Medical Properties Trust cemented itself as the clear global leader in providing capital to acute care facilities in 2019. In a truly marquee year, MPT built upon the strong financial and strategic foundation laid since its early years.
Among MPT’s accomplishments, our team completed a record $4.5 billion in domestic and international acquisitions with new and existing operators, highlighted by several landmark transactions. In May and June, we entered two exciting new countries as we acquired interests in 13 Swiss and 11 Australian hospitals for an aggregate dollar-equivalent investment of $1.3 billion. Our attention was then immediately turned back to the United States when we announced a further $1.75 billion in acquisitions of 24 hospitals from several operators, all new to us, in California, Pennsylvania and Kansas. Just past the halfway mark of 2019, we had already surpassed our acquisition guidance and established new records for the full year. With the addition of these outstanding hospitals to our portfolio, we initiated new operator relationships, extended into new geographic markets and expanded service lines, including not-for-profit and behavioral.
In November, we announced a $700 million transaction with LifePoint Health and Apollo Global Management for 10 acute care hospitals in six U.S. states, strengthening our relationship with both strategically important parties and bringing our total investment with LifePoint to 17 acute care hospitals and $1.2 billion. Late in the fourth quarter, we announced that in early 2020 we would complete a $2 billion acquisition of 30 hospital facilities in the U.K., adding to the eight U.K. hospitals we acquired in August for $434 million. MPT has assembled an irreplaceable portfolio of private hospitals that are critical to the delivery of acute health services across the U.K.
These major transactions join numerous others made over the course of the year. When combined, these transactions bring the company’s pro forma total gross assets to approximately $16.5 billion, including $13.5 billion in general acute care hospitals, $1.8 billion in inpatient rehabilitation hospitals and $0.4 billion in long-term acute care hospitals. Our portfolio—which includes approximately 390 properties and more than 41,000 licensed beds in 34 states and eight countries, and relationships with 41 hospital operating companies―is one of the strongest in the REIT world.
Our performance in 2019 has proven more than ever MPT’s ability to execute multiple large transactions simultaneously and seamlessly, providing us a key competitive advantage. Our commanding market share is a direct result of this focus and strong, strategic execution, which we will continue to deploy as we advance our leadership position in the market.
We made exciting progress this year to enhance our international presence with new portfolio properties and new relationships with world-class operators. With approximately $3.8 billion in international acquisitions in 2019 and in early 2020, MPT now has hospitals located in the United States, U.K., Germany, Switzerland, Spain, Italy, Portugal and Australia.
The first large transaction we closed this year expanded MPT’s business into a third continent. Our $0.9 billion transaction with Healthscope for 11 hospitals in Australia added critical assets in the country’s strongest markets to the MPT portfolio. This transaction also established an important new relationship with Australia’s second largest private hospital operator, with Healthscope becoming one of MPT’s leading operators by size and rental revenue.
In May, we entered the Swiss healthcare market by acquiring a 46% interest in a Swiss healthcare real estate company, Infracore SA, representing approximately $410 million in real estate value as Infracore’s largest shareholder. This transaction presented a unique opportunity for MPT to partner with Switzerland’s second largest private hospital operator and establish a new long-term relationship with Swiss Medical Network.
In Spain, MPT made an approximately $130 million equity investment for a 45% stake in two joint venture entities. These entities own the real estate of two Madrid acute care hospitals leased to and operated by HM Hospitales, one of the largest private hospital operators in Spain.
We also made our first hospital investment in Portugal. For approximately $31 million, MPT acquired a newly constructed hospital in Viseu operated by the José de Mello Group, Portugal’s largest private operator. This was particularly exciting for MPT given the opportunities in the Portuguese healthcare market to fill increasing coverage gaps in the public system. It also allowed MPT to establish itself in an increasingly consumer-driven healthcare marketplace with a leading, growth-oriented hospital operator.
In addition to our completed acquisition of 30 U.K. hospital facilities in January 2020, MPT acquired eight Ramsay Health Care hospitals for $434 million and BMI The Harbour Hospital for $45 million in the U.K.
To support our geographic expansion, we have grown our international office space as well, expanding our operations in Luxembourg and naming Luke Savage, vice president, International Acquisitions, as the senior head there. And we expect to open an Australian office, in Sydney, in the second quarter of 2020.
This was a year of unprecedented growth for MPT. We increased our enterprise value from approximately $10 billion at the end of 2018 to $19 billion―a remarkable 90% increase. Our portfolio generates strong, stable cash flows, with 81% of our rent and interest expiring beyond 2029, positioning us with the right calibration of financial flexibility and investments to continue generating immense value for shareholders.
We are proud to have delivered a market-leading 39% return to shareholders in 2019. From our IPO in 2005 through the end of 2019, we delivered to our shareholders cash dividends and increased share value exceeding $6.6 billion. We are proud of this extraordinary creation of real value for our investors and are excited about the opportunities we see in the future for additional value creation in the form of growing cash dividends and share value.
As the single largest year of acquisition growth in MPT’s history, 2019 set a new standard for what we can achieve. We have started 2020 by hitting the ground running with completed acquisitions already approximating $1.9 billion and by announcing an annual normalized FFO per share guidance increase of more than 25% over actual 2019 results.
In the year ahead, we are focused on developing a vibrant pipeline that exceeds $3 billion of property to meet a full $5 billion in 2020. We still see tremendous unmet need for behavioral hospitals in the U.S., and as we see growing recognition of the benefits of long-term lease financing of core hospital real estate, we expect MPT to be at the forefront of meeting those financing needs.
I am incredibly proud of the enormous drive of our team and all that we have accomplished over such an exciting year. With a continued focus on deliberate, value-creating actions, I am confident 2020 will be another great chapter in the MPT story.
On behalf of everyone at MPT, I thank you for your continued support of Medical Properties Trust. We hope to continue driving outstanding value for our shareholders for years to come.
Edward K. Aldag, Jr.
Chairman, President and CEO