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Document and Entity Information - USD ($)	12 Months Ended
Document and Entity Information - USD ($)	Dec. 31, 2017	Feb. 28, 2018	Jun. 30, 2017
Document Information [Line Items]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2017
Document Fiscal Period Focus	FY
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST INC
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		364,694,865
Entity Public Float			$ 4,646,202,407
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2017
Document Fiscal Period Focus	FY
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer

Consolidated Balance Sheets - USD ($)
$ in Thousands

Dec. 31, 2017

Dec. 31, 2016

Real estate assets

Land

$ 639,626

$ 417,368

Buildings and improvements

4,667,150

3,550,674

Construction in progress and other

47,695

53,648

Intangible lease assets

443,134

296,176

Real estate held for sale

146,615

Net investment in direct financing leases

698,727

648,102

Mortgage loans

1,778,316

1,060,400

Gross investment in real estate assets

8,421,263

6,026,368

Accumulated depreciation

(406,855)

^[1]

(292,786)

Accumulated amortization

(48,857)

(32,339)

Net investment in real estate assets

7,965,551

5,701,243

Cash and cash equivalents

171,472

83,240

Interest and rent receivables

78,970

57,698

Straight-line rent receivables

185,592

116,861

Other loans

150,209

155,721

Other assets

468,494

303,773

Total Assets

9,020,288

6,418,536

Liabilities

Debt, net

4,898,667

2,909,341

Accounts payable and accrued expenses

211,188

207,711

Deferred revenue

18,178

19,933

Lease deposits and other obligations to tenants

57,050

28,323

Total Liabilities

5,185,083

3,165,308

Commitments and Contingencies

Equity / Capital

Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding

Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding - 364,424 shares at December 31, 2017 and 320,514 shares at December 31, 2016

364

321

Limited Partners:

Additional paid-in capital

4,333,027

3,775,336

Distributions in excess of net income

(485,932)

(434,114)

Accumulated other comprehensive loss

(26,049)

(92,903)

Treasury shares, at cost

(777)

(262)

Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)

3,820,633

3,248,378

Non-controlling interests

14,572

4,850

Total Equity / Capital

3,835,205

3,253,228

Total Liabilities and Equity / Capital

9,020,288

6,418,536

Common Units [Member]

Limited Partners:

Total Equity / Capital

364

321

MPT Operating Partnership, L.P. [Member]

Real estate assets

Land

639,626

417,368

Buildings and improvements

4,667,150

3,550,674

Construction in progress and other

47,695

53,648

Intangible lease assets

443,134

296,176

Real estate held for sale

146,615

Net investment in direct financing leases

698,727

648,102

Mortgage loans

1,778,316

1,060,400

Gross investment in real estate assets

8,421,263

6,026,368

Accumulated depreciation

(406,855)

(292,786)

Accumulated amortization

(48,857)

(32,339)

Net investment in real estate assets

7,965,551

5,701,243

Cash and cash equivalents

171,472

83,240

Interest and rent receivables

78,970

57,698

Straight-line rent receivables

185,592

116,861

Other loans

150,209

155,721

Other assets

468,494

303,773

Total Assets

9,020,288

6,418,536

Liabilities

Debt, net

4,898,667

2,909,341

Accounts payable and accrued expenses

121,465

132,868

Deferred revenue

18,178

19,933

Lease deposits and other obligations to tenants

57,050

28,323

Payable due to Medical Properties Trust, Inc.

89,333

74,453

Total Liabilities

5,184,693

3,164,918

Commitments and Contingencies

Limited Partners:

Accumulated other comprehensive loss

(26,049)

(92,903)

Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)

3,821,023

3,248,768

Non-controlling interests

14,572

4,850

Total Equity / Capital

3,835,595

3,253,618

Total Liabilities and Equity / Capital

9,020,288

6,418,536

MPT Operating Partnership, L.P. [Member] | General Partner [Member]

Equity / Capital

General partner - issued and outstanding - 3,644 units at December 31, 2017 and 3,204 units at December 31, 2016

38,489

33,436

Limited Partners:

Total Equity / Capital

38,489

33,436

MPT Operating Partnership, L.P. [Member] | Common Units [Member]

Limited Partners:

Limited Partners Capital

$ 3,808,583

$ 3,308,235

[1]	Includes accumulated depreciation in real estate held for sale of $0.5 million. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million for 2017.

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2017	Dec. 31, 2016
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	364,424,000	320,514,000
Common stock, shares outstanding	364,424,000	320,514,000
MPT Operating Partnership, L.P. [Member] \| Common Units [Member]
Limited Partners, units issued	360,780,000	317,310,000
Limited Partners, units outstanding	360,780,000	317,310,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	3,644,000	3,204,000
General partner, units outstanding	3,644,000	3,204,000
LTIP Units [Member] \| MPT Operating Partnership, L.P. [Member]
LTIP Units, shares issued	292,000	292,000
LTIP Units, shares outstanding	292,000	292,000

Consolidated Statements of Net Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Revenues
Rent billed	$ 435,782	$ 327,269	$ 247,604
Straight-line rent	65,468	41,067	23,375
Income from direct financing leases	74,495	64,307	58,715
Interest and fee income	129,000	108,494	112,184
Total revenues	704,745	541,137	441,878
Expenses
Real estate depreciation and amortization	125,106	94,374	69,867
Impairment charges		7,229
Property-related	5,811	2,712	3,792
Acquisition expenses	29,645	46,273	61,342
General and administrative	58,599	48,911	43,639
Total operating expenses	219,161	199,499	178,640
Operating income	485,584	341,638	263,238
Other income (expense)
Interest expense	(176,954)	(159,597)	(120,884)
Gain on sale of real estate and other asset dispositions, net	7,431	61,224	3,268
Earnings (losses) from equity and other interests	10,058	(1,116)	2,849
Unutilized financing fees/ debt refinancing costs	(32,574)	(22,539)	(4,367)
Other income (expense)	374	(502)	(2,674)
Income tax (expense) benefit	(2,681)	6,830	(1,503)
Net other expenses	(194,346)	(115,700)	(123,311)
Income from continuing operations	291,238	225,938	139,927
Loss from discontinued operations		(1)
Net income	291,238	225,937	139,927
Net income attributable to non-controlling interests	(1,445)	(889)	(329)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 289,793	$ 225,048	$ 139,598
Earnings per share - basic
Income from continuing operations attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.64
Loss from discontinued operations attributable to MPT common stockholders(Operating Partnership partners)	0	0	0
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.64
Weighted average shares outstanding - basic	349,902	260,414	217,997
Earnings per share - diluted
Income from continuing operations attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.63
Loss from discontinued operations attributable to MPT common stockholders(Operating Partnership partners)	0	0	0
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.63
Weighted average shares outstanding - diluted	350,441	261,072	218,304
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 435,782	$ 327,269	$ 247,604
Straight-line rent	65,468	41,067	23,375
Income from direct financing leases	74,495	64,307	58,715
Interest and fee income	129,000	108,494	112,184
Total revenues	704,745	541,137	441,878
Expenses
Real estate depreciation and amortization	125,106	94,374	69,867
Impairment charges		7,229
Property-related	5,811	2,712	3,792
Acquisition expenses	29,645	46,273	61,342
General and administrative	58,599	48,911	43,639
Total operating expenses	219,161	199,499	178,640
Operating income	485,584	341,638	263,238
Other income (expense)
Interest expense	(176,954)	(159,597)	(120,884)
Gain on sale of real estate and other asset dispositions, net	7,431	61,224	3,268
Earnings (losses) from equity and other interests	10,058	(1,116)	2,849
Unutilized financing fees/ debt refinancing costs	(32,574)	(22,539)	(4,367)
Other income (expense)	374	(502)	(2,674)
Income tax (expense) benefit	(2,681)	6,830	(1,503)
Net other expenses	(194,346)	(115,700)	(123,311)
Income from continuing operations	291,238	225,938	139,927
Loss from discontinued operations		(1)
Net income	291,238	225,937	139,927
Net income attributable to non-controlling interests	(1,445)	(889)	(329)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 289,793	$ 225,048	$ 139,598
Earnings per share - basic
Income from continuing operations attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.64
Loss from discontinued operations attributable to MPT common stockholders(Operating Partnership partners)	0	0	0
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.64
Weighted average shares outstanding - basic	349,902	260,414	217,997
Earnings per share - diluted
Income from continuing operations attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.63
Loss from discontinued operations attributable to MPT common stockholders(Operating Partnership partners)	0	0	0
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.82	$ 0.86	$ 0.63
Weighted average shares outstanding - diluted	350,441	261,072	218,304

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Net income	$ 291,238	$ 225,937	$ 139,927
Other comprehensive income (loss):
Unrealized gain on interest rate swap		2,904	3,139
Foreign currency translation gain (loss)	66,854	(22,923)	(54,109)
Total comprehensive income	358,092	205,918	88,957
Comprehensive income attributable to non-controlling interests	(1,445)	(889)	(329)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	356,647	205,029	88,628
MPT Operating Partnership, L.P. [Member]
Net income	291,238	225,937	139,927
Other comprehensive income (loss):
Unrealized gain on interest rate swap		2,904	3,139
Foreign currency translation gain (loss)	66,854	(22,923)	(54,109)
Total comprehensive income	358,092	205,918	88,957
Comprehensive income attributable to non-controlling interests	(1,445)	(889)	(329)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 356,647	$ 205,029	$ 88,628

Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	Additional Paid-in Capital [Member]	Distributions in Excess of Net Income [Member]	Treasury Stock [Member]	Common Par Value [Member]	Accumulated Other Comprehensive Loss [Member]	Non-Controlling Interests [Member]	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] Accumulated Other Comprehensive Loss [Member]	MPT Operating Partnership, L.P. [Member] Non-Controlling Interests [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	MPT Operating Partnership, L.P. [Member] Limited Partner [Member] Common Par Value [Member]	MPT Operating Partnership, L.P. [Member] Limited Partner [Member] Long Term Incentive Plan [Member]
Beginning balance at Dec. 31, 2014	$ 1,382,047	$ 1,765,381	$ (361,330)	$ (262)	$ 172	$ (21,914)		$ 1,382,437	$ (21,914)		$ 14,055	$ 1,390,296
Beginning balance (in shares) at Dec. 31, 2014					172,743						1,722	171,021	292
Net income	139,927		139,598				$ 329	139,927		$ 329	$ 1,399	$ 138,199
Sale of non-controllinginterests	5,000						5,000
Sale of non-controlling interests								5,000		5,000
Unrealized gain on interest rate swap	3,139					3,139		3,139	3,139
Foreign currency translation gain (loss)	(54,109)					(54,109)		(54,109)	(54,109)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,122	11,120			$ 2			11,122			$ 111	$ 11,011
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)					751						8	743
Distributions to non-controlling interests	(332)						(332)	(332)		(332)
Proceeds from offering (net of offering costs)	817,389	817,326			$ 63			817,389			$ 8,175	$ 809,214
Proceeds from offering (net of offering costs) (shares)					63,250						633	62,617
Dividends (Distributions) declared ($0.88 in 2015, 0.91 in 2016 and 0.96 in 2017 per common share/ unit)	(196,918)		(196,918)					(196,918)			$ (1,967)	$ (194,951)
Ending balance at Dec. 31, 2015	2,107,265	2,593,827	(418,650)	(262)	$ 237	(72,884)	4,997	2,107,655	(72,884)	4,997	$ 21,773	$ 2,153,769
Ending balance (in shares) at Dec. 31, 2015					236,744						2,363	234,381	292
Net income	225,937		225,048				889	225,937		889	$ 2,251	$ 222,797
Unrealized gain on interest rate swap	2,904					2,904		2,904	2,904
Foreign currency translation gain (loss)	(22,923)					(22,923)		(22,923)	(22,923)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	7,942	7,941			$ 1			7,942			$ 80	$ 7,862
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)					1,021						10	1,011
Distributions to non-controlling interests	(1,036)						(1,036)	(1,036)		(1,036)
Proceeds from offering (net of offering costs)	1,173,651	1,173,568			$ 83			1,173,651			$ 11,737	$ 1,161,914
Proceeds from offering (net of offering costs) (shares)					82,749						831	81,918
Dividends (Distributions) declared ($0.88 in 2015, 0.91 in 2016 and 0.96 in 2017 per common share/ unit)	(240,512)		(240,512)					(240,512)			$ (2,405)	$ (238,107)
Ending balance at Dec. 31, 2016	3,253,228	3,775,336	(434,114)	(262)	$ 321	(92,903)	4,850	3,253,618	(92,903)	4,850	$ 33,436	$ 3,308,235
Ending balance (in shares) at Dec. 31, 2016					320,514						3,204	317,310	292
Net income	291,238		289,793				1,445	291,238		1,445	$ 2,898	$ 286,895
Sale of non-controllinginterests	10,000						10,000	10,000		10,000
Foreign currency translation gain (loss)	66,854					66,854		66,854	66,854
Stock (Unit) vesting and amortization of stock (unit)-based compensation	9,949	9,949						9,949			$ 99	$ 9,850
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)					785						9	776
Treasury stock acquired (41,270 shares)	(515)			(515)
Treasury stock acquired (41,270 shares)								(515)			$ (6)	$ (509)
Distributions to non-controlling interests	(1,723)						(1,723)	(1,723)		(1,723)
Proceeds from offering (net of offering costs)	547,785	547,742			$ 43			547,785			$ 5,478	$ 542,307
Proceeds from offering (net of offering costs) (shares)					43,125						431	42,694
Dividends (Distributions) declared ($0.88 in 2015, 0.91 in 2016 and 0.96 in 2017 per common share/ unit)	(341,611)		(341,611)					(341,611)			$ (3,416)	$ (338,195)
Ending balance at Dec. 31, 2017	$ 3,835,205	$ 4,333,027	$ (485,932)	$ (777)	$ 364	$ (26,049)	$ 14,572	$ 3,835,595	$ (26,049)	$ 14,572	$ 38,489	$ 3,808,583
Ending balance (in shares) at Dec. 31, 2017					364,424						3,644	360,780	292

Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Treasury stock acquired (shares)	41,270
Dividends (Distributions) declared per common share / unit	$ 0.96	$ 0.91	$ 0.88
Distributions in Excess of Net Income [Member]
Dividends (Distributions) declared per common share / unit	$ 0.96	0.91	0.88
Treasury Stock [Member]
Treasury stock acquired (shares)	41,270
MPT Operating Partnership, L.P. [Member]
Treasury stock acquired (shares)	41,270
Dividends (Distributions) declared per common share / unit	$ 0.96	0.91	0.88
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
Treasury stock acquired (shares)	41,270
Dividends (Distributions) declared per common share / unit	$ 0.96	0.91	0.88
Limited Partner [Member] \| MPT Operating Partnership, L.P. [Member] \| Common Par Value [Member]
Treasury stock acquired (shares)	41,270
Dividends (Distributions) declared per common share / unit	$ 0.96	$ 0.91	$ 0.88

Consolidated Statements of Cash Flows $ in Thousands	12 Months Ended
Consolidated Statements of Cash Flows $ in Thousands	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Operating activities
Net income	$ 291,238	$ 225,937	$ 139,927
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	131,979	97,601	71,827
Amortization of deferred financing costs and debt discount	6,521	7,613	6,085
Direct financing lease interest accretion	(9,933)	(9,120)	(8,032)
Straight-line rent revenue	(70,808)	(41,567)	(26,187)
Share / (Unit)-based compensation expense	9,949	7,942	11,122
Gain from sale of real estate and other asset dispositions, net	(7,431)	(61,224)	(3,268)
Impairment charges		7,229
Straight-line rent and other write-off	5,340	3,063	2,812
Unutilized financing fees/ debt refinancing costs	32,574	22,539	4,367
Other adjustments	(1,204)	3,563	(6,334)
Decrease (increase) in:
Interest and rent receivables	(21,116)	(13,247)	(5,599)
Other assets	(4,452)	(18,357)	(8,297)
Accounts payable and accrued expenses	2,494	41,583	26,540
Deferred revenue	(2,050)	(8,872)	2,033
Net cash provided by operating activities	363,101	264,683	206,996
Investing activities
Cash paid for acquisitions and other related investments	(2,246,788)	(1,682,409)	(2,218,869)
Net proceeds from sale of real estate	64,362	198,767	19,175
Principal received on loans receivable	8,480	906,757	771,785
Investment in loans receivable	(19,338)	(109,027)	(354,001)
Construction in progress and other	(73,812)	(171,209)	(146,372)
Investment in unsecured senior notes		(50,000)
Proceeds from sale of unsecured notes		50,000
Other investments, net	(94,970)	(69,423)	(17,339)
Net cash used for investing activities	(2,362,066)	(926,544)	(1,945,621)
Financing activities
Proceeds from term debt	2,355,280	1,000,000	681,000
Payments of term debt	(1,038,221)	(575,299)	(283)
Payment of deferred financing costs	(32,794)	(15,468)	(7,686)
Revolving credit facilities, net	550,415	(810,000)	509,415
Distributions paid	(326,729)	(218,393)	(182,980)
Lease deposits and other obligations to tenants	27,525	14,557	(10,839)
Proceeds from sale of common shares, net of offering costs	547,785	1,173,651	817,389
Other financing activities	(12,984)	(16,485)	(5,326)
Net cash provided by financing activities	2,070,277	552,563	1,800,690
Increase (decrease) in cash and cash equivalents for the year	71,312	(109,298)	62,065
Effect of exchange rate changes	16,920	(3,003)	(11,065)
Cash and cash equivalents at beginning of year	83,240	195,541	144,541
Cash and cash equivalents at end of year	171,472	83,240	195,541
Interest paid, including capitalized interest of $840 in 2017, $2,320 in 2016, and $1,425 in 2015	149,798	138,770	107,228
Supplemental schedule of non-cash investing activities:
(Decrease) increase in development project construction costs incurred, not paid	(18,805)	15,857	2,684
Supplemental schedule of non-cash financing activities:
Dividends declared, not paid	89,403	74,521	52,402
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	291,238	225,937	139,927
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	131,979	97,601	71,827
Amortization of deferred financing costs and debt discount	6,521	7,613	6,085
Direct financing lease interest accretion	(9,933)	(9,120)	(8,032)
Straight-line rent revenue	(70,808)	(41,567)	(26,187)
Share / (Unit)-based compensation expense	9,949	7,942	11,122
Gain from sale of real estate and other asset dispositions, net	(7,431)	(61,224)	(3,268)
Impairment charges		7,229
Straight-line rent and other write-off	5,340	3,063	2,812
Unutilized financing fees/ debt refinancing costs	32,574	22,539	4,367
Other adjustments	(1,204)	3,563	(6,334)
Decrease (increase) in:
Interest and rent receivables	(21,116)	(13,247)	(5,599)
Other assets	(4,452)	(18,357)	(8,297)
Accounts payable and accrued expenses	2,494	41,583	26,540
Deferred revenue	(2,050)	(8,872)	2,033
Net cash provided by operating activities	363,101	264,683	206,996
Investing activities
Cash paid for acquisitions and other related investments	(2,246,788)	(1,682,409)	(2,218,869)
Net proceeds from sale of real estate	64,362	198,767	19,175
Principal received on loans receivable	8,480	906,757	771,785
Investment in loans receivable	(19,338)	(109,027)	(354,001)
Construction in progress and other	(73,812)	(171,209)	(146,372)
Investment in unsecured senior notes		(50,000)
Proceeds from sale of unsecured notes		50,000
Other investments, net	(94,970)	(69,423)	(17,339)
Net cash used for investing activities	(2,362,066)	(926,544)	(1,945,621)
Financing activities
Proceeds from term debt	2,355,280	1,000,000	681,000
Payments of term debt	(1,038,221)	(575,299)	(283)
Payment of deferred financing costs	(32,794)	(15,468)	(7,686)
Revolving credit facilities, net	550,415	(810,000)	509,415
Distributions paid	(326,729)	(218,393)	(182,980)
Lease deposits and other obligations to tenants	27,525	14,557	(10,839)
Proceeds from sale of common shares, net of offering costs	547,785	1,173,651	817,389
Other financing activities	(12,984)	(16,485)	(5,326)
Net cash provided by financing activities	2,070,277	552,563	1,800,690
Increase (decrease) in cash and cash equivalents for the year	71,312	(109,298)	62,065
Effect of exchange rate changes	16,920	(3,003)	(11,065)
Cash and cash equivalents at beginning of year	83,240	195,541	144,541
Cash and cash equivalents at end of year	171,472	83,240	195,541
Interest paid, including capitalized interest of $840 in 2017, $2,320 in 2016, and $1,425 in 2015	149,798	138,770	107,228
Supplemental schedule of non-cash investing activities:
(Decrease) increase in development project construction costs incurred, not paid	(18,805)	15,857	2,684
Supplemental schedule of non-cash financing activities:
Dividends declared, not paid	$ 89,403	$ 74,521	$ 52,402

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Interest paid, capitalized	$ 840	$ 2,320	$ 1,425
MPT Operating Partnership, L.P. [Member]
Interest paid, capitalized	$ 840	$ 2,320	$ 1,425

Organization	12 Months Ended
Organization	Dec. 31, 2017
Accounting Policies [Abstract]
Organization	1. Organization Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the General Corporation Law of Maryland for the purpose of engaging in the business of investing in, owning, and leasing healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., through which we conduct all of our operations, was formed in September 2003. Through another wholly-owned subsidiary, Medical Properties Trust, LLC, we are the sole general partner of the Operating Partnership. At present, we directly own substantially all of the limited partnership interests in the Operating Partnership and have elected to report our required disclosures and that of the Operating Partnership on a combined basis, except where material differences exist. We have operated as a real estate investment trust (“REIT”) since April 6, 2004, and accordingly, elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will generally not be subject to United States (“U.S.”) federal income tax, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income. Our primary business strategy is to acquire and develop real estate and improvements, primarily for long-term lease to providers of healthcare services such as operators of general acute care hospitals, inpatient physical rehabilitation hospitals, long-term acute care hospitals, surgery centers, centers for treatment of specific conditions such as cardiac, pulmonary, cancer, and neurological hospitals, and other healthcare-oriented facilities. We also make mortgage and other loans to operators of similar facilities. In addition, we may obtain profits or equity interests in our tenants, from time to time, in order to enhance our overall return. We manage our business as a single business segment. All of our properties are located in the U.S. and Europe.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Use of Estimates: The preparation of financial statements in conformity with accounting principles generally accepted in the U.S. requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Principles of Consolidation: Property holding entities and other subsidiaries of which we own 100% of the equity or have a controlling financial interest evidenced by ownership of a majority voting interest are consolidated. All inter-company balances and transactions are eliminated. For entities in which we own less than 100% of the equity interest, we consolidate the property if we have the direct or indirect ability to control the entities’ activities based upon the terms of the respective entities’ ownership agreements. For these entities, we record a non-controlling interest representing equity held by non-controlling interests.

