MPT Q3 2026 Earnings Call: $0.11 FFO, Debt Refinancing and Rent Updates

Key Takeaways

• Medical Properties Trust (MPT) reported Q3 2026 normalized FFO of $0.11 per share, in line with management’s expectations except for HSA’s unpaid September rent.
• Year-to-date cash revenue exceeded $750 million, an annualized rate above $1 billion. Management continues to expect portfolio cash rent of more than $1 billion despite property sales.
• MPT completed a $2.4 billion secured debt refinancing in August, capturing approximately $123 million of net discount. It recognized $70 million of that amount as a quarterly gain.
• MPT and Priory reduced annual rent obligations by approximately 18%, or about £11 million initially. The amended agreement includes variable rent recovery and an MPT-controlled option to extend the lease through 2055.
• HSA’s rent-payment timing remains uncertain. Management said cash collections have increased 24% since August, while Ovation Healthcare has assumed management responsibilities across the hospital portfolio.
• MPT is working on the second phase of its refinancing plan, which management expects would address remaining 2027 maturities and leave no debt maturities until June 2028.

Key Financial Data

Business and Operating Performance

MPT said post-acute care remained a major source of portfolio momentum, while general acute-care performance was broadly stable. Behavioral health operators continued efforts to improve staffing, service mix and referral alignment.

In Europe, Median delivered strong occupancy, particularly in orthopedics, psychosomatic care and addiction treatment, alongside improved cost management. Circle Health recorded higher revenue, consistent volumes and robust margins.

Swiss Medical Network reported year-over-year hospital revenue growth and rent coverage above 2x following the Infracore IPO in July. In Spain, IMED’s surgeries increased more than 11% year over year, led by nearly 40% growth at its Valencia facility. New hospitals in Alicante and Barcelona are expected to expand capacity.

In the U.S., Ernest Health maintained rent coverage of 2.5x. NOR reported higher year-over-year volumes and 2.4x coverage on full contractual rent. It was paying 50% of contractual rent with all payments current and was scheduled to return to 100% payments in December.

HSA remained a key operational focus. Management said overall volume had increased 14% since September and surgeries were up 33%. Cash collections rose 24% from August, but management did not provide a date for rent payments to resume. Ovation Healthcare, which manages more than 500 U.S. hospitals, has taken responsibility for revenue-cycle management, IT, staffing, supply chain and other operating functions.

Management Outlook

Management continues to expect annual portfolio cash rent above $1 billion, even after selling nine properties for approximately $600 million in cash proceeds during the year.

The company expects to complete a new multiyear revolving credit facility in the coming weeks. Management said the proposed facility should eliminate the secured leverage covenant and provide additional headroom under fixed-charge coverage and total leverage covenants.

Phase two of MPT’s refinancing plan is intended to extend the revolver, permanently repay the $200 million term loan due in June 2027 and refinance the remaining $665 million of 2027 notes. If completed as contemplated, management expects MPT to have no maturities until June 2028, when approximately $600 million of sterling bonds mature.

Risks and Areas to Watch

HSA did not pay September rent, and management could not specify when collections would resume. Although hospital volumes and cash collections have improved, MPT identified billing and collections as the central operating problem.

Priory continues to face pressure from U.K. National Health Service budget constraints, which have limited NHS-funded patient volumes in behavioral health facilities. MPT’s rent reduction provides near-term relief, while recovery depends on Priory reaching specified revenue thresholds.

The second phase of MPT’s refinancing remains incomplete. Its timing and structure are still under evaluation, although management indicated a preference to complete it sooner rather than later.

MPT recorded approximately $24 million of impairments, mainly related to its Colombian investments after the country’s August earthquake.

Analyst Q&A Highlights

On HSA, management said stronger hospital activity had not yet translated into a defined rent-resumption date. A more substantial operator change would be considered if hospital operations declined or continued to deteriorate.

On Priory, management emphasized an improved credit perimeter involving Priory and its parent company. MPT also gained the sole discretion to extend the lease through 2055 and can recover some or all of the reduced rent if revenue improves.

On debt reduction, management said phase-two financing is expected to address the remaining 2027 maturities. Cash from asset sales could then be used against longer-dated debt, but no specific allocation has been determined.

