidiaries of IASIS, as the “Sellers”, and subsidiaries of MPT Operating Partnership, L.P., as the “MPT Parties”.

10.38(44)

Amendment to Master Lease Agreement, dated as of December  31, 2016, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.39(44)

Joinder and Amendment to Master Lease Agreement, dated as of May  1, 2017, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.40(44)

Amendment to Real Estate Loan Agreement, dated as of May  1, 2017, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.41(44)

Amendment to Master Lease Agreement, dated as of May  2, 2017, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.42(45)

Joinder and Amendment to Master Lease Agreement, dated as of September  29, 2017, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.43(45)

Joinder and Amendment to Real Estate Loan Agreement, dated as of September  29, 2017, by and among certain Affiliates of MPT Operating Partnership, L.P. and certain Affiliates of Steward Health Care System LLC.

10.44(47)

Amended and Restated Subscription Agreement dated as of June 7, 2018 by and among MPT Operating Partnership, L.P., Primotop Holding, S.a.r.l. and MPT RHM Holdco S.a.r.l.

21.1*

Subsidiaries of Medical Properties Trust, Inc.

23.1*

Consent of PricewaterhouseCoopers LLP

23.2*

Consent of PricewaterhouseCoopers LLP

31.1*

Certification of Chief Executive Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)

31.2*

Certification of Chief Financial Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)

31.3*

Certification of Chief Executive Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)

31.4*

Certification of Chief Financial Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)

104


Exhibit
Number

Exhibit Title

32.1**

Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (Medical Properties Trust, Inc.)

32.2**

Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (MPT Operating Partnership, L.P.)

Exhibit 101.INS

XBRL Instance Document

Exhibit 101.SCH

XBRL Taxonomy Extension Schema Document

Exhibit 101.CAL

XBRL Taxonomy Extension Calculation Linkbase Document

Exhibit 101.DEF

XBRL Taxonomy Extension Definition Linkbase Document

Exhibit 101.LAB

XBRL Taxonomy Extension Label Linkbase Document

Exhibit 101.PRE

XBRL Taxonomy Extension Presentation Linkbase Document

 

*

Filed herewith.

**

Furnished herewith.

(1)

Incorporated by reference to Registrant’s Registration Statement on FormS-11 filed with the Commission on October 26, 2004, as amended (FileNo. 333-119957).

(2)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on November 24, 2009.

Index to Financial Statements

(3)

Incorporated by reference to Registrant’s quarterly report on Form10-Q for the quarter ended September 30, 2005, filed with the Commission on November 10, 2005.

(4)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on July 20, 2006.

(5)

Reserved.

(6)

Incorporated by reference to the Registrant’s current report on Form8-K, filed with the Commission on January 13, 2009.

(7)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on October 18, 2005.

(8)

Incorporated by reference to Registrant’s definitive proxy statement on Schedule 14A, filed with the Commission on April 26, 2013.

Reserved.

(9)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on May 2, 2011.

(10)

Reserved.

(11)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on August 6, 2007, as amended by Medical Properties Trust, Inc.’s current report on Form8-K/A, filed with the Commission on August 15, 2007.

(12)

Reserved.

(13)

Reserved.

(14)

Reserved.

(15)

Reserved.

(16)

Incorporated by reference to Registrant’s annual report on Form10-K/A for the period ended December 31, 2007, filed with the Commission on July 11, 2008.

(17)

Incorporated by reference to Registrant’s annual report on Form10-K for the period ended December 31, 2008, filed with the Commission on March 13, 2009.

(18)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on June 11, 2010.

(19)

Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on January 31, 2012.

(20)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on February 24, 2012.

(21)

Reserved.

(22)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on November 9, 2012.

(23)

Incorporated by reference to Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and MPT Finance Corporation’s registration statement on FormS-3, filed with the Commission on August 9, 2013.

(24)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on August 20, 2013.

(25)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on October 16, 2013.

(26)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on March 3, 2014.

(27)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on August 11, 2014.

(28)

Incorporated by reference to Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and MPT Finance Corporation’s post-effective amendment to registration statement on FormS-3, filed with the Commission on April 10, 2014.

105


(29)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on April 23, 2014.

(30)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on June 25, 2014.

Index to Financial Statements

(31)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on March 2, 2015.

(32)

Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on June 26, 2015.

(33)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on August 10, 2015.

(34)

Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on August 21, 2015.

(35)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on November 9, 2015.

(36)

Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on February 22, 2016.

(37)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on February 29, 2016.

(38)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on May 10, 2016.

(39)

Incorporated by reference to Medical Properties Trust, Inc’sInc.’s Current Report on Form8-K filed with the Commission on July 22, 2016.

(40)

Incorporated by reference to Medical Properties Trust, Inc’sInc.’s Current Report on Form8-K filed with the Commission on November 16, 2016.

(41)

Incorporated by reference to Medical Properties Trust, Inc’sInc.’s Current Report on Form8-K filed with the Commission on February 22, 2017.

(42)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form 10-K, filed with the Commission on March 1, 2017.

(43)

Incorporated by reference to Medical Properties Trust, Inc.’s Current Report on Form 8-K filed with the Commission on March 27, 2017.

(44)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form 10-Q, filed with the Commission on August 9, 2017.

(45)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form 10-Q, filed with the Commission on November 9, 2017.

(46)

Incorporated by reference to Medical Properties Trust, Inc.’s Current Report on Form 8-K filed with the Commission on May 25, 2018.

(47)

Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form 10-Q, filed with the Commission on August 9, 2018.

 

ITEM 16.

Form10-K Summary Summary

None.

106


Index to Financial Statements

SIGNATURESSIGNATURES

Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the Registrant has duly caused this Report to be signed on its behalf by the undersigned, thereunto duly authorized.

 

MEDICAL PROPERTIES TRUST, INC.

By:

 

/s/ J. Kevin Hanna

J. Kevin Hanna

Vice President, Controller, and Chief Accounting Officer

MPT OPERATING PARTNERSHIP, L.P.

By:

 

/s/ J. Kevin Hanna

J. Kevin Hanna

Vice President, Controller, and Chief Accounting Officer of the sole member of the general partner of MPT Operating Partnership, L.P.

Date: March 1, 20172019

Pursuant to the requirements of the Securities Exchange Act of 1934, as amended, this Report has been signed by the following persons on behalf of the Registrant and in the capacities and on the dates indicated.

 

Signature

Title

Date

/s/ Edward K. Aldag, Jr.

Edward K. Aldag, Jr.

Chairman of the Board, President,

Chief Executive Officer and Director

(Principal Executive Officer)

March 1, 20172019

/s/ R. Steven Hamner

R. Steven Hamner

Executive Vice President,

Chief Financial Officer and Director

(Principal Financial Officer)

March 1, 20172019

/s/ G. Steven Dawson

G. Steven Dawson

Director

March 1, 20172019

/s/ Robert E. Holmes, Ph.D.Elizabeth N. Pitman

Robert E. Holmes, Ph.D.Elizabeth N. Pitman

Director

March 1, 20172019

/s/ Sherry A. KellettD. Paul Sparks, Jr.

Sherry A. KellettD. Paul Sparks, Jr.

Director

March 1, 2017

2019

/s/ William G. McKenzie

William G. McKenzie

Director

March 1, 2017

/s/ Michael G. Stewart

Michael G. Stewart

Director

March 1, 2017

2019

/s/ D. Paul Sparks, Jr.

D. Paul Sparks

Director

March 1, 2017

/s/ C. Reynolds Thompson, III

C. Reynolds Thompson, III

Director

March 1, 20172019

Index to Financial Statements
107


Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.

Schedule II: Valuation and Qualifying Accounts

December 31, 20162018

 

      Additions Deductions   

 

 

 

 

 

Additions

 

 

 

Deductions

 

 

 

 

 

 

Year Ended December 31,

  Balance at
Beginning of
Year(1)
   Charged
Against
Operations(1)
 Net
Recoveries/
Writeoffs(1)
 Balance at
End of Year(1)
 

 

Balance at

Beginning of

Year(1)

 

 

Charged

Against

Operations(1)

 

 

 

Net

Recoveries/

Write-offs(1)

 

 

 

Balance at

End of Year(1)

 

  (In thousands) 

 

(In thousands)

 

2018

 

$

16,397

 

 

$

57,285

 

(2)

 

$

(7,551

)

(3)

 

$

66,131

 

2017

 

$

18,852

 

 

$

2,525

 

(4)

 

$

(4,980

)

(5)

 

$

16,397

 

2016

  $27,384   $2,722(2)  $(11,254)(3)  $18,852 

 

$

27,384

 

 

$

2,722

 

(6)

 

$

(11,254

)

(7)

 

$

18,852

 

2015

  $20,129   $8,205(4)  $(950)(5)  $27,384 

2014

  $41,573   $65,512(6)  $(86,956)(7)  $20,129 

 

(1)

Includes allowance for doubtful accounts, straight-line rent reserves, allowance for loan losses, tax valuation allowances and other reserves.

(2)

Represents $48 million increase to real estate impairment reserve and $9.3 million increases in accounts receivable reserves during 2018.

(3)

Includes $7.7 million decrease in valuation allowance (which includes the $4.4 million release of domestic valuation allowances in the 2018 fourth quarter) that was originally recorded to reserve against our net deferred tax assets.

(4)

Represents increases in accounts receivable reserves during 2017.

(5)

Includes $4.9 million decrease in valuation allowance that was originally recorded to reserve against our net deferred tax assets.

(6)

Includes $1.9 million of rent reserves related to our Twelve Oaks facility and $0.8 million of rent reserves related to our Corinth facility.

(3)

(7)

Includes writeoffswrite-offs of $3.3 million related to payment of rent, late fees, and loans for our Twelve Oaks facility; $0.8 million of writeoffswrite-offs for rent and interest reserves related to the sale of the Corinth facility; $0.1 million of writeoffswrite-offs related to the McLeod Healthcare loan; and $6.1 million decrease in valuation allowanceallowances (which includes the $4 million release of foreign valuation allowances in the 2016 fourth quarter) that was originally recorded to reserve against our net deferred tax assets.

(4)Includes $1.5 million of rent and late fee reserves related to our Twelve Oaks facility; $0.5 million of rent reserves related to our Healthtrax properties; and $6.2 million to fully reserve our net deferred tax assets.
(5)Writeoffs of rent and interest reserves related to sale of Healthtrax properties.
(6)Includes the $47 million of impairment charges related to the Monroe property, $9.5 million of rent and interest reserves primarily related to the Monroe property (prior to change in operators — see Note 3 to Item 8 of this Annual Report on Form10-K for further details), and approximately $9 million increase in the valuation allowance to fully reserve our net deferred tax assets.
(7)Writeoffs of loans and other receivables related to the Monroe facility due to change in operators.

Index to Financial Statements

108


SCHEDULE III — REAL ESTATE INVESTMENTSINVESTMENTS AND ACCUMULATED DEPRECIATION

December 31, 20162018

 

    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

Bad Rappenau, Germany

 Rehabilitation hospital $—    $9,159  $—    $—    $—    $9,159  $9,159  $706  $—    1994 

November 30, 2013

  40 

Dahlen, Germany

 Rehabilitation hospital  360   19,863   —     —     360   19,863   20,223   1,531   —    1996 

November 30, 2013

  40 

Bad Dürkheim, Germany

 Rehabilitation hospital  3,074   14,531   —     —     3,074   14,531   17,605   1,120   —    1960 

November 30, 2013

  40 

Bad Liebenwerda, Germany

 Rehabilitation hospital  335   17,307   —     —     335   17,307   17,642   1,334   —    1994 

November 30, 2013

  40 

Ortenberg, Germany

 Rehabilitation hospital  89   5,070   —     —     89   5,070   5,159   391   —    1981 

November 30, 2013

  40 

Wiesbaden, Germany

 Rehabilitation hospital  2,980   14,334   —     —     2,980   14,334   17,314   1,105   —    1977 

November 30, 2013

  40 

Bad Dürkheim, Germany

 Rehabilitation hospital  —     28,758   —     —     —     28,758   28,758   2,217   —    1992 

November 30, 2013

  40 

Bad Liebenwerda, Germany

 Rehabilitation hospital  522   14,469   —     —     522   14,469   14,991   1,115   —    1904, 1995 

November 30, 2013

  40 

Bad Dürkheim, Germany

 Rehabilitation hospital  705   6,337   —     —     705   6,337   7,042   488   —    1980 

November 30, 2013

  40 

Bad Dürkheim, Germany

 Rehabilitation hospital  5,649   15,597   —     —     5,649   15,597   21,246   1,202   —    1930 

November 30, 2013

  40 

Bad Rappenau, Germany

 Rehabilitation hospital  3,312   5,642   —     —     3,312   5,642   8,954   435   —    1986 

November 30, 2013

  40 

Bad Tölz, Germany

 Rehabilitation hospital  2,134   9,187   —     —     2,134   9,187   11,321   478   —    1974 

November 19, 2014

  40 

Bad Liebenstein, Germany

 Rehabilitation hospital  1,554   32,836   —     —     1,554   32,836   34,390   1,779   —    1954, 1992 

November 5, 2014

  40 

Bad Mergentheim, Germany

 Rehabilitation hospital  —     10,891   —     —     —     10,891   10,891   567   —    1988, 1995 

December 11, 2014

  40 

Bath, UK

 Acute care general hospital  1,463   30,316   —     —     1,463   30,316   31,779   1,895   —    2008, 2009 

July 1, 2014

  40 

Ottenhöfen, Germany

 Rehabilitation hospital  2,182   12,278   105   —     2,287   12,278   14,565   471   —    1956/1957 

July 3, 2015

  40 

Bad Berka, Germany

 Rehabilitation hospital  3,124   14,569   163   —     3,287   14,569   17,856   531   —    1997 

July 22, 2015

  40 

Wiesbaden, Germany

 Rehabilitation hospital  1,557   7,220   37   —     1,594   7,220   8,814   274   —    1974 

