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To recap the year from an acquisitions perspective, we began the year with a $1 billion-plus investment in the leading provider of behavioral health in the United Kingdom, The Priory Group. However, if we're wrong, if we're totally and completely wrong and Prime does in fact exercise its options then what we've said is the result is well within that $78 million to $82 million guidance range. I've got friends at HCA. Pro forma for our expected joint venture proceeds of $1.3 billion that will repay our outstanding interim credit facilities, we anticipate having immediately available liquidity exceeding $1 billion in cash and revolver resources. Yes. And then just on the comment you made initially just sort of the more global nature now, has there been any change in the competition, especially post some of these larger deals and whether it's in the U.S. or any of your other global markets and just new players looking at this space? Okay. On a full year basis, our normalized FFO of $1.75 and AFFO of $1.37 also represent the continuation of double-digit growth, a record virtually unmatched among, not only our peers, but the entire universe of REITs with a similar or larger market cap. Sure, Jordan. So -- but inflation, the inflation escalation starts -- whether it's U.S. or not, it starts on a date specific, usually January 1. By definition, the CMS cost reports could actually show a negative profit margin and all of the rent and interest being paid at the same time. And just to reiterate what Steve pointed out, we don't own the hospital and widely, but we've been looking at the replacement facility for a long time. Entering text into the input field will update the search result below, forward-looking statements are subject to known and unknown risks, uncertainties and other factors that may cause our financial results and future events to differ materially from those expressed and/or underlying such forward-looking statements. I mentioned earlier that, any straight-line rent write-offs have not been related to lease amendments, but primarily highly profitable property sales. We estimate that this incremental cash rent in 2022 will approximate $24 million or $0.04 per share. As far as utility, food and other expenses they've seen increases over the last year so far, but not any new pressures here, fairly stable over the last couple of quarters and in line with their budgets. And by the way, we maintain a very strong payout ratio most recently in the 80% of AFFO range. In fact, going back to our 2005 IPO, we have delivered total shareholder return of 661%. The gross amount, of gains included approximately $600 million related to our sale of eight Steward facilities to the Macquarie joint venture, but we offset that with the accounting rules required write-off of about $125 million in unbilled straight-line rent. Retained cash earnings from an AFFO perspective amounts to several hundred million dollars over the course of the foreseeable future. Great. We wouldn't attempt to push down from the corporate level. So we are retaining earnings in the local currency and reinvesting in the local currency. And I know that I will not pronounce these names correctly, but Helsinki, Oulu, Turku and Kuopio, two of these hospitals are certified lead gold facilities and the other two are certified lead platinum facilities. Chairman of the Board. In my overall remarks today, I will also take time to address a few other points that have been raised in recent reports and media coverage about MPT. We reported the Q2 trailing 12-month coverage for 2021 of 2.14x during the last quarter. Second, even if one could accept that a company would execute such an overpayment strategy, the slides make clear that such overpayment would have gone to the sellers of the real estate such as the former owners of Steward or IASIS or community or tenant the parties from whom we bought the real estate and to whom was paid the sale proceeds. It keeps out of the $5 billion to $6 billion range. You don't have to -- you don't have to pay to get into a market. I appreciate the color there. Caterina A. Mozingo, CPA, PFS Tax Partner at Aldridge, Borden & Company, PC. Additionally, we're hosting a live webcast of today's call, which you can access in that same section. The IRF coverage for the trailing 12 months was 2.09x versus 2.12 trailing 12 months. And now, it sounds like, if I heard correctly you would be willing to bring in a partner upfront. Well, the offset will be we'll be collecting more cash rent. Similarly, I don't think there's any pattern and there's certainly not a list that we maintain of assets we'd like to sell. And then within that framework, I'm just wondering given the reimbursement rate hike, I think, the budget increase was $1.6 billion. Also, what difference in some of the other countries is the measurement itself. And just by way of quick background, the reason we look at it from a facility level basis is, if something happens stay at that top parent level. What different lease terms may be? That has not been an issue at all. The first was our $950 million acquisition of 18 additional inpatient behavioral health hospitals, along with an equity interest in the operating entity of Springstone LLC. I mean, it's a pretty short-term period right now. He seems to be hung up on maybe steward might go BK in the next 25 years. So when we've looked at the forward structure -- first of all, you have to start with regardless of whether you've got a forward component in your offering, do you want to offer equity and the pricing and the discount and all that. This investment included the real estate of 35 behavioral health facilities