Management said no meaningful asset sales were pending and MPT was not actively marketing a particular portfolio. However, one-off transactions remain possible as the company continues extending maturities and reducing debt.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Operator

Hello, everyone. Welcome to the Medical Properties Third Quarter 2026 Earnings Conference Call. [Operator Instructions] After todays' prepared remarks, we will host a question-and-answer session. If you would like to ask a question, please press star one to raise your hand. [Operator Instructions] I will now hand the conference call over to Charles Lambert, Senior Vice President. Charles, please go ahead.

Charles Lambert

Good morning. Welcome to the MPT conference call to discuss our third quarter 2026 financial results. With me today are Edward K Aldag Jr., Chairman, President and Chief Executive Officer of the company. Steven Hamner, Executive Vice President and Chief Financial Officer; Kevin Hanna, Senior Vice President, Controller and Chief Accounting Officer; Rose Williams, Senior Vice President of Operations and Secretary; and Jason Fray, Managing Director, Asset Management and underwriting.

Our press release was distributed this morning and furnished on Form 8-K with the Securities and Exchange Commission. If you did not receive a copy, it is available on our website at mpt.com in the Investor Relations section. Additionally, we're hosting a live webcast of today's call, which you can access in that same section.

During the course of this call, we will make projections and certain other statements that may be considered forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These 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.

We refer you to the company's reports filed with the Securities and Exchange Commission for a discussion of the factors that could cause the company's actual results or future events to differ materially from those expressed in this call. The information being provided today is as of this date only, and except as required by the federal securities laws, the company does not undertake a duty to update any such information.

In addition, during the course of the conference call, we will describe certain non-GAAP financial measures, which should be considered in addition to and not in lieu of comparable GAAP financial measures. Please note that in our press release, MPT has reconciled all non-GAAP financial measures to the most directly comparable GAAP measures in accordance with Reg G requirements. You can also refer to our website at mpt.com for the most directly comparable financial measures and related reconciliations. I will now turn the call over to our Chief Executive Officer, Ed Aldag.

Edward Aldag

Thank you, Charles, and thank all of you for joining us this morning. Earlier this year, we projected MPT would reach annualized cash rental revenue of at least $1 billion by the end of this year. Year-to-date, we have already collected more than $750 million of cash revenue, which annualizes to more than the $1 billion we projected earlier. .

This reflects the strength of our diverse portfolio of operators around the world. During the year, we've sold 9 properties for cash proceeds of approximately $600 million, and we still hit our target for 2027. Despite these cells, we continue to expect portfolio cash rent above $1 billion.

Now I'd like to address some recent changes at HSA. Many of you are aware that the 2 principles leading HSA have been engaged in a legal dispute that has served as an unfortunate distraction from core hospital operations. With the resolution of this matter and the exit of one of those principles, we now have a new tenant in place that goes by the name of our [indiscernible].

At this time, the hospitals will continue to operate under the HSA game. As we have discussed in the past few quarters, HSA's core challenges remain revenue cycle management. Simply put, these hospitals have not done a good enough job of billing and collecting.

To address these continued challenges, HSA has engaged Ovation Healthcare based in Nashville, Tennessee, to provide management services Ovation manages over 500 hospitals across the U.S. and will immediately take over all aspects of operations across the portfolio, including revenue cycle, IT staffing, supply chain and other areas.

Ovation's immediate focus will be on improving RCM. We are optimistic that Ovation can help HSA to unlock the significant potential of these hospitals. Turning to the U.K., where we have been discussing budget constraints that have adversely impacted the NHS for several quarters now. As a result of these challenges, the NHS has not been able to fully fund the robust demand the country continues to see for vehicle health services.

Recognizing these ongoing dynamics, MPT and Priory have reached an agreement to reduce the annual rental obligations by approximately 18% with the ability for rents to increase as patient volumes recover. As part of this agreement, we added an extension option at MPT's election that effectively extends priority lease by 10 years.

Following our recent asset sales at attractive valuations and the comprehensive steps we have taken to refinance our debt, as Steve will discuss in more detail shortly, we have meaningfully strengthened our balance sheet this year. Additionally, as ROSA will cover, our portfolio consists of more than 50 operators around the world that are well positioned to continue servicing increased global demand for health care services.