June 30, 2015

  40 

Bad Lausick, Germany

 Rehabilitation hospital  1,677   15,176   147   —     1,824   15,176   17,000   584   —    1993 

June 30, 2015

  40 

Bad Sülze, Germany

 Rehabilitation hospital  2,224   19,184   189   —     2,413   19,184   21,597   738   —    1993 

June 30, 2015

  40 

Kurort Berggießhübel, Germany

 Rehabilitation hospital  2,966   14,961   131   —     3,097   14,961   18,058   542   —    1993 

July 21, 2015

  40 

Braunfels, Germany

 Acute care general hospital  2,019   12,907   53   —     2,072   12,907   14,979   489   —    1977 

June 30, 2015

  40 

Bernkastel-Kues, Germany

 Rehabilitation hospital  3,386   14,709   42   —     3,428   14,709   18,137   525   —    1982 

July 15, 2015

  40 
Flechtingen, Germany Rehabilitation hospital  2,692   13,590   142   —     2,834   13,590   16,424   524   —    1993 June 30, 2015  40 

Flechtingen, Germany

 Rehabilitation hospital  2,692   21,291   210   —     2,902   21,291   24,193   819   —    1993-1995 

June 30, 2015

  40 

Nordrach, Germany

 Rehabilitation hospital  294   2,818   79   —     373   2,818   3,191   114   —    1960 

July 7, 2015

  40 

Bad Gottleuba, Germany

 Rehabilitation hospital  49   14,462   835   —     884   14,462   15,346   417   —    1913 

December 16, 2015

  40 

Grünheide, Germany

 Rehabilitation hospital  2,674   39,306   321   —     2,995   39,306   42,301   1,422   —    1994/2014 

July 31, 2015

  40 

Baden-Baden, Germany

 Rehabilitation hospital  1,230   8,652   121   —     1,351   8,652   10,003   337   —    1900/2002-
2003
 

June 30, 2015

  40 

Gyhum, Germany

 Rehabilitation hospital  3,755   21,461   330   —     4,085   21,461   25,546   838   —    1994 

June 30, 2015

  40 

Hannover, Germany

 Rehabilitation hospital  3,081   14,562   300   —     3,381   14,562   17,943   416   —    1900
(renovations in
1997, 2000,
2009)
 

December 1, 2015

  40 

Heiligendamm, Germany

 Rehabilitation hospital  4,049   25,235   200   —     4,249   25,235   29,484   966   —    1995 

June 30, 2015

  40 

Bad Camberg, Germany

 Rehabilitation hospital  1,961   14,956   252   —     2,213   14,956   17,169   586   —    1973 

June 30, 2015

  40 

Hoppegarten, Germany

 Rehabilitation hospital  3,770   23,351   231   —     4,001   23,351   27,352   849   —    1994 

July 27, 2015

  40 

Ban Nauheim, Germany

 Rehabilitation hospital  2,976   15,036   137   —     3,113   15,036   18,149   578   —    1977 

June 30, 2015

  40 

Kalbe, Germany

 Rehabilitation hospital  3,292   21,994   158   —     3,450   21,994   25,444   841   —    1995 

July 6, 2015

  40 

Bad Soden-Salmünster, Germany

 Rehabilitation hospital  904   6,276   116   —     1,020   6,276   7,296   247   —    1974 

June 30, 2015

  40 
Berlin, Germany Rehabilitation hospital  —     20,107   179   —     179   20,107   20,286   775   —    1998 

July 16, 2015

  40 

Index to Financial Statements
    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

Bad Lobenstein, Germany

 Rehabilitation hospital  3,429   19,442   174   —     3,603   19,442   23,045   746   —    1994 

June 30, 2015

  40 

Bernkastel-Kues, Germany

 Rehabilitation hospital  757   10,926   126   —     883   10,926   11,809   422   —    1993 

July 14, 2015

  40 

Magdeburg, Germany

 Rehabilitation hospital  13,931   51,674   242   —     14,173   51,674   65,847   1,853   —    1999/2014 

July 22, 2015

  40 

Schlangenbad, Germany

 Rehabilitation hospital  1,015   3,302   258   —     1,273   3,302   4,575   150   —    1973 

June 30, 2015

  40 

Bad Dürrheim, Germany

 Rehabilitation hospital  1,346   11,038   221   —     1,567   11,038   12,605   412   —    1960-1970 

July 24, 2015

  40 

Bad Krozingen, Germany

 Rehabilitation hospital  1,425   10,392   110   —     1,535   10,392   11,927   378   —    2008 

July 24, 2015

  40 

Bad Nauheim, Germany

 Rehabilitation hospital  1,704   8,906   53   —     1,757   8,906   10,663   339   —    1972-1973 

June 30, 2015

  40 

Bad Tennstedt, Germany

 Rehabilitation hospital  3,560   26,396   195   —     3,755   26,396   30,151   1,009   —    1993 

June 30, 2015

  40 

Wismar, Germany

 Rehabilitation hospital  3,355   19,989   189   —     3,544   19,989   23,533   769   —    1996 

June 30, 2015

  40 

Heidelberg, Germany

 Rehabilitation hospital  5,757   33,689   438   —     6,195   33,689   39,884   436   —    1885/1991 

June 22, 2016

  40 

Bad Kösen, Germany

 Rehabilitation hospital  1,189   6,941   —     —     1,189   6,941   8,130   29   —    1992 

October 27, 2016

  40 

Bad Kösen, Germany

 Rehabilitation hospital  1,203   7,095   —     —     1,203   7,095   8,298   30   —    1996 

October 27, 2016

  40 

Bad Kösen, Germany

 Rehabilitation hospital  717   4,473   —     —     717   4,473   5,190   19   —    1997 

October 27, 2016

  40 

Bad Salzdetfurth, Germany

 Rehabilitation hospital  1,129   6,556   —     —     1,129   6,556   7,685   14   —    1987 

November 23, 2016

  40 

Bad Bertrich, Germany

 Rehabilitation hospital  631   3,787   —     —     631   3,787   4,418   8   —    1910,1980-
1985
 

November 30, 2016

  40 

Lübeck, Germany

 Rehabilitation hospital  673   4,922   38   —     711   4,922   5,633   —     —    1900/2011 

December 31, 2016

  40 

Vitense-Parber, Germany

 Rehabilitation hospital  540   3,938   30   —     570   3,938   4,508   —     —    1800/1995 

December 31, 2016

  40 

Breuberg-Sandbach, Germany

 Rehabilitation hospital  1,554   11,485   88   —     1,642   11,485   13,127   —     —    1901/1984 

December 31, 2016

  40 

Ravensrush, Germany

 Rehabilitation hospital  407   3,199   25   —     432   3,199   3,631   —     —    1860/1992 

December 31, 2016

  40 

Wildeck, Germany

 Rehabilitation hospital  731   5,250   40   —     771   5,250   6,021   —     —    1600/2013 

December 31, 2016

  40 

Römhild, Germany

 Rehabilitation hospital  169   8,039   62   —     231   8,039   8,270   —     —    1902/2000 

December 31, 2016

  40 

Bad Hersfield, Germany

 Rehabilitation hospital  507   3,773   29   —     536   3,773   4,309   —     —    1930/2014 

December 31, 2016

  40 

Houston, TX

 Acute care general hospital  3,501   34,530   8,477   16,589   3,274   59,823   63,097   9,663   —    1960 

August 10, 2007

  40 

Allen, TX

 Freestanding ER  1,550   3,921   —     —     1,550   3,921   5,471   245   —    2014 

July 14, 2014

  40 

San Diego, CA

 Acute care general hospital  12,663   52,432   —     —     12,663   52,432   65,095   7,755   —    1973 

February 9, 2011

  40 

Alvin, TX

 Freestanding ER  105   4,087   —     —     105   4,087   4,192   258   —    2014 

March 19, 2014

  40 
Houston, TX Freestanding ER  950   4,576   —     —     950   4,576   5,526   29   —    2016 

September 26, 2016

  40 

Aurora, CO

 Freestanding ER  —     4,812   —     —     —     4,812   4,812   150   —    2015 

September 17, 2015

  40 

Ft. Worth, TX

 Freestanding ER  —     4,392   —     —     —     4,392   4,392   192   —    2015 

March 27, 2015

  40 

Bayonne, NJ

 Acute care general hospital  2,003   51,495   —     —     2,003   51,495   53,498   15,234   —    1918 

February 4, 2011

  20 

Bennettsville, SC

 Acute care general hospital  794   15,772   —     —     794   15,772   16,566   3,419   —    1984 

April 1, 2008

  40 

Blue Springs, MO

 Acute care general hospital  4,347   23,494   —     —     4,347   23,494   27,841   1,183   —    1980 

February 13, 2015

  40 

Bossier City, LA

 Long term acute care hospital  900   17,818   —     —     900   17,818   18,718   3,895   —    1982 

April 1, 2008

  40 

Brighton, MA

 Acute care general hospital  18,638   147,266   —     —     18,638   147,266   165,904   922   —    1917-2009 

October 3, 2016

  41 

Brockton, MA

 Acute care general hospital  18,141   66,562   —     —     18,141   66,562   84,703   526   —    1965-2010 

October 3, 2016

  41 

Austin, TX

 Freestanding ER  1,140   3,853   —     —     1,140   3,853   4,993   249   —    2014 

May 29, 2014

  40 

Broomfield, CO

 Freestanding ER  825   3,895   —     —     825   3,895   4,720   243   —    2014 

July 3, 2014

  40 

Glendale, AZ

 Freestanding ER  1,144   6,005   —     —     1,144   6,005   7,149   25   —    2016 

October 21, 2016

  40 

New Orleans, LA

 Freestanding ER  2,850   5,599   —     —     2,850   5,599   8,449   35   —    2016 

September 23, 2016

  40 

Index to Financial Statements
    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

Carrollton, TX

 Acute care general hospital  729   34,342   —     —     729   34,342   35,071   1,216   —    2015 

July 17, 2015

  40 

Cedar Hill. TX

 Freestanding ER  1,122   3,644   —     —     1,122   3,644   4,766   228   —    2014 

June 23, 2014

  40 

Spring, TX

 

Freestanding ER

  1,310   4,203   —     —     1,310   4,203   5,513   263   —    2014 

July 15, 2014

  40 

Chandler, AZ

 

Freestanding ER

  —     4,783   —     —     —     4,783   4,783   199   —    2015 

April 24, 2015

  40 

Chandler, AZ

 

Freestanding ER

  750   3,852   —     —     750   3,852   4,602   120   —    2015 

October 7, 2015

  40 

Cheraw, SC

 

Acute care general hospital

  657   19,576   —     —     657   19,576   20,233   4,242   —    1982 

April 1, 2008

  40 

Katy, TX

 

Freestanding ER

  —     3,873   —     —     —     3,873   3,873   113   —    2015 

October 21, 2015

  40 

Webster, TX

 Long term acute care hospital  663   33,751   —     —     663   33,751   34,414   5,063   —    2004 

December 21, 2010

  40 

Commerce City, TX

 Freestanding ER  707   4,236   —     —     707   4,236   4,943   221   —    2014 

December 11, 2014

  40 

Conroe, TX

 Freestanding ER  1,338   3,712   —     —     1,338   3,712   5,050   131   —    2015 

July 29, 2015

  40 

Converse, TX

 Freestanding ER  750   4,423   —     —     750   4,423   5,173   194   —    2015 

April 10, 2015

  40 

The Woodlands, TX

 Freestanding ER  —     4,740   —     —     —     4,740   4,740   89   —    2016 

March 28, 2016

  40 

Dallas, TX

 Long term acute care hospital  1,000   13,589   —     368   1,421   13,536   14,957   3,496   —    2006 

September 5, 2006

  40 

Denver, CO

 Freestanding ER  —     4,276   —     —     —     4,276   4,276   169   —    2015 

June 8, 2015

  40 

DeSoto, TX

 Freestanding ER  750   4,569   —     —     750   4,569   5,319   67   —    2016 

May 23, 2016

  40 

DeSoto, TX

 Long term acute care hospital  1,067   10,701   86   8   1,161   10,701   11,862   1,476   —    2008 

July 18, 2011

  40 

Detroit, MI

 Long term acute care hospital  1,220   8,687   —     (365  1,220   8,322   9,542   1,862   —    1956 

May 22, 2008

  40 

San Antonio, TX

 Freestanding ER  —     5,157   —     —     —     5,157   5,157   11   —    2016 

December 9, 2016

  40 

Dulles, TX

 Freestanding ER  1,076   3,784   —     —     1,076   3,784   4,860   220   —    2014 

September 12, 2014

  40 
Houston, TX Freestanding ER  1,345   3,678   —     —     1,345   3,678   5,023   230   —    2014 

June 20, 2014

  40 

Fairmont, CA

 Acute care general hospital  1,000   12,301   3,928   —     1,277   15,952   17,229   857   —    1939,1972,1985 

September 19, 2014

  40 

Fall River, MA

 Acute care general hospital  2,406   82,358   —     —     2,406   82,358   84,764   526   —    1950-2012 

October 3, 2016

  41 

Firestone, TX

 Freestanding ER  495   3,963   —     —     495   3,963   4,458   256   —    2014 

June 6, 2014

  40 

Florence, AZ

 Acute care general hospital  900   28,462   105   —     900   28,567   29,467   3,388   —    2012 

February 7, 2012

  40 

Fort Lauderdale, FL

 Rehabilitation hospital  3,499   21,939   —     1   3,499   21,940   25,439   4,763   —    1985 

April 22, 2008

  40 

Fountain, CO

 Freestanding ER  1,508   4,131   —     —     1,508   4,131   5,639   250   —    2014 

July 31, 2014

  40 

Frisco, TX

 Freestanding ER  —     4,735   —     —     —     4,735   4,735   99   —    2016 

March 4, 2016

  40 

Frisco, TX

 Freestanding ER  2,441   4,474   —     —     2,441   4,474   6,915   130   —    2015 

