Cash flow generation is fundamentally decoupled from reported earnings, as demonstrated by a negative FFO/NI ratio of -0.74 in 2025Q4 and periods of extreme negative AFFO, such as the -$885.5M reported in 2024Q1.
Medical Properties Trust, Inc. (MPT) cash flow statement — 22-year operating, investing & financing cash flows
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 | Dec'04 |
|---|
| Cash from Operations | 208.25M | 230.77M | 245.48M | 505.79M | 739.01M | 811.66M | 617.64M | 494.12M | 449.09M | 363.1M | 264.68M | 207M | 150.44M | 140.8M | 105.31M | 79.27M | 60.64M | 62.75M | 69.92M | 36.83M | 42.08M | 24.3M | 9.92M |
| Operating CF Margin % | - | 23.74% | 24.66% | 58.02% | 47.9% | 52.55% | 49.44% | 56.78% | 57.24% | 51.52% | 48.91% | 46.84% | 48.14% | 58.06% | 53.15% | 59.91% | 56.13% | 55.03% | 65.3% | 45.03% | 83.38% | 79.8% | 91.05% |
| Operating CF Growth % | -3783.89% | -5.99% | -51.47% | -31.56% | -8.95% | 31.41% | 25% | 10.03% | 23.68% | 37.18% | - | 37.59% | 6.85% | 33.7% | 32.85% | 30.73% | -3.37% | -10.25% | 89.84% | -12.48% | 73.17% | 145% | - |
| Net Income | 249.13M | -275.94M | -2.41B | -556.09M | 903.82M | 656.94M | 432.27M | 376.4M | 1.02B | 291.24M | 225.94M | 139.93M | 50.8M | 97.22M | 90.08M | 26.71M | 23.01M | 36.37M | 34.49M | 41.24M | 30.16M | 19.64M | 4.58M |
| Depreciation & Amortization | 298M | 272.82M | 453.75M | 616.13M | 345.58M | 333.78M | 275.95M | 156.57M | 141.49M | 131.98M | 97.6M | 71.83M | 55.16M | 38.82M | 35.59M | 35.48M | 26.31M | 26.31M | 26.54M | 13.17M | 8.32M | 4.57M | 1.52M |
| Stock-Based Compensation | -18.02M | 25.75M | 32.98M | 33.25M | 49.42M | 52.11M | 47.15M | 32.19M | 16.5M | 9.95M | 7.94M | 11.12M | 9.16M | 8.83M | 7.64M | 6.98M | 6.62M | 5.49M | 6.38M | 0 | 0 | 0 | 0 |
| Deferred Taxes | -261K | -11.23M | 5.12M | -167.33M | 10.7M | 42.75M | 21.84M | -20.53M | -671.38M | -7.43M | -53.99M | -3.27M | 47.27M | -7.66M | -16.37M | 16.07M | 17.47M | -3.99M | -3.13M | 0 | 0 | 0 | 0 |
| Other Non-Cash Items | -332.27M | 185.22M | 2.18B | 563.12M | -600.09M | -287.04M | -176.8M | -103.64M | -79M | -37.51M | -13.91M | -27.29M | -14.58M | -12.09M | -962K | -5.52M | -16.68M | -902K | -2.83M | -13.8M | 263.12K | -3.4M | -2.3M |
| Working Capital Changes | 11.85M | 34.15M | -15.6M | 16.72M | 29.59M | 13.12M | 17.22M | 53.13M | 23M | -25.12M | 1.11M | 14.68M | 2.63M | 15.69M | -10.67M | -452K | 3.9M | -520K | 8.47M | -3.78M | 3.34M | 3.5M | 6.12M |
| Change in Receivables | -483K | 7.11M | 2.78M | -141.73M | -116.42M | -23.87M | -2.44M | 12.91M | 46.5M | -21.12M | -13.25M | -5.6M | -3.86M | -13.21M | -17.26M | 0 | 0 | 0 | 0 | 2.97M | -2.69M | -2.8M | -729.54K |
| Change in Inventory | 0 | 0 | 0 | 0 | 116.42M | 23.87M | 2.44M | -39.63M | 5.6M | -4.45M | -18.36M | -8.3M | 764K | 1.85M | 91K | 0 | 0 | 0 | 0 | -12.33M | 6.7M | 4.21M | 6.22M |
| Change in Payables | -56.67M | 0 | 0 | 0 | 33.58M | 54.06M | -18.42M | 39.63M | -5.6M | 2.49M | 41.58M | 26.54M | 6.21M | 23.87M | 9.2M | 5.35M | -3.18M | 1.7M | 4.76M | -6.75M | 6.04M | 6.3M | 6.85M |
| Cash from Investing | -166.97M | -264.74M | 1.32B | 517.56M | 396.06M | -3.86B | -2.95B | -4.88B | 564.18M | -2.36B | -926.54M | -1.95B | -850.02M | -712.58M | -617.13M | -265.62M | 22.78M | -12.14M | -368.66M | -200.18M | -296.86M | -214.7M | -195.6M |
| Capital Expenditures | -14.52M | 0 | 0 | 0 | -1.54B | -65.55M | -4.29B | -4.86B | -1.43B | -2.25B | 27.56M | -2.22B | 0 | 0 | 0 | -269.51M | -144.45M | -421K | -430.71M | -212.98M | -235.77M | -97.81M | -128.13M |