As such, we remain confident that our business model is as important today as it has ever been, and we are well positioned to achieve our financial objectives and to create enduring value for our shareholders. Rosa?

Rosa Hooper

Thank you, Ed. Across the portfolio, Coast acute care remains a notable source of momentum general acute performance is broadly stable and operators in behavioral health are taking targeted steps to improve staffing, service mix and referral alignment.

Across Europe, operators are benefiting from strong performance trends. Median delivered another quarter of solid performance, driven by strong occupancy, particularly in orthopedics and psychosomatic and addiction treatment, combined with proved cost management. Circle help continues its strong performance, delivering increased revenue, consistent volumes and robust margins.

Following the successful Infracore IPO in July, Swiss Medical Network reported increasing hospital revenue year-over-year and coverage surpassing 2x, driven by its growing integrated care networks and cost containment initiatives.

Finally, in Spain, AMED is generating notable volume growth with surgeries increasing more than 11% year-over-year led by a nearly 40% increase at IMED alone in Valencia, which is reaching stabilization in its third year of operations. The opening of the new hospitals in Alicante and Barcelona in the coming months will further expand IMD's capacity in attractive Spanish markets.

In the U.S. Ernest Health remains a standout post-acute operator, maintaining a consistent coverage of 2.5x. NOR continues to produce strong earnings with volumes up year-over-year and coverage of 2.4x on full contractual rent. Nor is currently paying 50% of contractual rent as scheduled and with all payments current, and we'll begin paying 100% contractual rent in December.

In summary, we see meaningful momentum across several of our largest investments along with practical operating plans where improvement is needed. The strength of our portfolio's diversity is as evident as it has ever been. Post-acute care remains a clear portfolio differentiator supported by improving coverage and favorable demand. We are also encouraged by early signs of stabilization in behavioral health, while our general acute portfolio generates solid coverage. Together, these trends demonstrate the value of our diversified portfolio. Kevin?

James Hanna

Thank you, Rosa. Today, we reported normalized FFO of $0.11 per share for the third quarter of 2026. The which was in line with our expectations, excel for the nonpayment of September rent from HSA. The $2.4 billion secured debt refinancing transaction that was completed in August included extinguishments of existing unsecured notes at par and other extinguishments of debt below par, capturing an approximate $123 million of net discount.

We recognized $70 million of this discount as a gain in the quarter with the remainder to be recognized through interest expense over the term of the notes. Also in the quarter, we agreed to a rent modification of approximately 11 million pounds annually to Priority. We have incorporated a variable rent component to recapture some or all of that rent and priority were to reach certain revenue hurdles.

We've also effectively extended the lease term by an additional 10 years. The lease will continue to be classified as an operating lease and no material changes expected from a GAAP revenue perspective. As Ed mentioned, we monetized certain assets during the quarter. an aggregate, we recorded $158 million of gains on those transactions.

G&A expense for the quarter was lower year-over-year, primarily driven by stock compensation expense due to the change in fair market value of certain cash settled stock awards. Finally, during the quarter, we incurred approximately $24 million in impairment charges primarily related to our investments in Colombia due to the major earthquake the country suffered in August, with that said, our team has had recent discussions with representatives of the Colombian government, and we are encouraged about the direction and future of our facilities there. Steve?

R. Hamner

Thank you, Kevin. Last quarter, we described a 2-step process for addressing our 2026 and 2027 maturities and reducing our debt. I'll give a brief recap of Step 1, which was completed in early August, and a status report on step 2. In August, we issued $2.4 billion of secured notes to first fully redeem the EUR 500 million of notes due earlier this month, second, redeem about $735 million of the $1.4 billion of notes due next October. And third, exchange about $1 billion of longer-dated notes.

Through this exchange, we captured about $123 million in net discount and Kevin has just described the accounting for that. Step 2 will involve, one, the extension of our multiyear bank revolver two, the permanent repayment of our $200 million term loan due in June 2027 and three, the refinancing of the remaining $665 million in the 2027 notes.

Although Step 2 is not yet completed, I will describe our current progress as of today. We are in the bank market for a new multiyear revolver that we expect to complete in coming weeks. Importantly, we expect that the terms of the new revolver will eliminate the secured leverage financial covenant and provide additional headroom under both the fixed charge coverage covenant and the total leverage financial covenant.