We continually evaluate all of our transactions and investments to determine if they represent variable interests in a variable interest entity (“VIE”). If we determine that we have a variable interest in a VIE, we then evaluate if we are the primary beneficiary of the VIE. The evaluation is a qualitative assessment as to whether we have the ability to direct the activities of a VIE that most significantly impact the entity’s economic performance. We consolidate each VIE in which we, by virtue of or transactions with our investments in the entity, are considered to be the primary beneficiary.

At December 31, 2017, we had loans and/or equity investments in certain VIEs, which are also tenants of our facilities. We have determined that we are not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at December 31, 2017 (in thousands):


VIE Type	Maximum Loss Exposure(1)		Asset Type Classification	Carrying Amount(2)
Loans, net	$	333,398	Mortgage and other loans	$	234,386
Equity investments	$	13,367	Other assets	$	—

(1)

Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investment in VIEs represent the current carrying values of such investment plus any other related assets (such as rent receivables) less any liabilities.

(2)	Carrying amount reflects the net book value of our loan or equity interest only in the VIE.

For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance. As of December 31, 2017, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which it could be exposed to further losses (e.g., cash short falls).

Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower.

See Note 3 and 10 for additional description of the nature, purpose and activities of some of our VIEs (such as Ernest Health, Inc. (“Ernest”)) and interests therein.

Investments in Unconsolidated Entities: Investments in entities in which we have the ability to significantly influence (but not control) are accounted for by the equity method. Under the equity method of accounting, our share of the investee’s earnings or losses are included in our consolidated statements of net income, and we have elected to record our share of such investee’s earnings or losses on a 90-day lag basis. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the interest in the investee entity. Subsequently, our investments are increased/decreased by our share in the investees’ earnings/losses and decreased by cash distributions from our investees. To the extent that our cost basis is different from the basis reflected at the investee entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the investee.

Investments in entities in which we do not control nor do we have the ability to significantly influence (such as our investments in Steward Health Care System LLC (“Steward”) and Median Kliniken S.á.r.l. (“MEDIAN”) are accounted for using the cost method. The initial carrying value of such investments is based on the amount paid to purchase the interest in the investee entity. No income is recorded on our cost method investments until distributions are received.

We evaluate our equity and cost method investments for impairment based upon a comparison of the fair value of the equity method investment to its carrying value, when impairment indicators exist. If we determine a decline in the fair value of an investment in an unconsolidated investee entity below its carrying value is other-than-temporary, an impairment is recorded.

Cash and Cash Equivalents: Certificates of deposit, short-term investments with original maturities of three months or less and money-market mutual funds are considered cash equivalents. The majority of our cash and cash equivalents are held at major commercial banks, which at times may exceed the Federal Deposit Insurance Corporation limit. We have not experienced any losses to date on our invested cash. Cash and cash equivalents which have been restricted as to its use are recorded in other assets.

Revenue Recognition: We receive income from operating leases based on the fixed, minimum required rents (base rents) per the lease agreements. Rent revenue from base rents is recorded on the straight-line method over the terms of the related lease agreements for new leases and the remaining terms of existing leases for those acquired as part of a property acquisition. The straight-line method records the periodic average amount of base rent earned over the term of a lease, taking into account contractual rent increases over the lease term. The straight-line method typically has the effect of recording more rent revenue from a lease than a tenant is required to pay early in the term of the lease. During the later parts of a lease term, this effect reverses with less rent revenue recorded than a tenant is required to pay. Rent revenue, as recorded on the straight-line method, in the consolidated statements of net income is presented as two amounts: rent billed and straight-line revenue. Rent billed revenue is the amount of base rent actually billed to our tenants each period as required by the lease. Straight-line rent revenue is the difference between rent revenue earned based on the straight-line method and the amount recorded as rent billed revenue. We record the difference between base rent revenues earned and amounts due per the respective lease agreements, as applicable, as an increase or decrease to straight-line rent receivable.

We also receive additional rent (contingent rent) under some leases based on increases in the consumer price index (“CPI”) or when CPI exceeds the annual minimum percentage increase as stipulated in the lease. Contingent rents are recorded as rent billed revenue in the period earned. Rental payments received prior to their recognition as income are classified as deferred revenue.

We use direct financial lease (“DFL”) accounting to record rent on certain leases deemed to be financing leases, per accounting rules, rather than operating leases. For leases accounted for as DFLs, the future minimum lease payments are recorded as a receivable. The difference between the future minimum lease payments and the estimated residual values less the cost of the properties is recorded as unearned income. Unearned income is deferred and amortized to income over the lease terms to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unearned income.

We begin recording base rent income from our development projects when the lessee takes physical possession of the facility, which may be different from the stated start date of the lease. Also, during construction of our development projects, we may be entitled to accrue rent based on the cost paid during the construction period (construction period rent). We accrue construction period rent as a receivable with a corresponding offset to deferred revenue during the construction period. When the lessee takes physical possession of the facility, we begin recognizing the deferred construction period revenue on the straight-line method over the term of the lease.

We receive interest income from our tenants/borrowers on mortgage loans, working capital loans, and other long-term loans. Interest income from these loans is recognized as earned based upon the principal outstanding and terms of the loans.

Commitment fees received from lessees for development and leasing services are initially recorded as deferred revenue and recognized as income over the initial term of a lease to produce a constant effective yield on the lease (interest method). Commitment and origination fees from lending services are also recorded as deferred revenue initially and recognized as income over the life of the loan using the interest method.

Tenant payments for certain taxes, insurance, and other operating expenses related to our facilities (most of which are paid directly by our tenants to the government or appropriate third party vendor) are recorded net of the respective expense as generally our leases are “triple-net” leases, with terms requiring such expenses to be paid by our tenants. Failure on the part of our tenants to pay such expense or to pay late would result in a violation of the lease agreement, which could lead to an event of default, if not cured.

Acquired Real Estate Purchase Price Allocation: For properties acquired for leasing purposes, we currently account for such acquisitions based on business combination accounting rules. We allocate the purchase price of acquired properties to tangible and identified intangible assets acquired based on their fair values. In making estimates of fair values for purposes of allocating purchase prices of acquired real estate, we may utilize a number of sources, from time to time, including available real estate broker data, independent appraisals that may be obtained in connection with the acquisition or financing of the respective property, internal data from previous acquisitions or developments, and other market data. We also consider information obtained about each property as a result of our pre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the tangible and intangible assets acquired.

We measure the aggregate value of lease intangible assets acquired based on the difference between (i) the property valued with new or in-place leases adjusted to market rental rates and (ii) the property valued as if vacant. Management’s estimates of value are made using methods similar to those used by independent appraisers (e.g., discounted cash flow analysis). Factors considered by management in our analysis include an estimate of carrying costs during hypothetical expected lease-up periods, considering current market conditions, and costs to execute similar leases. We also consider information obtained about each targeted facility as a result of our pre-acquisition due diligence, marketing, and leasing activities in estimating the fair value of the intangible assets acquired. In estimating carrying costs, management includes real estate taxes, insurance and other operating expenses and estimates of lost rentals at market rates during the expected lease-up periods, which we expect to be about six months depending on specific local market conditions. Management also estimates costs to execute similar leases including leasing commissions, legal costs, and other related expenses to the extent that such costs are not already incurred in connection with a new lease origination as part of the transaction.

We record above-market and below-market in-place lease values, if any, for our facilities, which are based on the present value of the difference between (i) the contractual amounts to be paid pursuant to the in-place leases and (ii) management’s estimate of fair market lease rates for the corresponding in-place leases, measured over a period equal to the remaining non-cancelable term of the lease. We amortize any resulting capitalized above-market lease values as a reduction of rental income over the lease term. We amortize any resulting capitalized below-market lease values as an increase to rental income over the lease term.

Other intangible assets acquired may include customer relationship intangible values which are based on management’s evaluation of the specific characteristics of each prospective tenant’s lease and our overall relationship with that tenant. Characteristics to be considered by management in allocating these values include the nature and extent of our existing business relationships with the tenant, growth prospects for developing new business with the tenant, the tenant’s credit quality and expectations of lease renewals, including those existing under the terms of the lease agreement, among other factors.

We amortize the value of these intangible assets to expense over the term of the respective leases. If a lease is terminated early, the unamortized portion of the lease intangibles are charged to expense.

Goodwill: Goodwill, included in other assets on the balance sheet, is deemed to have an indefinite economic life and is not subject to amortization. Goodwill is tested annually for impairment and is tested for impairment more frequently if events and circumstances indicate that the asset might be impaired. To test for impairment, we first assess qualitative factors, such as current macroeconomic conditions and our overall financial and operating performance, to determine the likelihood that the fair value of a reporting unit is less than its carrying amount. If we determine it is more likely than not that the fair value of a reporting unit is less than its carrying amount, we proceed with the two-step approach to evaluating impairment. First, we estimate the fair value of the reporting unit and compare it to the reporting unit’s carrying value. If the carrying value exceeds fair value, we proceed with the second step, which requires us to assign the fair value of the reporting unit to all of the assets and liabilities of the reporting unit as if it had been acquired in a business combination at the date of the impairment test. The excess fair value of the reporting unit over the amounts assigned to the assets and liabilities is the implied value of goodwill and is used to determine the amount of impairment. We recognize an impairment loss to the extent the carrying value of goodwill exceeds the implied value in the current period.

Real Estate and Depreciation: Real estate, consisting of land, buildings and improvements, are maintained at cost. Although typically paid by our tenants, any expenditure for ordinary maintenance and repairs that we pay are expensed to operations as incurred. Significant renovations and improvements which improve and/or extend the useful life of the asset are capitalized and depreciated over their estimated useful lives. We record impairment losses on long-lived assets used in operations when events and circumstances indicate that the assets might be impaired and the undiscounted cash flows estimated to be generated by those assets, including an estimated liquidation amount, during the expected holding periods are less than the carrying amounts of those assets. Impairment losses are measured as the difference between carrying value and fair value of the assets. For assets held for sale, we cease recording depreciation expense and adjust the assets’ value to the lower of its carrying value or fair value, less cost of disposal. Fair value is based on estimated cash flows discounted at a risk-adjusted rate of interest. We classify real estate assets as held for sale when we have commenced an active program to sell the assets, and in the opinion of management, it is probable the asset will be sold within the next 12 months.

Construction in progress includes the cost of land, the cost of construction of buildings, improvements and fixed equipment, and costs for design and engineering. Other costs, such as interest, legal, property taxes and corporate project supervision, which can be directly associated with the project during construction, are also included in construction in progress. We commence capitalization of costs associated with a development project when the development of the future asset is probable and activities necessary to get the underlying property ready for its intended use have been initiated. We stop the capitalization of costs when the property is substantially complete and ready for its intended use.

Depreciation is calculated on the straight-line method over the estimated useful lives of the related real estate and other assets. Our weighted average useful lives at December 31, 2017 are as follows:


Buildings and improvements			39.1 years
Tenant lease intangibles			26.5 years
Leasehold improvements			18.2 years
Furniture, equipment and other			9.8 years

Losses from Rent Receivables: For all leases, we continuously monitor the performance of our existing tenants including, but not limited to: admission levels and surgery/procedure volumes by type; current operating margins; ratio of our tenants’ operating margins both to facility rent and to facility rent plus other fixed costs; trends in cash collections; trends in revenue and patient mix; and the effect of evolving healthcare regulations on tenants’ profitability and liquidity.

Losses from Operating Lease Receivables: We utilize the information above along with the tenant’s payment and default history in evaluating (on a property-by-property basis) whether or not a provision for losses on outstanding rent receivables is needed. A provision for losses on rent receivables (including straight-line rent receivables) is ultimately recorded when it becomes probable that the receivable will not be collected in full. The provision is an amount which reduces the receivable to its estimated net realizable value based on a determination of the eventual amounts to be collected either from the debtor or from existing collateral, if any.

Losses on DFL Receivables: Allowances are established for DFLs based upon an estimate of probable losses on a property-by-property basis. DFLs are impaired when it is deemed probable that we will be unable to collect all amounts due in accordance with the contractual terms of the lease. Like operating lease receivables, the need for an allowance is based upon our assessment of the lessee’s overall financial condition; economic resources and payment record; the prospects for support from any financially responsible guarantors; and, if appropriate, the realizable value of any collateral. These estimates consider all available evidence including the expected future cash flows discounted at the DFL’s effective interest rate, fair value of collateral, and other relevant factors, as appropriate. DFLs are placed on non-accrual status when we determine that the collectability of contractual amounts is not reasonably assured. If on non-accrual status, we generally account for the DFLs on a cash basis, in which income is recognized only upon receipt of cash.

Loans: Loans consist of mortgage loans, working capital loans and other long-term loans. Mortgage loans are collateralized by interests in real property. Working capital and other long-term loans are generally collateralized by interests in receivables and corporate and individual guarantees. We record loans at cost. We evaluate the collectability of both interest and principal on a loan-by-loan basis (using the same process as we do for assessing the collectability of rents) to determine whether they are impaired. A loan is considered impaired when, based on current information and events, it is probable that we will be unable to collect all amounts due according to the existing contractual terms. When a loan is considered to be impaired, the amount of the allowance is calculated by comparing the recorded investment to either the value determined by discounting the expected future cash flows using the loan’s effective interest rate or to the fair value of the collateral, if the loan is collateral dependent. If a loan is deemed to be impaired, we generally place the loan on non-accrual status and record interest income only upon receipt of cash.

Earnings Per Share/Units: Basic earnings per common share/unit is computed by dividing net income applicable to common shares/units by the weighted number of shares/units of common stock/units outstanding during the period. Diluted earnings per common share/units is calculated by including the effect of dilutive securities.

Our unvested restricted stock/unit awards contain non-forfeitable rights to dividends, and accordingly, these awards are deemed to be participating securities. These participating securities are included in the earnings allocation in computing both basic and diluted earnings per common share/unit.

Income Taxes: We conduct our business as a REIT under Sections 856 through 860 of the Internal Revenue Code of 1986, as amended (“the Code”). To qualify as a REIT, we must meet certain organizational and operational requirements, including a requirement to distribute to stockholders at least 90% of our REIT’s ordinary taxable income. As a REIT, we generally pay little U.S. federal and state income tax because of the dividends paid deduction that we are allowed to take. If we fail to qualify as a REIT in any taxable year, we will then be subject to U.S. federal income taxes on our taxable income at regular corporate rates and will not be permitted to qualify for treatment as a REIT for federal income tax purposes for four years following the year during which qualification is lost, unless the Internal Revenue Service grants us relief under certain statutory provisions. Such an event could materially adversely affect our net income and net cash available for distribution to stockholders. However, we intend to operate in such a manner so that we will remain qualified as a REIT for U.S. federal income tax purposes.

Our financial statements include the operations of taxable REIT subsidiaries (“TRS”), including MPT Development Services, Inc. (“MDS”), and with many other entities, which are single member LLCs that are disregarded for tax purposes and are reflected in the tax returns of MDS. Our TRS entities are not entitled to a dividends paid deduction and are subject to U.S. federal, state, and local income taxes. Our TRS entities are authorized to provide property development, leasing, and management services for third-party owned properties, and they may make loans to and/or investments in our lessees.

With the property acquisitions and investments in Europe, we are subject to income taxes internationally. However, we do not expect to incur any additional income taxes in the U.S. as such income from our international properties will flow through our REIT income tax returns. For our TRS and international subsidiaries, we determine deferred tax assets and liabilities based on the differences between the financial reporting and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Any increase or decrease in our deferred tax receivables/liabilities that results from a change in circumstances and that causes us to change our judgment about expected future tax consequences of events, is reflected in our tax provision when such changes occur. Deferred income taxes also reflect the impact of operating loss carryforwards. A valuation allowance is provided if we believe it is more likely than not that all or some portion of our deferred tax assets will not be realized. Any increase or decrease in the valuation allowance that results from a change in circumstances, and that causes us to change our judgment about our ability to realize the related deferred tax asset, is reflected in our tax provision when such changes occur.

The calculation of our income taxes involve dealing with uncertainties in the application of complex tax laws and regulations in a multitude of jurisdictions across our global operations. An income tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, on the basis of technical merits. However, if a more likely than not position cannot be reached, we record a liability as an off-set to the tax benefit and adjust the liabilities when our judgment changes as a result of the evaluation of new information not previously available. Because of the complexity of some of these uncertainties, the ultimate resolution may result in a payment that is materially different from our current estimate of the uncertain tax position liabilities. These differences will be reflected as increases or decreases to income tax expense in the period in which new information is available.

Stock-Based Compensation: We adopted the 2013 Equity Incentive Plan (the “Equity Incentive Plan”) during the second quarter of 2013. Awards of restricted stock, stock options and other equity-based awards with service conditions are amortized to compensation expense over the vesting periods (typically three years), using the straight-line method. Awards that contain market conditions are amortized to compensation expense over the derived vesting periods, which correspond to the periods over which we estimate the awards will be earned, which generally range from three to five years, using the straight-line method. Awards with performance conditions are amortized using the straight-line method over the service period in which the performance conditions are measured, adjusted for the probability of achieving the performance conditions. Forfeitures of stock-based awards are recognized as they occur.

Deferred Costs: Costs incurred that directly relate to the offerings of stock are deferred and netted against proceeds received from the offering. Leasing commissions and other leasing costs directly attributable to tenant leases are capitalized as deferred leasing costs and amortized on the straight-line method over the terms of the related lease agreements. Costs identifiable with loans made to borrowers are recognized as a reduction in interest income over the life of the loan.

Deferred Financing Costs: We generally capitalize financing costs incurred in connection with new financings and refinancings of debt. These costs are amortized over the lives of the related debt as an addition to interest expense. For debt with defined principal re-payment terms, the deferred costs are amortized to produce a constant effective yield on the debt (interest method) and are included within Debt, net on our consolidated balance sheets. For debt without defined principal repayment terms, such as revolving credit agreements, the deferred costs are amortized on the straight-line method over the term of the debt and are included as a component of Other Assets on our consolidated balance sheets.

Foreign Currency Translation and Transactions: Certain of our international subsidiaries’ functional currencies are the local currencies of their respective countries. We translate the results of operations of our foreign subsidiaries into U.S. dollars using average rates of exchange in effect during the period, and we translate balance sheet accounts using exchange rates in effect at the end of the period. We record resulting currency translation adjustments in accumulated other comprehensive income (loss), a component of stockholders’ equity on our consolidated balance sheets.

Certain of our U.S. subsidiaries will enter into short-term and long-term transactions denominated in a foreign currency from time to time. Gains or losses resulting from these foreign currency transactions are translated into U.S. dollars at the rates of exchange prevailing at the dates of the transactions. The effects of transaction gains or losses on our short-term transactions are included in other income in the consolidated statements of income, while the translation effects on our long-term investments are recorded in accumulated other comprehensive income (loss) on our consolidated balance sheets.

Derivative Financial Investments and Hedging Activities: During our normal course of business, we may use certain types of derivative instruments for the purpose of managing interest rate and/or foreign currency risk. We record our derivative and hedging instruments at fair value on the balance sheet. Changes in the estimated fair value of derivative instruments that are not designated as hedges or that do not meet the criteria for hedge accounting are recognized in earnings. For derivatives designated as cash flow hedges, the change in the estimated fair value of the effective portion of the derivative is recognized in accumulated other comprehensive income (loss) on our consolidated balance sheets, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings. For derivatives designated as fair value hedges, the change in the estimated fair value of the effective portion of the derivatives offsets the change in the estimated fair value of the hedged item, whereas the change in the estimated fair value of the ineffective portion is recognized in earnings. There was no derivative or hedging activity in place during the year ended December 31, 2017.

To qualify for hedge accounting, we formally document all relationships between hedging instruments and hedged items, as well as our risk management objective and strategy for undertaking the hedge prior to entering into a derivative transaction. This process includes specific identification of the hedging instrument and the hedge transaction, the nature of the risk being hedged and how the hedging instrument’s effectiveness in hedging the exposure to the hedged transaction’s variability in cash flows attributable to the hedged risk will be assessed. Both at the inception of the hedge and on an ongoing basis, we assess whether the derivatives that are used in hedging transactions are highly effective in offsetting changes in cash flows or fair values of hedged items. In addition, for cash flow hedges, we assess whether the underlying forecasted transaction will occur. We discontinue hedge accounting if a derivative is not determined to be highly effective as a hedge or that it is probable that the underlying forecasted transaction will not occur.

Fair Value Measurement: We measure and disclose the estimated fair value of financial assets and liabilities utilizing a hierarchy of valuation techniques based on whether the inputs to a fair value measurement are considered to be observable or unobservable in a marketplace. Observable inputs reflect market data obtained from independent sources, while unobservable inputs reflect our market assumptions. This hierarchy requires the use of observable market data when available. These inputs have created the following fair value hierarchy:

•

Level 1 — quoted prices for identical instruments in active markets;

•

Level 2 — quoted prices for similar instruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations in which significant inputs and significant value drivers are observable in active markets; and

•

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

We measure fair value using a set of standardized procedures that are outlined herein for all assets and liabilities which are required to be measured at their estimated fair value on either a recurring or non-recurring basis. When available, we utilize quoted market prices from an independent third party source to determine fair value and classify such items in Level 1. In some instances where a market price is available, but the instrument is in an inactive or over-the-counter market, we apply the dealer (market maker) pricing estimate and classify the asset or liability in Level 2.

If quoted market prices or inputs are not available, fair value measurements are based upon valuation models that utilize current market or independently sourced market inputs, such as interest rates, option volatilities, credit spreads, market capitalization rates, etc. Items valued using such internally-generated valuation techniques are classified according to the lowest level input that is significant to the fair value measurement. As a result, the asset or liability could be classified in either Level 2 or 3 even though there may be some significant inputs that are readily observable. Internal fair value models and techniques used by us include discounted cash flow and Monte Carlo valuation models. We also consider our counterparty’s and own credit risk on derivatives and other liabilities measured at their estimated fair value.