| CapEx % of Revenue | 1.41% | - | - | - | 99.84% | 4.24% | 343.04% | 558.32% | 182.4% | 318.81% | 5.09% | 502.15% | - | - | - | 203.68% | 133.72% | 0.37% | 402.27% | 260.41% | 467.14% | 321.2% | 1176.22% |
| Acquisitions | -61.32M | -142.09M | -93.96M | -222.76M | -1.32B | -5.28B | -4.18B | -4.57B | -1.43B | -2.25B | -1.68B | - | - | - | - | - | - | - | - | - | - | - | - |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 47.23M | -48.9M | 1.57B | 1.03B | 3.45B | 1.72B | 4.09B | 4.72B | 2.13B | -20.31M | 797.73M | 290.59M | -69.2M | -5.54M | 36.27M | 45.42M | 188.16M | -7.78M | 157.61M | 143.1M | 7.64M | -70.89M | -67.47M |
| Cash from Financing | -40.51M | 228.08M | -1.48B | -1.02B | -1.34B | 2.95B | 1.4B | 5.04B | -345.87M | 2.07B | 552.56M | 1.8B | 802.56M | 579.82M | 446.4M | 190.67M | -317K | -47.06M | 216.28M | 253.46M | 199.77M | 151.97M | 283.13M |
| Debt Issued (Net) | 154.82M | 501.77M | 102.38M | -420.25M | -537.49M | 2.58B | 1.58B | 2.98B | -51.98M | 1.87B | -385.3M | - | - | - | - | - | - | - | - | - | - | - | - |
| Equity Issued (Net) | -8.91M | -25.91M | -3.81M | -8.08M | -17.94M | 1.05B | 411.1M | 2.53B | 94.24M | 547.78M | 0 | 817.39M | 138.17M | 313.33M | 233.05M | 0 | 288.07M | 68M | 128.33M | 135.55M | 0 | 125.27M | 233.7M |
| Dividends Paid | -158.03M | -193.26M | -321.08M | -615.39M | -698.53M | -643.47M | -567.97M | -411.7M | -363.91M | -326.73M | -218.39M | -182.98M | -144.37M | -120.31M | -103.95M | -89.6M | -77.09M | -61.65M | -65.1M | -53.08M | -36.11M | -16.73M | -2.61M |
| Share Repurchases | 0 | -23.44M | 0 | -8.08M | -17.94M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -262K | 0 | -75K | 0 |
| Other Financing | -28.4M | -54.51M | -1.26B | 23.39M | -88.55M | -36.67M | -20.64M | -62.32M | -24.22M | -18.25M | 1.16B | -23.85M | -6.6M | -6.53M | -17.86M | -13.07M | -5.83M | 232K | -3.11M | 39.37M | -7.65M | -398.84K | -3.87M |
| Net Change in Cash | 61K | 208.82M | 79.22M | 14.41M | -220.34M | -94.49M | -911.62M | 645.57M | 650.18M | 88.23M | -112.3M | 51M | 98.56M | 8.67M | -65.42M | 4.32M | 83.1M | 3.56M | -82.47M | 90.11M | -55.01M | -38.43M | 97.44M |
| Free Cash Flow | 208.25M | 230.77M | 245.48M | 505.79M | -801.35M | 746.11M | -3.67B | -4.36B | -981.91M | -1.88B | 292.24M | -2.01B | 150.44M | 140.8M | 105.31M | -190.24M | -83.81M | 62.33M | -360.79M | -176.15M | -193.69M | -73.51M | -118.21M |
| FCF Margin % | 20.18% | 23.74% | 24.66% | 58.02% | -51.94% | 48.3% | -293.6% | -501.54% | -125.16% | -267.29% | 54.01% | -455.3% | 48.14% | 58.06% | 53.15% | -143.77% | -77.58% | 54.66% | -336.97% | -215.38% | -383.76% | -241.4% | -1085.17% |
| FCF Growth % | 41.29% | -5.99% | -51.47% | 163.12% | -207.4% | 120.34% | 15.97% | -344.51% | 47.87% | -744.57% | - | -1437.3% | 6.85% | 33.7% | 155.36% | -126.99% | -234.46% | 117.28% | -104.82% | 9.05% | -163.48% | 37.81% | - |
| FCF per Share | 0.35 | 0.38 | 0.41 | 0.85 | -1.34 | 1.26 | -6.91 | -10.19 | -2.68 | -5.38 | 1.12 | -9.22 | 0.88 | 0.92 | 0.80 | -1.72 | -0.83 | 0.80 | -5.81 | -3.68 | -4.88 | -2.27 | -6.12 |
| FCF Conversion (FCF/Net Income) | 0.84x | -0.83x | -0.10x | -0.91x | 0.82x | 1.24x | 1.43x | 1.32x | 0.44x | 1.25x | 1.18x | 1.48x | 2.98x | 1.45x | 1.17x | 2.99x | 2.65x | 1.73x | 2.14x | 0.89x | 1.40x | 1.24x | 2.17x |
| Interest Paid | -393.1M | 458.23M | 420.31M | 406.14M | 347.38M | 326.41M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Quick answers to the most common questions about buying MPT stock.