November 13, 2015

  40 

Frisco, TX

 Freestanding ER  1,500   3,863   27   (89  1,411   3,890   5,301   251   —    2014 

June 13, 2014

  40 

Garden Grove, CA

 Acute care general hospital  5,502   10,748   —     51   5,502   10,799   16,301   2,196   —    1982 

November 25, 2008

  40 

Garland, TX

 Freestanding ER  —     4,954   —     —     —     4,954   4,954   21   —    2016 

November 15, 2016

  40 

Garden Grove, CA

 Medical Office Building  862   7,888   —     28   862   7,916   8,778   1,603   —    1982 

November 25, 2008

  40 

Gilbert, AZ

 Acute care general hospital  150   15,553   —     —     150   15,553   15,703   2,333   —    2005 

January 4, 2011

  40 

Gilbert, AZ

 Freestanding ER  1,518   4,660   ���     —     1,518   4,660   6,178   165   —    2015 

July 22, 2015

  40 

Glendale, AZ

 Freestanding ER  —     4,046   —     —     —     4,046   4,046   160   —    2015 

June 5, 2015

  40 

Goodyear, AZ

 Freestanding ER  1,800   4,709   —     —     1,800   4,709   6,509   88   —    2016 

April 4, 2016

  40 

Index to Financial Statements
    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

Hartsville, SC

 Acute care general hospital  2,050   43,970   —     —     2,050   43,970   46,020   957   —    1999 

August 31, 2015

  34 

Hausman, TX

 Acute care general hospital  1,500   8,958   —     —     1,500   8,958   10,458   835   —    2013 

March 1, 2013

  40 

Helotes, TX

 Freestanding ER  1,900   5,297   —     —     1,900   5,297   7,197   110   —    2016 

March 10, 2016

  40 

Highland Village, TX

 Freestanding ER  —     4,016   —     —     —     4,016   4,016   126   —    2015 

September 22, 2015

  40 

Hill County, TX

 Acute care general hospital  1,120   17,882   —     —     1,120   17,882   19,002   7,492   —    1980 

September 17, 2010

  40 

Hoboken, NJ

 Acute care general hospital  1,387   44,351   —     —     1,387   44,351   45,738   11,394   —    1863 

November 4, 2011

  20 

Hoover, AL

 Freestanding ER  —     7,581   —     —     —     7,581   7,581   369   —    2015 

May 1, 2015

  34 

Hoover, AL

 Medical Office Building  —     1,034   —     —     —     1,034   1,034   50   —    2015 

May 1, 2015

  34 

Hot Springs, AR

 Acute care general hospital  7,100   59,432   19,113   —     7,100   78,545   85,645   2,480   —    1985 

August 31, 2015

  40 

Highlands Ranch, CO

 Freestanding ER  4,200   4,763   —     —     4,200   4,763   8,963   50   —    2016 

July 25, 2016

  40 

Idaho Falls, ID

 Acute care general hospital  1,822   37,467   —     4,665   1,822   42,132   43,954   9,086   —    2002 

April 1, 2008

  40 

Kansas City, MO

 Acute care general hospital  10,497   64,419   —     —     10,497   64,419   74,916   3,146   —    1978 

February 13, 2015

  40 

Katy, TX

 Freestanding ER  —     4,671   —     —     —     4,671   4,671   29   —    2016 

October 10, 2016

  40 

Camden, SC

 Acute care general hospital  —     22,739   —     —     —     22,739   22,739   384   —    1954-2004 

October 30, 2015

  20 

Lafayette, IN

 Rehabilitation hospital  800   14,968   (25  —     800   14,943   15,743   1,450   —    2013 

February 1, 2013

  40 
Little Elm, TX Freestanding ER  1,241   3,491   —     —     1,241   3,491   4,732   266   —    2013 

December 1, 2013

  40 

Longmont, CO

 Freestanding ER  —     4,770   —     —     —     4,770   4,770   109   —    2016 

February 10, 2016

  40 

Lubbock, TX

 Rehabilitation hospital  1,376   28,292   705   —     1,376   28,997   30,373   1,072   —    2008 

June 16, 2015

  40 

Mandeville, LA

 Freestanding ER  2,800   5,004   —     —     2,800   5,004   7,804   21   —    2016 

October 28, 2016

  40 

Marrero, LA

 Freestanding ER  —     5,756   —     —     —     5,756   5,756   72   —    2016 

July 15, 2016

  40 

McKinney, TX

 Freestanding ER  —     4,060   —     —     —     4,060   4,060   193   —    2015 

July 31, 2015

  30 

McMinnville, OR

 Acute care general hospital  5,000   97,900   —     —     5,000   97,900   102,900   1,663   —    1996 

August 31, 2015

  41 

Mesa, AZ

 Acute care general hospital  4,900   97,980   2,242   —     7,142   97,980   105,122   8,576   —    2007 

September 26, 2013

  40 

Methuen, MA

 Acute general care hospital  23,809   89,505   —     —     23,809   89,505   113,314   638   —    1950-2011 

October 3, 2016

  41 

Bloomington, IN

 Acute care general hospital  2,392   28,212   5,000   408   2,392   33,620   36,012   8,483   —    2006 

August 8, 2006

  40 

Montclair, NJ

 Acute care general hospital  7,900   99,632   585   —     8,477   99,640   108,117   7,152   —    1920-2000 

April 1, 2014

  40 

Muskogee, OK

 Acute care general hospital  1,420   51,953   —     —     1,420   51,953   53,373   1,046   —    1959,2009 

August 31, 2015

  30 
San Antonio, TX Freestanding ER  351   3,952   —     —     351   3,952   4,303   271   —    2014 

January 1, 2014

  40 

Houston, TX

 Acute care general hospital  4,757   56,238   (37  1,259   5,427   56,790   62,217   14,270   —    2006 

December 1, 2006

  40 

Colorado Springs, CO

 Freestanding ER  600   4,231   —     —     600   4,231   4,831   274   —    2014 

June 5, 2014

  40 

Northland, MO

 Long term acute care hospital  834   17,182   —     —     834   17,182   18,016   2,542   13,101  2007 

February 14, 2011

  40 

Index to Financial Statements
    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

Altoona, WI

 Acute care general hospital  —     29,062   —     —     —     29,062   29,062   1,695   —    2014 

August 31, 2014

  40 

Ogden, UT

 Rehabilitation hospital  1,759   16,414   —     —     1,759   16,414   18,173   1,150   —    2014 

March 1, 2014

  40 

Olympia, WA

 Acute care general hospital  7,220   89,348   —     —     7,220   89,348   96,568   993   —    1984 

July 22, 2016

  40 

Overlook, TX

 Acute care general hospital  2,452   9,666   7   —     2,452   9,673   12,125   926   —    2012 

February 1, 2013

  40 

San Diego, CA

 Acute care general hospital  6,550   15,653   —     77   6,550   15,730   22,280   3,799   —    1964 

May 9, 2007

  40 

Parker, CO

 Freestanding ER  1,301   4,448   —     —     1,301   4,448   5,749   130   —    2015 

November 6, 2015

  40 

Pearland, TX

 Freestanding ER  1,075   3,577   —     —     1,075   3,577   4,652   209   —    2014 

September 8, 2014

  40 

Petersburg, VA

 Rehabilitation hospital  1,302   9,121   —     —     1,302   9,121   10,423   1,938   —    2006 

July 1, 2008

  40 

Plano, TX

 Freestanding ER  —     5,060   —     —     —     5,060   5,060   32   —    2016 

September 30, 2016

  40 

Poplar Bluff, MO

 Acute care general hospital  2,659   38,694   —     1   2,660   38,694   41,354   8,400   —    1980 

April 22, 2008

  40 

Port Arthur, TX

 Acute care general hospital  3,000   72,341   1,062   —     4,062   72,341   76,403   6,071   —    2005 

September 26, 2013

  40 

Port Huron, MI

 Acute care general hospital  3,029   14,622   —     —     3,029   14,622   17,651   490   —    1953,
1973-1983
 

December 31, 2015

  40 

Portland, OR

 Long term acute care hospital  3,085   17,859   —     2,559   3,071   20,432   23,503   4,897   —    1964 

April 18, 2007

  40 

Post Falls, ID

 Rehabilitation hospital  417   12,175   1,905   —     767   13,730   14,497   1,039   —    2013 

December 31, 2013

  40 

San Antonio, TX

 Freestanding ER  —     4,837   —     —     —     4,837   4,837   20   —    2016 

October 27, 2016

  40 

Redding, CA

 Acute care general hospital  1,555   53,863   —     13   1,555   53,876   55,431   12,692   —    1974 

August 10, 2007

  40 

Redding, CA

 Long term acute care hospital  —     19,952   —     4,360   1,629   22,683   24,312   6,406   —    1991 

June 30, 2005

  40 

Rosenberg, TX

 

Freestanding ER

  —     4,731   —     —     —     4,731   4,731   118   —    2016 

January 15, 2016

  40 

San Dimas, CA

 Acute care general hospital  6,160   6,839   —     34   6,160   6,873   13,033   1,390   —    1972 

November 25, 2008

  40 

San Dimas, CA

 Medical Office Building  1,915   5,085   —     18   1,915   5,103   7,018   1,033   —    1979 

November 25, 2008

  40 

Sherman, TX

 Acute care general hospital  4,491   24,802   —     —     4,491   24,802   29,293   1,418   —    1913, 1960-
2010
 

October 31, 2014

  40 

Sienna, TX

 Freestanding ER  999   3,591   —     —     999   3,591   4,590   209   —    2014 

August 20, 2014

  40 

Spartanburg, SC

 Rehabilitation hospital  1,135   15,717   —     —     1,135   15,717   16,852   1,325   —    2013 

August 1, 2013

  40 

Houston, TX

 Freestanding ER  1,423   3,770   —     —     1,423   3,770   5,193   173   —    2015 

February 18, 2015

  40 

Taunton, MA

 Acute care general hospital  4,428   73,433   —     —     4,428   73,433   77,861   488   —    1940-2015 

October 3, 2016

  41 

Thornton, CO

 Freestanding ER  1,350   4,259   —     —     1,350   4,259   5,609   248   —    2014 

August 29, 2014

  40 
Toledo, OH Rehabilitation hospital  —     17,740   —     —     —     17,740   17,740   333   —    2016 

April 1, 2016

  40 

Tomball, TX

 Long term acute care hospital  1,299   23,982   —     —     1,299   23,982   25,281   3,597   —    2005 

December 21, 2010

  40 

Houston, TX

 Acute care general hospital  4,047   41,914   —     —     4,047   41,914   45,961   524   —    2016 

July 7, 2016

  40 

League City, TX

 Freestanding ER  —     3,901   —     —     —     3,901   3,901   146   —    2015 

June 19, 2015

  40 

Anaheim, CA

 Acute care general hospital  1,875   21,814   —     10   1,875   21,824   23,699   5,547   —    1964 

November 8, 2006

  40 

Index to Financial Statements
    Initial Costs  Additions Subsequent
to Acquisition
  Cost at December 31, 2016(1)  Accumulated
         Life on
which
depreciation
in latest
income
statements is
computed
(Years)
 

Location

 

Type of Property

 Land  Buildings  Improvements  Carrying
Costs
  Land  Buildings  Total  Depreciation  Encumbrances  Date of
Construction
 

Date

Acquired

 
  (Dollar amounts in thousands) 

West Monroe, LA

 Acute care general hospital  12,000   69,433   552   —     12,552   69,433   81,985   5,822   —    1962 

September 26, 2013

  40 

San Antonio, TX

 Acute care general hospital  2,248   5,880   —     —     2,248   5,880   8,128   609   —    2012 

October 2, 2012

  40 

West Valley City, UT

 Acute care general hospital  5,516   58,314   2,036   (114  5,402   60,350   65,752   12,716   —    1980 

April 22, 2008

  40 

Wichita, KS

 Rehabilitation hospital  1,019   18,373   —     1   1,019   18,374   19,393   4,018   —    1992 

April 4, 2008

  40 
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

    
  $403,141  $3,482,455  $52,564  $29,882  $417,368  $3,550,674  $3,968,042  $292,786  $13,101    
  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

  

 

 

    

 

 

 

 

Initial Costs

 

 

Additions Subsequent

to Acquisition

 

 

Cost at December 31, 2018(1)

 

 

Accumulated

 

 

 

 

 

 

 

 

 

 

Life on

which

depreciation

in latest

income

statements is

 

Location

 

Type of Property

 

Land

 

 

Buildings

 

 

Improve-

ments

 

 

Carrying

Costs

 

 

Land

 

 

Buildings

 

 

Total

 

 

Depreciation

 

 

Encum-

brances

 

 

Date of

Construction

 

Date

Acquired

 

computed

(Years)

 

 

 

(Dollar amounts in thousands)

 

Bath, UK

 

Acute care general hospital

 

$

1,512

 

 

$

31,334

 

 

$

 

 

$

 

 

$

1,512

 

 

$

31,334

 

 

$

32,846

 

 

$

3,526

 

 

$

 

 

2008, 2009

 

July 1, 2014

 

 

40

 

Braunfels, Germany

 

Acute care general hospital

 

 

2,202

 

 

 

14,073

 

 

 

57

 

 

 

 

 

 

2,259

 

 

 

14,073

 

 

 

16,332

 

 

 

1,245

 

 

 

 

 

1977

 

June 30, 2015

 

 

40

 

Heidelberg, Germany

 

Rehabilitation hospital

 

 

6,404

 

 

 

37,006

 

 

 

75

 

 

 

 

 

 

6,479

 

 

 

37,006

 

 

 

43,485

 

 

 

2,325

 

 

 

 

 

1885, 1991

 

June 22, 2016

 

 

40

 

Cologne, Germany

 

Acute care general hospital

 

 

4,494

 

 

 

15,545

 

 

 

104

 