Fair Value Option Election: For our equity interest in Ernest along with any related loans (as more fully described in Note 3 and 10), we have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other equity interests or loans that existed at December 31, 2017.

Recent Accounting Developments:

Revenue from Contracts with Customers

In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. This standard is effective for us beginning January 1, 2018, and we plan to adopt under the modified retrospective method. We do not expect this standard to have a significant impact on our financial results upon adoption, as a substantial portion of our revenue consists of rental income from leasing arrangements and interest income from loans, which are specifically excluded from ASU No. 2014-09. Under ASU No. 2014-09, we do expect more transactions to qualify as sales of real estate with gains on sales being recognized earlier than under current accounting guidance, as the new guidance is based on transfer of control versus whether or not the seller has continuing involvement. Thus, we expect to record an approximate $2 million adjustment to retained earnings upon adoption of ASU No. 2014-09 to fully recognize a gain on real estate sold in prior years that was required to be deferred under existing accounting guidance.

Clarifying the Definition of a Business

In January 2017, the FASB issued ASU No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”). The amendments in ASU 2017-01 provide an initial screen to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, in which case, the transaction would be accounted for as an asset acquisition rather than as a business combination. In addition, ASU 2017-01 clarifies the requirements for a set of activities to be considered a business and narrows the definition of an output. We plan to adopt ASU 2017-01 on January 1, 2018 using the prospective method. Upon adoption, we expect to recognize a majority of our real estate acquisitions as asset transactions rather than business combinations, which will result in the capitalization of third party transaction costs that are directly related to an acquisition and significantly decrease acquisition expenses. Indirect and internal transaction costs will continue to be expensed, but we do not expect to include these costs as an adjustment in deriving normalized funds from operations in the future. We expect this change in accounting, once adopted, may decrease our normalized funds from operations by $1 million to $2 million per quarter.

Leases

In February 2016, the FASB issued ASU 2016-02, “Leases”, which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either financing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases.

We expect to adopt this new standard on January 1, 2019. We are continuing to evaluate this standard and the impact to us from both a lessor and lessee perspective. We do have leases in which we are the lessee, including ground leases, on which certain of our facilities reside, along with corporate office and equipment leases, that will be required to be recorded on our balance sheet upon adoption of this standard. From a lessor perspective, we do expect certain non-lease components (including property taxes, insurance and other operating expenses that the tenants of our facilities are required to pay pursuant to our “triple-net” leases) to be recorded gross versus net of the respective expenses upon adoption of this standard in 2019 in accordance with ASU No. 2014-09.

Real Estate and Loans Receivable

12 Months Ended

Dec. 31, 2017

Text Block [Abstract]

Real Estate and Loans Receivable

3. Real Estate and Loans Receivable

Acquisitions

We acquired the following assets:


	2017			2016			2015
	(in thousands)
Assets Acquired
Land	$	229,091		$	91,071		$	120,746
Building		1,027,154			655,324			741,935
Intangible lease assets — subject to amortization (weighted average useful life of 28.0 years in 2017, 28.5 years in 2016 and 30.0 years in 2015)		150,971			94,167			176,383
Net investments in direct financing leases		40,450			178,000			174,801
Mortgage loans		700,000			600,000			380,000
Other loans		—			—			523,605
Equity investments and other assets		100,000			70,166			101,716
Liabilities assumed		(878	)		(6,319	)		(317	)

Total assets acquired	$	2,246,788		$	1,682,409		$	2,218,869
Loans repaid(1)		—			(193,262	)		(385,851	)

Total net assets acquired	$	2,246,788		$	1,489,147		$	1,833,018

(1)

The 2016 column includes $93.3 million of loans advanced to Capella in 2015 and repaid in 2016 as a part of the Capella transaction, along with $100.0 million loans advanced to Prime in 2015 and repaid in 2016 as part of the sale leaseback conversion of four properties in New Jersey. The 2015 column includes $385.9 million of loans advanced to MEDIAN in 2014 and repaid in 2015 as a part of the MEDIAN transaction.

Purchase price allocations attributable to certain acquisitions made during 2017 are preliminary. When all relevant information is obtained, resulting changes, if any, to our provisional purchase price allocation will be adjusted to reflect new information obtained about the facts and circumstances that existed as of the respective acquisition dates that, if known, would have affected the measurement of the amounts recognized as of those dates.

2017 Activity

Steward Transactions

On September 29, 2017, we acquired, from IASIS Healthcare LLC (“IASIS”), a portfolio of ten acute care hospitals and one behavioral health facility, along with ancillary land and buildings, that are located in Arizona, Utah, Texas, and Arkansas. The portfolio is now operated by Steward which separately completed its acquisition of the operations of IASIS on September 29, 2017. Our investment in the portfolio includes the acquisition of eight acute care hospitals and one behavioral health facility for approximately $700 million, the making of $700 million in mortgage loans on two acute care hospitals, and a $100 million minority equity contribution in Steward, for a combined investment of approximately $1.5 billion.

On May 1, 2017, we acquired eight hospitals previously affiliated with Community Health Systems, Inc. in Florida, Ohio, and Pennsylvania for an aggregate purchase price of $301.3 million.

See “2016 Activity — Acquisition of Steward Portfolio” below for details of the master lease and mortgage loan terms.

MEDIAN Transactions

On November 29, 2017, we acquired three rehabilitation hospitals in Germany for an aggregate purchase price of €80 million. The facilities are leased to affiliates of MEDIAN, pursuant to a new long-term master lease. The lease began on November 30, 2017, and the term is for 27 years (ending in November 2044). The lease provides for increases in rent at the greater of one percent or 70% of the change in German CPI.

During the third quarter of 2017, we acquired two rehabilitation hospitals in Germany for an aggregate purchase price of €39.2 million, in addition to 11 rehabilitation hospitals in Germany that we acquired in the second quarter of 2017 for an aggregate purchase price of €127 million. These 13 properties are leased to affiliates of MEDIAN, pursuant to a third master lease entered into in 2016. (See “2016 Activity” below for details of this master lease.) These acquisitions are the final properties of the portfolio of 20 properties in Germany that we agreed to acquire in July 2016 for €215.7 million, of which seven properties totaling €49.5 million closed in December 2016.

On June 22, 2017, we acquired an acute care hospital in Germany for a purchase price of €19.4 million, of which €18.6 million was paid upon closing with the remainder being paid over four years. This property is leased to affiliates of MEDIAN, pursuant to an existing master lease agreement that ends in December 2042 with annual escalators at the greater of one percent or 70% of the change in German CPI.

On January 30, 2017, we acquired an inpatient rehabilitation hospital in Germany for €8.4 million. This acquisition was the final property to close as part of the six hospital portfolio that we agreed to buy in September 2016 for an aggregate amount of €44.1 million. This property is leased to affiliates of MEDIAN pursuant to the original long-term master lease agreement reached with MEDIAN in 2015. (See “2015 Activity” below for further details of this master lease.)

Other Transactions

On June 1, 2017, we acquired the real estate assets of Ohio Valley Medical Center, a 218-bed acute care hospital located in Wheeling, West Virginia, and the East Ohio Regional Hospital, a 139-bed acute care hospital in Martins Ferry, Ohio, from Ohio Valley Health Services, a not-for-profit entity in West Virginia, for an aggregate purchase price of approximately $40 million. We simultaneously leased the facilities to Alecto Healthcare Services LLC (“Alecto”), pursuant to a lease with a 15-year initial term with 2% annual minimum rent increases and three 5-year extension options. The facilities are cross-defaulted and cross-collateralized with our other hospitals currently operated by Alecto. We also agreed to provide up to $20.0 million in capital improvement funding on these two facilities — none of which has been funded to date. With these acquisitions, we also obtained a 20% interest in the operator of these facilities.

On May 1, 2017, we acquired the real estate of St. Joseph Regional Medical Center, a 145-bed acute care hospital in Lewiston, Idaho for $87.5 million. This facility is leased to RCCH Healthcare Partners (“RCCH”), pursuant to the existing long-term master lease entered into with RCCH in April 2016.

From the respective acquisition dates in 2017 through year-end, the properties acquired during the year ended December 31, 2017, contributed $72.9 million and $57.8 million of revenue and income (excluding related acquisition expenses), respectively, for the year ended December 31, 2017. In addition, we incurred $24.4 million of acquisition-related costs on the 2017 acquisitions for the year ended December 31, 2017.

2016 Activity

Acquisition of Steward Portfolio

On October 3, 2016, we closed on a portfolio of nine acute care hospitals in Massachusetts operated by Steward. Our investment in the portfolio included the acquisition of five hospitals for $600 million, the making of $600 million in mortgage loans on four facilities, and a $50 million minority equity contribution in Steward, for a combined investment of $1.25 billion. The five facilities acquired are being leased to Steward under a master lease agreement that has a 15-year term (ending October 31, 2031) with three 5-year extension options, plus annual inflation-based escalators. The terms of the mortgage loan are substantially similar to the master lease.

Other Acquisitions

From October 27, 2016 to December 31, 2016, we acquired 12 rehabilitation hospitals in Germany for an aggregate purchase price to us of €85.2 million. Of these acquisitions, five properties (totaling €35.6 million) are leased to affiliates of MEDIAN, pursuant to a master lease agreement reached with MEDIAN in 2015. (See “2015 Activity” below for further details of this master lease). The remaining seven properties (totaling €49.5 million) are leased to affiliates of MEDIAN, pursuant to a third master lease that has terms similar to the original master lease in 2015 with a fixed 27-year lease term ending in August 2043.

On October 21, 2016, we acquired three general acute care hospitals and one free-standing emergency department and health center in New Jersey from Prime Healthcare Services, Inc. (“Prime”) (as originally contemplated in the agreements) by reducing the $100 million mortgage loan made in September 2015 and advancing an additional $15 million. We are leasing these properties to Prime pursuant to a fifth master lease, which has a 15-year initial term (ending in May 2031) with three five-year extension options, plus consumer-price indexed increases.

On July 22, 2016, we acquired an acute care facility in Olympia, Washington in exchange for a $93.3 million loan and an additional $7 million in cash, as contemplated in the initial Capella Healthcare Inc. (“Capella”) acquisition transaction in 2015. The terms of the Olympia lease are substantially similar to those of the master lease with Capella post lease amendment. See the Capella Disposal Transaction under the subheading “Disposals” below for further details on the terms of the Capella leases.

On June 22, 2016, we closed on the final property of the initial MEDIAN transaction that began in 2014 for a purchase price of € 41.6 million. See “2015 Activity” for a description of the initial MEDIAN Transaction and related master lease terms.

On May 2, 2016, we acquired an acute care hospital in Newark, New Jersey for an aggregate purchase price of $63 million leased to Prime pursuant to the fifth master lease. Furthermore, we committed to advance an additional $30 million to Prime over a three-year period to be used solely for capital additions to the real estate; any such addition will be added to the basis upon which the lessee will pay us rents. None of the additional $30 million has been funded to date.

From the respective acquisition dates through the 2016 year-end, the properties acquired during 2016, contributed $37.4 million and $31.7 million of revenue and income (excluding related acquisition expense), respectively, for the year ended December 31, 2016. In addition, we incurred $12.1 million of acquisition-related costs on the 2016 acquisitions for the year ended December 31, 2016.

2015 Activity

Acquisition of Capella Portfolio

In July 2015, we entered into definitive agreements to acquire a portfolio of seven acute care hospitals owned and operated by Capella for a combined purchase price and investment of approximately $900 million, adjusted for any cash on hand. The transaction included our investments in seven acute care hospitals (two of which were in the form of mortgage loans) for an aggregate investment of approximately $600 million, an acquisition loan for approximately $290 million and a 49% equity interest in the ongoing operator of the facilities.

On August 31, 2015, we closed on six of the seven Capella properties, two of which were in the form of mortgage loans. We closed on the seventh property on July 22, 2016 (as discussed above). We entered into a master lease, a stand-alone lease, and mortgage loans for the acquired properties providing for 15-year terms with four 5-yearextension options, plus consumer price-indexed increases, limited to a 2% floor and a 4% ceiling annually. The acquisition loan had a 15-year term and carried a fixed interest rate of 8%.

On October 30, 2015, we acquired an additional acute hospital in Camden, South Carolina for an aggregate purchase price of $25.8 million. We leased this hospital to Capella pursuant to the 2015 master lease. In connection with the transaction, we funded an additional acquisition loan to Capella of $9.2 million.

See the Capella Disposal Transaction under the subheading “Disposals” below for an update to this transaction.

MEDIAN Transaction

During early 2015, we made additional interim loans (as part of the initial MEDIAN transaction entered into in October 2014) of approximately €240 million on behalf of MEDIAN, to complete step one of a two-step process to acquire the healthcare real estate of MEDIAN. In addition, we entered into a series of definitive agreements with MEDIAN to complete step two, which involved the acquisition of the real estate assets of 32 hospitals owned by MEDIAN for an aggregate purchase price of approximately €688 million. Upon acquisition, each property became subject to a new master lease between us and MEDIAN providing for the leaseback of the property to MEDIAN. The master lease had an initial term of 27 years (ending in March 2042) and provided for annual escalations of rent at the greater of one percent or 70% of the change in German CPI.

At each closing, the purchase price for each facility was reduced and offset against the interim loans made to affiliates of MEDIAN and against the amount of any debt assumed or repaid by us in connection with the closing. As of December 31, 2015, we had closed on 31 of the 32 properties for an aggregate amount of € 646 million, and we had no loans outstanding to MEDIAN. The final property was acquired in June 2016 as noted above.

Other Acquisitions

On December 3, 2015, we acquired a 266-bed outpatient rehabilitation clinic located in Hannover, Germany from MEDIAN for €18.7 million. Upon acquisition, the facility was leased back under the initial master lease entered into with MEDIAN in 2013, that provided for an initial term of 27 years (ending in November 2040) and annual rent increases of 2.0% in 2017 and 0.5% thereafter. On December 31, 2020 and every three years thereafter, rent will be further increased, if needed, to reflect 70% of cumulative increases in the German CPI.

On November 18, 2015, we acquired seven acute care hospitals and a freestanding clinic in northern Italy for an aggregate purchase price to us of approximately €90 million. The acquisition was effected through a joint venture between us and affiliates of AXA Real Estate, in which we own a 50% interest. The facilities are leased to an Italian acute care hospital operator, pursuant to a long-term master lease. We are accounting for our 50% interest in this joint venture under the equity method.

On September 30, 2015, we provided a $100 million mortgage financing to Prime for three general acute care hospitals and one free-standing emergency department and health center in New Jersey. The loan had a five-year term and provided for consumer-priced indexed interest increases, subject to a floor. As previously noted above, we acquired these facilities in October 2016 by reducing the mortgage loan and advancing an additional $15 million.

On September 9, 2015, we acquired the real estate of a general acute care hospital under development located in Valencia, Spain. The acquisition was effected through a joint venture between us and clients of AXA Real Estate, in which we own a 50% interest. Our share of the aggregate purchase and development price was approximately €21 million. See IMED Group under the subheading “Development Activities” for an update on this transaction along with additional details.

On August 31, 2015, we closed on a $30 million mortgage loan transaction with Prime for the acquisition of Lake Huron Medical Center, a 144-bed general acute care hospital located in Port Huron, Michigan. The loan provided for consumer-priced indexed interest increases, subject to a floor. The mortgage loan had a five-year term with conversion rights to our standard sale leaseback agreement, which we exercised on December 31, 2015, when we acquired the real estate of Lake Huron Medical Center for $20 million, which reduced the mortgage loan accordingly. The facility is being leased to Prime under our master lease agreement.

On June 16, 2015, we acquired the real estate of two facilities in Lubbock, Texas, a 60-bed inpatient rehabilitation hospital and a 37-bed long-term acute care hospital (“LTACH”), for an aggregate purchase price of $31.5 million. We entered into a 20-year lease (ending in June 2035) with Ernest for the rehabilitation hospital, which provides for three five-year extension options, and separately entered into a lease with Ernest for the long-term acute care hospital that has a final term ending December 31, 2034. In connection with the transaction, we funded an acquisition loan to Ernest of approximately $12.0 million. Ernest operates the rehabilitation hospital in a joint venture with Covenant Health System. Effective July 18, 2016, we amended the lease of the rehabilitation hospital to include the long-term acute care hospital. Ernest converted the long-term acute care facility into a rehabilitation facility in the second quarter of 2017.

On February 27, 2015, we acquired an inpatient rehabilitation hospital in Weslaco, Texas for $10.7 million. We have leased this hospital to Ernest pursuant to the 2012 master lease, which had an initial 20-year fixed term (ending in February 2032) and three extension options of five years each. This lease provides for consumer-priced-indexed annual rent increases, subject to a floor and a cap. In addition, we funded an acquisition loan in the amount of $5 million.

On February 13, 2015, we acquired two general acute care hospitals in the Kansas City area for $110 million. Prime is the tenant and operator pursuant to a new master lease that has similar terms and security enhancements as the other master lease agreements entered into in 2013. This master lease has a 10-year initial fixed term (ending in February 2025) with two extension options of five years each. The lease provides for consumer-price-indexed annual rent increases, subject to a specified floor. In addition, we funded a mortgage loan in the amount of $40 million, which has a 10-year term.

From the respective acquisition dates in 2015 through that year end, the properties and mortgage loans acquired in 2015 contributed $102.7 million and $87.7 million of revenue and income (excluding related acquisition expenses), respectively, for the year ended December 31, 2015. In addition, we incurred $58 million of acquisition related costs on the 2015 acquisitions for the year ended December 31, 2015.

Pro Forma Information

The following unaudited supplemental pro forma operating data is presented below as if each acquisition was completed on January 1, 2016 and January 1, 2015 for the year ended December 31, 2017 and 2016, respectively. The unaudited supplemental pro forma operating data is not necessarily indicative of what actuals would have been assuming the transactions had been completed as set forth above, nor do they purport to represent our results of operations for future periods (in thousands, except per share/unit amounts).


	For the Year Ended December 31, (Unaudited)
	2017		2016
Total revenues	$	839,568	$	836,211
Net income		418,811		427,295
Net income per share/unit-diluted	$	1.14	$	1.17

Development Activities

2017 Activity

During 2017, we completed construction and began recording rental income on the following facilities:

•

Adeptus Health, Inc. (“Adeptus Health”) — We completed four acute care facilities for this tenant during 2017 totaling approximately $68 million in development costs. These facilities are leased pursuant to an existing long-term master lease.

•

IMED Group (“IMED”) — Our general acute facility located in Valencia, Spain opened on March 31, 2017, and is being leased to IMED pursuant to a 30-year lease that provides for quarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020. Our ownership in this facility is effected through a joint venture between us and clients of AXA Real Estate, in which we own a 50% interest. Our share of the aggregate purchase and development cost of this facility is approximately €21 million.

In April 2017, we completed the acquisition of the long leasehold interest of a development site in Birmingham, England from the Circle Health Group (“Circle”) (the tenant of our existing site in Bath, England) for a purchase price of £2.7 million. Simultaneously with the acquisition, we entered into contracts with the property landlord and Circle committing us to construct an acute care hospital on the site. Our total development costs are anticipated to be approximately £30 million. Circle is contracted to enter into a lease of the hospital following completion of construction for an initial 15-year term with rent to be calculated based on our total development costs.

On December 19, 2017, we entered into an agreement to finance the development of and lease an acute care hospital in Idaho Falls, Idaho, for $113.5 million. This facility will be leased to Surgery Partners, Inc. (“Surgery Partners”) pursuant to a long-term lease and is expected to be completed in the first quarter of 2020.

2016 Activity

During 2016, we completed construction and began recording rental income on the following facilities:

•

Adeptus Health — We completed 19 acute care facilities for this tenant during 2016 totaling $136.6 million. These facilities are leased pursuant to an existing long-term master lease.

•

Ernest Toledo — This $18.4 million inpatient rehabilitation facility located in Toledo, Ohio opened on April 1, 2016 and is being leased to Ernest pursuant to the original 2012 master lease.

On August 23, 2016, we entered into an agreement to finance the development of and lease an inpatient rehabilitation facility in Flagstaff, Arizona, for $28.1 million, which will be leased to Ernest pursuant to a stand-alone lease, with terms generally similar to the original master lease.

2015 Activity

During 2015, we completed construction and began recording rental income on the following facilities:

•

Adeptus Health — We completed 17 acute care facilities for this tenant during 2015 totaling $102.6 million. These properties are leased pursuant to a master lease that generally has a 15-year initial term with three extension options of five years each that provide for annual rent increases based on changes in CPI with a 2% minimum.

•

UAB Medical West — This $8.6 million acute care facility and medical office building located in Birmingham, Alabama is leased to Medical West, an affiliate of The University of Alabama at Birmingham, for 15 years and contains four renewal options of five years each. The rent increases 2% annually.

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


Property	Commitment		Costs Incurred as of December 31, 2017		Estimated Completion Date
Ernest (Flagstaff, Arizona)	$	28,067	$	21,794		1Q 2018
Circle (Birmingham, England)		43,592		14,694		1Q 2019
Surgery Partners (Idaho Falls, Idaho)		113,468		11,207		1Q 2020

	$	185,127	$	47,695

Disposals

2017 Activity

On March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to RCCH. Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million, partially offset by a $0.6 million non-cash charge to revenue to write-off related straight-line rent receivables on this property.

The sale of Muskogee facility was not a strategic shift in our operations and therefore the results of the Muskogee operations were not reclassified to discontinued operations.

2016 Activity

Capella Disposal Transaction

Effective April 30, 2016, our investment in the operator of Capella merged with RegionalCare Hospital Partners, Inc. (“RegionalCare”), an affiliate of certain funds managed by affiliates of Apollo Global Management, LLC (“Apollo”), to form RCCH. As part of the transaction, we received net proceeds of approximately $550 million including approximately $492 million for our equity investment and loans made as part of the original Capella acquisition that closed on August 31, 2015. In addition, we received $210 million in prepayment of two mortgage loans for hospitals in Russellville, Arkansas, and Lawton, Oklahoma that we made in connection with the original Capella transaction. We made a new $93.3 million loan for a hospital property in Olympia, Washington that was subsequently converted to real estate on July 22, 2016 as previously disclosed. Additionally, we and an Apollo affiliate invested $50 million each in unsecured senior notes issued by RegionalCare, which we sold to a large institution on June 20, 2016 at par. The proceeds from this transaction represented the recoverability of our investment in full, except for transaction costs incurred of $6.3 million.

