Real Estate and Other Activities (Tables)

9 Months Ended

Sep. 30, 2025

Real Estate [Abstract]

Net Assets Acquired

We acquired or invested in the following net assets (in thousands):

	For the Nine Months Ended September 30,
	2025		2024
Land and land improvements	$	23,375	$	—
Buildings and other		23,699		—
Investments in unconsolidated real estate joint ventures		63,015		107,908
Liabilities assumed		—		(2,290	)
Total net assets acquired	$	110,089	$	105,618

Summary of Status on Current Development and Capital Additions Projects

See table below for a status summary of our current development and capital addition projects (in thousands):

Property	Commitment		Costs Paid as of September 30, 2025		Cost Remaining
IMED Hospitales ("IMED") (Spain)	$	57,196	$	33,884	$	23,312
IMED (Spain)		42,246		37,608		4,638
Healthcare Systems of America (Florida)		37,000		551		36,449
Lifepoint Behavioral (Arizona)		10,659		6,623		4,036
Other (Various)		554		210		344
	$	147,655	$	78,876	$	68,779

Components of Total Investment in Financing Leases

The components of our total investment in financing leases consisted of the following (in thousands):

	As of September 30,    2025			As of December 31,    2024
Minimum lease payments receivable	$	575,398		$	591,142
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(529,826	)		(547,770	)
Net investment in direct financing leases		249,390			247,190
Other financing leases (net of allowance for credit loss)		694,360			810,580
Total investment in financing leases	$	943,750		$	1,057,770

Summary of Investments in Unconsolidated Operating Entities

The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands):

Operator	Ownership Percentage	As of September 30,    2025		As of December 31,    2024
Swiss Medical Network	70%	$	603,933	$	483,770
Median Kliniken S.á.r.l ("MEDIAN")	50%		490,512		431,964
CommonSpirit (Utah partnership)	25%		147,165		113,202
Policlinico di Monza	50%		85,110		77,592
HM Hospitales	45%		52,880		49,869
Total		$	1,379,600	$	1,156,397

The following is a summary of our investments in unconsolidated operating entities (amounts in thousands):

Operator	As of September 30,    2025		As of December 31,    2024
Swiss Medical Network	$	196,537	$	172,453
Aevis Victoria SA ("Aevis")		62,858		63,409
Priory Group ("Priory")		43,877		38,739
Aspris Children's Services ("Aspris")		15,920		15,950
PHP Holdings		—		149,027
Total	$	319,192	$	439,578

Summary of Activity in Credit Loss reserves

The following table summarizes the activity in our credit loss reserves (in thousands):

	For the Three Months Ended September 30,
	2025		2024
Balance at beginning of the period	$	564,796	$	538,534
Provision for credit loss, net (1)		85,111		438,154
Expected credit loss reserve written off or related to financial      instruments sold, repaid, or satisfied		—		(825,548	)	(2)
Balance at end of the period	$	649,907	$	151,140

	For the Nine Months Ended September 30,
	2025		2024
Balance at beginning of the year	$	511,473	$	96,001
Provision for credit loss, net (1)		138,434		880,687
Expected credit loss reserve written off or related to financial      instruments sold, repaid, or satisfied		—		(825,548	)	(2)
Balance at end of the period	$	649,907	$	151,140

(1)The amount in 2025 is primarily related to Prospect; whereas, the amount in 2024 is primarily related to loans involving Steward. See "Leasing Operations (Lessor)" in this Note 3 for further discussion.

(2)Includes write-offs in the third quarter of 2024 of previously reserved loans to Steward.

Schedule of Concentrations of Credit Risk

See below for our concentration details (dollars in thousands):

Total Assets by Operator

	As of September 30, 2025					As of December 31, 2024
Operators	Total Assets (1)		Percentage of Total Assets			Total Assets (1)		Percentage of Total Assets
Circle Health Ltd ("Circle")	$	2,135,280		14.3	%	$	2,026,778		14.2	%
Priory		1,306,202		8.8	%		1,233,462		8.6	%
Healthcare Systems of America		1,202,187		8.1	%		1,187,006		8.3	%
Swiss Medical Network		863,329		5.8	%		719,632		5.1	%
Lifepoint Behavioral		814,878		5.5	%		813,584		5.7	%
Other operators		6,809,539		45.5	%		6,624,256		46.3	%
Other assets		1,792,780		12.0	%		1,689,876		11.8	%
Total	$	14,924,195		100.0	%	$	14,294,594		100.0	%

(1)Total assets by operator are generally comprised of real estate assets, mortgage loans, investments in unconsolidated real estate joint ventures, investments in unconsolidated operating entities, and other loans.

