Steward's international arm: Malta, Spain and Colombia

analysisAccording to a 2020 analysis of filings at the Malta Business Registry, Vitals Global Healthcare was registered on May 13, 2015, and on November 30, 2015 it and its subsidiary companies signed a services concession agreement with the government of Malta for the redevelopment, maintenance, management and operation of St Luke's Hospital, Karin Grech Rehabilitation Hospital and Gozo General Hospital, effective June 1, 2016. A June 2024 investigative report stated that in 2015 Malta agreed to pay €2.1 billion to the newly formed Vitals group to renovate three of the country's four public hospitals, while a September 2024 newspaper investigation described the arrangement as covering four of Malta's eight public hospitals. The concession agreement itself is not in the reviewed record. ^{1 2 3}

analysisSteward acquired Vitals Global Healthcare in 2018 through Steward Health Care International Ltd, which the registry analysis says was set up in Malta on November 1, 2017 with share capital of 1,200 shares of €1 each; its sole shareholder was Steward Health Care International Holdings Limited, registered in the United Kingdom, its sole director was Nathalie Hibble, and its audited financial statements had never been filed. On February 16, 2018 the holding company that had owned all 1,200 shares of Vitals Global Healthcare transferred 1,140 of them to Steward Health Care International Ltd and 60 to an individual, and the two Vitals-era directors were replaced by Armin Ernst and Michael Callum, with Ernst also appointed company secretary. A research institute's timeline dates the acquisition to February 20, 2018 and describes it as the beginning of a new division called Steward Health Care International. On May 18, 2018 Vitals Global Healthcare changed its name to Steward Malta Ltd, and its wholly owned subsidiaries Vitals Global Healthcare Management Ltd and Vitals Global Healthcare Assets Ltd became Steward Malta Management Ltd and Steward Malta Assets Ltd, with Ernst and Callum replacing their directors on that date. A June 2024 investigative report likewise states that ownership passed to Steward three years after the 2015 award and that the company was renamed Steward Malta. ^{2 4 1}

analysisAn undated ownership chart published by an investigative outlet places the Maltese companies under Steward Health Care System LLC: the System holds 100% of Steward Operations Holdings LLC, which holds 100% of Steward Health Care International LLC (Delaware); below it is Steward Health Care International Ltd (Malta), shown with 95% of Steward Malta Ltd and the other 5% attributed to an individual, and Steward Malta Ltd holds 100% each of Steward Malta Management Ltd, Steward Malta Assets Ltd and Steward Malta Personnel Limited. The chart is a scan with imperfect text recognition, and the percentage linking the Delaware company to the Maltese one is not legible; the 95%/5% split matches the February 2018 transfer of 1,140 and 60 of the 1,200 shares, while the 2020 registry analysis names Steward Health Care International Holdings Limited (UK) as the Maltese company's sole shareholder. The chart lists Nathalie Hibble and Joseph C. Maher as directors of Steward Health Care International Ltd, and Armin Ernst and Michael Callum as directors of Steward Malta Ltd, Steward Malta Management Ltd, Steward Malta Assets Ltd and Steward Malta Personnel Limited, without stating when they held these posts. ^{5 2}

analysisA 2020 analysis of Malta Business Registry filings states that the audited consolidated financial statements of the Steward Malta group for 2015 and 2016, years before the Steward takeover, were signed by Armin Ernst and Michael Callum on May 31, 2018 and filed with the registry on February 19, 2020, while the 2017 and 2018 accounts had not been filed. They show losses of €2.9 million in 2015 and €6 million in 2016, an accumulated loss of €8.9 million, and 2016 revenue of €38.9 million, of which €29.7 million came from the government allocation; the auditor referred to a material uncertainty about the group's ability to continue as a going concern. ²