We maintained our ownership of five hospitals in Hot Springs, Arkansas; Camden, South Carolina; Hartsville, South Carolina; Muskogee, Oklahoma; and McMinnville, Oregon. Pursuant to the transaction described above, the underlying leases, one of which is a master lease covering all but one property was amended to shorten the initial fixed lease term (to 13.5 years for the master lease and 11.5 years for the other stand-alone lease) , increase the security deposit, and eliminate the lessees’ purchase option provisions. Due to this lease amendment, we reclassified the lease of the properties under the master lease from a DFL to an operating lease. This reclassification resulted in a write-off of $2.6 million of unbilled DFL rent receivables in 2016.

Post Acute Transaction

On May 23, 2016, we sold five properties (three of which were in Texas and two in Louisiana) that were leased and operated by Post Acute Medical. As part of this transaction, our outstanding loans of $4 million were paid in full, and we recovered our investment in the operations. Total proceeds from this transaction were $71 million, resulting in a net gain of approximately $15 million.

Corinth Transaction

On June 17, 2016, we sold the Atrium Medical Center real estate located in Corinth, Texas, which was leased and operated by Corinth Investor Holdings. Total proceeds from the transaction were $28 million, resulting in a gain on the sale of real estate of approximately $8 million. This gain on real estate was offset by approximately $9 million of non-cash charges that included the write-off of our investment in the operations of the facility, straight-line rent receivables, and a lease intangible.

HealthSouth Transaction

On July 20, 2016, we sold three inpatient rehabilitation hospitals located in Texas and operated by HealthSouth Corporation for $111.5 million, resulting in a net gain of approximately $45 million.

Summary of Operations for Disposed Assets in 2016

The properties sold during 2016 did not meet the definition of discontinued operations. However, the following represents the operating results (excluding gain on sale, transaction costs, and impairment or other non-cash charges) from these properties (excluding loans repaid in the Capella Disposal Transaction) for the periods presented (in thousands):


	For the Year Ended December 31,
	2016			2015
Revenues	$	7,851		$	18,112
Real estate depreciation and amortization		(1,754	)		(3,795	)
Property-related expenses		(114	)		(121	)
Other income (expense)		(23	)		1,079

Income from real estate dispositions, net	$	5,960		$	15,275

2015 Activity

On July 30, 2015, we sold a long-term acute care facility in Luling, Texas for approximately $9.7 million, resulting in a gain of $1.5 million. Due to this sale, we wrote off $0.9 million of straight-line rent receivables. On August 5, 2015, we sold six wellness centers in the U.S. for total proceeds of approximately $9.5 million (of which $1.5 million was in the form of a promissory note), resulting in a gain of $1.7 million. Due to this sale, we wrote off $0.9 million of billed rent receivables. With these disposals, we accelerated the amortization of the related lease intangible assets resulting in approximately $0.7 million of additional expense.

The sale of the Luling facility and the six wellness centers were not strategic shifts in our operations, and therefore the results of operations related to these facilities were not reclassified as discontinued operations.

Intangible Assets

At December 31, 2017 and 2016, our intangible lease assets were $443 million ($394 million, net of accumulated amortization) and $296 million ($264 million, net of accumulated amortization), respectively.

We recorded amortization expense related to intangible lease assets of $15.8 million, $13.4 million, and $9.1 million in 2017, 2016, and 2015, respectively, and expect to recognize amortization expense from existing lease intangible assets as follows (amounts in thousands):


For the Year Ended December 31:
2018	$	17,707
2019		17,654
2020		17,440
2021		17,373
2022		17,359

As of December 31, 2017, capitalized lease intangibles have a weighted average remaining life of 24.3 years.

Leasing Operations

At December 31, 2017, leases on two Alecto facilities, 15 Ernest facilities and ten Prime facilities are accounted for as DFLs. The components of our net investment in DFLs consisted of the following (in thousands):


	As of December 31, 2017			As of December 31, 2016
Minimum lease payments receivable	$	2,294,081		$	2,207,625
Estimated residual values		448,339			407,647
Less unearned income		(2,043,693	)		(1,967,170	)

Net investment in direct financing leases	$	698,727		$	648,102

Minimum rental payments due to us in future periods under operating leases and DFLs, which have non-cancelable terms extending beyond one year at December 31, 2017, are as follows (amounts in thousands):


	Total Under Operating Leases		Total Under DFLs		Total
2018	$	496,379	$	67,436	$	563,815
2019		499,417		68,784		568,201
2020		502,309		70,160		572,469
2021		509,991		71,563		581,554
2022		503,679		72,994		576,673
Thereafter		10,472,481		1,734,085		12,206,566

	$	12,984,256	$	2,085,022	$	15,069,278

Adeptus Health

On April 4, 2017, we announced that we had agreed in principle with Deerfield Management Company, L.P. (“Deerfield”), a healthcare-only investment firm, to the restructuring in bankruptcy of Adeptus Health. In furtherance of the restructuring, Adeptus Health and certain of its subsidiaries filed voluntary petitions for relief under Chapter 11 of the U.S. Bankruptcy Code on April 19, 2017. Funds advised by Deerfield acquired Adeptus Health’s outstanding bank debt, and Deerfield agreed to provide additional financing, along with operational and managerial support, to Adeptus Health as part of the restructuring.

On September 29, 2017, the U.S. Bankruptcy Court for the Northern District of Texas, Dallas Division, entered an order confirming the Debtors’ Third Amended Joint Plan of Reorganization under Chapter 11 of the Bankruptcy Code (the “Plan”). The Plan became effective on October 2, 2017 (the “Confirmation Effective Date”). In connection with the confirmation of the Plan, Deerfield agreed that it would assume all of the master leases and related agreements between us and Adeptus Health, cure all defaults that had arisen prior to the commencement of the bankruptcy proceedings with respect to all properties, and continue to pay rent with respect to all but 16 of the 56 Adeptus Health properties according to the terms of the master leases and related agreements. Rent will remain the same, and a previously disclosed rent concession was removed from the terms. We plan to re-lease or sell the remaining 16 properties, and Adeptus Health will continue to pay rent with respect to those 16 properties until the earlier of (a) transition to a new operator is complete, (b) two years following the Confirmation Effective Date (for one facility), (c) one year following the Confirmation Effective Date (for seven facilities), (d) six months following the Confirmation Effective Date (for three facilities), and (e) three months following the Confirmation Effective Date (for five facilities). As part of the Plan, our lease with Adeptus Health was amended to shorten the lease term of the 16 transition properties resulting in an acceleration of straight-line rent receivable amortization of $4.2 million in the 2017 fourth quarter. Although no assurances can be made that we will not recognize a loss in the future, we believe at December 31, 2017 that the sale or re-leasing of the assets related to these 16 transition facilities will not result in any material loss or impairment.

On December 7, 2017, we announced that UCHealth Partners LLC (“UCHealth”), an affiliate of University of Colorado Hospital, had acquired all of Adeptus Health’s Colorado joint venture interests, assuming the existing master lease of 11 of our free standing emergency facilities. The 11 facilities that are now master leased to UCHealth affiliates represent a gross investment of $58.6 million. The master lease was amended to provide a new 15-year initial term effective January 1, 2018 with three five-year renewal options, while retaining annual escalation provisions of the increase in the CPI with a 2% minimum.

On April 4, 2017, we announced that our Louisiana freestanding emergency facilities then-operated by Adeptus Health (with a total budgeted investment of approximately $24.5 million) had been re-leased to Ochsner Clinic Foundation (“Ochsner”), a health care system in the New Orleans area. We incurred a non-cash charge of $0.5 million to write-off the straight-line rent receivables associated with the previous Adeptus Health lease on these properties. On October 18, 2017, Ochsner agreed to an amended and restated lease that provided for initial terms of 15 years with a 9.2% average minimum lease rate based on our total development and construction cost, as well as the addition of three five-year renewal options.

Twelve Oaks Facility

In the third quarter of 2015, we sent notice of termination of the lease to the tenant at our Twelve Oaks facility. As a result of the lease terminating, we recorded a charge of $1.9 million to reserve against the straight-line rent receivables. In addition, we accelerated the amortization of the related lease intangible asset resulting in $0.5 million of additional expense during 2015. During the third quarter of 2016, the former tenant paid us approximately $2.5 million representing substantially all amounts owed to us at that time. The former tenant has continued to occupy the facility and is current on its obligations through December 31, 2017. However, we expect this tenant will vacate the facility by mid-year 2018, at which time we will re-lease the facility. Although no assurances can be made that we will not have any impairment charges in the future, we believe our real estate investment in Twelve Oaks at December 31, 2017 is fully recoverable.

Loans

The following is a summary of our loans ($ amounts in thousands):


	As of December 31, 2017					As of December 31, 2016
	Balance		Weighted Average Interest Rate			Balance		Weighted Average Interest Rate
Mortgage loans	$	1,778,316		8.3	%	$	1,060,400		8.8	%
Acquisition loans		118,448		13.8	%		121,464		13.7	%
Working capital and other loans		31,760		7.6	%		34,257		9.0	%

	$	1,928,524				$	1,216,121

Our mortgage loans cover 14 of our properties with four operators. The increase in mortgage loans relates to the loans made to Steward totaling $700 million for two properties on September 29, 2017, as part of the Steward Transaction.

Other loans typically consist of loans to our tenants for acquisitions and working capital purposes. At December 31, 2017, acquisition loans include $114 million loaned to Ernest.

Concentration of Credit Risks

Revenue by Operator

(Dollar amounts in thousands)


	For the Years Ended December 31,
	2017					2016
Operators	Total Revenue		Percentage of Total Revenue			Total Revenue		Percentage of Total Revenue
Steward(1)	$	190,172		27.0	%	$	54,068		10.0	%
Prime		126,269		17.9	%		120,558		22.3	%
MEDIAN		100,531		14.3	%		93,425		17.3	%
Ernest		70,665		10.0	%		67,742		12.5	%
RCCH		41,890		5.9	%		52,720		9.7	%
Other operators		175,218		24.9	%		152,624		28.2	%

Total	$	704,745		100.0	%	$	541,137		100.0	%

(1)

Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017.

Revenue by U.S. State and Country

(Dollar amounts in thousands)


	For the Years Ended December 31,
	2017					2016
U.S. States and Other Countries	Total Revenue		Percentage of Total Revenue			Total Revenue		Percentage of Total Revenue
Massachusetts	$	107,195		15.2	%	$	26,098		4.8	%
Texas		102,926		14.6	%		96,992		17.9	%
California		66,241		9.4	%		66,197		12.2	%
Arizona		36,393		5.2	%		23,798		4.4	%
Utah		28,831		4.1	%		9,942		1.8	%
Other states		235,545		33.4	%		216,505		40.1	%

Total U.S.	$	577,131		81.9	%	$	439,532		81.2	%
Germany	$	123,453		17.5	%	$	97,382		18.0	%
United Kingdom, Italy, and Spain		4,161		0.6	%		4,223		0.8	%

Total International	$	127,614		18.1	%	$	101,605		18.8	%

Total	$	704,745		100.0	%	$	541,137		100.0	%

From an asset perspective, approximately 80% of our total assets are in the U.S., while 20% reside in Europe (primarily Germany) as of December 31, 2017, consistent with December 31, 2016.

Related Party Transactions

Lease and interest revenue earned from tenants in which we have an equity interest in were $422.4 million, $282.9 million and $215.4 million in 2017, 2016 and 2015, respectively.

Debt

12 Months Ended

Dec. 31, 2017

Debt Disclosure [Abstract]

Debt

4. Debt

The following is a summary of debt ($ amounts in thousands):


	As of December 31, 2017			As of December 31, 2016
Revolving credit facility(A)	$	840,810		$	290,000
Term loans		200,000			263,101
6.375% Senior Unsecured Notes due 2022:
Principal amount		—			350,000
Unamortized premium		—			1,814

		—			351,814
5.750% Senior Unsecured Notes due 2020(B)		—			210,340
4.000% Senior Unsecured Notes due 2022(B)		600,250			525,850
5.500% Senior Unsecured Notes due 2024		300,000			300,000
6.375% Senior Unsecured Notes due 2024		500,000			500,000
3.325% Senior Unsecured Notes due 2025(B)		600,250			—
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			—

	$	4,941,310		$	2,941,105
Debt issue costs, net		(42,643	)		(31,764	)

	$	4,898,667		$	2,909,341

(A)	The 2017 column includes £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2017.

(B)	These notes are Euro-denominated and reflect the exchange rate at December 31, 2017 and December 31, 2016, respectively.

As of December 31, 2017, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows ($ amounts in thousands):


2018	$	—
2019		—
2020		—
2021		840,810
2022		800,250
Thereafter		3,300,250

Total	$	4,941,310

Credit Facility

On February 1, 2017, we replaced our previous unsecured credit facility (which we had entered into in 2014 and amended in 2015) with a new revolving credit and term loan agreement (the “Credit Facility”). The new agreement includes a $1.3 billion unsecured revolving loan facility (same amount as the previous revolving loan facility), a $200 million unsecured term loan facility ($50 million lower than the previous term loan facility), and a new €200 million unsecured term loan facility. The new unsecured revolving loan facility matures in February 2021 and can be extended for an additional 12 months at our option. The $200 million unsecured term loan facility matures on February 1, 2022, and the €200 million unsecured term loan facility had a maturity date of January 31, 2020; however, it was paid off on March 30, 2017 — see below. The term loan and/or revolving loan commitments may be increased in an aggregate amount not to exceed $500 million.

At our election, loans under the Credit Facility may be made as either ABR Loans or Eurodollar Loans. The applicable margin for term loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.95% based on our current credit rating. The applicable margin for term loans that are Eurodollar Loans is adjustable on a sliding scale from 0.90% to 1.95% based on our current credit rating. The applicable margin for revolving loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.65% based on our current credit rating. The applicable margin for revolving loans that are Eurodollar Loans is adjustable on a sliding scale from 0.875% to 1.65% based on our current credit rating. The commitment fee is adjustable on a sliding scale from 0.125% to 0.30% based on our current credit rating and is payable on the revolving loan facility.

At December 31, 2017 and 2016, we had $840.8 million and $290 million, respectively, outstanding on the revolving credit facility. At December 31, 2017, our availability under our revolving credit facility was $0.5 billion. The weighted average interest rate on this facility was 2.4% and 2.0% for 2017 and 2016, respectively.

At December 31, 2017 and 2016, the interest rate in effect on our term loan was 2.98% and 2.36%, respectively.

Term Loan — Northland Mortgage

In connection with our acquisition of the Northland LTACH Hospital on February 14, 2011, we assumed a $14.6 million mortgage. The Northland mortgage loan required monthly principal and interest payments based on a 30-year amortization period. The Northland mortgage loan had a fixed interest rate of 6.2%, a maturity date of January 1, 2018 and could be prepaid, without penalty within 120 days of the term of the loan. On September 29, 2017, we prepaid the principal amount of this mortgage loan at par in the amount of $12.9 million.

6.375% Senior Unsecured Notes due 2022

On February 17, 2012, we completed a $200 million offering of senior unsecured notes (“6.375% Senior Unsecured Notes due 2022”), and on August 20, 2013, we completed a $150 million tack on to the notes. These 6.375% Senior Unsecured Notes due 2022 accrued interest at a fixed rate of 6.375% per year and had a maturity date of February 15, 2022. The 2013 tack on offering, was issued at a premium (price of 102%), resulting in an effective rate of 5.998%. Interest on these notes was payable semi-annually on February 15 and August 15 of each year, and offered a redemption option to redeem some or all of the notes at a premium that decreased over time, plus accrued and unpaid interest to, but not including, the redemption date.

On October 7, 2017, we redeemed these notes and incurred an $11.2 million redemption premium.

5.750% Senior Unsecured Notes due 2020

On October 10, 2013, we completed a €200 million offering of senior unsecured notes (“5.750% Senior Unsecured Notes due 2020”). Interest on the notes was payable semi-annually on April 1 and October 1 of each year. The 5.750% Senior Unsecured Notes due 2020 paid interest in cash at a rate of 5.750% per year. The notes had a maturity date of October 1, 2020, and offered a redemption option to redeem some or all of the notes at any time at a “make-whole” redemption price that decreased over time.

On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020 and incurred a redemption premium of approximately $9 million.

4.000% Senior Unsecured Notes due 2022

On August 19, 2015, we completed a €500 million senior unsecured notes offering (“4.000% Senior Unsecured Notes due 2022”). Interest on the notes is payable annually on August 19 of each year. The notes pay interest in cash at a rate of 4.000% per year. The notes mature on August 19, 2022. We may redeem some or all of the 4.000% Senior Unsecured Notes due 2022 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 4.000% Senior Unsecured Notes due 2022 are fully and unconditionally guaranteed on an unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of the purchase.

5.500% Senior Unsecured Notes due 2024

On April 17, 2014, we completed a $300 million senior unsecured notes offering (“5.500% Senior Unsecured Notes due 2024”). Interest on the notes is payable semi-annually on May 1 and November 1 of each year. The notes pay interest in cash at a rate of 5.500% per year. The notes mature on May 1, 2024. We may redeem some or all of the notes at any time prior to May 1, 2019 at a “make-whole” redemption price. On or after May 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to May 1, 2017, we may redeem up to 35% of the aggregate principal amount of the notes using the proceeds of one or more equity offerings. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

6.375% Senior Unsecured Notes due 2024

On February 22, 2016, we completed a $500 million senior unsecured notes offering (“6.375% Senior Unsecured Notes due 2024”). Interest on the notes is payable on March 1 and September 1 of each year. Interest on the notes is paid in cash at a rate of 6.375% per year. The notes mature on March 1, 2024. We may redeem some or all of the notes at any time prior to March 1, 2019 at a “make whole” redemption price. On or after March 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to March 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 106.375% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

3.325% Senior Unsecured Notes due 2025

On March 24, 2017, we completed a €500 million senior unsecured notes offering (“3.325% Senior Unsecured Notes due 2025”). Interest on the notes is payable annually on March 24 of each year. The notes pay interest in cash at a rate of 3.325% per year. The notes mature on March 24, 2025. We may redeem some or all of the 3.325% Senior Unsecured Notes due 2025 at any time. If the notes are redeemed prior to 90 days before maturity, the redemption price will be equal to 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest up to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 3.325% Senior Unsecured Notes due 2025 are fully and unconditionally guaranteed on a senior unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest up to, but excluding, the date of the purchase.

5.250% Senior Unsecured Notes due 2026

On July 22, 2016, we completed a $500 million senior unsecured notes offering (“5.250% Senior Unsecured Notes due 2026”). Interest on the notes is payable on February 1 and August 1 of each year. Interest on the notes is to be paid in cash at a rate of 5.250% per year. The notes mature on August 1, 2026. We may redeem some or all of the notes at any time prior to August 1, 2021 at a “make whole” redemption price. On or after August 1, 2021, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to August 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 105.250% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

5.000% Senior Unsecured Notes due 2027

On September 7, 2017, we completed a $1.4 billion senior unsecured notes offering (“5.000% Senior Unsecured Notes due 2027”). Interest on the notes is payable annually on April 15 and October 15 of each year, commencing on April 15, 2018. The notes pay interest in cash at a rate of 5.000% per year. The notes mature on October 15, 2027. We may redeem some or all of the notes at any time prior to October 15, 2022 at a “make whole” redemption price. On or after October 15, 2022, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to October 15, 2020, we may redeem up to 40% of the notes at a redemption price equal to 105% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.

With the completion of the 5.000% Senior Unsecured Notes due 2027 offering, we canceled a $1.0 billion term loan facility commitment from J.P. Morgan Chase Bank, N.A. that we received to assist in funding the September 2017 Steward Transaction.

Unutilized Financing Fees/Debt Refinancing Costs

2017

With the replacement of our previous credit facility, the early redemption of the 5.750% Senior Unsecured Notes due 2020 and the 6.375% Senior Unsecured Notes due 2022, the payoff of our €200 million euro term loan, the cancellation of the $1.0 billion term loan facility commitment, and the payment of our $12.9 million mortgage loan, we incurred a charge of $32.6 million (including redemption premiums and accelerated amortization of deferred debt issuance cost and commitment fees) during the year ended December 31, 2017.

2016

On July 22, 2016, we used the net proceeds from the 5.250% Senior Unsecured Notes due 2026 offering to redeem $450 million of senior unsecured notes that had an original maturity date in 2021. This redemption resulted in a $22.5 million debt refinancing charge, consisting of a $15.5 million redemption premium and the write-off of deferred debt issuance costs.

2015

In 2015, we incurred $4.4 million of debt related charges, of which $3.9 million related to structuring and underwriting fees associated with a $1.0 billion senior unsecured bridge loan facility entered into (but not used) to fund the acquisition of Capella.

Covenants

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. Through 2017, the dividend restriction was 95% of NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. This Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At December 31, 2017, we were in compliance with all such financial and operating covenants.

Income Taxes

12 Months Ended

Dec. 31, 2017

Income Tax Disclosure [Abstract]

Income Taxes

5. Income Taxes

Medical Properties Trust, Inc.

We have maintained and intend to maintain our election as a REIT under the Code, including the recently enacted Tax Reform law, H.R. To qualify as a REIT, we must meet a number of organizational and operational requirements, including a requirement to distribute at least 90% of our taxable income to our stockholders. As a REIT, we generally will not be subject to U.S. federal income tax if we distribute 100% of our taxable income to our stockholders and satisfy certain other requirements. Income tax is paid directly by our stockholders on the dividends distributed to them. If our taxable income exceeds our dividends in a tax year, REIT tax rules allow us to designate dividends from the subsequent tax year in order to avoid current taxation on undistributed income. If we fail to qualify as a REIT in any taxable year, we will be subject to U.S. federal income taxes at regular corporate rates, including any applicable alternative minimum tax (eliminated for 2018 and future tax years). Taxable income from non-REIT activities managed through our TRS is subject to applicable U.S. federal, state and local income taxes. Our international subsidiaries are also subject to income taxes in the jurisdictions in which they operate.