We expect that this new covenant package will provide us with significant flexibility to address longer-dated maturities beyond 2027. We are still considering the appropriate size of the new revolver. But in any case, we will purposefully downsize the current revolver commitment of about $1.3 billion to a level more aligned with our current needs.

By doing so, and freeing up the collateral that currently secures our total roughly $1.5 billion credit facility, along with repaying the $200 million term loan, we will create substantial additional secured financing capacity to further refinance our existing debt, including the 2027 notes that I just mentioned.

We continue to evaluate the timing and structure of that refinancing, but we are eager to get it done sooner than later. However, we decide to allocate this $1.5 billion collateral capacity between a revolver and other secured financing alternatives. We expect the result will be that we have no maturities until June 2028 when about $600 million of sterling bonds are due and that expected position does not contemplate use of the cash we have as of September 30.

That cash gives us flexibility to decide which additional longer-term debt to retire and win. To recap what we have previously reported, we received $600 million in sale proceeds in the second quarter. Third quarter, approximately $140 million from Infracore $170 million from the sale of our minority interest in a U.S. joint venture and $370 million from the sale of 2 Idaho facilities.

Both of the U.S. portfolios transacted at sub-7% cap rate. And as a reminder, since 2022, we have sold hospital real estate for which we paid about $5.6 billion for an aggregate sale price of more than $6.8 billion. And we have collateralized another roughly $3.9 billion in assets at underwritten valuations, similarly in excess of our original investments.

Combined, those transactions reflect about a 23% increase in value over our original undepreciated book values. Our bond indentures provide us with flexibility as well. As of September '30, our unencumbered assets to unsecured debt ratio is more than 180%, reflecting substantial headroom in excess of the 150% covenant.

Headroom created by our August financing. We anticipate that further headroom will be created with the completion of step 2, up to 225%. And and it could increase even further with additional transactions that we are considering. That headroom, together with the additional financial covenant headroom and secured financing capacity we expect to create through our revolver extension. As well as further financing optionality provided under our bond indentures will provide us with additional flexibility to continue deleveraging our balance sheet. With that, we'll open up the call for questions. Jesse?

Operator

[Operator Instructions] Your first question comes from the line of Mike Mueller with JPMorgan. Please go ahead.

Question-and-Answer Session

Michael Mueller

I'll ask just 2 HSA questions. I'm sure you're going to get a bunch of priority questions. But -- but when do you expect to now resume rent collections for that portfolio? And at what level compared to the last time you were collecting rent? And then the second question would be -- like what would it take to trigger a real plan B here where you're looking at bringing in completely different operators or just something along those.

Edward Aldag

Mike, I think it's important to note that the operations at these hospitals is very strong. and continues to be strong. Let me just give you some points here. The surgeries, the overall volume is up 14% since September. The surgeries themselves are up 33%. They've recently entered to agreement with Miami's largest HMO that has made these hospitals, the preferred hospital network for their members. That should start increasing the patient volumes even further. I know we always focus on the Miami hospitals, but also in Houston. Sam Houston State University has entered into an agreement to begin their residency program at the St. Joseph Hospital Lea Hospital's residency program has now been accepted and will be started in '27.

Both of those 2 items will increase the CMS reimbursement for HSA, so from an operational standpoint, we feel good about the hospitals. Ovation has been in there for about a month, reviewing the situation at the hospitals reviewing the different procedures.

Since since August, the cash collections at HSA has increased 24%. Those are all significant items. So exactly when they'll start paying rent in, I'm not exactly sure. We certainly haven't projected it at this point. But it's not as if there's an issue with the operations at the hospital it literally has been an issue with the billing and the collections. We have a lot of confidence in Ovation's ability to come in and fix that. And was there a second part of the question?

R. Hamner

When might we do something more drastic.

Edward Aldag

Well, if HSAs operations were declining or continuing to decline. That's certainly an item that we would look at doing. .

Operator

Your next question comes from the line of Varel Granite with Bank of America.

Unknown Analyst

This is Andrew Real on for Farrell. I guess, first, just with asset sale proceeds now in hand, could you just speak in a little more detail to how much room they're creating under the secured debt limit? And then should we expect those proceeds to go towards the remaining 27 maturities?