located throughout the U.K. as well as a 9.9% equity interest in the operating entity. They are seeing some rising labor costs as the rest of the country has, but rebounding surgical volumes are helping to offset those costs with growing revenues. So the answer is yes. We do not necessarily assume that Prime is going to exercise its options to buy roughly $330-ish million of properties. First of all, Ed and as well as Steve, you did talk about labor quite a bit and kind of the increasing risk of rising labor on some of your hospital tenants. Average occupancy was approximately 2.5 points ahead of where it was last year. And in addition to earning a current rate of interest on this loan, MPT expects to receive value equivalent to that ownership interest upon certain events. They are seeing strong growth on the surgical side of business that should help continuing coverage growth. That was a German portfolio. So it is really, really good to see that information, and I continue to kind of encourage that going forward. Priory. Medical Properties Trust - Wikipedia And just one follow-up. But there's no carryover. As a result of moving 3 behavioral facilities to -- Steward into prospects to the behavioral health property type, the Q2 2021 trailing 12-month acute care coverage being reported this quarter is 3.11x. And then the second question is around Prime. I think that for the most part, there are a number of rural hospitals or hospitals that weren't operating in 2019 that probably need some additional funding. Thank you, Ed. Now just thinking into context of the inflationary pressure. When I say RIDEA, I'm talking about as I mentioned for example the Springstone transaction. Edward Aldag But I guess just to throw it out there I'm curious whether or not you guys have completed any sort of stress test calculations for your overall 2.7% EBITDARM rent coverage ratio across the entire portfolio specifically related to rising labor costs? But historically, the main adjustments that we make are for dilution from Board of Director approved disposition strategies. You had another question Connor about private pay was. Check out the steps below: Our research team will validate your information, Log in to the GRI platform to activate your Complimentary Access. Based on GAAP reporting and the results achieved by relying on CMS reports, the comparison is on Slide 9. I'll point to another business the recently announced acquisition by Blackstone of ACC certainly didn't show any cap rate compression that one might have expected an answer to your question at least that was my personal observation Mike. MEDICAL PROPERTIES TRUST INC This will place HCA as one of MPT's 5 largest tenants and reduce the percentage of MPT's portfolio represented by Steward to just below 19%. It went public on the New York Stock Exchange via an IPO on July 7, 2005. With that, I will turn the call back to the operator for questions. I guess, I'm just trying to understand how that can be the case, do you not have a right as the owner of those properties to say who operates them? Your line is open. 2021 was also another banner year for acquisitions. Please go ahead. In other words, to clarify a misstatement from one recent report, these adjustments to straight-line rent are routine ordinary cores and have nothing to do with lease amendments. Beyond this, we assume no other investments or capital markets transactions, and we'll plan to update the market in the future as they occur. I think that has an impact of less than $1 million. Food cost, they have not seen a large increase as they have worked very hard to keep costs down through their GPO. And the outcome with Ernest was we bought 16 properties, and then we paid another $100 million, I think, for the OpCo. Like for example, for every 1% incremental increase in labor costs across all your operators how much would that 1% change your EBITDARM rent coverage ratio if at all? So that is the primary reason, coupled with some other just market issues, the local community badly wanted to reacquire the facility through their hospital local authority, and that's where we are right now. Our people were working from their homes, remote offices, through Zoom and Teams in any way we could keep moving forward. Yes. WebEdward K. Aldag Chairman, President & Chief Executive Officer, Medical Properties Trust, Inc. We welcome each of you to speak directly with me, Steve, Drew or Tim as we are eager to address any questions or concerns you may have. This transaction closed in October of 2021. What if something bad happened at the Steward parent level 12 months ago and we had to start taking back our facilities where we would capture those Utah assets and any others we wanted. One is yes, again, we announced this morning that we sold two general acute care hospitals that used to be in the Adeptus portfolio. I probably wouldn't speculate now about what the terms of --again, we expect will be a new or an extended lease, but we're probably not prepared to talk about potential terms. And then if I can squeeze one more in. Now I'd like to provide some updates on some of our largest operators. Priory has only reported 1 quarter of operational financial information to MPT thus far, but that 1 quarter is right in line with our underwriting projections. I guess, what was the CPI increase? All of those are decisions that are -- all of those are data points we take into a decision we will ultimately make about that. With me today are Edward K. Aldag, Jr., That's it for me. Jonathan, we have discussions at the Board level about all of our governance -- all the relative governance points. Back in 2013, we bought a portfolio that became median, and we used 100% debt financing in