From our TRSs and our foreign operations, income tax expense (benefit) were as follows (in thousands):


	For the years ended December 31,
	2017			2016			2015
Current income tax (benefit) expense:
Domestic	$	(41	)	$	42		$	147
Foreign		3,062			1,856			1,614

		3,021			1,898			1,761
Deferred income tax (benefit) expense:
Domestic		(233	)		147			(360	)
Foreign		(107	)		(8,875	)		102

		(340	)		(8,728	)		(258	)

Income tax expense (benefit)	$	2,681		$	(6,830	)	$	1,503

A reconciliation of the income tax expense (benefit) at the statutory income tax rate and the effective tax rate for income from continuing operations before income taxes for the years ended December 31, 2017, 2016, and 2015 is as follows (in thousands):


	2017			2016			2015
Income from continuing operations (before-tax)	$	293,919		$	219,108		$	141,430
Income tax at the US statutory federal rate (35%)		102,872			76,688			49,501
Increase (decrease) resulting from:
Foreign rate differential		(2,326	)		1,434			5,047
State income taxes, net of federal benefit		—			66			(601	)
Dividends paid deduction		(98,026	)		(84,927	)		(57,109	)
Equity investments		3,293			4,297			—
Change in valuation allowance		(5,391	)		(6,104	)		6,174
Other items, net		2,259			1,716			(1,509	)

Total income tax expense (benefit)	$	2,681		$	(6,830	)	$	1,503

The foreign income tax provision is based on foreign losses before income taxes of $0.1 million in 2017, $23.5 million in 2016, and $29.4 million in 2015.

The domestic income tax provision is based on income before income taxes of $13.9 million in 2017, a loss before income taxes of $1.4 million in 2016, and income before income taxes of $7.1 million in 2015 from our TRS.

At December 31, 2017 and 2016, components of our deferred tax assets and liabilities were as follows (in thousands):


	2017			2016
Deferred tax liabilities:
Property and equipment	$	(4,336	)	$	(3,781	)
Unbilled rent		(8,953	)		(7,045	)
Partnership investments		(2,099	)		(5,103	)
Other		(6,702	)		(6,757	)

Total deferred tax liabilities	$	(22,090	)	$	(22,686	)
Deferred tax assets:
Operating loss and interest deduction carry forwards	$	24,580		$	28,289
Other		8,726			10,085

Total deferred tax assets		33,306			38,374
Valuation allowance		(11,101	)		(15,975	)

Total net deferred tax assets	$	22,205		$	22,399

Net deferred tax asset (liability)	$	115		$	(287	)

At December 31, 2017, our U.S. net operating losses (“NOLs”) consisted of $68.2 million of federal NOLs and $51.4 million of state NOLs available as offsets to future years’ taxable income. We have federal and state capital loss carryforwards of $9.5 million. The NOLs primarily expire between 2021 and 2035 and the capital loss carryforward expires in 2022. We have alternative minimum tax credits of $0.3 million as of December 31, 2017. To the extent these alternative minimum tax credits exceed regular tax liability in tax years 2018 through 2020, 50% of the excess credit will be refunded. Any remaining alternative minimum tax credit will be refunded in 2021. At December 31, 2017, we had foreign NOLs of $23 million that may be carried forward indefinitely.

Valuation Allowance

In the evaluation of the need for a valuation allowance on the U.S. deferred income tax assets, we considered all available positive and negative evidence, including scheduled reversals of deferred income tax liabilities, carryback of future period losses to prior periods, projected future taxable income, tax planning strategies and recent financial performance. Based on our review of all positive and negative evidence, including a three year U.S. cumulative pre-tax loss, we concluded that a valuation allowance (approximately $6.8 million) should remain against those deferred income tax assets that are not expected to be realized through future sources of taxable income generated from scheduled reversals of deferred income tax liabilities. As a result, a valuation allowance continues to be recorded to reflect the portion of the U.S. federal and state deferred income tax assets that are not likely to be realized based upon all available evidence. If we later determine that we will more likely than not realize all, or a portion, of the deferred income tax assets, we will reverse the valuation allowance in a future period. All future reversals of the valuation allowance would result in a tax benefit in the period recognized.

In 2016, we released $4 million of valuation allowances on our foreign deferred income tax assets due to a strong positive trend in foreign earnings and forecasted foreign income projections on the majority of our foreign entities. However, at December 31, 2016, there were still 11 foreign entities that did not have sufficient objective positive evidence to support a similar release in valuation allowances; thus, we continued to reserve against $2.2 million of related foreign deferred tax assets. For these 11 foreign entities and seven new entities formed in 2017, we evaluated the need for a valuation allowance on our foreign deferred income tax assets at December 31, 2017. In doing so, we considered all available evidence to determine whether it is more likely than not that the foreign deferred income tax assets will be realized. Based on our review of all positive and negative evidence, we concluded that a valuation allowance of $4.3 million should remain against certain foreign deferred income tax assets that are not expected to be realized through future sources of taxable income generated from scheduled reversals of deferred income tax liabilities and forecasted taxable income from operating activity.

We have no material uncertain tax position liabilities and related interest or penalties recorded at December 31, 2017.

REIT Status

We have met the annual REIT distribution requirements by payment of at least 90% of our estimated taxable income in 2017, 2016, and 2015. Earnings and profits, which determine the taxability of such distributions, will differ from net income reported for financial reporting purposes due primarily to differences in cost basis, differences in the estimated useful lives used to compute depreciation, and differences between the allocation of our net income and loss for financial reporting purposes and for tax reporting purposes.

A schedule of per share distributions we paid and reported to our stockholders is set forth in the following:


	For the Years Ended December 31,
	2017		2016		2015
Common share distribution	$	0.950000	$	0.900000	$	0.870000
Ordinary income		0.655535		0.619368		0.769535
Capital gains(1)		0.021022		0.102552		—
Unrecaptured Sec. 1250 gain		0.004647		0.045432		—
Return of capital		0.273443		0.178080		0.100465

(1)	Capital gains include unrecaptured Sec. 1250 gains.

MPT Operating Partnership, L.P.

As a partnership, the allocated share of income of the Operating Partnership is included in the income tax returns of the general and limited partners. Accordingly, no accounting for income taxes is generally required for such income of the Operating Partnership. However, the Operating Partnership has formed TRSs on behalf of Medical Properties Trust, Inc., which are subject to U.S. federal, state and local income taxes at regular corporate rates, and its international subsidiaries are subject to income taxes in the jurisdictions in which they operate. See discussion above under Medical Properties Trust, Inc. for more details of income taxes associated with our TRSs and international operations.

Earnings Per Share/Unit

12 Months Ended

Dec. 31, 2017

Earnings Per Share [Abstract]

Earnings Per Share/Unit

6. Earnings Per Share/Unit

Medical Properties Trust, Inc.

Our earnings per share were calculated based on the following (amounts in thousands):


	For the Years Ended December 31,
	2017			2016			2015
Numerator:
Income from continuing operations	$	291,238		$	225,938		$	139,927
Non-controlling interests’ share in continuing operations		(1,445	)		(889	)		(329	)
Participating securities’ share in earnings		(1,409	)		(559	)		(1,029	)

Income from continuing operations, less participating securities’ share in earnings		288,384			224,490			138,569
Loss from discontinued operations		—			(1	)		—

Net income, less participating securities’ share in earnings	$	288,384		$	224,489		$	138,569

Denominator:
Basic weighted average common shares		349,902			260,414			217,997
Dilutive potential common shares		539			658			307

Diluted weighted average common shares		350,441			261,072			218,304

MPT Operating Partnership, L.P.

Our earnings per unit were calculated based on the following (amounts in thousands):


	For the Years Ended December 31,
	2017			2016			2015
Numerator:
Income from continuing operations	$	291,238		$	225,938		$	139,927
Non-controlling interests’ share in continuing operations		(1,445	)		(889	)		(329	)
Participating securities’ share in earnings		(1,409	)		(559	)		(1,029	)

Income from continuing operations, less participating securities’ share in earnings		288,384			224,490			138,569
Loss from discontinued operations		—			(1	)		—

Net income, less participating securities’ share in earnings	$	288,384		$	224,489		$	138,569

Denominator:
Basic weighted average units		349,902			260,414			217,997
Dilutive potential units		539			658			307

Diluted weighted average units		350,441			261,072			218,304

Stock Awards

12 Months Ended

Dec. 31, 2017

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock Awards

7. Stock Awards

Stock Awards

Our Equity Incentive Plan authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units and awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 8,196,770 shares of common stock for awards under the Equity Incentive Plan and 3,676,000 shares remain available for future stock awards as of December 31, 2017. The Equity Incentive Plan contains a limit of 5,000,000 shares as the maximum number of shares of common stock that may be awarded to an individual in any fiscal year. Awards under the Equity Incentive Plan are subject to forfeiture due to termination of employment prior to vesting. In the event of a change in control, outstanding and unvested options will immediately vest, unless otherwise provided in the participant’s award or employment agreement, and restricted stock, restricted stock units, deferred stock units and other stock-based awards will vest if so provided in the participant’s award agreement. The term of the awards is set by the Compensation Committee, though Incentive Stock Options may not have terms of more than ten years. Forfeited awards are returned to the Equity Incentive Plan and are then available to be re-issued as future awards. For each share of common stock issued by Medical Properties Trust, Inc. pursuant to its Equity Incentive Plan, the Operating Partnership issues a corresponding number of Operating Partnership units.

The following awards have been granted pursuant to our Equity Incentive Plan (and its predecessor plan):

Restricted Equity Awards

These stock-based awards are in the form of service-based awards and performance awards based on either company-specific performance hurdles or certain market conditions.

Service-Based Awards

The service-based awards vest as the employee provides the required service (typically three years). Service based awards are valued at the average price per share of common stock on the date of grant. Dividends are generally paid on these awards prior to vesting. See table below for a summary of activity involving service-based awards.

Performance-Based Awards

In 2017, 2016, and 2015, the Compensation Committee granted performance-based awards to employees. Generally, dividends are not paid on performance awards until the award is earned. See below for details of such performance award grants:

2017 performance awards — The 2017 performance awards were granted in three parts:

Certain 2017 performance awards (target number) were granted based on the achievement of specific performance thresholds as set by our compensation committee for the one-year performance period of 2017. However, more or less shares than the target number of shares were allowed to be earned based on our performance. The pre-established performance thresholds for 2017 were as follows:

Approximately 42% of the target shares were earned based on the achievement of a one-year total shareholder return as compared to the SNL U.S. REIT Healthcare Index (“SNL Index”) over the period from January 1, 2017 through December 31, 2017. If the shareholder return was equal to the SNL Index minus 3% for the one-year period, 50% of these shares would be earned; while, if shareholder return was greater than or equal to the SNL Index plus 3%, 200% of these target shares would be earned. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rates of 1%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of three years.

Approximately 47% of the target shares were earned based on our return on equity (“ROE”), as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our ROE was at least equal to 12.5% for the one-year period, 50% of these shares would be earned; and, if our ROE was greater than or equal to 13.5%, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

Approximately 11% of the target shares were earned based on general and administrative expenses (“G&A”) as a percentage of revenue, as defined by our compensation committee, over the period from January 1, 2017 through December 31, 2017. If our G&A as a percentage of revenue was no more than 10% for the one-year period, 50% of these shares would be earned; while, if our G&A as a percentage of revenue was 9% or less, 200% of these shares would be earned. The fair value of this award was based on the average price per share of common stock on the date of grant with the number of shares adjusted as needed based on the probability of such performance hurdles being met. For this performance hurdle, 200% of the target shares was earned.

At the end of the one-year performance period, all earned shares will vest in equal annual amounts on January 1, 2018, 2019, and 2020.

Certain other 2017 performance awards were based on the achievement of a multi-year cumulative total shareholder return as compared to pre-established returns set by our compensation committee. If the cumulative shareholder return from January 1, 2017 through December 31, 2019 is 27% or greater, then 30% of these shares will be earned (“2019 award”). If the cumulative shareholder return from January 1, 2017 through December 31, 2020 is 36% or greater, then 30% of these shares may be earned (“2020 award”). However, the maximum percentage cumulatively earned in connection with both the 2019 award and the 2020 award shall not exceed 30% of the total award. If the cumulative shareholder return from January 1, 2017 through December 31, 2021 is 45% or greater, then all remaining shares will be earned. At the end of each of the performance periods, any earned shares during such period will vest on January 1 of the following calendar year. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rates of 1.9%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 5 years.

The final portion of our 2017 performance awards will be earned if our total shareholder return outpaces that of the SNL Index over the cumulative period from January 1, 2017 to December 31, 2019. Our total shareholder return must be within 3% of the SNL Index to earn the minimum number of shares under this award; while, it must exceed the SNL Index by 3% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2020, 2021, and 2022. The fair value of this award was estimated on the grant date using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.5%; expected volatility of 25%; expected dividend yield of 6.9%; and expected service period of 3 years.

In 2017, 596,472 shares were earned but not vested, and 14,000 performance awards were forfeited. At December 31, 2017, we have 1,130,531 of 2017 performance awards remaining to be earned.

2016 performance awards — The 2016 performance awards were granted in two parts:

One-half of the 2016 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2016 to December 31, 2018. The minimum total shareholder return needed to earn a portion of this award is 27.0% with 100% of the award earned if our total shareholder return reaches 35.0%. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rates of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

The remainder of the 2016 performance awards will be earned if our total shareholder return outpaces that of the MSCI U.S. REIT Index (“MSCI Index”) over the cumulative period from January 1, 2016 to December 31, 2018. Our total shareholder return must be within 3% of the MSCI Index to earn the minimum number of shares under this award, while it must exceed the MSCI Index by 3% to earn 100% of the award. If any shares are earned from this award, the shares will vest in equal annual amounts on January 1, 2019, 2020, and 2021. The fair value of this award was estimated on the dates of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.0%; expected volatility of 24.4%; expected dividend yield of 7.0%; and expected service period of 5 years.

In 2017 and 2016, no shares were earned and vested, while 16,000 and 2,400 performance awards were forfeited in 2017 and 2016, respectively. At December 31, 2017, we have 781,404 of 2016 performance awards remaining to be earned.

2015 performance awards — The 2015 performance awards were granted in three parts:

Approximately 40% of the 2015 performance awards were based on us achieving a simple 9.0% annual total shareholder return. For the three-year period from January 1, 2015 through December 31, 2017, one-third of the awards was earned annually (until the award is fully earned) if a 9.0% total shareholder return was achieved. If total shareholder return did not reach 9.0% in a particular year, shares for that year were earned in a future period (during the three-year period) if the cumulative total shareholder return was equal to or greater than a 9.0% annual return for such cumulative period. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%; expected volatility of 20%; expected dividend yield of 7.2%; and expected service period of 3 years.

Approximately 30% of the 2015 performance awards were based on us achieving a cumulative total shareholder return from January 1, 2015 to December 31, 2017. The minimum total shareholder return needed to earn a portion of this award was 27.0% with 100% of the award earned if our total shareholder return reached 35.0%. If any shares were earned from this award, the shares were to be vested in equal annual amounts on December 31, 2017, 2018, and 2019. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%; expected volatility of 20%; expected dividend yield of 7.2%; and expected service period of 5 years.

The remainder of the 2015 performance awards were earned if our total shareholder return outpaced the MSCI Index over the cumulative period from January 1, 2015 to December 31, 2017. Our total shareholder return must have exceeded that of the MSCI Index to earn the minimum number of shares under this award, while it must have exceeded the MSCI Index by 6% to earn 100% of the award. If any shares were earned from this award, the shares were to be vested in equal annual amounts on December 31, 2017, 2018, and 2019. The fair value of this award was estimated on the date of grant using a Monte Carlo valuation model that assumed the following: risk free interest rate of 1.1%; expected volatility of 20%; expected dividend yield of 7.2%; and expected service period of 5 years.

In 2017 and 2016, 348,966 and 98,526 shares were earned, respectively. No 2015 performance awards were earned and vested in 2015. In 2017, 2016, and 2015, 353,104, 66,792, and 4,500 performance awards, respectively, were forfeited. At December 31, 2017, we have no 2015 performance awards remaining to be earned and 168,348 performance awards remaining to vest in 2018 and 2019.

The following summarizes restricted equity award activity in 2017 and 2016 (which includes awards granted in 2017, 2016, 2015, and any applicable prior years), respectively:

For the Year Ended December 31, 2017:


	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		347,128		$	13.35		1,811,675		$	6.78
Awarded		249,841		$	12.40		1,741,003		$	8.21
Vested		(304,613	)	$	12.86		(491,071	)	$	6.84
Forfeited		(16,076	)	$	12.75		(384,852	)	$	5.65

Nonvested awards at end of year		276,280		$	12.68		2,676,755		$	7.86

For the Year Ended December 31, 2016:


	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		509,634		$	13.25		2,331,152		$	6.38
Awarded		254,574		$	13.07		799,804		$	7.30
Vested		(349,356	)	$	13.07		(671,983	)	$	6.50
Forfeited		(67,724	)	$	13.06		(647,298	)	$	6.28

Nonvested awards at end of year		347,128		$	13.35		1,811,675		$	6.78

The value of stock-based awards is charged to compensation expense over the service periods. In the years ended December 31, 2017, 2016, and 2015, we recorded $9.9 million, $7.9 million, and $11.1 million, respectively, of non-cash compensation expense. The remaining unrecognized cost from restricted equity awards at December 31, 2017, is $17.7 million, which will be recognized over a weighted average period of 2.98 years. Restricted equity awards that vested in 2017, 2016, and 2015 had a value of $10.4 million, $12.7 million, and $10.2 million, respectively.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2017

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

8. Commitments and Contingencies

Commitments

On September 28, 2016, we entered into definitive agreements to acquire an acute care hospital in Washington for a purchase price of $17.5 million. Upon closing, the facility will be leased to RCCH, pursuant to the current master lease. Closing of this transaction, which is now expected to be completed in the first half of 2018 is subject to customary real estate, regulatory and other closing conditions.

Operating leases, in which we are the lessee, primarily consist of ground leases on which certain of our facilities or other related property reside along with corporate office and equipment leases. The ground leases are long-term leases (almost all having terms of 30 years or more), some of which contain escalation provisions and one contains a purchase option. Properties subject to these ground leases are subleased to our tenants. Lease and rental expense (which is recorded on the straight-line method) for 2017, 2016, and 2015 was $9.8 million, $6.8 million, and $4.6 million, respectively, which was offset by sublease rental income of $6.6 million, $4.2 million, and $2.3 million for 2017, 2016, and 2015, respectively.

Fixed minimum payments due under operating leases with non-cancelable terms of more than one year and amounts to be received in the future from non-cancelable subleases at December 31, 2017 are as follows: (amounts in thousands)


	Fixed minimum payments		Amounts to be received from subleases			Net payments
2018	$	8,210	$	(4,386	)	$	3,824
2019		8,753		(3,946	)		4,807
2020		8,967		(4,097	)		4,870
2021		8,063		(4,175	)		3,888
2022		8,121		(4,118	)		4,003
Thereafter		191,457		(96,028	)		95,429	(1)

	$	233,571	$	(116,750	)	$	116,821

(1)

Reflects certain ground leases, in which we are the lessee, that have longer fixed terms than our existing sublease to our tenants. However, we would expect to either renew the related sublease, enter into a lease with a new tenant or early terminate the ground lease to reduce or avoid any significant impact from such ground leases.

Contingencies

We are a party to various legal proceedings incidental to our business. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to these proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

Common Stock/Partner's Capital	12 Months Ended
Common Stock/Partner's Capital	Dec. 31, 2017
Equity [Abstract]
Common Stock/Partner's Capital	9. Common Stock/Partner’s Capital Medical Properties Trust, Inc. 2017 Activity On May 1, 2017, we completed an underwritten public offering of 43.1 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 5.6 million shares) of our common stock, resulting in net proceeds of approximately $548 million, after deducting offering expenses. On November 13, 2017, we entered into a new at-the-market equity offering program, which gives us the ability to sell up to $750 million of stock with a commission rate up to 2.0%. During 2017, we did not sell any shares of our common stock under this program. 2016 Activity On October 7, 2016, we sold 10.3 million shares of common stock in a private placement to an affiliate of Cerberus, the controlling member of Steward, and certain members of Steward management. We sold these shares at a price per share of $14.50, equal to the public offering price of our September 2016 equity offering, generating total proceeds of $150 million. On September 30, 2016, we completed an underwritten public offering of 57.5 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 7.5 million shares) of our common stock, resulting in net proceeds of $799.5 million, after deducting estimated offering expenses. During 2016, we sold approximately 15 million shares of our common stock under a previously existing at-the-market equity offering program (that ended in 2016), resulting in net proceeds of approximately $224 million, after deducting approximately $2.8 million of commissions. MPT Operating Partnership, L.P. The Operating Partnership is made up of a general partner, Medical Properties Trust, LLC (“General Partner”) and limited partners, including the Company (which owns 100% of the General Partner) and three other partners. By virtue of its ownership of the General Partner, the Company has a 99.9% ownership interest in Operating Partnership via its ownership of all the common units. The remaining ownership interest is held by the two employees and the estate of one former director via their ownership of LTIP units. These LTIP units were issued pursuant to the 2007 Multi-Year Incentive Plan, which is now part of the Equity Incentive Plan discussed in Note 7 and once vested in accordance with their award agreement, may be converted to common units per the Second Amended and Restated Agreement of Limited Partnership of MPT Operating Partnership, L.P. (“Operating Partnership Agreement”). In regards to distributions, the Operating Partnership shall distribute cash at such times and in such amounts as are determined by the General Partner in its sole and absolute discretion, to common unit holders who are common unit holders on the record date. However, per the Operating Partnership Agreement, the General Partner shall use its reasonable efforts to cause the Operating Partnership to distribute amounts sufficient to enable the Company to pay stockholder dividends that will allow the Company to (i) meet its distribution requirement for qualification as a REIT and (ii) avoid any U.S. federal income or excise tax liability imposed by the Code, other than to the extent the Company elects to retain and pay income tax on its net capital gain. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for distribution purposes. The Operating Partnership’s net income will generally be allocated first to the General Partner to the extent of any cumulative losses and then to the limited partners in accordance with their respective percentage interests in the common units issued by the Operating Partnership. Any losses of the Operating Partnership will generally be allocated first to the limited partners until their capital account is zero and then to the General Partner. In accordance with the Operating Partnership Agreement, LTIP units are treated as common units for purposes of income and loss allocations. Limited partners have the right to require the Operating Partnership to redeem part or all of their common units. It is at the Operating Partnership’s discretion to redeem such common units for cash based on the fair market value of an equivalent number of shares of the Company’s common stock at the time of redemption or, alternatively, redeem the common units for shares of the Company’s common stock on a one-for-one basis, subject to adjustment in the event of stock splits, stock dividends, or similar events. LTIP units must wait two years from the issuance of the LTIP units to be redeemed, and then converted to common units. For each share of common stock issued by Medical Properties Trust, Inc., the Operating Partnership issues a corresponding number of operating partnership units.