R. Hamner

Well, in the spirit of everything is fungible, we expect the step 2 financings that I just described will address the remaining [ 2027 ] And that leaves cash from asset sales, as I mentioned, for addressing longer-dated maturities beyond the 27 whether it's sequentially just to bring down the 28 sort to spread it across the maturities, we have those -- we have that optionality. But we haven't made any specific determination at this point. .

Unknown Analyst

Okay. And then where does the working capital balance to HSA stand today .

R. Hamner

Our loan to HSA. You said.

Unknown Analyst

Correct .

R. Hamner

About $150 million. .

Operator

Your next question comes from the line of Michael Carroll with RBC Capital Markets.

Unknown Analyst

I guess, Ed or Steve, can you provide some additional color on the priority lease restructuring? Like what did MPT receive in return for the rent cut? I know you mentioned something that MPT can share on the upside when the recovery happens. Is that like some form of percentage rent. And then you said there was an ability to extend the lease termeture option. When does the lease expire now and you can extend it out 10 years from that point?

Edward Aldag

Yes. So Mike, let me -- I'll answer your questions, but let me point out that we have a great deal of confidence in Priority's ability to operate. This truly is in a situation where there's a lack of demand or inability to operate. We believe that priority is absolutely the best operator for these facilities. This is entirely a situation where the U.K. government and obviously, where we're concerned, particularly the NHS as budget constraints and has limited the number of NHS patients in April health facilities. Probably the most important thing that we received out of this is greatly enhancing our financial credit with the parent company priority.

R. Hamner

That's the main thing, Mike, is, as I just mentioned, we have a much improved credit perimeter with Priory and actually its ownership parent. Our ability now is to extend the lease to 2055. That's totally within our discretion. And yes as revenue recovers, whether from NHS or elsewhere, we have the opportunity to recover the foregone rent I think Kevin mentioned starting at 11 million pounds that escalates.

But as revenue recovers, the rent would also recover. And I would point out that in recent weeks, if not months, -- we think we did this at the bottom because revenue is already increasing. We're already seeing improving operations in revenue at Priory.

Unknown Analyst

And then switching over to NOR and HSA. It looks like in the supplemental on the development tab that the budget for the NOR development and some of the HSA developments increased pretty noticeably. specifically at NOR. Can you kind of talk about what drove those increases? I mean did new projects get added to that? Or did the scope of the existing projects just get bigger?

Edward Aldag

Remember that on or the vast majority of that is for a new ET at the largest hospital in that portfolio. And that actually started under the previous owners prospect. Obviously, there's also the continued seismic work that's going on there, but the vast majority of it is the -- that's an important project. It was an important project on a prospect. It got sidelined during the bankruptcy, and it's back in full speed.

Unknown Executive

The -- all that to with that HSA is primarily elevators, boil, chillers, roofs, basic type of situation. The biggest project is the project that we announced a while back, which is the replacement of a parking garage at Haile.

Unknown Analyst

And then just if I can sneak 1 last 1 in there. I guess, Steve, can you talk about I guess, how MPT plans on raising additional capital? I know you talked a little bit about some -- the Phase 2 of the debt refinancing. I mean are there more asset sales on TAP? And at what point do you start thinking about the dividend just given where earnings have been trending with the priority in the HSA situations.

R. Hamner

So as we've discussed below these many quarters now, we continue to have a lot of flexibility, Mike. You mentioned asset sales. There's nothing meaningful pending. We're not in the market for any particular portfolios or assets. I mean there may be a one-off here and there like we've done recently. My point in kind of going through the recent history where we've sold or monetized upwards of $9 billion in assets at significant premiums over our original investment -- what was, in fact, to point out that, that is available.

We continue with the balance sheet restructuring, the extension of maturities and modest reduction of debt to give us longer runway to continue improving operations, including with the HSA situation. So we have options, and we have the luxury of some time before we have to or would consider more drastic alternatives.

Operator

This concludes today's Q&A. I will now turn the call back over to Ed Aldag, CEO, for closing remarks.

Edward Aldag

Thank you, Jesse. And if anybody has any follow-up questions, please don't hesitate to reach out to Charles, and we'll get back with you. So thank you very much. .

Operator

This concludes today's call. Thank you for attending. You may now disconnect.