Medical Properties Trust, Inc. (MPT) generated $230.8M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Medical Properties Trust, Inc. (MPT) generated $230.8M in free cash flow in 2025. Free cash flow is the cash left over after capital expenditures, which can be used to pay dividends, repurchase shares, or pay down debt.
Medical Properties Trust, Inc. (MPT) spent $0.0M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
In 2025, Medical Properties Trust, Inc. (MPT) returned $193.3M to shareholders via cash dividends and spent $23.4M on share repurchases. This shows the company's commitment to returning capital to its equity investors.
Key Metrics
Top Statement Risk
Tenant credit and concentration
Metrics are mathematically derived from official filings.
FFO Conversion Remains Highly Erratic
According to recent SEC filings, the divergence between GAAP operating cash flow and FFO is stark, with FFO/NI ratios frequently turning negative, such as the -0.74 observed in 2025Q4, indicating that non-cash impairments and credit adjustments are fundamentally decoupling reported earnings from actual cash generation capabilities.
The persistent negative FFO/NI ratios suggest that GAAP net income is being heavily distorted by non-cash charges, likely related to asset impairments and tenant loan write-downs. Investors should monitor this conversion gap, as it implies that the company's core earnings capacity is significantly more volatile than headline figures might suggest.
Dividend Coverage Remains Under Pressure
Based on reported financial statements, the company's ability to generate positive AFFO has been severely compromised, with periods of negative AFFO, such as the -$885.5M reported in 2024Q1, indicating that the dividend payout is currently being supported by capital recycling rather than recurring operational cash flow.
The lack of consistent positive AFFO suggests that the dividend is not currently covered by organic property-level cash flows. This reliance on asset sales to fund distributions warrants further investigation into the long-term sustainability of the current payout policy.
Impairments Obscure True Earnings Reality
As reported in quarterly financial statements, the massive disparity between GAAP net income and FFO, exemplified by the -$801.2M net loss in 2024Q3, highlights how recurring asset impairments and credit-related write-downs are masking the underlying cash-generating potential of the remaining hospital portfolio.
The magnitude of these GAAP distortions suggests that the company is undergoing a significant structural reset of its asset base. Analysts should interpret these figures as evidence of a portfolio in transition, where historical book values may no longer reflect the current market reality of the underlying facilities.
Hidden Risks in Tenant Support
Data from recent filings suggests that the company's cash flow statement may hide significant capital outflows disguised as tenant loans or equity investments, which effectively subsidize operator rent obligations and artificially inflate the appearance of stable, recurring rental income across the portfolio.
These off-balance-sheet-like support mechanisms may indicate that the true credit quality of the tenant base is weaker than the reported rent collection figures imply. Investors should be cautious, as these capital injections may be necessary to prevent immediate defaults, thereby creating a cycle of dependency that limits the company's financial flexibility.