Fair Value of Financial Instruments

12 Months Ended

Dec. 31, 2017

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

10. Fair Value of Financial Instruments

We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents, and accounts payable and accrued expenses approximate their fair values. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as discounting the estimated future cash flows using the current rates at which similar receivables would be made to others with similar credit ratings and for the same remaining maturities. The fair value of our mortgage and working capital loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes, using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our revolving credit facility and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt.

Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):


	December 31, 2017						December 31, 2016
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	78,970		$	78,028		$	57,698		$	57,707
Loans(1)		1,698,471			1,722,101			986,987			1,017,428
Debt, net		(4,898,667	)		(5,073,707	)		(2,909,341	)		(2,966,759	)

(1)	Excludes loans related to Ernest since they are recorded at fair value as discussed below.

Items Measured at Fair Value on a Recurring Basis

Our equity interest in Ernest and related loans, as discussed in Note 2, are being measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method. We have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other equity interests or loans existing at December 31, 2017.

At December 31, 2017, the amounts recorded under the fair value option method were as follows (in thousands):


Asset (Liability)	Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	115,000	$	115,000		Mortgage loans
Equity investment and other loans		114,554		118,354		Other loans/other assets

	$	229,554	$	233,354

At December 31, 2016, the amounts recorded under the fair value option method were as follows (in thousands):


Asset (Liability)	Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	112,836	$	112,836		Mortgage loans
Equity investment and other loans		119,598		119,598		Other loans/other assets

	$	232,434	$	232,434

Our mortgage and other loans with Ernest are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investments in Ernest are recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify the equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuation requires management judgment due to the absence of quoted market prices. For these cash flow models, our observable inputs include use of a capitalization rate, discount rate (which is based on a weighted average cost of capital), and market interest rates, and our unobservable input includes an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at December 31, 2017.

In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections are provided by Ernest. However, we will modify such projections (including underlying assumptions used) as needed based on our review and analysis of their historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors including the percent of control, the nature of the underlying investee’s business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(5	)
- 100 basis points		5

Because the fair value of Ernest investments noted above is below our original cost, we recognized an unrealized loss during 2017. We did not recognize any unrealized gains/losses on the Ernest investments in 2016 or 2015. To date, we have not received any distribution payments from our equity investment in Ernest.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Other Assets

12 Months Ended

Dec. 31, 2017

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]

Other Assets

11. Other Assets

The following is a summary of our other assets (in thousands):


	At December 31,
	2017		2016
Debt issue costs, net(1)	$	7,093	$	4,478
Equity investments		288,398		177,430
Other corporate assets		117,827		77,580
Prepaids and other assets		55,176		44,285

Total other assets	$	468,494	$	303,773

(1)

Relates to revolving credit facility

Equity investments have increased over the prior year primarily due to our $100 million additional equity investment in Steward — see Note 3 for further details. Other corporate assets include leasehold improvements associated with our corporate offices, furniture and fixtures, equipment, software, deposits, etc. Included in prepaids and other assets is prepaid insurance, prepaid taxes, goodwill, deferred income tax assets (net of valuation allowances, if any), and lease inducements made to tenants, among other items.

Quarterly Financial Data (unaudited)

12 Months Ended

Dec. 31, 2017

Quarterly Financial Information Disclosure [Abstract]

Quarterly Financial Data (unaudited)

12. Quarterly Financial Data (unaudited)

Medical Properties Trust, Inc.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2017 and 2016: (amounts in thousands, except for per share data)


	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Income from continuing operations		68,185		73,796		76,881		72,376
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT common stockholders		67,970		73,415		76,464		71,944
Net income attributable to MPT common stockholders per share — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT common stockholders per share — diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — diluted		321,423		350,319		365,046		364,977


	For the Three Month Periods in 2016 Ended
	March 31		June 30		September 30		December 31
Revenues	$	134,999	$	126,300	$	126,555	$	153,283
Income from continuing operations		58,226		53,924		70,543		43,245
Net income		58,225		53,924		70,543		43,245
Net income attributable to MPT common stockholders		57,927		53,724		70,358		43,039
Net income attributable to MPT common stockholders per share — basic	$	0.24	$	0.23	$	0.29	$	0.13
Weighted average shares outstanding — basic		237,510		238,082		246,230		319,833
Net income attributable to MPT common stockholders per share —diluted	$	0.24	$	0.22	$	0.28	$	0.13
Weighted average shares outstanding — diluted		237,819		239,008		247,468		319,994

MPT Operating Partnership, L.P.

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2017 and 2016: (amounts in thousands, except for per unit data)


	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Income from continuing operations		68,185		73,796		76,881		72,376
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT Operating Partnership partners		67,970		73,415		76,464		71,944
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average units outstanding — diluted		321,423		350,319		365,046		364,977


	For the Three Month Periods in 2016 Ended
	March 31		June 30		September 30		December 31
Revenues	$	134,999	$	126,300	$	126,555	$	153,283
Income from continuing operations		58,226		53,924		70,543		43,245
Net income		58,225		53,924		70,543		43,245
Net income attributable to MPT Operating Partnership partners		57,927		53,724		70,358		43,039
Net income attributable to MPT Operating Partnership partners per unit — basic	$	0.24	$	0.23	$	0.29	$	0.13
Weighted average units outstanding — basic		237,510		238,082		246,230		319,833
Net income attributable to MPT Operating Partnership partners per unit — diluted	$	0.24	$	0.22	$	0.28	$	0.13
Weighted average units outstanding — diluted		237,819		239,008		247,468		319,994

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2017
Subsequent Events [Abstract]
Subsequent Events	13. Subsequent Events St. Joseph’s Transaction On March 1, 2018, we sold the real estate of St. Joseph Medical Center in Houston, Texas, at our original cost to Steward with the purchase price of which is evidenced by a promissory note, with such note secured in the mortgage on the underlying real estate. The mortgage loan has terms consistent with the other mortgage loans in the Steward portfolio. At December 31, 2017, this facility was designated as held for sale.

Schedule II: Valuation and Qualifying Accounts

12 Months Ended

Dec. 31, 2017

Valuation and Qualifying Accounts [Abstract]

Schedule II: Valuation and Qualifying Accounts

Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.

Schedule II: Valuation and Qualifying Accounts

December 31, 2017


			Additions			Deductions
Year Ended December 31,	Balance at Beginning of Year(1)		Charged Against Operations(1)			Net Recoveries/ Write-offs(1)			Balance at End of Year(1)
	(In thousands)
2017	$	18,852	$	2,525	(2)	$	(4,980	)(3)	$	16,397
2016	$	27,384	$	2,722	(4)	$	(11,254	)(5)	$	18,852
2015	$	20,129	$	8,205	(6)	$	(950	)(7)	$	27,384

(1)	Includes allowance for doubtful accounts, straight-line rent reserves, allowance for loan losses, tax valuation allowances and other reserves.

(2)	Represents increases in accounts receivable reserves during 2017.

(3)	Includes $4.9 million decrease in valuation allowance to reserve our net deferred tax assets.

(4)	Includes $1.9 million of rent reserves related to our Twelve Oaks facility and $0.8 million of rent reserves related to our Corinth facility.

(5)

Includes write-offs of $3.3 million related to payment of rent, late fees, and loans for our Twelve Oaks facility; $0.8 million of write-offs for rent and interest reserves related to the sale of the Corinth facility; $0.1 million of write-offs related to the McLeod Healthcare loan; and $6.1 million decrease in valuation allowances (which includes the $4 million release of foreign valuation allowances in the 2016 fourth quarter) to reserve against our net deferred tax assets.

(6)	Includes $1.5 million of rent and late fee reserves related to our Twelve Oaks facility; $0.5 million of rent reserves related to our Healthtrax properties; and $6.2 million to fully reserve our net deferred tax assets.

(7)	Write-offs of rent and interest reserves related to sale of Healthtrax properties.

SCHEDULE III - REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

12 Months Ended

Dec. 31, 2017

SEC Schedule III, Real Estate and Accumulated Depreciation Disclosure [Abstract]