euros. But I don't think that you'll see a very large increase in the percentage of development deals that we continue to do. With healthcare expertise and global reach, Medical Properties Trust (MPT) is the leading source of capital for hospitals, working with operators in the U.S., Europe and Medical Properties Trust Inc. MPW (U.S.: NYSE) - The Wall Street We would not just sell $100 of assets and buy $100 of assets necessarily. We did that, obviously with Springstone. And second, just conceptual to interpret the CMS numbers as indicative of true profitability would imply that virtually no hospital in the country is profitable. Medical Properties Trust Because the great majority of our debt is at fixed interest rates even in a rising interest rate environment, we expect to realize higher rents when our interest expense is rising only modestly, which will certainly be the case in 2022. I will now turn it back over to Ed Aldag, for closing remarks. And you may remember, Andrew, I mean, when we did the first deed, which really set the pattern for us. Peter, thank you very much. Staffing pressures have been identified as a concern with personnel costs through February being up 4%, but year-over-year only 1% over budget. For the first quarter, February was not a great month for everyone. But you don't have any prospective acquisitions in there. So is leverage temporarily running higher this year with plans to get that back down in the five to six times range say in the next 12 or 24 months? With our execution we have historically delivered, and we believe we'll continue to deliver in the foreseeable future, well-covered cash dividends, outperforming AFFO growth and value creation, with a conservative approach to funding this growth that have made it a substantial total shareholder return out pro forma over virtually any period. So this hospital operator got very little to no grants, federal grants from COVID or Medicare advances from COVID. Finland has a cooperative public private healthcare system. So that's kind of our general observation. So when we announced the Macquarie transaction several months ago, I think even at that time, we announced -- we talked about the high level of interest in from other potential partners that had been going on for a while. Your line is open. This Macquarie-controlled subsidiary will acquire a 50% interest in a portfolio of 8 Massachusetts-based general acute care hospitals owned by MPT and operated by Steward Healthcare System. There's a retail price index in the U.K., for example, that some of our tenants prefer and frankly, it's not it's not much different. We appreciate all of the questions. About $900 million or 60% of this is half of our MEDIAN asset and half of our Steward Massachusetts assets that are in those two joint ventures. And then is there anything in the normalized run rate guide related to the Prime expiry? Our tenants are generating strong lease coverages and are poised for a strong 2022. I don't think it will be in the $4 billion range that we did in the last 2 years. We presented these to correct what may have been misinterpreted based on recent third-party commentary. Labor. The wealth management firm can be reached at 516-466-3300 or 800-353-3775. Soon your Account Manager will get back to you regarding this request. Web4. And move forward, we did. First, we will no longer project the rents to be received upon completion of development and other capital projects. Steward, which represents 19% of our portfolio on a pro forma basis, continues to perform well with coverage near 3x. So Connor we disagree with your original statement in there and so do our operators now. Thank you for prepared remarks and enhanced disclosures. They were primarily related to the acquisition of IASIS and some COVID numbers in there. But I think if you realistically look at somewhere between $1 billion and $3 billion is probably the right range. I'm assuming there are some opportunistic deals. Previously, it was always kind of like a you would do it after you had closed on a deal kind of created the value upfront. So that's one. There's opportunity for acquisitions. We will continue to consider the types of joint venture access to capital that we did with Primonial and more recently with Macquarie. Okay. Medical Properties Trust, Inc. (NYSE:MPW) Q4 2021 Results Conference Call February 3, 2022 11:00 AM ET, Charles Lambert - Treasurer and Managing Director, Edward Aldag - Chairman, President and Chief Executive, Steven Hamner - Executive Vice President and Chief Financial Officer, Good day and thank you for standing by. This of course, is testimony to MPT's underwriting and to Steward's strategic and operational expertise. That's what I was trying to answer to Arthur. No, not in the near recent past, there hasn't. Slides 10 and 11 are included simply to address the absurd concept, proposed by a recent news article that implied that MPT consciously, deliberately overpays for real estate so seller lessees will have liquidity to pay the subsequent rent. Okay. So even that is not an issue for us. Okay. Welcome to the Medical Properties Trust conference call to discuss our first quarter 2022 financial results. But thanks for all the additional disclosure and color. So, our previous guidance included approximately $25 million in anticipated rents primarily from our development projects, even though the tenants had not commenced paying rent. We estimate our annualized FFO run rate to be between $1.81 and $1.85 at our current pro forma leverage ratio of 6.4x. It does include common equity either and/or ATM underwritten offerings. The Capital Medical Center asset and the Western Plains Medical Complex. It just feels that that's