analysisA Maltese news report of May 23, 2024 stated that investigators in the magisterial inquiry into the hospitals deal, conducted by Magistrate Gabriella Vella since 2019, had recommended criminal charges against 34 individuals and 31 companies. Those named included Steward CEO Ralph de la Torre and Armin Ernst, described as Vitals CEO and later managing director, for money laundering, trading in influence, criminal conspiracy and bribery of former Prime Minister Joseph Muscat, former minister Konrad Mizzi and former chief of staff Keith Schembri, with alleged document forgery also recommended against Ernst; the companies included Steward Healthcare International Limited. The report also named Vitals-side managers and the owner of a consultancy, who are private individuals. A report of May 26, 2024 on the published proces-verbal, the 1,200-page record of the inquiry, listed Ernst and Accutor AG among the “key players” identified, together with Muscat, Schembri and Mizzi; it stated that the magistrate had found no one guilty and that the Attorney General had decided to charge everyone the magistrate recommended without further investigation, with charges filed through summons. Being recommended for charges or named a “key player” is not a finding of guilt. Steward told an investigative outlet in June 2024 that it had “entered Malta in good faith” and that “We categorically deny any accusations of wrongdoing and will vigorously defend ourselves”; Accutor's owner said he preferred not to comment because he might be the subject of proceedings. According to a June 2024 investigative report, the Steward CEO had been recommended for charges but not charged, and Accutor had not been charged. By March 2026 Ernst faced charges arising from the concession, to which he pleaded not guilty, and a court had found sufficient prima facie evidence for the company Steward Healthcare Malta to stand trial; no verdict appears in the reviewed record. ^{1 2 3 4 5}

analysisAn investigative report of June 17, 2024, based on leaked company emails, stated that an April 2024 Maltese criminal inquiry report alleged that Steward had used the Swiss firm Accutor and related firms to create a “political support fund” diverting money from the hospital contract to former Prime Minister Joseph Muscat, former chief of staff Keith Schembri and former minister Konrad Mizzi; that Steward's Malta companies and Accutor had been recommended for prosecution but not formally charged; and that the U.S. Steward company was not recommended for charges, while its chief executive was recommended but not charged. These are the inquiry's allegations as reported, not court findings. The report stated that Steward paid Accutor roughly €7.6 million between 2018 and 2020, including fifteen payments totalling €5.3 million in 2018 and monthly fees of €80,000 that internal emails showed were intended for two consultants employed by Accutor, a businessman and a member of his family; that many of the payments were personally approved by Armin Ernst; and that in June 2020 Steward wired €400,000 to Accutor from its Bank of America account to cover five months of consultancy payments for the businessman. The report itself says there is no direct evidence that Steward knew the payments ended up in the alleged bribes, it does not identify the paying Steward legal entity, and no court ruling on the payments appears in the reviewed record. Steward said it “strenuously objects” to any suggestion that it gave financial favors to Maltese officials, that Accutor was hired as a “business management consultant” to help “regularise” its hospital contract, that it had “entered Malta in good faith” and that it categorically denied any accusations of wrongdoing. Ernst did not reply to the report's request for comment, and Accutor's owner said he preferred not to comment because he might be the subject of proceedings. ^{2 5}

analysisThe June 17, 2024 investigative report also quoted a November 2017 email in which Armin Ernst, described as CEO of Steward Health Care's international branch and formerly CEO of Vitals Global Healthcare (VGH), wrote that he and Steward CEO Ralph de la Torre had “shook hands” with a businessman and a member of his family, whom Ernst called the “2 major principles”, and a 2017 email in which Ernst told de la Torre that the businessman's family held a “silent 60%” of the Vitals companies. The emails are not in the reviewed record. The businessman told reporters he “was never owner nor director of VGH or any of its subsidiaries or related companies”, and Ernst did not reply to the request for comment. According to the same report, after Steward ended its agreement with Accutor in August 2020, emails and transaction records showed it began paying another Swiss company, Canberra International, controlled by the businessman's family member, and internal financial reports showed Steward paying Canberra around €450,000 in 2021–2022 for what was listed as business development. That person declined to comment because proceedings were ongoing, and no court ruling on these payments appears in the reviewed record. ²

analysisTwo Maltese news reports of March 2026 describe a court decree in the concession case differently. A report of March 4, 2026 states that, in a decree delivered by Magistrate Lara Lanfranco, the Court of Magistrates found sufficient prima facie evidence for the company Steward Healthcare Malta to be placed under a bill of indictment before the Criminal Court, that is, sent for trial, on charges including fraud, bribery, misappropriation and money laundering linked to the 2015 concession for St Luke's, Karin Grech and Gozo General hospitals, which was transferred from Vitals Global Healthcare (VGH) to Steward Healthcare in 2018. The court stated that it was not determining the company's guilt and, at this preliminary stage, rejected the defence argument that part of the prosecution's case relied on a forensic report that was an exercise in gathering information rather than admissible evidence. That report carries a correction that an earlier version wrongly said Armin Ernst, rather than the company, was set to stand trial. A report of March 5, 2026 instead describes the decree as finding sufficient prima facie evidence for Ernst, former CEO of Vitals Global Healthcare and Steward Malta, to be placed under a bill of indictment. It states that Ernst faces charges including fraud, bribery, misappropriation of funds, money laundering, conspiracy and trading in influence arising from the 2015 concession, that prosecutors allege he was the key interlocutor between the government and VGH/Steward in the negotiations, that he has pleaded not guilty, and that in separate proceedings Magistrate Rachel Montebello issued a €20 million freezing order preventing him from transferring assets without court permission. Criminal charges are allegations, and no verdict appears in the reviewed record. ^{1 2}