 

 

 

 

 

4,598

 

 

 

15,545

 

 

 

20,143

 

 

 

593

 

 

 

 

 

2011

 

June 23, 2017

 

 

40

 

Bad Salzuflen, Germany

 

Rehabilitation hospital

 

 

9,972

 

 

 

27,611

 

 

 

939

 

 

 

 

 

 

10,911

 

 

 

27,611

 

 

 

38,522

 

 

 

816

 

 

 

 

 

1974, 2016

 

November 30, 2017

 

 

40

 

Bad Salzuflen, Germany

 

Rehabilitation hospital

 

 

7,062

 

 

 

24,283

 

 

 

353

 

 

 

 

 

 

7,415

 

 

 

24,283

 

 

 

31,698

 

 

 

683

 

 

 

 

 

1989, 2016

 

November 30, 2017

 

 

40

 

Bad Oeynhausen, Germany

 

Rehabilitation hospital

 

 

1,042

 

 

 

2,859

 

 

 

127

 

 

 

 

 

 

1,169

 

 

 

2,859

 

 

 

4,028

 

 

 

87

 

 

 

 

 

1973, 2010

 

November 30, 2017

 

 

40

 

Dormagen, Germany

 

Rehabilitation hospital

 

 

1,843

 

 

 

5,848

 

 

 

140

 

 

 

 

 

 

1,983

 

 

 

5,848

 

 

 

7,831

 

 

 

52

 

 

 

 

 

1993, 2006

 

August 28, 2018

 

 

40

 

Grefath, Germany

 

Rehabilitation hospital

 

 

1,145

 

 

 

3,127

 

 

 

102

 

 

 

 

 

 

1,247

 

 

 

3,127

 

 

 

4,374

 

 

 

28

 

 

 

 

 

1886, 1983

 

August 28, 2018

 

 

40

 

Remscheid, Germany

 

Rehabilitation hospital

 

 

1,029

 

 

 

2,614

 

 

 

60

 

 

 

 

 

 

1,089

 

 

 

2,614

 

 

 

3,703

 

 

 

23

 

 

 

 

 

1951, 1983

 

August 28, 2018

 

 

40

 

Houston, TX

 

Acute care general hospital

 

 

3,501

 

 

 

34,530

 

 

 

8,477

 

 

 

16,589

 

 

 

3,274

 

 

 

59,823

 

 

 

63,097

 

 

 

12,943

 

 

 

 

 

1960

 

August 10, 2007

 

 

40

 

Allen, TX

 

Freestanding ER

 

 

1,550

 

 

 

866

 

 

 

 

 

 

 

 

 

1,550

 

 

 

866

 

 

 

2,416

 

 

 

441

 

 

 

 

 

2014

 

July 14, 2014

 

 

40

 

San Diego, CA

 

Acute care general hospital

 

 

12,663

 

 

 

52,431

 

 

 

 

 

 

 

 

 

12,663

 

 

 

52,431

 

 

 

65,094

 

 

 

10,377

 

 

 

 

 

1973

 

February 9, 2011

 

 

40

 

Alvin, TX

 

Freestanding ER

 

 

105

 

 

 

4,087

 

 

 

 

 

 

 

 

 

105

 

 

 

4,087

 

 

 

4,192

 

 

 

462

 

 

 

 

 

2014

 

March 19, 2014

 

 

40

 

Houston, TX

 

Freestanding ER

 

 

950

 

 

 

3,996

 

 

 

 

 

 

 

 

 

950

 

 

 

3,996

 

 

 

4,946

 

 

 

225

 

 

 

 

 

2016

 

September 26, 2016

 

 

40

 

Aurora, CO

 

Freestanding ER

 

 

 

 

 

4,812

 

 

 

 

 

 

 

 

 

 

 

 

4,812

 

 

 

4,812

 

 

 

391

 

 

 

 

 

2015

 

September 17, 2015

 

 

40

 

Ft. Worth, TX

 

Freestanding ER

 

 

 

 

 

4,392

 

 

 

 

 

 

 

 

 

 

 

 

4,392

 

 

 

4,392

 

 

 

412

 

 

 

 

 

2015

 

March 27, 2015

 

 

40

 

Ayer, MA

 

Acute care general hospital

 

 

9,048

 

 

 

77,913

 

 

 

1,603

 

 

 

 

 

 

9,048

 

 

 

79,516

 

 

 

88,564

 

 

 

911

 

 

 

 

 

1970-2013

 

June 27, 2018

 

 

47

 

Bayonne, NJ

 

Acute care general hospital

 

 

2,003

 

 

 

51,495

 

 

 

 

 

 

 

 

 

2,003

 

 

 

51,495

 

 

 

53,498

 

 

 

20,383

 

 

 

 

 

1918

 

February 4, 2011

 

 

20

 

Bennettsville, SC

 

Acute care general hospital

 

 

794

 

 

 

15,772

 

 

 

 

 

 

 

 

 

794

 

 

 

15,772

 

 

 

16,566

 

 

 

4,157

 

 

 

 

 

1984

 

April 1, 2008

 

 

42

 

Blue Springs, MO

 

Acute care general hospital

 

 

4,347

 

 

 

23,494

 

 

 

 

 

 

 

 

 

4,347

 

 

 

23,494

 

 

 

27,841

 

 

 

2,417

 

 

 

 

 

1980

 

February 13, 2015

 

 

40

 

Boise, ID

 

Long term acute care hospital

 

 

1,558

 

 

 

11,027

 

 

 

 

 

 

 

 

 

1,558

 

 

 

11,027

 

 

 

12,585

 

 

 

173

 

 

 

 

 

2008

 

February 29, 2012

 

 

50

 

Bossier City, LA

 

Long term acute care hospital

 

 

900

 

 

 

17,818

 

 

 

628

 

 

 

 

 

 

900

 

 

 

18,446

 

 

 

19,346

 

 

 

4,786

 

 

 

 

 

1982

 

April 1, 2008

 

 

40

 

Brighton, MA

 

Acute care general hospital

 

 

18,540

 

 

 

146,490

 

 

 

11,176

 

 

 

 

 

 

18,540

 

 

 

157,666

 

 

 

176,206

 

 

 

8,304

 

 

 

 

 

1917-2009

 

October 3, 2016

 

 

41

 

Brockton, MA

 

Acute care general hospital

 

 

18,328

 

 

 

67,248

 

 

 

4,296

 

 

 

 

 

 

18,328

 

 

 

71,544

 

 

 

89,872

 

 

 

4,798

 

 

 

 

 

1965-2010

 

October 3, 2016

 

 

41

 

Austin, TX

 

Freestanding ER

 

 

1,140

 

 

 

1,777

 

 

 

 

 

 

 

 

 

1,140

 

 

 

1,777

 

 

 

2,917

 

 

 

441

 

 

 

 

 

2014

 

May 29, 2014

 

 

40

 

Broomfield, CO

 

Freestanding ER

 

 

825

 

 

 

3,895

 

 

 

 

 

 

 

 

 

825

 

 

 

3,895

 

 

 

4,720

 

 

 

438

 

 

 

 

 

2014

 

July 3, 2014

 

 

40

 

Glendale, AZ

 

Freestanding ER

 

 

1,144

 

 

 

6,087

 

 

 

 

 

 

 

 

 

1,144

 

 

 

6,087

 

 

 

7,231

 

 

 

330

 

 

 

 

 

2016

 

October 21, 2016

 

 

40

 

New Orleans, LA

 

Freestanding ER

 

 

2,850

 

 

 

6,125

 

 

 

 

 

 

 

 

 

2,850

 

 

 

6,125

 

 

 

8,975

 

 

 

346

 

 

 

 

 

2016

 

September 23, 2016

 

 

40

 

Carrollton, TX

 

Acute care general hospital

 

 

729

 

 

 

34,342

 

 

 

 

 

 

 

 

 

729

 

 

 

34,342

 

 

 

35,071

 

 

 

2,933

 

 

 

 

 

2015

 

July 17, 2015

 

 

40

 

Cedar Hill. TX

 

Freestanding ER

 

 

1,122

 

 

 

3,644

 

 

 

 

 

 

 

 

 

1,122

 

 

 

3,644

 

 

 

4,766

 

 

 

410

 

 

 

 

 

2014

 

June 23, 2014

 

 

40

 

Spring, TX

 

Freestanding ER

 

 

1,310

 

 

 

3,639

 

 

 

 

 

 

 

 

 

1,310

 

 

 

3,639

 

 

 

4,949

 

 

 

409

 

 

 

 

 

2014

 

July 15, 2014

 

 

40

 

 

109


 

 

 

 

Initial Costs

 

 

Additions Subsequent

to Acquisition

 

 

Cost at December 31, 2018(1)

 

 

Accumulated

 

 

 

 

 

 

 

 

 

 

Life on

which

depreciation

in latest

income statements is

 

Location

 

Type of Property

 

Land

 

 

Buildings

 

 

Improve-

ments

 

 

Carrying

Costs

 

 

Land

 

 

Buildings

 

 

Total

 

 

Depreciation

 

 

Encum-

brances

 

 

Date of

Construction

 

Date

Acquired

 

computed

(Years)

 

 

 

(Dollar amounts in thousands)

 

Chandler, AZ

 

Freestanding ER

 

 

 

 

 

4,783

 

 

 

 

 

 

 

 

 

 

 

 

4,783

 

 

 

4,783

 

 

 

438

 

 

 

 

 

2015

 

April 24, 2015

 

 

40

 

Chandler, AZ

 

Freestanding ER

 

 

750

 

 

 

3,852

 

 

 

0

 

 

 

 

 

 

750

 

 

 

3,852

 

 

 

4,602

 

 

 

313

 

 

 

 

 

2015

 

October 7, 2015

 

 

40

 

Cheraw, SC

 

Acute care general hospital

 

 

657

 

 

 

19,576

 

 

 

 

 

 

 

 

 

657

 

 

 

19,576

 

 

 

20,233

 

 

 

5,158

 

 

 

 

 

1982

 

April 1, 2008

 

 

42

 

Katy, TX

 

Freestanding ER

 

 

 

 

 

3,873

 

 

 

 

 

 

 

 

 

 

 

 

3,873

 

 

 

3,873

 

 

 

307

 

 

 

 

 

2015

 

October 21, 2015

 

 

40

 

Webster, TX

 

Long term acute care hospital

 

 

663

 

 

 

33,751

 

 

 

 

 

 

 

 

 

663

 

 

 

33,751

 

 

 

34,414

 

 

 

6,750

 

 

 

 

 

2004

 

December 21, 2010

 

 

40

 

Commerce City, TX

 

Freestanding ER

 

 

707

 

 

 

4,248

 

 

 

 

 

 

 

 

 

707

 

 

 

4,248

 

 

 

4,955

 

 

 

434

 

 

 

 

 

2014

 

December 11, 2014

 

 

40

 

Conroe, TX

 

Freestanding ER

 

 

1,338

 

 

 

3,712

 

 

 

 

 

 

 

 

 

1,338

 

 

 

3,712

 

 

 

5,050

 

 

 

317

 

 

 

 

 

2015

 

July 29, 2015

 

 

40

 

Converse, TX

 

Freestanding ER

 

 

750

 

 

 

4,423

 

 

 

 

 

 

 

 

 

750

 

 

 

4,423

 

 

 

5,173

 

 

 

415

 

 

 

 

 

2015

 

April 10, 2015

 

 

40

 

The Woodlands, TX

 

Freestanding ER

 

 

 

 

 

4,524

 

 

 

 

 

 

 

 

 

 

 

 

4,524

 

 

 

4,524

 

 

 

311

 

 

 

 

 

2016

 

March 28, 2016

 

 

40

 

Houston, TX

 

Freestanding ER

 

 

 

 

 

4,267

 

 

 

 

 

 

 

 

 

 

 

 

4,267

 

 

 

4,267

 

 

 

203

 

 

 

 

 

2017

 

May 8, 2017

 

 

35

 

Dallas, TX

 

Long term acute care hospital

 

 

1,000

 

 

 

13,589

 

 

 

 

 

 

368

 

 

 

1,421

 

 

 

13,536

 

 

 

14,957

 

 

 

4,173

 

 

 

 

 

2006

 

September 5, 2006

 

 

40

 

Denver, CO

 

Freestanding ER

 

 

 

 

 

4,276

 

 

 

 

 

 

 

 

 

 

 

 

4,276

 

 

 

4,276

 

 

 

383

 

 

 

 

 

2015

 

June 8, 2015

 

 

40

 

DeSoto, TX

 

Freestanding ER

 

 

750

 

 

 

4,234

 

 

 

 

 

 

 

 

 

750

 

 

 

4,234

 

 

 

4,984

 

 

 

273

 

 

 

 

 

2016

 

May 23, 2016

 

 

40

 

Detroit, MI

 

Long term acute care hospital

 

 

1,220

 

 

 

8,687

 

 

 

 

 

 

(365

)

 

 

1,220

 

 

 

8,322

 

 

 

9,542

 

 

 

2,274

 

 

 

 

 

1956

 

May 22, 2008

 

 

40

 

San Antonio, TX

 

Freestanding ER

 

 

 

 

 

4,801

 

 

 

 

 

 

 

 

 

 

 

 

4,801

 

 

 

4,801

 

 

 

250

 

 

 

 

 

2016

 

December 9, 2016

 

 

40

 

Dorchester, MA

 

Acute care general hospital

 

 

14,428

 

 

 

219,575

 

 

 

5,394

 

 

 

 

 

 

14,428

 

 

 

224,969

 

 

 

239,397

 

 

 

1,371

 

 

 

 

 

1953-2015

 

October 15, 2018

 

 

42

 

Dulles, TX

 

Freestanding ER

 

 

1,076

 

 

 

3,784

 

 

 

 

 

 

 

 

 

1,076

 

 

 

3,784

 

 

 

4,860

 

 

 

410

 

 

 

 

 

2014

 