become more and more of an important source of capital apart from the dispositions just given where the stock price is. And then maybe just circling back to the guidance one more time, the run rate guidance. Most of the labor issues Prospects are occurring at their Pennsylvania hospitals. And yet today, I think we own 25 or 26 properties that generate extraordinarily strong coverage and rent payments for us. And then just jump back to coverage real quick. Medical Properties Trust, Inc. (MPW) CEO Edward Aldag on Q2 I'd like to refer all of you to our website to see the recently posted case studies on 1 of Prime hospital and 1 pipeline hospital. That's really all that I meant was that, we're not dependent long term on our growth to waiting for the stock to come back. Please note that in our press release, Medical Properties Trust has reconciled all non-GAAP financial measures to the most directly comparable GAAP measures in accordance with Reg G requirements. Circle is seeing some labor shortages primarily with nurse staffing as a result of the spike in Omicron that called an unusually high number of nurses to be out sick or in quarantine. Obviously this was on the list of agenda in my discussions with them. Sorry, go ahead. And in the inflationary environment that looks like, it may be with us for a while, this free capital is likely to accelerate. With me today are Edward K. Aldag, Jr., Chairman, President and Chief Executive Officer of the company; and Steven Hamner, Executive Vice President and Chief Financial Officer. Thank you, Charles, and thank all of you for listening in today on our first quarter earnings call for 2022. And I guess as part of this, there is some talk for the federal government to potentially forgive any remaining Medicare receivable loans that were taken out by some of the hospitals earlier on in the pandemic. Yeah, I might follow-up on that post the call. But the report then implies that, there is something surprising that on a consolidated balance sheet basis MPT's gross yield is declining. Okay. I'll just point out that we have recently sold the last of the major Adeptus hospitals both at substantial profits resulting in a quantifiable value well in excess of the $415 million investment we had made when Adeptus went into bankruptcy. We have always considered and prominently displayed the AFFO metric because we, like many real estate investors think it's critically important to measure results not only based on GAAP, which includes mandated, non-cash straight-line rent, but on a measure that does not include this non-cash unbilled rent concept. Okay. I'd also like to highlight the 2021 award received by Circle in November for Excellence In Acute Health Care Services with a focus on innovation. Is there something that you could do there at some pretty attractive cap rates just on the opportunistic side? I'll start with Steward. So that's our outlook on currency for the most part. So going back to your question about the 2020 financials all of the financial statements that we filed last June or July. So you can't put a cap rate when we didn't have any income coming in on Houston. Just -- I know you talked about the Prime purchase option, but maybe itd be helpful if you go over what else is under a tenant purchase option as I'd be particularly interested in knowing if there's any other in 2022 and 2023? This morning we reported as widely expected normalized FFO of $0.47 per diluted share. Volumes have shown steady improvement year-over-year. So that's really hard to say exactly. The short answer is that I think we've seen the worst I think that the numbers are reflected in some of the third quarter, they'll be reflected in some of the fourth quarter. If you read in the proxy statement as described very well in there why the Board is comfortable with me remaining as the Chairman and the CEO. To demonstrate, the sustainability of this cash-driven business plan, I already called your attention to our new disclosure in the supplemental that summarizes the coverage strength of our major tenants. So Ed, do your operators have a time frame when they believe overall labor expenses will retract back to a normal run rate? And I don't know if that answers your question, but we'll continue to collect the cash rent due to inflation without respect to the straight-line rent. There will be small additions to it, but there aren't any additional really big investments. The opportunities are good, worldwide opportunities out there. But I'll just reiterate we're not in a position to predict when we might have something to announce. You may now disconnect. As a reminder, this growth comes on top of 2020 results, in which normalized FFO per share growth exceeded 20% and AFFO grew at a similar mid-teens rate. And of course as our slide number 8 shows that's exactly how our leases perform, virtually without exception as the chart in the top half of that slide demonstrates. I think you mentioned it's probably higher than that. A business and finance graduate of the University of Alabama, Ed serves on the board of Childrens of Alabama, one of the nations leading hospitals for children, and as a director and member of the investment committee of the Alabama Childrens Hospital Foundation. I mean, can you kind of highlight how active those are right now? Again, I think the information is great and I just really encourage you guys to do more of it going forward. While we typically don't respond to the various third-party reports of this nature and some of this information may seem like real estate one-on-one, we have heard from many of you our shareholders and others that we should take the opportunity to set the record straight and correct some of the