SCHEDULE III - REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

SCHEDULE III — REAL ESTATE INVESTMENTS AND ACCUMULATED DEPRECIATION

December 31, 2017


		Initial Costs				Additions Subsequent to Acquisition						Cost at December 31, 2017(1)						Accumulated							Life on which depreciation in latest income statements is computed (Years)
Location	Type of Property	Land		Buildings		Improve- ments			Carrying Costs			Land		Buildings		Total		Depreciation		Encum- brances		Date of Construction		Date Acquired
	(Dollar amounts in thousands)
Bad Rappenau, Germany	Rehabilitation hospital	$	—	$	10,455	$	—		$	—		$	—	$	10,455	$	10,455	$	1,067	$	—	1994		November 30, 2013		40
Dahlen, Germany	Rehabilitation hospital		411		22,674		—			—			411		22,674		23,085		2,315		—	1996		November 30, 2013		40
Bad Dürkheim, Germany	Rehabilitation hospital		3,509		16,587		—			—			3,509		16,587		20,096		1,693		—	1960		November 30, 2013		40
Bad Liebenwerda, Germany	Rehabilitation hospital		383		19,755		—			—			383		19,755		20,138		2,017		—	1994		November 30, 2013		40
Ortenberg, Germany	Rehabilitation hospital		101		5,787		—			—			101		5,787		5,888		591		—	1981		November 30, 2013		40
Wiesbaden, Germany	Rehabilitation hospital		3,402		16,362		—			—			3,402		16,362		19,764		1,670		—	1977		November 30, 2013		40
Bad Dürkheim, Germany	Rehabilitation hospital		—		32,826		—			—			—		32,826		32,826		3,351		—	1992		November 30, 2013		40
Bad Liebenwerda, Germany	Rehabilitation hospital		595		16,516		—			—			595		16,516		17,111		1,686		—	1904, 1995		November 30, 2013		40
Bad Dürkheim, Germany	Rehabilitation hospital		805		7,234		—			—			805		7,234		8,039		738		—	1980		November 30, 2013		40
Bad Dürkheim, Germany	Rehabilitation hospital		6,448		17,804		—			—			6,448		17,804		24,252		1,818		—	1930		November 30, 2013		40
Bad Rappenau, Germany	Rehabilitation hospital		3,780		6,440		—			—			3,780		6,440		10,220		657		—	1986		November 30, 2013		40
Bad Tölz, Germany	Rehabilitation hospital		2,436		10,273		214			—			2,436		10,487		12,923		808		—	1974		November 19, 2014		40
Bad Liebenstein, Germany	Rehabilitation hospital		1,774		37,482		—			—			1,774		37,482		39,256		2,967		—	1954, 1992		November 5, 2014		40
Bad Mergentheim, Germany	Rehabilitation hospital		—		12,432		—			—			—		12,432		12,432		958		—	1988, 1995		December 11, 2014		40
Bath, UK	Acute care general hospital		1,602		33,197		—			—			1,602		33,197		34,799		2,906		—	2008, 2009		July 1, 2014		40
Ottenhöfen, Germany	Rehabilitation hospital		2,490		14,015		120			—			2,610		14,015		16,625		896		—	1956/1957		July 3, 2015		40
Bad Berka, Germany	Rehabilitation hospital		3,565		16,630		186			—			3,751		16,630		20,381		1,035		—	1997		July 22, 2015		40
Wiesbaden, Germany	Rehabilitation hospital		1,776		8,242		3,104			—			1,818		11,304		13,122		562		—	1974		June 30, 2015		40
Bad Lausick, Germany	Rehabilitation hospital		1,914		17,324		168			—			2,082		17,324		19,406		1,111		—	1993		June 30, 2015		40
Bad Sülze, Germany	Rehabilitation hospital		2,538		21,899		216			—			2,754		21,899		24,653		1,405		—	1993		June 30, 2015		40
Kurort Berggießhübel, Germany	Rehabilitation hospital		3,385		17,078		150			—			3,535		17,078		20,613		1,057		—	1993		July 21, 2015		40
Braunfels, Germany	Acute care general hospital		2,305		14,733		60			—			2,365		14,733		17,098		931		—	1977		June 30, 2015		40
Bernkastel-Kues, Germany	Rehabilitation hospital		3,866		16,790		48			—			3,914		16,790		20,704		1,022		—	1982		July 15, 2015		40
Flechtingen, Germany	Rehabilitation hospital		3,073		15,513		162			—			3,235		15,513		18,748		997		—	1993		June 30, 2015		40
Flechtingen, Germany	Rehabilitation hospital		3,073		24,303		240			—			3,313		24,303		27,616		1,559		—	1993-1995		June 30, 2015		40
Nordrach, Germany	Rehabilitation hospital		336		3,216		90			—			426		3,216		3,642		216		—	1960		July 7, 2015		40
Bad Gottleuba, Germany	Rehabilitation hospital		57		16,508		954			—			1,011		16,508		17,519		953		—	1913		December 16, 2015		40
Grünheide, Germany	Rehabilitation hospital		3,053		44,867		366			—			3,419		44,867		48,286		2,770		—	1994/2014		July 31, 2015		40
Baden-Baden, Germany	Rehabilitation hospital		1,405		9,876		138			—			1,543		9,876		11,419		640		—	1900/2002- 2003		June 30, 2015		40
Gyhum, Germany	Rehabilitation hospital		4,286		24,497		377			—			4,663		24,497		29,160		1,594		—	1994		June 30, 2015		40
Hannover, Germany	Rehabilitation hospital		3,518		16,622		342			—			3,860		16,622		20,482		913		—	1900 (renovations in 1997, 2000, 2009)		December 1, 2015		40
Heiligendamm, Germany	Rehabilitation hospital		4,622		28,805		228			—			4,850		28,805		33,655		1,838		—	1995		June 30, 2015		40
Bad Camberg, Germany	Rehabilitation hospital		2,240		17,072		3,717			—			2,527		20,502		23,029		1,160		—	1973		June 30, 2015		40
Hoppegarten, Germany	Rehabilitation hospital		4,304		26,655		264			—			4,568		26,655		31,223		1,653		—	1994		July 27, 2015		40
Ban Nauheim, Germany	Rehabilitation hospital		3,397		17,163		156			—			3,553		17,163		20,716		1,099		—	1977		June 30, 2015		40
Kalbe, Germany	Rehabilitation hospital		3,758		25,106		180			—			3,938		25,106		29,044		1,599		—	1995		July 6, 2015		40
Bad Soden-Salmünster, Germany	Rehabilitation hospital		1,032		7,164		132			—			1,164		7,164		8,328		470		—	1974		June 30, 2015		40
Berlin, Germany	Rehabilitation hospital		—		22,952		204			—			204		22,952		23,156		1,509		—	1998		July 16, 2015		40
Bad Lobenstein, Germany	Rehabilitation hospital		3,914		22,192		198			—			4,112		22,192		26,304		1,420		—	1994		June 30, 2015		40
Bernkastel-Kues, Germany	Rehabilitation hospital		864		12,471		144			—			1,008		12,471		13,479		803		—	1993		July 14, 2015		40
Magdeburg, Germany	Rehabilitation hospital		15,901		58,985		276			—			16,177		58,985		75,162		3,608		—	1999/2014		July 22, 2015		40
Schlangenbad, Germany	Rehabilitation hospital		1,159		3,770		294			—			1,453		3,770		5,223		285		—	1973		June 30, 2015		40
Bad Dürrheim, Germany	Rehabilitation hospital		1,537		12,599		252			—			1,789		12,599		14,388		802		—	1960-1970		July 24, 2015		40
Bad Krozingen, Germany	Rehabilitation hospital		1,627		11,863		126			—			1,753		11,863		13,616		737		—	2008		July 24, 2015		40
Bad Nauheim, Germany	Rehabilitation hospital		1,945		10,166		60			—			2,005		10,166		12,171		645		—	1972-1973		June 30, 2015		40
Bad Tennstedt, Germany	Rehabilitation hospital		4,064		30,130		222			—			4,286		30,130		34,416		1,920		—	1993		June 30, 2015		40
Wismar, Germany	Rehabilitation hospital		3,830		22,817		216			—			4,046		22,817		26,863		1,462		—	1996		June 30, 2015		40
Heidelberg, Germany	Rehabilitation hospital		6,705		38,743		78			—			6,783		38,743		45,526		1,461		—	1885/1991		June 22, 2016		40
Bad Kösen, Germany	Rehabilitation hospital		840		8,380		60			—			900		8,380		9,280		249		—	1992		October 27, 2016		40
Bad Kösen, Germany	Rehabilitation hospital		943		8,026		504			—			1,447		8,026		9,473		273		—	1996		October 27, 2016		40
Bad Kösen, Germany	Rehabilitation hospital		486		5,024		414			—			900		5,024		5,924		179		—	1997		October 27, 2016		40
Bad Salzdetfurth, Germany	Rehabilitation hospital		1,122		7,595		54			—			1,176		7,595		8,771		210		—	1987		November 23, 2016		40
Bad Bertrich, Germany	Rehabilitation hospital		546		4,424		72			—			618		4,424		5,042		125		—	1910,1980- 1985		November 30, 2016		40
Lübeck, Germany	Rehabilitation hospital		1,164		5,235		30			—			1,194		5,235		6,429		133		—	1900/2011		December 31, 2016		40
Vitense-Parber, Germany	Rehabilitation hospital		864		4,197		84			—			948		4,197		5,145		111		—	1800/1995		December 31, 2016		40
Breuberg-Sandbach, Germany	Rehabilitation hospital		804		13,872		306			—			1,110		13,872		14,982		367		—	1901/1984		December 31, 2016		40
Ravensrush, Germany	Rehabilitation hospital		1,062		2,993		90			—			1,152		2,993		4,145		81		—	1860/1992		December 31, 2016		40
Wildeck, Germany	Rehabilitation hospital		846		5,961		66			—			912		5,961		6,873		153		—	1600/2013		December 31, 2016		40
Römhild, Germany	Rehabilitation hospital		107		9,603		240			—			347		9,603		9,950		264		—	1902/2000		December 31, 2016		40
Bad Hersfield, Germany	Rehabilitation hospital		438		4,385		96			—			534		4,385		4,919		116		—	1930/2014		December 31, 2016		40
Bad Dürkheim, Germany	Rehabilitation hospital		3,054		21,727		171			—			3,225		21,727		24,952		277		—	1981,2015		July 7, 2017		40
Bad Oeynhausen, Germany	Rehabilitation hospital		591		4,350		40			—			631		4,350		4,981		10		—	1973,2010		November 30, 2017		40
Bad Pyrmont, Germany	Rehabilitation hospital		3,055		21,790		170			—			3,225		21,790		25,015		324		—	1960,2010		June 1, 2017		40
Bad Salzuflen, Germany	Rehabilitation hospital		4,240		31,794		282			—			4,522		31,794		36,316		69		—	1989,2016		November 30, 2017		40
Bad Salzuflen, Germany	Rehabilitation hospital		5,601		41,854		372			—			5,973		41,854		47,827		90		—	1974,2016		November 30, 2017		40
Cologne, Germany	Acute care general hospital		2,576		18,842		144			—			2,720		18,842		21,562		240		—	2011		June 23, 2017		40
Schalkenmehren, Germany	Rehabilitation hospital		199		1,354		11			—			210		1,354		1,564		20		—	1911,2012		June 15, 2017		40
Daun, Germany	Rehabilitation hospital		1,475		10,484		82			—			1,557		10,484		12,041		156		—	1960,2009		June 15, 2017		40
Darscheid, Germany	Rehabilitation hospital		1,753		12,503		98			—			1,851		12,503		14,354		186		—	1940,2004		June 15, 2017		40
Germersheim, Germany	Rehabilitation hospital		797		5,647		44			—			841		5,647		6,488		84		—	1964,2013		June 8, 2017		40
Kevelaer, Germany	Rehabilitation hospital		1,089		7,746		61			—			1,150		7,746		8,896		115		—	1967,1996		June 10, 2017		40
Willich, Germany	Rehabilitation hospital		425		2,979		24			—			449		2,979		3,428		44		—	Unknown		May 31, 2017		40
Bad Bertrich, Germany	Rehabilitation hospital		1,357		7,746		24			—			1,381		7,746		9,127		179		—	1910		January 31, 2017		40
Neunkirchen, Germany	Rehabilitation hospital		3,108		22,198		173			—			3,281		22,198		25,479		378		—	1977,2001		May 13, 2017		40
Lübstorf, Germany	Rehabilitation hospital		3,094		22,053		173			—			3,267		22,053		25,320		328		—	1994,2004		June 1, 2017		40
Ahrweiler, Germany	Rehabilitation hospital		1,262		8,952		70			—			1,332		8,952		10,284		133		—	1964,1973		May 27, 2017		40
Rieden, Germany	Rehabilitation hospital		611		4,310		34			—			645		4,310		4,955		55		—	1970		June 17, 2017		40
Oppenweiler, Germany	Rehabilitation hospital		2,152		15,349		121			—			2,273		15,349		17,622		163		—	1900,2012		July 28, 2017		40
Houston, TX	Acute care general hospital		3,501		34,530		8,477			16,589			3,274		59,823		63,097		11,303		—	1960		August 10, 2007		40
Allen, TX	Freestanding ER		1,550		3,921		—			—			1,550		3,921		5,471		343		—	2014		July 14, 2014		40
San Diego, CA	Acute care general hospital		12,663		52,432		—			—			12,663		52,432		65,095		9,066		—	1973		February 9, 2011		40
Alvin, TX	Freestanding ER		105		4,087		—			—			105		4,087		4,192		360		—	2014		March 19, 2014		40
Houston, TX	Freestanding ER		950		3,996		—			—			950		3,996		4,946		125		—	2016		September 26, 2016		40
Aurora, CO	Freestanding ER		—		4,812		—			—			—		4,812		4,812		271		—	2015		September 17, 2015		40
Ft. Worth, TX	Freestanding ER		—		4,392		—			—			—		4,392		4,392		302		—	2015		March 27, 2015		40
Bayonne, NJ	Acute care general hospital		2,003		51,495		—			—			2,003		51,495		53,498		17,809		—	1918		February 4, 2011		20
Bennettsville, SC	Acute care general hospital		794		15,772		—			—			794		15,772		16,566		3,788		—	1984		April 1, 2008		40
Blue Springs, MO	Acute care general hospital		4,347		23,494		—			—			4,347		23,494		27,841		1,800		—	1980		February 13, 2015		40
Bossier City, LA	Long term acute care hospital		900		17,818		—			—			900		17,818		18,718		4,341		—	1982		April 1, 2008		40
Brighton, MA	Acute care general hospital		18,540		146,490		836			—			18,540		147,326		165,866		4,584		—	1917-2009		October 3, 2016		41
Brockton, MA	Acute care general hospital		18,328		67,248		1,516			—			18,328		68,764		87,092		2,656		—	1965-2010		October 3, 2016		41
Austin, TX	Freestanding ER		1,140		3,853		—			—			1,140		3,853		4,993		345		—	2014		May 29, 2014		40
Broomfield, CO	Freestanding ER		825		3,895		—			—			825		3,895		4,720		341		—	2014		July 3, 2014		40
Glendale, AZ	Freestanding ER		1,144		6,087		—			—			1,144		6,087		7,231		178		—	2016		October 21, 2016		40
New Orleans, LA	Freestanding ER		2,850		6,125		—			—			2,850		6,125		8,975		191		—	2016		September 23, 2016		40
Carrollton, TX	Acute care general hospital		729		34,342		—			—			729		34,342		35,071		2,075		—	2015		July 17, 2015		40
Cedar Hill. TX	Freestanding ER		1,122		3,644		—			—			1,122		3,644		4,766		319		—	2014		June 23, 2014		40
Spring, TX	Freestanding ER		1,310		3,583		—			—			1,310		3,583		4,893		314		—	2014		July 15, 2014		40
Chandler, AZ	Freestanding ER		—		4,783		—			—			—		4,783		4,783		319		—	2015		April 24, 2015		40
Chandler, AZ	Freestanding ER		750		3,852		—			—			750		3,852		4,602		217		—	2015		October 7, 2015		40
Cheraw, SC	Acute care general hospital		657		19,576		—			—			657		19,576		20,233		4,700		—	1982		April 1, 2008		40
Katy, TX	Freestanding ER		—		3,873		—			—			—		3,873		3,873		210		—	2015		October 21, 2015		40
Webster, TX	Long term acute care hospital		663		33,751		—			—			663		33,751		34,414		5,906		—	2004		December 21, 2010		40
Commerce City, TX	Freestanding ER		707		4,248		—			—			707		4,248		4,955		327		—	2014		December 11, 2014		40
Conroe, TX	Freestanding ER		1,338		3,712		—			—			1,338		3,712		5,050		224		—	2015		July 29, 2015		40
Converse, TX	Freestanding ER		750		4,423		—			—			750		4,423		5,173		304		—	2015		April 10, 2015		40
The Woodlands, TX	Freestanding ER		—		4,524		—			—			—		4,524		4,524		198		—	2016		March 28, 2016		40
Houston, TX	Freestanding ER		—		4,365		—			—			—		4,365		4,365		83		—	2017		May 8, 2017		35
Dallas, TX	Long term acute care hospital		1,000		13,589		—			368			1,421		13,536		14,957		3,835		—	2006		September 5, 2006		40
Denver, CO	Freestanding ER		—		4,276		—			—			—		4,276		4,276		276		—	2015		June 8, 2015		40
DeSoto, TX	Freestanding ER		750		4,234		—			—			750		4,234		4,984		168		—	2016		May 23, 2016		40
DeSoto, TX	Long term acute care hospital		1,067		10,701		86			8			1,161		10,701		11,862		1,750		—	2008		July 18, 2011		40
Detroit, MI	Long term acute care hospital		1,220		8,687		—			(365	)		1,220		8,322		9,542		2,068		—	1956		May 22, 2008		40
San Antonio, TX	Freestanding ER		—		4,801		—			—			—		4,801		4,801		130		—	2016		December 9, 2016		40
Dulles, TX	Freestanding ER		1,076		3,784		—			—			1,076		3,784		4,860		315		—	2014		September 12, 2014		40
Easton, PA	Acute care general hospital		13,898		40,245		—			—			13,898		40,245		54,143		710		—	1930,2005		May 1, 2017		41
Houston, TX	Freestanding ER		1,345		3,678		—			—			1,345		3,678		5,023		322		—	2014		June 20, 2014		40
Fairmont, CA	Acute care general hospital		1,000		12,301		5,277			—			1,277		17,301		18,578		1,343		—	1939,1972,1985		September 19, 2014		40
Fall River, MA	Acute care general hospital		2,406		82,358		15,555			—			2,406		97,913		100,319		2,632		—	1950-2012		October 3, 2016		41
Firestone, TX	Freestanding ER		495		3,963		—			—			495		3,963		4,458		355		—	2014		June 6, 2014		40
Florence, AZ	Acute care general hospital		900		28,462		105			—			900		28,567		29,467		4,103		—	2012		February 7, 2012		40
Fort Lauderdale, FL	Rehabilitation hospital		3,499		21,939		—			1			3,499		21,940		25,439		5,313		—	1985		April 22, 2008		40
Fountain, CO	Freestanding ER		1,508		4,131		—			—			1,508		4,131		5,639		353		—	2014		July 31, 2014		40
Frisco, TX	Freestanding ER		—		4,738		—			—			—		4,738		4,738		217		—	2016		March 4, 2016		40
Frisco, TX	Freestanding ER		2,441		4,474		—			—			2,441		4,474		6,915		242		—	2015		November 13, 2015		40
Frisco, TX	Freestanding ER		1,500		3,863		27			(89	)		1,411		3,890		5,301		348		—	2014		June 13, 2014		40
Garden Grove, CA	Acute care general hospital		5,502		10,748		—			51			5,502		10,799		16,301		2,466		—	1982		November 25, 2008		40
Garland, TX	Freestanding ER		—		4,647		—			—			—		4,647		4,647		136		—	2016		November 15, 2016		40
Garden Grove, CA	Medical Office Building		862		7,888		—			28			862		7,916		8,778		1,801		—	1982		November 25, 2008		40
Gilbert, AZ	Acute care general hospital		150		15,553		—			—			150		15,553		15,703		2,722		—	2005		January 4, 2011		40
Gilbert, AZ	Freestanding ER		1,518		4,660		—			—			1,518		4,660		6,178		282		—	2015		July 22, 2015		40
Glendale, AZ	Freestanding ER		—		4,046		—			—			—		4,046		4,046		261		—	2015		June 5, 2015		40
Goodyear, AZ	Freestanding ER		1,800		4,713		—			—			1,800		4,713		6,513		206		—	2016		April 4, 2016		40
Hartsville, SC	Acute care general hospital		2,050		43,970		—			—			2,050		43,970		46,020		2,392		—	1999		August 31, 2015		34
Hausman, TX	Acute care general hospital		1,500		8,958		—			—			1,500		8,958		10,458		1,060		—	2013		March 1, 2013		40
Helotes, TX	Freestanding ER		1,900		5,115		—			—			1,900		5,115		7,015		234		—	2016		March 10, 2016		40
Highland Village, TX	Freestanding ER		—		4,016		—			—			—		4,016		4,016		226		—	2015		September 22, 2015		40
Hill County, TX	Acute care general hospital		1,120		17,882		—			—			1,120		17,882		19,002		8,691		—	1980		September 17, 2010		40
Warren, OH	Rehabilitation hospital		2,417		15,857		—			—			2,417		15,857		18,274		356		—	1922-2000		May 1, 2017		46
Hoboken, NJ	Acute care general hospital		1,387		44,351		—			—			1,387		44,351		45,738		13,616		—	1863		November 4, 2011		20
Hoover, AL	Freestanding ER		—		7,581		—			—			—		7,581		7,581		590		—	2015		May 1, 2015		34
Hoover, AL	Medical Office Building		—		1,034		—			—			—		1,034		1,034		80		—	2015		May 1, 2015		34
Hope, AR	Acute care general hospital		1,651		3,359		—			—			1,651		3,359		5,010		45		—	1984-2001		September 29, 2017		41
Hot Springs. AR	Acute care general hospital		7,100		59,432		19,996			—			7,100		79,428		86,528		4,626		—	1985		August 31, 2015		40
Houston, TX	Acute care general hospital		33,627		97,745		—			—			33,627		97,745		131,372		494		—	1940-1950		September 29, 2017		41
Houston, TX	Acute care general hospital		4,757		56,238		(37	)		1,259			5,427		56,790		62,217		15,691		—	2006		December 1, 2006		40
Colorado Springs, CO	Freestanding ER		600		4,231		—			—			600		4,231		4,831		379		—	2014		June 5, 2014		40
Northland, MO	Long term acute care hospital		834		17,182		—			—			834		17,182		18,016		2,971		—	2007		February 14, 2011		40
Highlands Ranch, CO	Freestanding ER		4,200		4,778		—			—			4,200		4,778		8,978		169		—	2016		July 25, 2016		40
Idaho Falls, ID	Acute care general hospital		1,822		37,467		—			4,665			1,822		42,132		43,954		10,143		—	2002		April 1, 2008		40
Kansas City, MO	Acute care general hospital		10,497		64,419		—			—			10,497		64,419		74,916		4,788		—	1978		February 13, 2015		40
Katy, TX	Freestanding ER		—		4,183		—			—			—		4,183		4,183		131		—	2016		October 10, 2016		40
Camden, SC	Acute care general hospital		—		22,739		—			—			—		22,739		22,739		972		—	1954-2004		October 30, 2015		39
Lafayette, IN	Rehabilitation hospital		800		14,968		(25	)		—			800		14,943		15,743		1,824		—	2013		February 1, 2013		40
Lehi, UT	Acute care general hospital		13,403		29,950		—			—			13,403		29,950		43,353		221		—	2015		September 29, 2017		45
Lewiston, ID	Acute care general hospital		10,577		70,247		—			—			10,577		70,247		80,824		1,585		—	1922		May 1, 2017		40
Little Elm, TX	Freestanding ER		1,241		3,491		—			—			1,241		3,491		4,732		353		—	2013		December 1, 2013		40
Longmont, CO	Freestanding ER		—		4,181		—			—			—		4,181		4,181		200		—	2016		February 10, 2016		40
Lubbock. TX	Rehabilitation Hospital		1,376		28,292		3,648			—			1,376		31,940		33,316		1,844		—	2008		June 16, 2015		40
Mandeville, LA	Freestanding ER		2,800		5,370		—			—			2,800		5,370		8,170		157		—	2016		October 28, 2016		40
Marrero, LA	Freestanding ER		—		5,801		—			—			—		5,801		5,801		218		—	2016		July 15, 2016		40
McKinney, TX	Freestanding ER		—		4,060		—			—			—		4,060		4,060		330		—	2015		July 31, 2015		30
McMinnville, OR	Acute care general hospital		5,000		97,900		—			—			5,000		97,900		102,900		4,157		—	1996		August 31, 2015		41
Melbourne, FL	Acute care general hospital		5,642		17,087		—			—			5,642		17,087		22,729		363		—	2002		May 1, 2017		42
Mesa, AZ	Acute care general hospital		6,264		99,175		2,242			—			8,506		99,175		107,681		11,183		—	2007		September 26, 2013		40
Phoenix, AZ	Acute care general hospital		5,576		45,774		—			—			5,576		45,774		51,350		1,049		—	2017		February 10, 2017		40
Methuen, MA	Acute care general		23,809		89,505		810			—			23,809		90,315		114,124		3,191		—	1950-2011		October 3, 2016		41
Bloomington, IN	Acute care general hospital		2,392		28,212		5,000			408			2,392		33,620		36,012		9,430		—	2006		August 8, 2006		40
Montclair, NJ	Acute care general hospital		7,900		99,632		585			—			8,477		99,640		108,117		9,682		—	1920-2000		April 1, 2014		40
San Antonio, TX	Freestanding ER		351		3,952		—			—			351		3,952		4,303		369		—	2014		January 1, 2014		40
Altoona, WI	Acute care general hospital		—		29,062		—			—			—		29,062		29,062		2,422		—	2014		August 31, 2014		40
Odessa. TX	Acute care general hospital		6,772		123,215		—			—			6,772		123,215		129,987		788		—	1973-2004		September 29, 2017		41
Ogden, UT	Rehabilitation hospital		1,759		16,414		—			—			1,759		16,414		18,173		1,560		—	2014		March 1, 2014		40
Olympia, WA	Acute care general hospital		7,220		89,348		11,775			—			7,220		101,123		108,343		3,375		—	1984		July 22, 2016		40
Overlook, TX	Acute care general hospital		2,452		9,666		7			—			2,452		9,673		12,125		1,168		—	2012		February 1, 2013		40
San Diego, CA	Acute care general hospital		6,550		15,653		—			77			6,550		15,730		22,280		4,193		—	1964		May 9, 2007		40
Parker, CO	Freestanding ER		1,301		4,448		—			—			1,301		4,448		5,749		241		—	2015		November 6, 2015		40
Pearland, TX	Freestanding ER		1,075		3,577		—			—			1,075		3,577		4,652		298		—	2014		September 8, 2014		40
Petersburg, VA	Rehabilitation hospital		1,302		9,121		—			—			1,302		9,121		10,423		2,166		—	2006		July 1, 2008		40
Phoenix, AZ	Acute care general hospital		2,396		26,521		—			—			2,396		26,521		28,917		160		—	1979		September 29, 2017		42
Phoenix, AZ	Acute care general hospital		13,852		73,773		—			—			13,852		73,773		87,625		500		—	1968-1976		September 29, 2017		43
Plano, TX	Freestanding ER		—		4,842		—			—			—		4,842		4,842		151		—	2016		September 30, 2016		40
Poplar Bluff, MO	Acute care general hospital		2,659		38,694		—			1			2,660		38,694		41,354		9,370		—	1980		April 22, 2008		40
Port Arthur, TX	Acute care general hospital		10,593		76,398		1,062			—			11,655		76,398		88,053		7,976		—	2005		September 26, 2013		40
Port Huron, MI	Acute care general hospital		3,029		14,622		—			—			3,029		14,622		17,651		998		—	1953, 1973-1983		December 31, 2015		40
Portland, OR	Long term acute care hospital		3,085		17,859		—			2,559			3,071		20,432		23,503		5,410		—	1964		April 18, 2007		40
Post Falls, ID	Rehabilitation hospital		417		12,175		1,905			—			767		13,730		14,497		1,382		—	2013		December 31, 2013		40
San Antonio, TX	Freestanding ER		—		4,253		—			—			—		4,253		4,253		124		—	2016		October 27, 2016		40
Redding, CA	Acute care general hospital		1,555		53,863		—			13			1,555		53,876		55,431		14,039		—	1974		August 10, 2007		40
Redding, CA	Long term acute care hospital		—		19,952		—			4,360			1,629		22,683		24,312		6,979		—	1991		June 30, 2005		40
Austin, TX	Freestanding ER		—		4,979		—			—			—		4,979		4,979		104		—	2017		March 2, 2017		40
Rockledge, FL	Acute care general hospital		13,919		23,282		—			—			13,919		23,282		37,201		581		—	1950,1970		May 1, 2017		42
Rosenberg, TX	Freestanding ER		—		4,505		—			—			—		4,505		4,505		225		—	2016		January 15, 2016		40
Columbus, OH	Freestanding ER		1,726		—		—			—			1,726		—		1,726		—		—	2016		August 30, 2016		—
Salt Lake City, UT	Acute care general hospital		17,204		101,915		—			—			17,204		101,915		119,119		635		—	1906-1987		September 29, 2017		41
San Antonio, TX	Acute care general hospital		8,053		29,333		—			—			8,053		29,333		37,386		204		—	1978-2002		September 29, 2017		41
San Dimas, CA	Acute care general hospital		6,160		6,839		—			34			6,160		6,873		13,033		1,563		—	1972		November 25, 2008		40
San Dimas, CA	Medical Office Building		1,915		5,085		—			18			1,915		5,103		7,018		1,161		—	1979		November 25, 2008		40
Phoenix, AZ	Freestanding ER		1,132		5,052		—			—			1,132		5,052		6,184		95		—	2017		April 13, 2017		40
Sebastian, FL	Acute care general hospital		5,733		49,136		—			—			5,733		49,136		54,869		910		—	1974		May 1, 2017		41
Sharon, PA	Acute care general hospital		6,179		9,066		—			—			6,179		9,066		15,245		435		—	1950-1980		May 1, 2017		41
Sherman, TX	Acute care general hospital		4,491		24,802		—			—			4,491		24,802		29,293		2,061		—	1913, 1960- 2010		October 31, 2014		40
Sienna, TX	Freestanding ER		999		3,591		—			—			999		3,591		4,590		299		—	2014		August 20, 2014		40
Spartanburg, SC	Rehabilitation hospital		1,135		15,717		—			—			1,135		15,717		16,852		1,718		—	2013		August 1, 2013		40
Houston, TX	Freestanding ER		1,423		3,770		—			—			1,423		3,770		5,193		267		—	2015		February 18, 2015		40
Taunton, MA	Acute care general hospital		4,428		73,433		—			—			4,428		73,433		77,861		2,441		—	1940-2015		October 3, 2016		41
Tempe, AZ	Acute care general hospital		6,050		10,986		—			—			6,050		10,986		17,036		95		—	1940		September 29, 2017		41
Texarkana, TX	Acute care general hospital		12,402		—		—			—			12,402		—		12,402		—		—	2017		September 29, 2017		—
Thornton, CO	Freestanding ER		1,350		4,259		—			—			1,350		4,259		5,609		355		—	2014		August 29, 2014		40
Toledo, OH	Rehabilitation hospital		—		17,740		—			—			—		17,740		17,740		773		—	2016		April 1, 2016		40
Tomball, TX	Long term acute care hospital		1,299		23,982		—			—			1,299		23,982		25,281		4,197		—	2005		December 21, 2010		40
Houston, TX	Acute care general hospital		4,047		36,864		—			—			4,047		36,864		40,911		1,383		—	2016		July 7, 2016		40
League City, TX	Freestanding ER		—		3,901		—			—			—		3,901		3,901		244		—	2015		June 19, 2015		40
Anaheim, CA	Acute care general hospital		1,875		21,814		—			10			1,875		21,824		23,699		6,092		—	1964		November 8, 2006		40
Warren, OH	Acute care general hospital		5,385		47,588		—			—			5,385		47,588		52,973		997		—	1982		May 1, 2017		41
West Monroe, LA	Acute care general hospital		12,000		69,433		10,068			—			12,552		78,949		91,501		7,705		—	1962		September 26, 2013		40
San Antonio, TX	Acute care general hospital		2,248		5,880		—			—			2,248		5,880		8,128		757		—	2012		October 2, 2012		40
West Valley City, UT	Acute care general hospital		5,516		58,314		2,036			(114	)		5,402		60,350		65,752		14,237		—	1980		April 22, 2008		40
Wichita, KS	Rehabilitation hospital		1,019		18,373		—			1			1,019		18,374		19,393		4,478		—		1992			April 4, 2008	40
Woodland Park, CO	Acute care general hospital		54		428		—			—			54		428		482		3		—		1948			September 29, 2017	40
Youngstown, OH	Acute care general hospital		4,335		3,565		—			—			4,335		3,565		7,900		385		—		1929-2003			May 1, 2017	41

		$	654,736	$	4,644,787	$	108,743		$	29,882		$	673,253	$	4,764,895	$	5,438,148	$	407,349	$	—

(1)	The aggregate cost for federal income tax purposes is $5,876,327.

The changes in total real estate assets (excluding construction in progress, intangible lease assets, investment in direct financing leases, and mortgage loans) are as follows for the years ended (in thousands):


	December 31, 2017			December 31, 2016			December 31, 2015
COST
Balance at beginning of period	$	3,968,042		$	2,991,590		$	2,040,727
Acquisitions		1,256,245			745,948			975,239
Transfers from construction in progress		74,441			163,080			23,163
Additions		36,828			33,279			7,376
Dispositions		(53,372	)		(138,886	)		(24,701	)
Other		155,964	(2)		173,031			(30,214	)

Balance at end of period	$	5,438,148	(3)	$	3,968,042		$	2,991,590

The changes in accumulated depreciation are as follows for the years ended (in thousands):


	December 31, 2017			December 31, 2016			December 31, 2015
ACCUMULATED DEPRECIATION
Balance at beginning of period	$	292,786		$	232,675		$	181,441
Depreciation		109,307			81,010			60,796
Depreciation on disposed property		(1,438	)		(19,086	)		(8,887	)
Other		6,694			(1,813	)		(675	)

Balance at end of period	$	407,349	(4)	$	292,786		$	232,675

(2)	Represents foreign currency fluctuations and purchase price allocation adjustments.

(3)	Includes $131.4 million of land and building cost reflected in real estate held for sale at December 31, 2017. Excludes intangible lease assets that are included in real estate held for sale of $15.8 million at December 31, 2017.

(4)	Includes $0.5 million of accumulated depreciation reflected in real estate held for sale at December 31, 2017. Excludes accumulated amortization related to intangible lease assets that are included in real estate held for sale of $0.1 million at December 31, 2017.

SCHEDULE IV - MORTGAGE LOANS ON REAL ESTATE

12 Months Ended

Dec. 31, 2017

Mortgage Loans on Real Estate [Abstract]

SCHEDULE IV - MORTGAGE LOANS ON REAL ESTATE

SCHEDULE IV — MORTGAGE LOANS ON REAL ESTATE

MEDICAL PROPERTIES TRUST, INC. AND MPT OPERATING PARTNERSHIP, L.P.


Column A	Column B			Column C		Column D		Column E			Column F		Column G(3)		Column H
Description	Interest Rate			Final Maturity Date		Periodic Payment Terms		Prior Liens			Face Amount of Mortgages		Carrying Amount of Mortgages		Principal Amount of Loans Subject to Delinquent Principal or Interest
	(Dollar amounts in thousands)
Long-term first mortgage loan:							Payable in monthly installments of interest plus principal payable in full at maturity
Desert Valley Hospital		11.0	%		2022				(1	)	$	70,000	$	70,000		(2	)
Desert Valley Hospital		11.9	%		2022				(1	)		20,000		20,000		(2	)
Desert Valley Hospital		11.0	%		2019				(1	)		12,500		12,500		(2	)
Chino Valley Medical Center		11.0	%		2022				(1	)		50,000		50,000		(2	)
Paradise Valley Hospital		10.7	%		2022				(1	)		25,000		25,000		(2	)
Ernest Mortgage Loan(4)		9.8	%		2032				(1	)		115,000		115,000		(2	)
Centinela Hospital Medical Center		11.4	%		2022				(1	)		100,000		100,000		(2	)
Olympia Medical Center		11.4	%		2024				(1	)		20,000		20,000		(2	)
St. Joseph Medical Center		8.8	%		2025				(1	)		30,000		30,000		(2	)
St. Mary’s Medical Center		8.8	%		2025				(1	)		10,000		10,000		(2	)
Lake Huron Medical Center		8.8	%		2020				(1	)		10,000		10,000		(2	)
Steward Mortgage Loan(6)		7.5	%		2031				(1	)		1,315,764		1,315,764		(2	)

											$	1,778,264	$	1,778,264		(5	)

(1)	There were no prior liens on loans as of December 31, 2017.