September 12, 2014

 

 

40

 

Easton, PA

 

Acute care general hospital

 

 

13,898

 

 

 

40,245

 

 

 

2,921

 

 

 

 

 

 

13,898

 

 

 

43,166

 

 

 

57,064

 

 

 

1,786

 

 

 

 

 

1930-2005

 

May 1, 2017

 

 

41

 

Houston, TX

 

Freestanding ER

 

 

1,345

 

 

 

3,678

 

 

 

 

 

 

 

 

 

1,345

 

 

 

3,678

 

 

 

5,023

 

 

 

414

 

 

 

 

 

2014

 

June 20, 2014

 

 

40

 

Fairmont, CA

 

Acute care general hospital

 

 

1,000

 

 

 

6,072

 

 

 

5,278

 

 

 

 

 

 

1,277

 

 

 

11,073

 

 

 

12,350

 

 

 

1,798

 

 

 

 

 

1939, 1972, 1985

 

September 19, 2014

 

 

40

 

Fall River, MA

 

Acute care general hospital

 

 

3,526

 

 

 

82,358

 

 

 

22,205

 

 

 

 

 

 

3,525

 

 

 

104,564

 

 

 

108,089

 

 

 

4,977

 

 

 

 

 

1950-2012

 

October 3, 2016

 

 

41

 

Firestone, TX

 

Freestanding ER

 

 

495

 

 

 

3,963

 

 

 

 

 

 

 

 

 

495

 

 

 

3,963

 

 

 

4,458

 

 

 

454

 

 

 

 

 

2014

 

June 6, 2014

 

 

40

 

Flagstaff, AZ

 

Rehabilitation hospital

 

 

3,049

 

 

 

22,464

 

 

 

 

 

 

 

 

 

3,049

 

 

 

22,464

 

 

 

25,513

 

 

 

468

 

 

 

 

 

2016

 

August 23, 2016

 

 

40

 

Florence, AZ

 

Acute care general hospital

 

 

900

 

 

 

28,462

 

 

 

105

 

 

 

 

 

 

900

 

 

 

28,567

 

 

 

29,467

 

 

 

4,817

 

 

 

 

 

2012

 

February 7, 2012

 

 

40

 

Fort Lauderdale, FL

 

Rehabilitation hospital

 

 

3,499

 

 

 

21,939

 

 

 

 

 

 

1

 

 

 

3,499

 

 

 

21,940

 

 

 

25,439

 

 

 

5,862

 

 

 

 

 

1985

 

April 22, 2008

 

 

40

 

Fountain, CO

 

Freestanding ER

 

 

1,508

 

 

 

4,131

 

 

 

 

 

 

 

 

 

1,508

 

 

 

4,131

 

 

 

5,639

 

 

 

456

 

 

 

 

 

2014

 

July 31, 2014

 

 

40

 

Frisco, TX

 

Freestanding ER

 

 

 

 

 

1,806

 

 

 

 

 

 

 

 

 

 

 

 

1,806

 

 

 

1,806

 

 

 

336

 

 

 

 

 

2016

 

March 4, 2016

 

 

40

 

Frisco, TX

 

Freestanding ER

 

 

2,441

 

 

 

185

 

 

 

 

 

 

 

 

 

2,441

 

 

 

185

 

 

 

2,626

 

 

 

354

 

 

 

 

 

2015

 

November 13, 2015

 

 

40

 

Frisco, TX

 

Freestanding ER

 

 

1,500

 

 

 

3,863

 

 

 

27

 

 

 

(89

)

 

 

1,411

 

 

 

3,890

 

 

 

5,301

 

 

 

446

 

 

 

 

 

2014

 

June 13, 2014

 

 

40

 

Garden Grove, CA

 

Acute care general hospital

 

 

5,502

 

 

 

10,748

 

 

 

 

 

 

51

 

 

 

5,502

 

 

 

10,799

 

 

 

16,301

 

 

 

2,736

 

 

 

 

 

1982

 

November 25, 2008

 

 

40

 

Garland, TX

 

Freestanding ER

 

 

 

 

 

4,647

 

 

 

 

 

 

 

 

 

 

 

 

4,647

 

 

 

4,647

 

 

 

252

 

 

 

 

 

2016

 

November 15, 2016

 

 

40

 

Garden Grove, CA

 

Medical Office Building

 

 

862

 

 

 

7,888

 

 

 

 

 

 

28

 

 

 

862

 

 

 

7,916

 

 

 

8,778

 

 

 

1,999

 

 

 

 

 

1982

 

November 25, 2008

 

 

40

 

Gilbert, AZ

 

Acute care general hospital

 

 

150

 

 

 

15,553

 

 

 

 

 

 

 

 

 

150

 

 

 

15,553

 

 

 

15,703

 

 

 

3,111

 

 

 

 

 

2005

 

January 4, 2011

 

 

40

 

Gilbert, AZ

 

Freestanding ER

 

 

1,517

 

 

 

4,660

 

 

 

 

 

 

 

 

 

1,517

 

 

 

4,660

 

 

 

6,177

 

 

 

398

 

 

 

 

 

2015

 

July 22, 2015

 

 

40

 

Glendale, AZ

 

Freestanding ER

 

 

 

 

 

4,046

 

 

 

 

 

 

 

 

 

 

 

 

4,046

 

 

 

4,046

 

 

 

362

 

 

 

 

 

2015

 

June 5, 2015

 

 

40

 

Goodyear, AZ

 

Freestanding ER

 

 

1,800

 

 

 

4,713

 

 

 

 

 

 

 

 

 

1,800

 

 

 

4,713

 

 

 

6,513

 

 

 

324

 

 

 

 

 

2016

 

April 4, 2016

 

 

40

 

Hartsville, SC

 

Acute care general hospital

 

 

2,050

 

 

 

43,970

 

 

 

 

 

 

 

 

 

2,050

 

 

 

43,970

 

 

 

46,020

 

 

 

3,827

 

 

 

 

 

1999

 

August 31, 2015

 

 

34

 

Hausman, TX

 

Acute care general hospital

 

 

1,500

 

 

 

8,957

 

 

 

 

 

 

 

 

 

1,500

 

 

 

8,957

 

 

 

10,457

 

 

 

1,284

 

 

 

 

 

2013

 

March 1, 2013

 

 

40

 

Haverhill, MA

 

Acute care general hospital

 

 

5,651

 

 

 

105,848

 

 

 

1,888

 

 

 

 

 

 

5,651

 

 

 

107,736

 

 

 

113,387

 

 

 

936

 

 

 

 

 

1982-2005

 

August 31, 2018

 

 

40

 

Helotes, TX

 

Freestanding ER

 

 

1,900

 

 

 

5,115

 

 

 

 

 

 

 

 

 

1,900

 

 

 

5,115

 

 

 

7,015

 

 

 

362

 

 

 

 

 

2016

 

March 10, 2016

 

 

40

 

110


 

 

 

 

Initial Costs

 

 

Additions Subsequent

to Acquisition

 

 

Cost at December 31, 2018(1)

 

 

Accumulated

 

 

 

 

 

 

 

 

 

 

Life on

which

depreciation

in latest

income statements is

 

Location

 

Type of Property

 

Land

 

 

Buildings

 

 

Improve-

ments

 

 

Carrying

Costs

 

 

Land

 

 

Buildings

 

 

Total

 

 

Depreciation

 

 

Encum-

brances

 

 

Date of

Construction

 

Date

Acquired

 

computed

(Years)

 

 

 

(Dollar amounts in thousands)

 

Highland Village, TX

 

Freestanding ER

 

 

 

 

 

1,551

 

 

 

 

 

 

 

 

 

 

 

 

1,551

 

 

 

1,551

 

 

 

326

 

 

 

 

 

2015

 

September 22, 2015

 

 

40

 

Hill County, TX

 

Acute care general hospital

 

 

1,120

 

 

 

17,882

 

 

 

 

 

 

 

 

 

1,120

 

 

 

17,882

 

 

 

19,002

 

 

 

9,890

 

 

 

 

 

1980

 

September 17, 2010

 

 

15

 

Warren, OH

 

Rehabilitation hospital

 

 

2,417

 

 

 

15,857

 

 

 

35

 

 

 

 

 

 

2,417

 

 

 

15,892

 

 

 

18,309

 

 

 

891

 

 

 

 

 

1922-2000

 

May 1, 2017

 

 

46

 

Hoboken, NJ

 

Acute care general hospital

 

 

1,387

 

 

 

44,351

 

 

 

 

 

 

 

 

 

1,387

 

 

 

44,351

 

 

 

45,738

 

 

 

15,838

 

 

 

 

 

1863

 

November 4, 2011

 

 

20

 

Hoover, AL

 

Freestanding ER

 

 

 

 

 

7,581

 

 

 

 

 

 

 

 

 

 

 

 

7,581

 

 

 

7,581

 

 

 

812

 

 

 

 

 

2015

 

May 1, 2015

 

 

34

 

Hoover, AL

 

Medical Office Building

 

 

 

 

 

1,034

 

 

 

 

 

 

 

 

 

 

 

 

1,034

 

 

 

1,034

 

 

 

111

 

 

 

 

 

2015

 

May 1, 2015

 

 

34

 

Hope, AR

 

Acute care general hospital

 

 

1,651

 

 

 

3,359

 

 

 

373

 

 

 

 

 

 

1,651

 

 

 

3,732

 

 

 

5,383

 

 

 

223

 

 

 

 

 

1984-2001

 

September 29, 2017

 

 

41

 

Hot Springs, AR

 

Acute care general hospital

 

 

7,100

 

 

 

59,432

 

 

 

21,221

 

 

 

 

 

 

7,100

 

 

 

80,653

 

 

 

87,753

 

 

 

6,795

 

 

 

 

 

1985

 

August 31, 2015

 

 

40

 

Houston, TX

 

Acute care general hospital

 

 

28,687

 

 

 

104,028

 

 

 

5,999

 

 

 

 

 

 

28,687

 

 

 

110,027

 

 

 

138,714

 

 

 

878

 

 

 

 

 

1940-1950

 

September 29, 2017

 

 

41

 

Highlands Ranch, CO

 

Freestanding ER

 

 

4,200

 

 

 

4,779

 

 

 

 

 

 

 

 

 

4,200

 

 

 

4,779

 

 

 

8,979

 

 

 

289

 

 

 

 

 

2016

 

July 25, 2016

 

 

40

 

Idaho Falls, ID

 

Acute care general hospital

 

 

1,822

 

 

 

37,467

 

 

 

441

 

 

 

4,665

 

 

 

1,822

 

 

 

42,573

 

 

 

44,395

 

 

 

11,201

 

 

 

 

 

2002

 

April 1, 2008

 

 

40

 

Kansas City, MO

 

Acute care general hospital

 

 

10,497

 

 

 

64,419

 

 

 

 

 

 

 

 

 

10,497

 

 

 

64,419

 

 

 

74,916

 

 

 

6,429

 

 

 

 

 

1978

 

February 13, 2015

 

 

40

 

Katy, TX

 

Freestanding ER

 

 

 

 

 

4,174

 

 

 

 

 

 

 

 

 

 

 

 

4,174

 

 

 

4,174

 

 

 

235

 

 

 

 

 

2016

 

October 10, 2016

 

 

40

 

Camden, SC

 

Acute care general hospital

 

 

 

 

 

22,739

 

 

 

 

 

 

 

 

 

 

 

 

22,739

 

 

 

22,739

 

 

 

1,555

 

 

 

 

 

1954-2004

 

October 30, 2015

 

 

39

 

Lafayette, IN

 

Rehabilitation hospital

 

 

800

 

 

 

14,968

 

 

 

(25

)

 

 

 

 

 

800

 

 

 

14,943

 

 

 

15,743

 

 

 

2,198

 

 

 

 

 

2013

 

February 1, 2013

 

 

40

 

Lehi, UT

 

Acute care general hospital

 

 

13,403

 

 

 

29,950

 

 

 

156

 

 

 

(35

)

 

 

13,368

 

 

 

30,106

 

 

 

43,474

 

 

 

1,108

 

 

 

 

 

2015

 

September 29, 2017

 

 

45

 

Lewiston, ID

 

Acute care general hospital

 

 

5,389

 

 

 

75,435

 

 

 

 

 

 

 

 

 

5,389

 

 

 

75,435

 

 

 

80,824

 

 

 

4,251

 

 

 

 

 

1922

 

May 1, 2017

 

 

40

 

Little Elm, TX

 

Freestanding ER

 

 

1,241

 

 

 

3,491

 

 

 

 

 

 

 

 

 

1,241

 

 

 

3,491

 

 

 

4,732

 

 

 

441

 

 

 

 

 

2013

 

December 1, 2013

 

 

40

 

Longmont, CO

 

Freestanding ER

 

 

 

 

 

4,181

 

 

 

 

 

 

 

 

 

 

 

 

4,181

 

 

 

4,181

 

 

 

305

 

 

 

 

 

2016

 

February 10, 2016

 

 

40

 

Lubbock, TX

 

Rehabilitation hospital

 

 

1,376

 

 

 

28,292

 

 

 

3,648

 

 

 

 

 

 

1,376

 

 

 

31,940

 

 

 

33,316

 

 

 

2,657

 

 

 

 

 

2008

 

June 16, 2015

 

 

40

 

Mandeville, LA

 

Freestanding ER

 

��

2,800

 

 

 

5,370

 

 

 

 

 

 

 

 

 

2,800

 

 

 

5,370

 

 

 

8,170

 

 

 

291

 

 

 

 

 

2016

 

October 28, 2016

 

 

40

 

Marrero, LA

 

Freestanding ER

 

 

 

 

 

5,801

 

 

 

 

 

 

 

 

 

 

 

 

5,801

 

 

 

5,801

 

 

 

364

 

 

 

 

 

2016

 

July 15, 2016

 

 

40

 

McKinney, TX

 

Freestanding ER

 

 

