2025 Texas Ownership White Paper

Our medical and healthcare commercial real estate team continues work documenting the evolving landscape of healthcare real estate
ownership in Texas. Our original research paper, released in August 2022, offered a first-of-its-kind look at how ownership was split
across key asset classes – Medical Office Buildings (MOBs), Ambulatory Surgical Centers (ASCs), Hospitals, and Behavioral Health
Facilities – within Texas’s four core markets: Austin, Dallas, Houston, and San Antonio.

Why Texas? It’s simple. Everyone in this space is watching Texas. The state’s healthcare real estate sector is dynamic, and with four
dominant metros, it provides just the right balance of scale and concentration for investors, operators, lenders, and developers to target
efficiently. Unlike states with fragmented markets, Texas is compact yet rich in opportunity.

In updating our data to reflect 2025 trends, we’ve analyzed ownership shifts and current market compositions using fresh datasets.
Ownership types remain varied, including hospital/health systems, RElTs, private investors, owner/providers, REPEs/advisors, and
developers/operators. This year’s data confirms ongoing consolidation among health systems, growth in REIT presence – especially in
MOBs and ASCs – and subtle shifts in behavioral health ownership toward private and specialized investors.

The charts in this paper break down ownership by asset class and by market. This matters because it’s not just academic – it’s directional.
Whether you’re evaluating new acquisitions, looking to lend, or targeting potential partnerships, understanding who owns what in Texas
guides strategy. With this breakdown, stakeholders can see where they fit, where there’s room to grow, and where opportunities may lie
hidden beneath the surface.

This 2025 edition continues our commitment to covering the healthcare real estate sector in Texas with precision and relevance – and
provides an indispensable tool for market participants planning their next move.