erroneous information that has been published. Okay. I will now hand the conference over to your first speaker today, Charles Lambert. You don't have to put in a whole lot of capital. In the meantime, Prospect has made a number of operational changes to those facilities, particularly at Crozer, which have resulted in some improvements to their operations there. Utility cost, they've seen some inflationary pressures but not material. Currently, Mr. Aldag is Chairman, President & Chief Executive Officer at this company and President, Chief Executive Officer These items alone, net of the benefit of refinancing activities and investments since we introduced this range in early September, account for an approximate annualized $0.05 per share. We are confident that we are in the early stages of development of a global market that we helped greatly to create. There's just a lot of -- and most of the value came from these two hospitals we just sold. The law firm can be reached at 718-261-1700, 516-466-4422, or toll free at 1-877-ELDER-LAW or 1-877-ESTATES. It also takes into account our expectations concerning the outcome of Prime's repurchase options, for two of the five prime master leases. I think, I answered a similar question from Mike Carroll. In other countries, we accrue, and so that chips away a little bit at that $0.04 of CPI, perhaps as much as $0.01 out of the $0.04. 2021 EBITDARM increased by approximately 21% year-over-year, fueled by both acquisitions and organic growth. I'll not repeat that explanation because most analysts on this call have considered this a long time ago and already understand that the CMS numbers are not meant to arrive at true operating margins. Medical Properties Trust, Inc. (MPW) CEO Edward K. Aldag, Jr. on Q2 2021 Results - Earnings Call Transcript. Well, I'm not sure a lot of those were empty. Again, a much smaller part of your portfolio now, but they do constitute most of your lease maturities in '22. Once again, Healthscope's coverage exceeds two times. So our 2022 and future rental rates will reflect incremental increases. Please. You can also refer to our website at medicalpropertiestrust.com for the most directly comparable financial measures and related reconciliations. So I just want to clarify, I didn't realize that you had RIDEA exposure in some of the hospitals -- in two of the hospitals you mentioned. While we are not free to disclose expected returns on this interest in anticipation of certain pending transactions, we can reiterate that we are highly satisfied with the likely profitability of this investment. So in other words, if we do a transaction on July 1, because from day 1, the rent is in place, it's 100% leased and it's collected, so we annualize that. So all of them believe that this is short term and that we won't see any long-term effects from this. Or would that be exposed to currency moves? Could you give us a sense of some of the things they're doing to come back that and what potentially the impact could be on rent coverage as we kind of look into 2022? These represent the most recent 2 examples in our history of highly profitable equity investments in certain of our operators. So we're not able to predict when we might announce an agreement. Welcome to the Medical Properties Trust conference call to discuss our first quarter 2021 financial results. And we are always evaluating a large portfolio, typically the master leases are working with and trying to accommodate the needs of our tenants. Ed, I guess on the comment about not doing large-scale acquisitions until the stock comes back. Today, MPT is the worlds preeminent source of capital for hospitals, with a portfolio of almost 400 facilities across the United States, Western Europe and Australia. Our next question comes from John Pawlowski with Green Street. This was originally $150 million but has since been reduced by an $11 million distribution last year. And even in 2021, we generated a 14% 1-year total shareholder return. And then, lease coverage, again, the additional detail is great. Andre Schmidt, the CEO and his management team have done a superb job throughout MPT's relationship with Median. Or how many percentage points of labor cost would it take to move that by 10 basis points from 2.7% to like a hypothetical 2.6%? Great. And just as a reminder, there are approximately 100 of our 435 facilities that are either not yet reporting because they were just recently acquired, not required to report other than parent company information because they were acquired from other landlords or facilities operated by operators who only provide the parent company financial information. Similarly, certain revenue that is included in fourth quarter results, primarily revenue from 50% of our Steward Massachusetts assets that are pending sale to the joint venture and the noncash straight-line rent I just mentioned, will not be included in future quarters. However, most of our operators are experiencing staffing issues as health care workers battle burn-out from the pandemic and from federal and state mandates requiring health care workers to be vaccinated. Okay. And the primary reason would be we do not expect inflation to hit only the cost side of the income statement. As first quarter results continue to demonstrate, the MPT in its portfolio are in the strongest positions in our history. All of them -- all of these major operators ones that I discussed today are expecting that 2022 is going to be a good year for them. Or does the guidance just reflect the minimum escalators? And that's the pattern we tried to follow when we have followed to a great extent. Last quarter, I think we made a couple of similar announcements and then late last year.