 

 

 

4,060

 

 

 

 

 

 

 

 

 

 

 

 

4,060

 

 

 

4,060

 

 

 

466

 

 

 

 

 

2015

 

July 31, 2015

 

 

30

 

McMinnville, OR

 

Acute care general hospital

 

 

5,000

 

 

 

97,900

 

 

 

 

 

 

 

 

 

5,000

 

 

 

97,900

 

 

 

102,900

 

 

 

6,652

 

 

 

 

 

1996

 

August 31, 2015

 

 

41

 

Melbourne, FL

 

Acute care general hospital

 

 

5,642

 

 

 

17,087

 

 

 

2,282

 

 

 

 

 

 

5,642

 

 

 

19,369

 

 

 

25,011

 

 

 

922

 

 

 

 

 

2002

 

May 1, 2017

 

 

42

 

Mesa, AZ

 

Acute care general hospital

 

 

6,534

 

 

 

100,042

 

 

 

289

 

 

 

 

 

 

6,533

 

 

 

100,332

 

 

 

106,865

 

 

 

13,819

 

 

 

 

 

2007

 

September 26, 2013

 

 

40

 

Phoenix, AZ

 

Acute care general hospital

 

 

5,576

 

 

 

45,782

 

 

 

 

 

 

 

 

 

5,576

 

 

 

45,782

 

 

 

51,358

 

 

 

2,194

 

 

 

 

 

2017

 

February 10, 2017

 

 

40

 

Methuen, MA

 

Acute care general hospital

 

 

23,809

 

 

 

89,505

 

 

 

5,698

 

 

 

 

 

 

23,809

 

 

 

95,203

 

 

 

119,012

 

 

 

5,766

 

 

 

 

 

1950-2011

 

October 3, 2016

 

 

41

 

Bloomington, IN

 

Acute care general hospital

 

 

2,392

 

 

 

28,212

 

 

 

5,000

 

 

 

408

 

 

 

2,392

 

 

 

33,620

 

 

 

36,012

 

 

 

10,377

 

 

 

 

 

2006

 

August 8, 2006

 

 

40

 

Montclair, NJ

 

Acute care general hospital

 

 

7,900

 

 

 

99,640

 

 

 

577

 

 

 

 

 

 

8,477

 

 

 

99,640

 

 

 

108,117

 

 

 

12,211

 

 

 

 

 

1920-2000

 

April 1, 2014

 

 

40

 

San Antonio, TX

 

Freestanding ER

 

 

351

 

 

 

3,952

 

 

 

 

 

 

 

 

 

351

 

 

 

3,952

 

 

 

4,303

 

 

 

468

 

 

 

 

 

2014

 

January 1, 2014

 

 

40

 

Colorado Springs, CO

 

Freestanding ER

 

 

600

 

 

 

4,231

 

 

 

 

 

 

 

 

 

600

 

 

 

4,231

 

 

 

4,831

 

 

 

485

 

 

 

 

 

2014

 

June 5, 2014

 

 

40

 

Northland, MO

 

Long term acute care hospital

 

 

834

 

 

 

17,182

 

 

 

 

 

 

 

 

 

834

 

 

 

17,182

 

 

 

18,016

 

 

 

3,401

 

 

 

 

 

2007

 

February 14, 2011

 

 

40

 

Norwood, MA

 

Acute care general hospital

 

 

7,073

 

 

 

154,496

 

 

 

7,745

 

 

 

 

 

 

7,073

 

 

 

162,241

 

 

 

169,314

 

 

 

1,781

 

 

 

 

 

1926-2001

 

June 27, 2018

 

 

46

 

Altoona, WI

 

Acute care general hospital

 

 

 

 

 

29,062

 

 

 

 

 

 

 

 

 

 

 

 

29,062

 

 

 

29,062

 

 

 

3,148

 

 

 

 

 

2014

 

August 31, 2014

 

 

40

 

Odessa, TX

 

Acute care general hospital

 

 

6,535

 

 

 

123,518

 

 

 

254

 

 

 

 

 

 

6,535

 

 

 

123,772

 

 

 

130,307

 

 

 

3,950

 

 

 

 

 

1973-2004

 

September 29, 2017

 

 

41

 

Ogden, UT

 

Rehabilitation hospital

 

 

1,759

 

 

 

16,414

 

 

 

 

 

 

 

 

 

1,759

 

 

 

16,414

 

 

 

18,173

 

 

 

1,971

 

 

 

 

 

2014

 

March 1, 2014

 

 

40

 

Olympia, WA

 

Acute care general hospital

 

 

7,220

 

 

 

89,348

 

 

 

15,930

 

 

 

 

 

 

7,220

 

 

 

105,278

 

 

 

112,498

 

 

 

6,138

 

 

 

 

 

1984

 

July 22, 2016

 

 

40

 

Overlook, TX

 

Acute care general hospital

 

 

2,452

 

 

 

9,666

 

 

 

7

 

 

 

 

 

 

2,452

 

 

 

9,673

 

 

 

12,125

 

 

 

1,411

 

 

 

 

 

2012

 

February 1, 2013

 

 

40

 

San Diego, CA

 

Acute care general hospital

 

 

6,550

 

 

 

15,653

 

 

 

 

 

 

77

 

 

 

6,550

 

 

 

15,730

 

 

 

22,280

 

 

 

4,586

 

 

 

 

 

1964

 

May 9, 2007

 

 

40

 

111


 

 

 

 

Initial Costs

 

 

Additions Subsequent

to Acquisition

 

 

Cost at December 31, 2018(1)

 

 

Accumulated

 

 

 

 

 

 

 

 

 

 

Life on

which

depreciation

in latest

income

statements is

 

Location

 

Type of Property

 

Land

 

 

Buildings

 

 

Improve-

ments

 

 

Carrying

Costs

 

 

Land

 

 

Buildings

 

 

Total

 

 

Depreciation

 

 

Encum-

brances

 

 

Date of

Construction

 

Date

Acquired

 

computed

(Years)

 

 

 

(Dollar amounts in thousands)

 

Parker, CO

 

Freestanding ER

 

 

1,300

 

 

 

4,448

 

 

 

 

 

 

 

 

 

1,300

 

 

 

4,448

 

 

 

5,748

 

 

 

352

 

 

 

 

 

2015

 

November 6, 2015

 

 

40

 

Pasco, WA

 

Acute care general hospital

 

 

2,594

 

 

 

13,195

 

 

 

 

 

 

 

 

 

2,594

 

 

 

13,195

 

 

 

15,789

 

 

 

150

 

 

 

 

 

1920

 

August 31, 2018

 

 

30

 

Pearland, TX

 

Freestanding ER

 

 

1,075

 

 

 

3,577

 

 

 

 

 

 

 

 

 

1,075

 

 

 

3,577

 

 

 

4,652

 

 

 

388

 

 

 

 

 

2014

 

September 8, 2014

 

 

40

 

Petersburg, VA

 

Rehabilitation hospital

 

 

1,302

 

 

 

9,121

 

 

 

 

 

 

 

 

 

1,302

 

 

 

9,121

 

 

 

10,423

 

 

 

2,394

 

 

 

 

 

2006

 

July 1, 2008

 

 

40

 

Phoenix, AZ

 

Acute care general hospital

 

 

2,396

 

 

 

26,521

 

 

 

2,931

 

 

 

 

 

 

2,396

 

 

 

29,452

 

 

 

31,848

 

 

 

817

 

 

 

 

 

1979

 

September 29, 2017

 

 

42

 

Phoenix, AZ

 

Acute care general hospital

 

 

12,695

 

 

 

73,774

 

 

 

2,432

 

 

 

 

 

 

12,695

 

 

 

76,206

 

 

 

88,901

 

 

 

2,502

 

 

 

 

 

1968-1976

 

September 29, 2017

 

 

43

 

Plano, TX

 

Freestanding ER

 

 

 

 

 

2,492

 

 

 

 

 

 

 

 

 

 

 

 

2,492

 

 

 

2,492

 

 

 

272

 

 

 

 

 

2016

 

September 30, 2016

 

 

40

 

Poplar Bluff, MO

 

Acute care general hospital

 

 

2,660

 

 

 

38,693

 

 

 

 

 

 

1

 

 

 

2,660

 

 

 

38,694

 

 

 

41,354

 

 

 

10,339

 

 

 

 

 

1980

 

April 22, 2008

 

 

40

 

Port Arthur, TX

 

Acute care general hospital

 

 

12,972

 

 

 

78,051

 

 

 

859

 

 

 

 

 

 

12,972

 

 

 

78,910

 

 

 

91,882

 

 

 

10,155

 

 

 

 

 

2005

 

September 26, 2013

 

 

40

 

Port Huron, MI

 

Acute care general hospital

 

 

3,029

 

 

 

14,622

 

 

 

 

 

 

 

 

 

3,029

 

 

 

14,622

 

 

 

17,651

 

 

 

1,498

 

 

 

 

 

1953, 1973-1983

 

December 31, 2015

 

 

30

 

Post Falls, ID

 

Rehabilitation hospital

 

 

417

 

 

 

12,175

 

 

 

1,905

 

 

 

 

 

 

767

 

 

 

13,730

 

 

 

14,497

 

 

 

1,725

 

 

 

 

 

2013

 

December 31, 2013

 

 

40

 

San Antonio, TX

 

Freestanding ER

 

 

 

 

 

4,253

 

 

 

 

 

 

 

 

 

 

 

 

4,253

 

 

 

4,253

 

 

 

230

 

 

 

 

 

2016

 

October 27, 2016

 

 

40

 

Redding, CA

 

Acute care general hospital

 

 

1,555

 

 

 

53,863

 

 

 

 

 

 

13

 

 

 

1,555

 

 

 

53,876

 

 

 

55,431

 

 

 

15,387

 

 

 

 

 

1974

 

August 10, 2007

 

 

40

 

Austin, TX

 

Freestanding ER

 

 

 

 

 

4,200

 

 

 

 

 

 

 

 

 

 

 

 

4,200

 

 

 

4,200

 

 

 

231

 

 

 

 

 

2017

 

March 2, 2017

 

 

40

 

Rockledge, FL

 

Acute care general hospital

 

 

13,919

 

 

 

23,282

 

 

 

1,831

 

 

 

 

 

 

13,919

 

 

 

25,113

 

 

 

39,032

 

 

 

1,460

 

 

 

 

 

1950, 1970

 

May 1, 2017

 

 

42

 

Rosenberg, TX

 

Freestanding ER

 

 

 

 

 

4,505

 

 

 

 

 

 

 

 

 

 

 

 

4,505

 

 

 

4,505

 

 

 

338

 

 

 

 

 

2016

 

January 15, 2016

 

 

40

 

Columbus, OH

 

Freestanding ER

 

��

1,726

 

 

 

 

 

 

 

 

 

 

 

 

1,726

 

 

 

 

 

 

1,726

 

 

 

 

 

 

 

 

2016

 

August 30, 2016

 

-

 

Salt Lake City, UT

 

Acute care general hospital

 

 

13,590

 

 

 

101,915

 

 

 

726

 

 

 

 

 

 

13,590

 

 

 

102,641

 

 

 

116,231

 

 

 

3,178

 

 

 

 

 

1906-1987

 

September 29, 2017

 

 

41

 

San Antonio, TX

 

Acute care general hospital

 

 

8,053

 

 

 

29,333

 

 

 

675

 

 

 

 

 

 

8,053

 

 

 

30,008

 

 

 

38,061

 

 

 

1,024

 

 

 

 

 

1978-2002

 

September 29, 2017

 

 

41

 

San Dimas, CA

 

Acute care general hospital

 

 

6,160

 

 

 

6,839

 

 

 

 

 

 

34

 

 

 

6,160

 

 

 

6,873

 

 

 

13,033

 

 

 

1,735

 

 

 

 

 

1972

 

November 25, 2008

 

 

40

 

San Dimas, CA

 

Medical Office Building

 

 

1,915

 

 

 

5,085

 

 

 

 

 

 

18

 

 

 

1,915

 

 

 

5,103

 

 

 

7,018

 

 

 

1,289

 

 

 

 

 

1979

 

November 25, 2008

 

 

40

 

Phoenix, AZ

 

Freestanding ER

 

 

1,132

 

 

 

5,052

 

 

 

 

 

 

 

 

 

1,132

 

 

 

5,052

 

 

 

6,184

 

 

 

221

 

 

 

 

 

2017

 

April 13, 2017

 

 

40

 

Sebastian, FL

 

Acute care general hospital

 

 

5,733

 

 

 

49,136

 

 

 

16,829

 

 

 

 

 

 

5,733

 

 

 

65,965

 

 

 

71,698

 

 

 

2,288

 

 

 

 

 

1974

 

May 1, 2017

 

 

41

 

Sharon, PA

 

Acute care general hospital

 

 

6,179

 

 

 

9,066

 

 

 

1,808

 

 

 

 

 

 

6,179

 

 

 

10,874

 

 

 

17,053

 

 

 

1,096

 

 

 

 

 

1950-1980

 

May 1, 2017

 

 

41

 

Sherman, TX

 

Acute care general hospital

 

 

4,493

 

 

 

11,081

 

 

 

 

 

 

 

 

 

4,493

 

 

 

11,081

 

 

 

15,574

 

 

 

2,703

 

 

 

 

 

1913, 1960-2010

 

October 31, 2014

 

 

40

 

Sienna, TX

 

Freestanding ER

 

 

1,000

 

 

 

3,591

 

 

 

 

 

 

 

 

 

1,000

 

 

 

3,591

 

 

 

4,591

 

 

 

389

 

 

 

 

 

2014

 

August 20, 2014

 

 

40

 

Spartanburg, SC

 

Rehabilitation hospital

 

 

1,135

 

 

 

15,717

 

 

 

 

 

 

 

 

 

1,135

 

 

 

15,717

 

 

 

16,852

 

 

 

2,112

 

 

 

 

 

