HCA Healthcare is set to take over the operations of five Utah hospitals owned by Steward Health Care System for an undisclosed sum. In addition, real estate investment firm Medical Properties Trust, which holds a $1.2 billion stake in all five properties together, plans to lease them to HCA Healthcare.

The facilities in question include Davis Hospital in Layton, Jordan Valley Medical Center in West Jordan, Jordan Valley Medical Center-West Valley Campus, Mountain Point Medical Center in Lehi, and Salt Lake Regional Medical Center in Salt Lake City, according to KSL News.

Under the agreement with Steward, the facilities will become part of HCA Healthcare’s mountain division, which already includes 11 hospitals in Utah, Idaho and Alaska. The sale is expected to allow Steward to focus more on other states and locations it serves, including Arizona, Texas, Arkansas, Louisiana, Florida, Ohio, Pennsylvania and Massachusetts.

Steward says it will also be able to reinvest in more risk-based opportunities, as well as invest more in its accountable care model, which is the largest in the U.S. and second largest in shared savings for MSSP 2020. “We are confident that the combination with HCA Healthcare will enable the achievement of cost savings and further improved quality of care for patients in Utah,” said Steward Health Care chairman and CEO Ralph de la Torre in a statement.

Steward is based in Dallas and currently operates 39 hospitals in the U.S. HCA Healthcare is in Nashville and is one of the largest providers in the U.S., with 187 hospitals and approximately 2,000 ambulatory sites. These include surgery centers, freestanding ERs, urgent care centers and physician clinics spread out across 20 states and in the U.K.

It says Utah is a fast-growing area and that the state’s healthcare needs continue to grow. “We believe the addition of these facilities will help us improve healthcare network options for patients and enable investment in services to meet increasing demand for healthcare,” said Sam Hazen, chief executive officer of HCA Healthcare, in a statement.

MPT acquired the hospitals in 2017 for $1.2 billion, and has accrued more than $300 million in real estate rent and interest from them. As they represent approximately 5% of MPT’s total pro forma gross assets, the purchase by HCA Healthcare will make the medical provider one of the five largest tenants in the MPT portfolio.

Following the completion of its deal with Steward, HCA Healthcare will enter into a 15-year master lease with MPT for the five facilities. There will be no change to the cash rent that is owed to MPT under its existing master lease with Steward.

HCA will have five extension options of five years each, with rental payments increasing annually at CPI and subject to a 2% floor and 5% ceiling. HCA Healthcare will also have certain options for purchasing the facilities starting in 2028, and MPT will have certain options to sell them to HCA Healthcare, according to Edward Aldag Jr., MPT’s chairman, president and CEO. “The resulting new 15-year lease with HCA Healthcare strongly validates our initial underwriting and $1.2 billion purchase price for these properties.”

The deal follows another major M&A agreement out west this past week, in which Intermountain Healthcare agreed to merge with SCL Health into a $14 billion operation made up of 33 hospitals and 385 clinics across Utah, Idaho, Nevada, Colorado, Montana and Kansas.

Meanwhile, Steward announced earlier this month that Macquarie Infrastructure Partners V would acquire a 50% interest in eight of its hospitals in Massachusetts, with Medical Properties Trust planning to use $1.3 billion for the purchase to repay debt and fund its Springstone inpatient behavioral health facility transactions, according to Modern Healthcare.

Both of HCA's agreements with Steward and MPT are expected to be completed in the first half of 2022 and are subject to certain regulatory approvals and other customary conditions.