analysisReports differ on Ralph de la Torre's own position in Malta. A September 3, 2024 newspaper investigation reported that much of Steward Health Care International's revenue came from the public-private partnership with the government of Malta and that de la Torre and Steward Health Care International CEO Armin Ernst were “currently wanted in Malta on criminal corruption charges related to the failed deal.” A reference work states that, although the magistrate's report recommended charges against de la Torre, Maltese officials had not formally charged him as of September 2024, and a June 2024 investigative report also said he had been recommended for charges but not charged. No Maltese charge against de la Torre appears in the reviewed record, while a March 5, 2026 news report stated that Ernst faced charges arising from the concession and had pleaded not guilty. The newspaper said Steward declined to comment and a spokesperson for de la Torre did not respond. According to the reference work, Steward responded publicly to a whistleblower's September 2024 account by saying that Steward Health Care International operated “in a lawful and transparent manner throughout the period in which the company was operating Malta” and that there was “no basis to accuse Dr. de la Torre of anything.” ^{3 4 5 2}

analysisA Maltese news report of January 26, 2026 stated that the government paid an estimated €400 million in fees in the first years of the concession, that Maltese courts later found the project tainted by fraud and ordered its termination in a case brought by opposition MP Adrian Delia, and that the Steward operation left behind debts including an estimated €37 million in unpaid VAT, a €30 million loan with Bank of Valletta and numerous supplier lawsuits; it said it was unclear what assets, if any, the Maltese company held. The report does not name the debtor company for each item, and the annulment judgment and the loan and tax records are not in the reviewed record. According to the same report, in two separate judgments Maltese courts ordered Steward Malta Management Ltd, the former operator of the three hospitals, to pay close to €1 million: more than €283,000 in unpaid water and electricity bills to the state-owned utilities provider ARMS Ltd, in a ruling by Judge Lawrence Mintoff in the Court of Appeal, and €841,000 for cleaning, sanitation and upkeep services to Zenith Malta Division Ltd, in a ruling by Judge Mark Simiana. Steward argued in both cases that it was no longer liable after the courts annulled its 30-year concession, and the courts rejected the argument. The judgments themselves are not in the reviewed record, and no outcome of the VAT arrears, the bank loan or the other supplier cases appears in it. ⁶

analysisSteward Health Care System LLC's audited 2020 consolidated financial statements record that on May 11, 2020, in a related-party transaction, Steward Health Care International Holdings Ltd, the System's international operations, was transferred to a company owned by certain of the System's management equity holders and Medical Properties Trust, Inc. (MPT). The System received $200.0 million in cash for assets of approximately $27.0 million and recorded the resulting $173.0 million net cash contribution as a contribution to equity of $130.5 million after tax. In their July 15, 2025 adversary complaint, a lawsuit brought within the bankruptcy case in the U.S. Bankruptcy Court for the Southern District of Texas, the debtors allege that, as one of three interrelated transactions that closed on May 12, 2020, MPT formed a new entity with Ralph de la Torre called Manolete Health, LLC to acquire Steward Healthcare International Holdings Ltd. and its tangible assets from the debtors for approximately $200 million in cash. De la Torre's website states that in 2020 he guaranteed an approximately $200 million loan with certain personal assets, the proceeds of which Steward used, and that auditors deemed most of the proceeds of that note a capital contribution into Steward Health Care System LLC; an October 2026 trade-publication report states that he has disputed the allegations in the suit. The proceeding continued with the trustee of the SHC Creditor Litigation Trust among the plaintiffs; on July 1, 2026 the defendants, including de la Torre, filed a proposed discovery schedule, and no ruling on the merits appears in the docket extract reviewed, last updated October 13, 2026. ^{1 2 3 4 5}