2013

 

August 1, 2013

 

 

40

 

Houston, TX

 

Freestanding ER

 

 

1,423

 

 

 

3,772

 

 

 

 

 

 

 

 

 

1,423

 

 

 

3,772

 

 

 

5,195

 

 

 

361

 

 

 

 

 

2015

 

February 18, 2015

 

 

40

 

Taunton, MA

 

Acute care general hospital

 

 

4,428

 

 

 

73,228

 

 

 

2,951

 

 

 

 

 

 

4,428

 

 

 

76,179

 

 

 

80,607

 

 

 

4,400

 

 

 

 

 

1940-2015

 

October 3, 2016

 

 

41

 

Tempe, AZ

 

Acute care general hospital

 

 

6,050

 

 

 

10,986

 

 

 

871

 

 

 

 

 

 

6,050

 

 

 

11,857

 

 

 

17,907

 

 

 

476

 

 

 

 

 

1940

 

September 29, 2017

 

 

41

 

Texarkana, TX

 

Acute care general hospital

 

 

14,562

 

 

 

 

 

 

 

 

 

 

 

 

14,562

 

 

 

 

 

 

14,562

 

 

 

 

 

 

 

 

2017

 

September 29, 2017

 

-

 

Thornton, CO

 

Freestanding ER

 

 

1,350

 

 

 

4,259

 

 

 

 

 

 

 

 

 

1,350

 

 

 

4,259

 

 

 

5,609

 

 

 

461

 

 

 

 

 

2014

 

August 29, 2014

 

 

40

 

Toledo, OH

 

Rehabilitation hospital

 

 

 

 

 

17,740

 

 

 

 

 

 

 

 

 

 

 

 

17,740

 

 

 

17,740

 

 

 

1,220

 

 

 

 

 

2016

 

April 1, 2016

 

 

40

 

Tomball, TX

 

Long term acute care hospital

 

 

1,299

 

 

 

23,982

 

 

 

 

 

 

 

 

 

1,299

 

 

 

23,982

 

 

 

25,281

 

 

 

4,796

 

 

 

 

 

2005

 

December 21, 2010

 

 

40

 

Houston, TX

 

Acute care general hospital

 

 

4,047

 

 

 

36,862

 

 

 

 

 

 

 

 

 

4,047

 

 

 

36,862

 

 

 

40,909

 

 

 

2,304

 

 

 

 

 

2016

 

July 7, 2016

 

 

40

 

League City, TX

 

Freestanding ER

 

 

 

 

 

3,901

 

 

 

 

 

 

 

 

 

 

 

 

3,901

 

 

 

3,901

 

 

 

341

 

 

 

 

 

2015

 

June 19, 2015

 

 

40

 

Anaheim, CA

 

Acute care general hospital

 

 

1,875

 

 

 

21,813

 

 

 

 

 

 

10

 

 

 

1,875

 

 

 

21,823

 

 

 

23,698

 

 

 

6,638

 

 

 

 

 

1964

 

November 8, 2006

 

 

40

 

Warren, OH

 

Acute care general hospital

 

 

5,385

 

 

 

47,588

 

 

 

5,142

 

 

 

 

 

 

5,385

 

 

 

52,730

 

 

 

58,115

 

 

 

2,509

 

 

 

 

 

1982

 

May 1, 2017

 

 

41

 

West Monroe, LA

 

Acute care general hospital

 

 

12,000

 

 

 

69,433

 

 

 

11,013

 

 

 

 

 

 

12,552

 

 

 

79,894

 

 

 

92,446

 

 

 

9,746

 

 

 

 

 

1962

 

September 26, 2013

 

 

40

 

San Antonio, TX

 

Acute care general hospital

 

 

2,248

 

 

 

5,880

 

 

 

 

 

 

 

 

 

2,248

 

 

 

5,880

 

 

 

8,128

 

 

 

904

 

 

 

 

 

2012

 

October 2, 2012

 

 

40

 

West Valley City, UT

 

Acute care general hospital

 

 

5,516

 

 

 

58,314

 

 

 

2,478

 

 

 

(114

)

 

 

5,402

 

 

 

60,792

 

 

 

66,194

 

 

 

15,762

 

 

 

 

 

1980

 

April 22, 2008

 

 

40

 

Wichita, KS

 

Rehabilitation hospital

 

 

1,019

 

 

 

18,373

 

 

 

 

 

 

1

 

 

 

1,019

 

 

 

18,374

 

 

 

19,393

 

 

 

4,937

 

 

 

 

 

1992

 

April 4, 2008

 

 

40

 

Youngstown, OH

 

Acute care general hospital

 

 

4,335

 

 

 

3,565

 

 

 

604

 

 

 

 

 

 

4,334

 

 

 

4,170

 

 

 

8,504

 

 

 

965

 

 

 

 

 

1929-2003

 

May 1, 2017

 

 

41

 

 

 

 

 

$

544,228

 

 

$

4,026,620

 

 

$

188,640

 

 

$

21,661

 

 

$

547,894

 

 

$

4,233,255

 

 

$

4,781,149

 

 

$

414,331

 

 

$

 

 

 

 

 

 

 

 

 

(1)

The aggregate cost for federal income tax purposes is $4,471,179.$4,873,085.

Index to Financial Statements

112


The changes in total real estate assets (excluding construction in progress, intangible lease assets, investment in direct financing leases, and mortgage loans) are as follows for the years ended (in thousands):

 

  December 31, 2016 December 31, 2015 December 31, 2014 

 

December 31, 2018

 

 

 

December 31, 2017

 

 

December 31, 2016

 

COST

    

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at beginning of period

  $2,991,590  $2,040,727  $1,733,194 

 

$

5,438,148

 

 

 

$

3,968,042

 

 

$

2,991,590

 

Acquisitions

   745,948  975,239  263,811 

 

 

758,619

 

 

 

 

1,256,245

 

 

 

745,948

 

Transfers from construction in progress

   163,080  23,163  41,772 

 

 

25,513

 

 

 

 

74,441

 

 

 

163,080

 

Additions

   33,279  7,376  84,831 

 

 

96,775

 

 

 

 

36,828

 

 

 

33,279

 

Dispositions

   (138,886 (24,701 (56,590

 

 

(1,318,238

)

 

 

 

(53,372

)

 

 

(138,886

)

Other

   173,031  (30,214 (26,291

 

 

(219,668

)

(2)

 

 

155,964

 

(2)

 

173,031

 

  

 

  

 

  

 

 

Balance at end of period

  $3,968,042  $2,991,590  $2,040,727 

 

$

4,781,149

 

 

 

$

5,438,148

 

(3)

$

3,968,042

 

  

 

  

 

  

 

 

The changes in accumulated depreciation are as follows for the years ended (in thousands):

 

  December 31, 2016 December 31, 2015 December 31, 2014 

 

December 31, 2018

 

 

 

December 31, 2017

 

 

December 31, 2016

 

ACCUMULATED DEPRECIATION

    

 

 

 

 

 

 

 

 

 

 

 

 

 

Balance at beginning of period

  $232,675  $181,441  $144,235 

 

$

407,349

 

 

 

$

292,786

 

 

$

232,675

 

Depreciation

   81,010  60,796  46,935 

 

 

115,497

 

 

 

 

109,307

 

 

 

81,010

 

Depreciation on disposed property

   (19,086 (8,887 (9,213

 

 

(101,967

)

 

 

 

(1,438

)

 

 

(19,086

)

Other

   (1,813 (675 (516

 

 

(6,548

)

 

 

 

6,694

 

 

 

(1,813

)

  

 

  

 

  

 

 

Balance at end of period

  $292,786  $232,675  $181,441 

 

$

414,331

 

 

 

$

407,349

 

(4)

$

292,786

 

  

 

  

 

  

 

 

(2)

Represents foreign currency fluctuations and purchase price allocation adjustments.

(3)

Includes $131.4 million of land and building cost reflected in real estate held for sale at December 31, 2017. Excludes intangible lease assets that are included in real estate held for sale of $15.8 million at December 31, 2017.

(4)

Includes $0.5 million of accumulated depreciation reflected in real estate held for sale at December 31, 2017. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million at December 31, 2017.

113


Index to Financial Statements

SCHEDULE IV — MORTGAGE LOANS ON REAL ESTATE

MEDICAL PROPERTIES TRUST, INC. AND MPT OPERATING PARTNERSHIP, L.P.

 

Column A

 Column B Column C Column D Column E Column F Column G(3) Column H 

 

Column B

 

 

Column C

 

Column D

 

Column E

 

 

Column F

 

 

Column G(3)

 

 

Column H

 

Description

 Interest
Rate
 Final
Maturity
Date
 Periodic Payment
Terms
 Prior
Liens
 Face
Amount of
Mortgages
 Carrying
Amount of
Mortgages
 Principal
Amount of
Loans
Subject to
Delinquent
Principal or
Interest
 

 

Interest

Rate

 

 

Final

Maturity

Date

 

Periodic Payment

Terms

 

Prior

Liens

 

 

Face

Amount of

Mortgages

 

 

Carrying

Amount of

Mortgages

 

 

Principal

Amount of

Loans

Subject to

Delinquent

Principal or

Interest

 

 (Dollar amounts in thousands) 

 

(Dollar amounts in thousands)

 

Long-term first mortgage loan:

    



Payable in monthly
installments of
interest plus
principal payable
in full at maturity




 
    

 

 

 

 

 

 

 

Payable in monthly

installments of interest plus

principal payable in full at maturity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Desert Valley Hospital

 11.0 2022           (1)  $70,000  $70,000          (2) 

 

 

11.0

%

 

2022

 

 

 

 

(1

)

 

$

70,000

 

 

$

70,000

 

 

 

(2

)

Desert Valley Hospital

 11.7 2022           (1)  20,000  20,000          (2) 

 

 

12.2

%

 

2022

 

 

 

 

(1

)

 

 

20,000

 

 

 

20,000

 

 

 

(2

)

Desert Valley Hospital

 11.0 2022           (1)  12,500  12,500          (2) 

 

 

11.0

%

 

2020

 

 

 

 

(1

)

 

 

12,500

 

 

 

12,500

 

 

 

(2

)

Chino Valley Medical Center

 11.0 2022           (1)  50,000  50,000          (2) 

 

 

11.0

%

 

2022

 

 

 

 

(1

)

 

 

50,000

 

 

 

50,000

 

 

 

(2

)

Paradise Valley Hospital

 10.6 2022           (1)  25,000  25,000          (2) 

 

 

11.0

%

 

2022

 

 

 

 

(1

)

 

 

25,000

 

 

 

25,000

 

 

 

(2

)

Ernest Mortgage Loan(4)

 9.6 2032           (1)  112,836  112,836          (2) 

 

 

10.0

%

 

2032

 

 

 

 

(1

)

 

 

115,000

 

 

 

115,000

 

 

 

(2

)

Centinela Hospital Medical Center

 11.2 2022           (1)  100,000  100,000          (2) 

 

 

11.6

%

 

2022

 

 

 

 

(1

)

 

 

100,000

 

 

 

100,000

 

 

 

(2

)

Olympia Medical Center

 11.2 2024           (1)  20,000  20,000          (2) 

 

 

10.7

%

 

2024

 

 

 

 

(1

)

 

 

25,000

 

 

 

25,000

 

 

 

(2

)

St. Joseph Medical Center

 8.7 2025           (1)  30,000  30,000          (2) 

 

 

9.0

%

 

2025

 

 

 

 

(1

)

 

 

30,000

 

 

 

30,000

 

 

 

(2

)

St. Mary’s Medical Center

 8.7 2025           (1)  10,000  10,000          (2) 

 

 

9.0

%

 

2025

 

 

 

 

(1

)

 

 

10,000

 

 

 

10,000

 

 

 

(2

)

Lake Huron Medical Center

 8.7 2020           (1)  10,000  10,000          (2) 

 

 

9.0

%

 

2020

 

 

 

 

(1

)

 

 

10,000

 

 

 

10,000

 

 

 

(2

)

Steward Mortgage Loan(6)

 7.5 2031           (1)  600,000  600,000          (2) 

 

 

7.5

%

 

2031

 

 

 

 

(1

)

 

 

727,508

 

 

 

727,508

 

 

 

(2

)

Vibra Mortgage Loan

 

 

11.5

%

 

2024

 

 

 

 

(1

)

 

 

18,275

 

 

 

18,275

 

 

 

(2

)

     

 

  

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

$

1,213,283

 

 

$

1,213,283

 

 

 

(5

)

     $1,060,336  $1,060,336          (5) 
     

 

  

 

  

 

(1)

There were no prior liens on loans as of December 31, 2016.2018.

(2)

The mortgage loan was not delinquent with respect to principal or interest.

(3)

The aggregate cost for federal income tax purposes is $1,060,336.$1,213,283.

(4)

Mortgage loans covering four properties in two tranches. Interest rate is weighted average of both tranches.

(5)

Excludes unamortized loan issue costs of $0.1$0.04 million at December 31, 2016.2018.

(6)

Mortgage loans covering fourtwo properties.