Total Assets by U.S. State and Country (1)

	As of September 30, 2025					As of December 31, 2024
U.S. States and Other Countries	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Texas	$	1,429,105		9.6	%	$	1,394,296		9.8	%
California		1,032,272		6.9	%		935,470		6.4	%
Florida		838,271		5.6	%		840,876		5.9	%
Ohio		332,436		2.2	%		327,577		2.3	%
Arizona		330,494		2.2	%		379,801		2.7	%
All other states		2,548,691		17.1	%		2,636,587		18.5	%
Other domestic assets		949,691		6.4	%		951,486		6.6	%
Total U.S.	$	7,460,960		50.0	%	$	7,466,093		52.2	%
United Kingdom	$	4,204,908		28.2	%	$	3,985,672		27.9	%
Switzerland		863,328		5.8	%		719,632		5.0	%
Germany		757,239		5.1	%		672,343		4.7	%
Spain		289,878		1.9	%		247,996		1.7	%
All other countries		504,793		3.4	%		464,468		3.3	%
Other international assets		843,089		5.6	%		738,390		5.2	%
Total international	$	7,463,235		50.0	%	$	6,828,501		47.8	%
Grand total	$	14,924,195		100.0	%	$	14,294,594		100.0	%

Total Assets by Facility Type (1)

	As of September 30, 2025					As of December 31, 2024
Facility Types	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
General acute care hospitals	$	8,912,538		59.7	%	$	8,493,331		59.4	%
Behavioral health facilities		2,456,058		16.5	%		2,376,460		16.7	%
Post acute care facilities		1,647,940		11.0	%		1,617,596		11.3	%
Freestanding ER/urgent care facilities		114,879		0.8	%		117,331		0.8	%
Other assets		1,792,780		12.0	%		1,689,876		11.8	%
Total	$	14,924,195		100.0	%	$	14,294,594		100.0	%

(1)For geographic and facility type concentration metrics in the tables above, we allocate our investments in unconsolidated operating entities pro rata based on the gross book value of the real estate. Such pro rata allocations are subject to change from period to period.

On an individual property basis, our largest investment in any single property was less than 2% of our total assets as of September 30, 2025.

On a revenue basis, concentration in 2025 compared to the same periods of 2024 is as follows:

Total Revenues by Geographic Location

	For the Three Months Ended September 30,
	2025					2024
Geographic Location	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Total U.S.	$	120,650		50.8	%	$	115,640		51.2	%
United Kingdom		95,713		40.3	%		91,776		40.6	%
All other countries		21,159		8.9	%		18,411		8.2	%
Grand total	$	237,522		100.0	%	$	225,827		100.0	%

Total Revenues by Facility Type

	For the Three Months Ended September 30,
	2025					2024
Facility Types	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
General acute care hospitals	$	144,760		60.9	%	$	139,075		61.6	%
Behavioral health facilities		54,726		23.1	%		52,799		23.4	%
Post acute care facilities		36,097		15.2	%		30,278		13.4	%
Freestanding ER/urgent care facilities		1,939		0.8	%		3,675		1.6	%
Total	$	237,522		100.0	%	$	225,827		100.0	%

The following shows those tenants that represented 10% or more of our total revenues for the three and nine months ended September 30, 2025 and 2024:

	For the Three Months Ended September 30,
	2025					2024
Operators	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Circle	$	54,228		22.8	%	$	52,427		23.2	%
Priory		27,481		11.6	%		25,934		11.5	%
Other operators		155,813		65.6	%		147,466		65.3	%
Total	$	237,522		100.0	%	$	225,827		100.0	%

	For the Nine Months Ended September 30,
	2025					2024
Operators	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Circle	$	158,664		22.6	%	$	153,994		20.2	%
Priory		78,878		11.2	%		76,449		10.0	%
Other operators		464,138		66.2	%		533,260		69.8	%
Total	$	701,680		100.0	%	$	763,703		100.0	%