analysisAn investigative report of October 2024 based on leaked documents stated that a May 2020 presentation to MPT's board described $400 million to be injected into Steward, half of it to be raised by MPT and Ralph de la Torre forming a new company to buy Steward's international rights and assets for $200 million, and that an internal Steward “Project Easter” presentation discussed “$200 million of value from Malta's intangible assets sold to Manolete,” the company created by de la Torre and MPT. The same report quoted a February 2023 email from Mark Rich saying that the $200 million cash due to be raised from the sale of the Utah hospitals would not be found by auditors: “Everyone thinks the audit of Davis/Jordan will explain this. Guess what? It won't. It's all buried probably in partner's equity.” The presentations and the email are not in the reviewed record. An MPT spokesperson told the outlet: “We strongly reject the false and misleading premise of these assertions.” Asked about the Cerberus exit deal, a spokesperson for de la Torre said the only benefit he received from the May 2020 recapitalization was to ensure that the hospitals were not put into bankruptcy in the middle of the pandemic and had sufficient funds to continue operating during COVID. A spokesperson for Rich said he resigned as CFO in 2017 and did not hold that position again until March 2023, and so was not in a position to oversee most of the instances raised. ^{6 2 3}

analysisSpanish commercial registry data reproduced from the official gazette identify Steward Health Care International S.L. (NIF B88616321) as a Madrid holding company, a sociedad limitada or private limited company, incorporated on May 18, 2020, formerly named Cordiant Healthcare Services KSA SL, with share capital of €1,203,000 and active status as of July 10, 2026. A gazette entry registered on November 3, 2020 records that the sole shareholder of the single-member company changed to Manolete Management LLC. From December 17, 2020 to July 1, 2024 the company was governed by a board of directors chaired by Ralph de la Torre, with Armin Ernst as vice-chair, and both men held individual powers of attorney from December 17, 2020. On July 1, 2024 the board was replaced by de la Torre and Ernst as joint and several administrators, and on June 27, 2025 by de la Torre as sole administrator; Ernst's power of attorney was revoked on July 10, 2026. Audalia Nexia Auditores SL is listed as auditor, including of the consolidated accounts, from February 16, 2022, with a further appointment filed on February 5, 2024. The same November 3, 2020 gazette issue records that Cordiant Health Care Services Colombia SL changed from a sole administrator, de la Torre, to two joint and several administrators, de la Torre and Ernst. ^{1 2 3 4}

analysisA September 3, 2024 newspaper investigation reported that, according to several organizational charts shared among company executives and attached to emails obtained by an investigative outlet, Ralph de la Torre had an 87.9 percent share of Steward Health Care International as of 2021; the charts are not in the reviewed record, and the report does not say which legal entity or class of interest the figure refers to. De la Torre's website states that media have attempted to conflate financial distributions with ownership and that voting shares do not equal financial distributions; the newspaper said Steward declined to comment and his spokesperson did not respond. The debtors' July 15, 2025 adversary complaint names Steward Health Care International S.L., a Spanish limited liability company, as a defendant and alleges that it owned an interest in Steward Health Care Investors LLC, received into United States bank accounts distributions that are the subject of the claims, and on January 8, 2021 received from Steward Health Care Investors LLC $4,338,274 of the $111 million dividend; on information and belief, the complaint states that de la Torre held the company's ultimate majority ownership. No ruling on the merits appears in the reviewed record, nor any statement by the Spanish company itself; an October 2026 trade-publication report stated that de la Torre has disputed the allegations in the suit, which the trustee of the SHC Creditor Litigation Trust was by then pursuing. On July 1, 2026 the defendants, including the Spanish company, filed a proposed discovery schedule, and the case was at the discovery stage. ^{5 6 7 8 9}

analysisA research institute's timeline records that on November 17, 2020 Steward's international arm acquired two hospitals in Colombia and the real estate belonging to a third, with funding from MPT; it does not name the acquiring or selling legal entities or the hospitals. A Colombian news report of September 4, 2024, citing a regional newspaper's investigation and relying partly on anonymous sources, stated that the Bogotá hospitals Hospital Universitario Clínica San Rafael and Clínica Centenario, owned by the Steward Health Care group, faced an acute financial crisis traced to the group's U.S. Chapter 11 bankruptcy filing: the general directors of both hospitals had resigned, some employees were owed up to six months' wages and medical supplies were short. The clinics attributed the non-payments to not receiving the funds they needed, some of which the government was to transfer through the maximum budgets allocated to health insurers (EPS) for treatments outside the health benefits plan. According to the same report, by mid-2024 the two hospitals had received 84.610 billion and 33.426 billion Colombian pesos respectively in direct government transfers, an unnamed source directly affected by the non-payments put the resulting deficit at up to 100 billion pesos, and the national health superintendency had not intervened; no official statement is cited for the deficit. The clinics' legal owner is not identified in the reviewed record, and Steward Health Care System LLC's audited 2020 statements say the international operations were transferred out of the System in May 2020. ^{1 2 3}