Changes in mortgage loans (excluding unamortized loan issue costs) for the years ended December 31, 2016, 2015,2018, 2017, and 20142016 are summarized as follows:

 

   Year Ended December 31, 
   2016  2015  2014 
   (Dollar amounts in thousands) 

Balance at beginning of year

  $757,500  $397,500  $388,650 

Additions during year:

    

New mortgage loans and additional advances on existing loans

   612,836   380,000   12,500 
  

 

 

  

 

 

  

 

 

 
   1,370,336   777,500   401,150 
  

 

 

  

 

 

  

 

 

 

Deductions during year:

    

Collection of principal

   (310,000  (20,000  (3,650
  

 

 

  

 

 

  

 

 

 
   (310,000  (20,000  (3,650
  

 

 

  

 

 

  

 

 

 

Balance at end of year

  $1,060,336  $757,500  $397,500 
  

 

 

  

 

 

  

 

 

 

Index to Financial Statements

INDEX TO EXHIBITS

 

 

Year Ended December 31,

 

 

 

2018

 

 

2017

 

 

2016

 

 

 

(Dollar amounts in thousands)

 

Balance at beginning of year

 

$

1,778,264

 

 

$

1,060,336

 

 

$

757,500

 

Additions during year:

 

 

 

 

 

 

 

 

 

 

 

 

New mortgage loans and additional advances on

   existing loans

 

 

50,783

 

 

 

717,928

 

 

 

612,836

 

 

 

 

1,829,047

 

 

 

1,778,264

 

 

 

1,370,336

 

Deductions during year:

 

 

 

 

 

 

 

 

 

 

 

 

Collection of principal

 

 

(615,764

)

 

 

 

 

 

(310,000

)

 

 

 

(615,764

)

 

 

 

 

 

(310,000

)

Balance at end of year

 

$

1,213,283

 

 

$

1,778,264

 

 

$

1,060,336

 

 

Exhibit

Number

Exhibit Title

  3.1(1)Medical Properties Trust, Inc. Second Articles of Amendment and Restatement
  3.2(3)Articles of Amendment of Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.
  3.3(6)Articles of Amendment of Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.
  3.4(19)Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.
  3.5(32)Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.
  3.6(33)Articles of Amendment to Second Articles of Amendment and Restatement of Medical Properties Trust, Inc.
  3.7(2)Medical Properties Trust, Inc. Second Amended and Restated Bylaws
  3.8(32)Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.
  3.9(40)Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.
  3.10(41)Amendment to Second Amended and Restated Bylaws of Medical Properties Trust, Inc.
  4.1(1)Form of Common Stock Certificate
  4.2(4)Indenture, dated July 14, 2006, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and the Wilmington Trust Company, as trustee
  4.3(9)Indenture, dated as of April 26, 2011, Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust Company, as Trustee.
  4.4(26)First Supplemental Indenture to 2011 Indenture, dated as of August 10, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.5(26)Second Supplemental Indenture to 2011 Indenture, dated as of October 3, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.6(26)Third Supplemental Indenture to 2011 Indenture, dated as of December 2, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.7(26)Fourth Supplemental Indenture to 2011 Indenture, dated as of January 19, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.8(26)Fifth Supplemental Indenture to 2011 Indenture, dated as of April 9, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.9(26)Sixth Supplemental Indenture to 2011 Indenture, dated as of June 27, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.10(26)Seventh Supplemental Indenture to 2011 Indenture, dated as of July 31, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.11(26)Eighth Supplemental Indenture to 2011 Indenture, dated as of September 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.12(26)Ninth Supplemental Indenture to 2011 Indenture, dated as of December 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.13(26)Tenth Supplemental Indenture to 2011 Indenture, dated as of June 27, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.14(26)Eleventh Supplemental Indenture to 2011 Indenture, dated as of August 8, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.15(26)Twelfth Supplemental Indenture to 2011 Indenture, dated as of October 30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.16(26)Thirteenth Supplemental Indenture to 2011 Indenture, dated as of December 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.17(31)Fourteenth Supplemental Indenture to 2011 Indenture, dated as of March 31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.18(27)Fifteenth Supplemental Indenture to 2011 Indenture, dated as of June 30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.19(31)Sixteenth Supplemental Indenture to 2011 Indenture, dated as of October 3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.20(20)Indenture, dated as of February 17, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.21(23)First Supplemental Indenture to 2012 Indenture, dated as of April 9, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.22(23)Second Supplemental Indenture to 2012 Indenture, dated as of June 27, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.23(23)Third Supplemental Indenture to 2012 Indenture, dated as of July 31, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.24(23)Fourth Supplemental Indenture to 2012 Indenture, dated as of September 28, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.25(23)Fifth Supplemental Indenture to 2012 Indenture, dated as of December 26, 2012, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.26(23)Sixth Supplemental Indenture to 2012 Indenture, dated as of June 27, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.27(23)Seventh Supplemental Indenture to 2012 Indenture, dated as of August 8, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.28(24)Eighth Supplemental Indenture to 2012 Indenture, dated as of August 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.29(26)Ninth Supplemental Indenture to 2012 Indenture, dated as of October 30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.30(26)Tenth Supplemental Indenture to 2012 Indenture, dated as of December 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.31(28)Eleventh Supplemental Indenture to 2012 Indenture, dated as of March 31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.32(27)Twelfth Supplemental Indenture to 2012 Indenture, dated as of June 30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.33(31)Thirteenth Supplemental Indenture to 2012 Indenture, dated as of October 3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.34(25)Indenture, dated as of October 10, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.35(25)First Supplemental Indenture to 2013 Indenture, dated as of October 10, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.36(26)Second Supplemental Indenture to 2013 Indenture, dated as of October 30, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.37(26)Third Supplemental Indenture to 2013 Indenture, dated as of December 20, 2013, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.38(28)Fourth Supplemental Indenture to 2013 Indenture, dated as of March 31, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.39(29)Fifth Supplemental Indenture to 2013 Indenture, dated as of April 17, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

  4.40(27)Sixth Supplemental Indenture to 2013 Indenture, dated as of June 30, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.41(31)Seventh Supplemental Indenture to 2013 Indenture, dated as of October 3, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, the Subsidiary Guarantors and Wilmington Trust, N.A., as Trustee.
  4.42(34)Eighth Supplemental Indenture to 2013 Indenture, dated as of August 19, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., MPT Finance Corporation, Wilmington Trust, N.A., as Trustee, Deutsche Bank Trust Company Americas, as Paying Agent, and Deutsche Bank Luxembourg S.A., as Registrar and Transfer Agent.
  4.43(36)Ninth Supplemental Indenture, dated as of February 22, 2016, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as trustee.
  4.44(39)Tenth Supplemental Indenture, dated as of July 22, 2016, by and among MPT Operating Partnership, L.P. and MPT Finance Corporation, as issuers, Medical Properties Trust, Inc., as parent and guarantor, and Wilmington Trust, National Association, as trustee.
10.2(8)Medical Properties Trust, Inc. 2013 Equity Incentive Plan
10.3(7)Form of Stock Option Award
10.4(7)Form of Restricted Stock Award
10.5(7)Form of Deferred Stock Unit Award
10.6(1)Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated September 10, 2003
10.7(1)First Amendment to Employment Agreement between Registrant and Edward K. Aldag, Jr., dated March 8, 2004
10.8(1)Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated September 10, 2003
10.9(1)Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated September 10, 2003
10.10(1)Form of Indemnification Agreement between Medical Properties Trust, Inc. and executive officers and directors
10.11(11)Form of Medical Properties Trust, Inc. 2007 Multi-Year Incentive Plan Award Agreement (LTIP Units)
10.12(11)Form of Medical Properties Trust, Inc. 2007 Multi-Year Incentive Plan Award Agreement (Restricted Shares)
10.13(16)Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated September 29, 2006
10.14(16)First Amendment to Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated September 29, 2006
10.15(16)First Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated September 29, 2006

Index to Financial Statements

Exhibit

Number

Exhibit Title

10.16(17)Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated January 1, 2008
10.17(17)Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and Emmett E. McLean, dated January 1, 2009
10.18(17)Second Amendment to Employment Agreement between Medical Properties Trust, Inc. and Richard S. Hamner, dated January 1, 2008
10.19(17)Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and R. Steven Hamner, dated January 1, 2009
10.20(17)Third Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated January 1, 2008
10.21(17)Fourth Amendment to Employment Agreement between Medical Properties Trust, Inc. and Edward K. Aldag, Jr., dated January 1, 2009
10.22(9)Amended and Restated Revolving Credit and Term Loan Agreement, dated as of April 26, 2011, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., KeyBank National Association as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent
10.23(30)Amended and Restated Revolving Credit and Term Loan Agreement, dated as of June 19, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.
10.24(31)First Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of October 17, 2014, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.
10.25(35)Second Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of August 4, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.
10.26(35)Third Amendment to Amended and Restated Revolving Credit and Term Loan Agreement, dated as of September 30, 2015, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.
10.27(19)Master Sublease Agreement between certain subsidiaries of MPT Development Services, Inc. as Lessor, and certain subsidiaries of Ernest Health, Inc., as Lessee.
10.28(22)Master Lease Agreement I between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment and Master Lease Agreement II between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment.
10.29(33)Form of Master Lease Agreement between certain subsidiaries of MPT Operating Partnership, L.P., as Lessor, and MEDIAN Kliniken S.a.r.l. and certain of its subsidiaries, as Lessee, and related first and second amendments.
10.30(37)Master Lease Agreement between certain subsidiaries of MPT Development Services, Inc., as Lessor, and certain subsidiaries of Capella Holdings, Inc., as Lessee.

Index to Financial Statements

Exhibit

Number

Exhibit Title

10.31(37)Joinder and Amendment to Master Lease Agreement between certain subsidiaries of MPT Development Services, Inc., as Lessor, and certain subsidiaries of Capella Holdings, Inc., as Lessee.
10.32(38)Amended and Restated Master Lease Agreement between certain subsidiaries of MPT Operating Partnership, L.P., as lessor and certain subsidiaries of Capella Holdings, Inc., as lessee.
10.33*Master Lease Agreement by and among certain subsidiaries of MPT Operating Partnership, L.P. as Lessor and certain subsidiaries of Steward Health Care System LLC, Lessee.
10.34*Real Estate Loan Agreement by and among certain subsidiaries of MPT Operating Partnership, L.P. as Lessor and certain subsidiaries of Steward Health Care System LLC, Lessee.
10.35*Amended and Restated Revolving Credit and Term Loan Agreement, dated as of February 1, 2017, among Medical Properties Trust, Inc., MPT Operating Partnership, L.P., the several lenders from time to time party thereto, Bank of America, N.A., as syndication agent, and JPMorgan Chase Bank, N.A., as administrative agent.
12.1*Statement re Computation of Ratios
21.1*Subsidiaries of Medical Properties Trust, Inc.
23.1*Consent of PricewaterhouseCoopers LLP
23.2*Consent of PricewaterhouseCoopers LLP
31.1*Certification of Chief Executive Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.2*Certification of Chief Financial Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.3*Certification of Chief Executive Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
31.4*Certification of Chief Financial Officer pursuant to Rule13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
32.1**Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (Medical Properties Trust, Inc.)
32.2**Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (MPT Operating Partnership, L.P.)

Exhibit 101.INSXBRL Instance Document
Exhibit 101.SCHXBRL Taxonomy Extension Schema Document
Exhibit 101.CALXBRL Taxonomy Extension Calculation Linkbase Document
Exhibit 101.DEFXBRL Taxonomy Extension Definition Linkbase Document
Exhibit 101.LABXBRL Taxonomy Extension Label Linkbase Document
Exhibit 101.PREXBRL Taxonomy Extension Presentation Linkbase Document

*Filed herewith.
**Furnished herewith.
(1)Incorporated by reference to Registrant’s Registration Statement on FormS-11 filed with the Commission on October 26, 2004, as amended (FileNo. 333-119957).

Index to Financial Statements
(2)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on November 24, 2009.
(3)Incorporated by reference to Registrant’s quarterly report on Form10-Q for the quarter ended September 30, 2005, filed with the Commission on November 10, 2005.
(4)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on July 20, 2006.
(5)Reserved.
(6)Incorporated by reference to the Registrant’s current report on Form8-K, filed with the Commission on January 13, 2009.
(7)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on October 18, 2005.
(8)Incorporated by reference to Registrant’s definitive proxy statement on Schedule 14A, filed with the Commission on April 26, 2013.
(9)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on May 2, 2011.
(10)Reserved.
(11)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on August 6, 2007, as amended by Medical Properties Trust, Inc.’s current report on Form8-K/A, filed with the Commission on August 15, 2007.
(12)Reserved.
(13)Reserved.
(14)Reserved.
(15)Reserved.
(16)Incorporated by reference to Registrant’s annual report on Form10-K/A for the period ended December 31, 2007, filed with the Commission on July 11, 2008.
(17)Incorporated by reference to Registrant’s annual report on Form10-K for the period ended December 31, 2008, filed with the Commission on March 13, 2009.
(18)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on June 11, 2010.
(19)Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on January 31, 2012.
(20)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on February 24, 2012.
(21)Reserved.
(22)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on November 9, 2012.
(23)Incorporated by reference to Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and MPT Finance Corporation’s registration statement on FormS-3, filed with the Commission on August 9, 2013.
(24)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on August 20, 2013.
(25)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on October 16, 2013.
(26)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on March 3, 2014.
(27)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on August 11, 2014.
(28)Incorporated by reference to Medical Properties Trust, Inc., MPT Operating Partnership, L.P. and MPT Finance Corporation’s post-effective amendment to registration statement on FormS-3, filed with the Commission on April 10, 2014.
(29)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on April 23, 2014.

Index to Financial Statements
(30)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s current report on Form8-K, filed with the Commission on June 25, 2014.
(31)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on March 2, 2015.
(32)Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on June 26, 2015.
(33)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on August 10, 2015.
(34)Incorporated by reference to Medical Properties Trust, Inc.’s current report on Form8-K, filed with the Commission on August 21, 2015.
(35)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on November 9, 2015.
(36)Incorporated by reference to Registrant’s current report on Form8-K, filed with the Commission on February 22, 2016.
(37)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s annual report on Form10-K, filed with the Commission on February 29, 2016.
(38)Incorporated by reference to Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.’s quarterly report on Form10-Q, filed with the Commission on May 10, 2016.
(39)Incorporated by reference to Medical Properties Trust, Inc’s Current Report on Form8-K filed with the Commission on July 22, 2016.
(40)Incorporated by reference to Medical Properties Trust, Inc’s Current Report on Form8-K filed with the Commission on November 16, 2016.
(41)Incorporated by reference to Medical Properties Trust, Inc’s Current Report on Form8-K filed with the Commission on February 22, 2017.

 

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