(2)	The mortgage loan was not delinquent with respect to principal or interest.

(3)	The aggregate cost for federal income tax purposes is $1,778,264.

(4)	Mortgage loans covering four properties in two tranches. Interest rate is weighted average of both tranches.

(5)	Excludes unamortized loan issue costs of $0.1 million at December 31, 2017.

(6)	Mortgage loans covering six properties.

Changes in mortgage loans (excluding unamortized loan issue costs) for the years ended December 31, 2017, 2016, and 2015 are summarized as follows:


	Year Ended December 31,
	2017		2016			2015
	(Dollar amounts in thousands)
Balance at beginning of year	$	1,060,336	$	757,500		$	397,500
Additions during year:
New mortgage loans and additional advances on existing loans		717,928		612,836			380,000

		1,778,264		1,370,336			777,500

Deductions during year:
Collection of principal		—		(310,000	)		(20,000	)

		—		(310,000	)		(20,000	)

Balance at end of year	$	1,778,264	$	1,060,336		$	757,500

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Use of Estimates

Principles of Consolidation


VIE Type	Maximum Loss Exposure(1)		Asset Type Classification	Carrying Amount(2)
Loans, net	$	337,841	Mortgage and other loans	$	234,386
Equity investments	$	13,367	Other assets	$	—

(1)

(2)	Carrying amount reflects the net book value of our loan or equity interest only in the VIE.

See Note 3 and 10 for additional description of the nature, purpose and activities of some of our VIEs (such as Ernest Health, Inc. (“Ernest”)) and interests therein.

Investments in Unconsolidated Entities

Investments in Unconsolidated Entities: Investmentsin entities in which we have the ability to significantly influence (but not control) are accounted for by the equity method. Under the equity method of accounting, our share of the investee’s earnings or losses are included in our consolidated statements of net income, and we have elected to record our share of such investee’s earnings or losses on a 90-day lag basis. The initial carrying value of investments in unconsolidated entities is based on the amount paid to purchase the interest in the investee entity. Subsequently, our investments are increased/decreased by our share in the investees’ earnings/losses and decreased by cash distributions from our investees. To the extent that our cost basis is different from the basis reflected at the investee entity level, the basis difference is generally amortized over the lives of the related assets and liabilities, and such amortization is included in our share of equity in earnings of the investee.

Cash and Cash Equivalents

Revenue Recognition

Acquired Real Estate Purchase Price Allocation

Goodwill

Real Estate and Depreciation


Buildings and improvements			39.1 years
Tenant lease intangibles			26.5 years
Leasehold improvements			18.2 years
Furniture, equipment and other			9.8 years

Losses from Rent Receivables

Loans

Earnings Per Share/Units

Income Taxes

Stock-Based Compensation

Deferred Costs

Deferred Financing Costs

Foreign Currency Translation and Transactions

Derivative Financial Investments and Hedging Activities

Fair Value Measurement

•

Level 1 — quoted prices for identical instruments in active markets;

•

Level 3 — fair value measurements derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.

Recent Accounting Developments

Recent Accounting Developments:

Revenue from Contracts with Customers

Clarifying the Definition of a Business

Leases

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Carrying Value and Classification of Related Assets and Maximum Exposure to Loss

The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at December 31, 2017 (in thousands):


VIE Type	Maximum Loss Exposure(1)		Asset Type Classification	Carrying Amount(2)
Loans, net	$	333,398	Mortgage and other loans	$	234,386
Equity investments	$	13,367	Other assets	$	—

(1)

(2)	Carrying amount reflects the net book value of our loan or equity interest only in the VIE.

Estimated Useful Lives of Related Real Estate and Other Assets


Buildings and improvements			39.1 years
Tenant lease intangibles			26.5 years
Leasehold improvements			18.2 years
Furniture, equipment and other			9.8 years

- Definition

Tabular disclosure of the significant judgments and assumptions made in determining whether a variable interest (as defined) held by the entity requires the variable interest entity (VIE) (as defined) to be consolidated and (or) disclose information about its involvement with the VIE, individually or in aggregate (as applicable); the nature of restrictions, if any, on the consolidated VIE's assets and on the settlement of its liabilities reported by an entity in its statement of financial position, including the carrying amounts of such assets and liabilities; the nature of, and changes in, the risks associated with involvement in the VIE; how involvement with the VIE affects the entity's financial position, financial performance, and cash flows; the lack of recourse if creditors (or beneficial interest holders) of the consolidated VIE have no recourse to the general credit of the primary beneficiary (if applicable); the terms of arrangements, giving consideration to both explicit arrangements and implicit variable interests, if any, that could require the entity to provide financial support to the VIE, including events or circumstances that could expose the entity to a loss; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; the significant factors considered and judgments made in determining that the power to direct the activities of a VIE that most significantly impact the VIE's economic performance are shared (as defined); the carrying amounts and classification of assets and liabilities of the VIE included in the statement of financial position; the entity's maximum exposure to loss, if any, as a result of its involvement with the VIE, including how the maximum exposure is determined and significant sources of the entity's exposure to the VIE; a comparison of the carrying amounts of the assets and liabilities and the entity's maximum exposure to loss; information about any liquidity arrangements, guarantees, and (or) other commitments by third parties that may affect the fair value or risk of the entity's variable interest in the VIE; whether or not the entity has provided financial support or other support (explicitly or implicitly) to the VIE that it was not previously contractually required to provide or whether the entity intends to provide that support, including the type and amount of the support and the primary reasons for providing the support; and supplemental information the entity determines necessary to provide.

+ References + Details

Real Estate and Loans Receivable (Tables)

12 Months Ended

Dec. 31, 2017

Text Block [Abstract]

Assets Acquired

We acquired the following assets:


	2017			2016			2015
	(in thousands)
Assets Acquired
Land	$	229,091		$	91,071		$	120,746
Building		1,027,154			655,324			741,935
Intangible lease assets — subject to amortization (weighted average useful life of 28.0 years in 2017, 28.5 years in 2016 and 30.0 years in 2015)		150,971			94,167			176,383
Net investments in direct financing leases		40,450			178,000			174,801
Mortgage loans		700,000			600,000			380,000
Other loans		—			—			523,605
Equity investments and other assets		100,000			70,166			101,716
Liabilities assumed		(878	)		(6,319	)		(317	)

Total assets acquired	$	2,246,788		$	1,682,409		$	2,218,869
Loans repaid(1)		—			(193,262	)		(385,851	)

Total net assets acquired	$	2,246,788		$	1,489,147		$	1,833,018

(1)

Schedule of Unaudited Supplemental Pro Forma Operating Data


	For the Year Ended December 31, (Unaudited)
	2017		2016
Total revenues	$	839,568	$	836,211
Net income		418,811		427,295
Net income per share/unit-diluted	$	1.14	$	1.17

Summary of Status on Current Development Projects

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


Property	Commitment		Costs Incurred as of December 31, 2017		Estimated Completion Date
Ernest (Flagstaff, Arizona)	$	28,067	$	21,794		1Q 2018
Circle (Birmingham, England)		43,592		14,694		1Q 2019
Surgery Partners (Idaho Falls, Idaho)		113,468		11,207		1Q 2020

	$	185,127	$	47,695

Summary of Operations for Disposed Assets in 2016


	For the Year Ended December 31,
	2016			2015
Revenues	$	7,851		$	18,112
Real estate depreciation and amortization		(1,754	)		(3,795	)
Property-related expenses		(114	)		(121	)
Other income (expense)		(23	)		1,079

Income from real estate dispositions, net	$	5,960		$	15,275

Amortization Expense from Existing Lease Intangible Assets


For the Year Ended December 31:
2018	$	17,707
2019		17,654
2020		17,440
2021		17,373
2022		17,359

Components of Net Investment in Direct Financing Leases

The components of our net investment in DFLs consisted of the following (in thousands):


	As of December 31, 2017			As of December 31, 2016
Minimum lease payments receivable	$	2,294,081		$	2,207,625
Estimated residual values		448,339			407,647
Less unearned income		(2,043,693	)		(1,967,170	)

Net investment in direct financing leases	$	698,727		$	648,102

Minimum Rental Payments Due under Operating Leases with Non-Cancelable Terms


	Total Under Operating Leases		Total Under DFLs		Total
2018	$	496,379	$	67,436	$	563,815
2019		499,417		68,784		568,201
2020		502,309		70,160		572,469
2021		509,991		71,563		581,554
2022		503,679		72,994		576,673
Thereafter		10,472,481		1,734,085		12,206,566

	$	12,984,256	$	2,085,022	$	15,069,278

Summary of Loans

The following is a summary of our loans ($ amounts in thousands):


	As of December 31, 2017					As of December 31, 2016
	Balance		Weighted Average Interest Rate			Balance		Weighted Average Interest Rate
Mortgage loans	$	1,778,316		8.3	%	$	1,060,400		8.8	%
Acquisition loans		118,448		13.8	%		121,464		13.7	%
Working capital and other loans		31,760		7.6	%		34,257		9.0	%

	$	1,928,524				$	1,216,121

Schedule of Revenue by Operator

Revenue by Operator

(Dollar amounts in thousands)


	For the Years Ended December 31,
	2017					2016
Operators	Total Revenue		Percentage of Total Revenue			Total Revenue		Percentage of Total Revenue
Steward(1)	$	190,172		27.0	%	$	54,068		10.0	%
Prime		126,269		17.9	%		120,558		22.3	%
MEDIAN		100,531		14.3	%		93,425		17.3	%
Ernest		70,665		10.0	%		67,742		12.5	%
RCCH		41,890		5.9	%		52,720		9.7	%
Other operators		175,218		24.9	%		152,624		28.2	%

Total	$	704,745		100.0	%	$	541,137		100.0	%

(1)

Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017.

Schedule of Revenue from External Customers by Geographic Areas

Revenue by U.S. State and Country

(Dollar amounts in thousands)


	For the Years Ended December 31,
	2017					2016
U.S. States and Other Countries	Total Revenue		Percentage of Total Revenue			Total Revenue		Percentage of Total Revenue
Massachusetts	$	107,195		15.2	%	$	26,098		4.8	%
Texas		102,926		14.6	%		96,992		17.9	%
California		66,241		9.4	%		66,197		12.2	%
Arizona		36,393		5.2	%		23,798		4.4	%
Utah		28,831		4.1	%		9,942		1.8	%
Other states		235,545		33.4	%		216,505		40.1	%

Total U.S.	$	577,131		81.9	%	$	439,532		81.2	%
Germany	$	123,453		17.5	%	$	97,382		18.0	%
United Kingdom, Italy, and Spain		4,161		0.6	%		4,223		0.8	%

Total International	$	127,614		18.1	%	$	101,605		18.8	%

Total	$	704,745		100.0	%	$	541,137		100.0	%

Debt (Tables)

12 Months Ended

Dec. 31, 2017

Debt Disclosure [Abstract]

Summary of Debt

The following is a summary of debt ($ amounts in thousands):


	As of December 31, 2017			As of December 31, 2016
Revolving credit facility(A)	$	840,810		$	290,000
Term loans		200,000			263,101
6.375% Senior Unsecured Notes due 2022:
Principal amount		—			350,000
Unamortized premium		—			1,814

		—			351,814
5.750% Senior Unsecured Notes due 2020(B)		—			210,340
4.000% Senior Unsecured Notes due 2022(B)		600,250			525,850
5.500% Senior Unsecured Notes due 2024		300,000			300,000
6.375% Senior Unsecured Notes due 2024		500,000			500,000
3.325% Senior Unsecured Notes due 2025(B)		600,250			—
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			—

	$	4,941,310		$	2,941,105
Debt issue costs, net		(42,643	)		(31,764	)

	$	4,898,667		$	2,909,341

(A)	The 2017 column includes £8 million of GBP-denominated borrowings that reflect the exchange rate at December 31, 2017.

(B)	These notes are Euro-denominated and reflect the exchange rate at December 31, 2017 and December 31, 2016, respectively.

Principal Payments Due on Debt

As of December 31, 2017, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows ($ amounts in thousands):


2018	$	—
2019		—
2020		—
2021		840,810
2022		800,250
Thereafter		3,300,250

Total	$	4,941,310

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2017

Income Tax Disclosure [Abstract]

Schedule of Income Tax Expense (Benefit)

From our TRSs and our foreign operations, income tax expense (benefit) were as follows (in thousands):


	For the years ended December 31,
	2017			2016			2015
Current income tax (benefit) expense:
Domestic	$	(41	)	$	42		$	147
Foreign		3,062			1,856			1,614

		3,021			1,898			1,761
Deferred income tax (benefit) expense:
Domestic		(233	)		147			(360	)
Foreign		(107	)		(8,875	)		102

		(340	)		(8,728	)		(258	)

Income tax expense (benefit)	$	2,681		$	(6,830	)	$	1,503

Summary of Reconciliation of the Income Tax Expense (Benefit) at the Statutory Income Tax Rate and the Effective Tax Rate for Income from Continuing Operations before Income Taxes


	2017			2016			2015
Income from continuing operations (before-tax)	$	293,919		$	219,108		$	141,430
Income tax at the US statutory federal rate (35%)		102,872			76,688			49,501
Increase (decrease) resulting from:
Foreign rate differential		(2,326	)		1,434			5,047
State income taxes, net of federal benefit		—			66			(601	)
Dividends paid deduction		(98,026	)		(84,927	)		(57,109	)
Equity investments		3,293			4,297			—
Change in valuation allowance		(5,391	)		(6,104	)		6,174
Other items, net		2,259			1,716			(1,509	)

Total income tax expense (benefit)	$	2,681		$	(6,830	)	$	1,503

Schedule of Deferred Tax Assets and Liabilities

At December 31, 2017 and 2016, components of our deferred tax assets and liabilities were as follows (in thousands):


	2017			2016
Deferred tax liabilities:
Property and equipment	$	(4,336	)	$	(3,781	)
Unbilled rent		(8,953	)		(7,045	)
Partnership investments		(2,099	)		(5,103	)
Other		(6,702	)		(6,757	)

Total deferred tax liabilities	$	(22,090	)	$	(22,686	)
Deferred tax assets:
Operating loss and interest deduction carry forwards	$	24,580		$	28,289
Other		8,726			10,085

Total deferred tax assets		33,306			38,374
Valuation allowance		(11,101	)		(15,975	)

Total net deferred tax assets	$	22,205		$	22,399

Net deferred tax asset (liability)	$	115		$	(287	)

Schedule of Per Share Distributions to Stockholders

A schedule of per share distributions we paid and reported to our stockholders is set forth in the following:


	For the Years Ended December 31,
	2017		2016		2015
Common share distribution	$	0.950000	$	0.900000	$	0.870000
Ordinary income		0.655535		0.619368		0.769535
Capital gains(1)		0.021022		0.102552		—
Unrecaptured Sec. 1250 gain		0.004647		0.045432		—
Return of capital		0.273443		0.178080		0.100465

(1)	Capital gains include unrecaptured Sec. 1250 gains.

Earnings Per Share/Unit (Tables)

12 Months Ended

Dec. 31, 2017

Earnings Per Share [Abstract]

Calculation of Earnings Per Share

Medical Properties Trust, Inc.

Our earnings per share were calculated based on the following (amounts in thousands):


	For the Years Ended December 31,
	2017			2016			2015
Numerator:
Income from continuing operations	$	291,238		$	225,938		$	139,927
Non-controlling interests’ share in continuing operations		(1,445	)		(889	)		(329	)
Participating securities’ share in earnings		(1,409	)		(559	)		(1,029	)

Income from continuing operations, less participating securities’ share in earnings		288,384			224,490			138,569
Loss from discontinued operations		—			(1	)		—

Net income, less participating securities’ share in earnings	$	288,384		$	224,489		$	138,569

Denominator:
Basic weighted average common shares		349,902			260,414			217,997
Dilutive potential common shares		539			658			307

Diluted weighted average common shares		350,441			261,072			218,304

MPT Operating Partnership, L.P.

Our earnings per unit were calculated based on the following (amounts in thousands):


	For the Years Ended December 31,
	2017			2016			2015
Numerator:
Income from continuing operations	$	291,238		$	225,938		$	139,927
Non-controlling interests’ share in continuing operations		(1,445	)		(889	)		(329	)
Participating securities’ share in earnings		(1,409	)		(559	)		(1,029	)

Income from continuing operations, less participating securities’ share in earnings		288,384			224,490			138,569
Loss from discontinued operations		—			(1	)		—

Net income, less participating securities’ share in earnings	$	288,384		$	224,489		$	138,569

Denominator:
Basic weighted average units		349,902			260,414			217,997
Dilutive potential units		539			658			307

Diluted weighted average units		350,441			261,072			218,304

Stock Awards (Tables)

12 Months Ended

Dec. 31, 2017

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Restricted Equity Awards Activity

The following summarizes restricted equity award activity in 2017 and 2016 (which includes awards granted in 2017, 2016, 2015, and any applicable prior years), respectively:

For the Year Ended December 31, 2017:


	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		347,128		$	13.35		1,811,675		$	6.78
Awarded		249,841		$	12.40		1,741,003		$	8.21
Vested		(304,613	)	$	12.86		(491,071	)	$	6.84
Forfeited		(16,076	)	$	12.75		(384,852	)	$	5.65

Nonvested awards at end of year		276,280		$	12.68		2,676,755		$	7.86

For the Year Ended December 31, 2016:


	Vesting Based on Service					Vesting Based on Market/Performance Conditions
	Shares			Weighted Average Value at Award Date		Shares			Weighted Average Value at Award Date
Nonvested awards at beginning of the year		509,634		$	13.25		2,331,152		$	6.38
Awarded		254,574		$	13.07		799,804		$	7.30
Vested		(349,356	)	$	13.07		(671,983	)	$	6.50
Forfeited		(67,724	)	$	13.06		(647,298	)	$	6.28

Nonvested awards at end of year		347,128		$	13.35		1,811,675		$	6.78

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2017

Commitments and Contingencies Disclosure [Abstract]

Fixed Minimum Rental Payable under Operating Leases Sublease Receivable And Net Payments Due with Non-cancelable Terms


	Fixed minimum payments		Amounts to be received from subleases			Net payments
2018	$	8,210	$	(4,386	)	$	3,824
2019		8,753		(3,946	)		4,807
2020		8,967		(4,097	)		4,870
2021		8,063		(4,175	)		3,888
2022		8,121		(4,118	)		4,003
Thereafter		191,457		(96,028	)		95,429	(1)

	$	233,571	$	(116,750	)	$	116,821

(1)

Fair Value of Financial Instruments (Tables)

12 Months Ended

Dec. 31, 2017

Fair Value Disclosures [Abstract]

Summary of Fair Value Information of Financial Instruments

The following table summarizes fair value estimates for our financial instruments (in thousands):


	December 31, 2017						December 31, 2016
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	78,970		$	78,028		$	57,698		$	57,707
Loans(1)		1,698,471			1,722,101			986,987			1,017,428
Debt, net		(4,898,667	)		(5,073,707	)		(2,909,341	)		(2,966,759	)

(1)	Excludes loans related to Ernest since they are recorded at fair value as discussed below.

Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis

At December 31, 2017, the amounts recorded under the fair value option method were as follows (in thousands):


Asset (Liability)	Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	115,000	$	115,000		Mortgage loans
Equity investment and other loans		114,554		118,354		Other loans/other assets

	$	229,554	$	233,354

At December 31, 2016, the amounts recorded under the fair value option method were as follows (in thousands):


Asset (Liability)	Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	112,836	$	112,836		Mortgage loans
Equity investment and other loans		119,598		119,598		Other loans/other assets

	$	232,434	$	232,434

Summary Showing Sensitivity Analysis by Using Basis Point Variations

To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands):


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(5	)
- 100 basis points		5

Other Assets (Tables)

12 Months Ended

Dec. 31, 2017

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]

Summary of Other Assets

The following is a summary of our other assets (in thousands):


	At December 31,
	2017		2016
Debt issue costs, net(1)	$	7,093	$	4,478
Equity investments		288,398		177,430
Other corporate assets		117,827		77,580
Prepaids and other assets		55,176		44,285

Total other assets	$	468,494	$	303,773

(1)

Relates to revolving credit facility

Quarterly Financial Data (unaudited) (Tables)

12 Months Ended

Dec. 31, 2017

Medical Properties Trust, Inc. [Member]

Unaudited Quarterly Financial Information

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2017 and 2016: (amounts in thousands, except for per share data)


	For the Three Month Periods in 2017 Ended
	March 31		June 30		September 30		December 31
Revenues	$	156,397	$	166,807	$	176,580	$	204,961
Income from continuing operations		68,185		73,796		76,881		72,376
Net income		68,185		73,796		76,881		72,376
Net income attributable to MPT common stockholders		67,970		73,415		76,464		71,944
Net income attributable to MPT common stockholders per share — basic	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — basic		321,057		349,856		364,315		364,382
Net income attributable to MPT common stockholders per share — diluted	$	0.21	$	0.21	$	0.21	$	0.19
Weighted average shares outstanding — diluted		321,423		350,319		365,046		364,977


	For the Three Month Periods in 2016 Ended
	March 31		June 30		September 30		December 31
Revenues	$	134,999	$	126,300	$	126,555	$	153,283
Income from continuing operations		58,226		53,924		70,543		43,245
Net income		58,225		53,924		70,543		43,245
Net income attributable to MPT common stockholders		57,927		53,724		70,358		43,039
Net income attributable to MPT common stockholders per share — basic	$	0.24	$	0.23	$	0.29	$	0.13
Weighted average shares outstanding — basic		237,510		238,082		246,230		319,833
Net income attributable to MPT common stockholders per share —diluted	$	0.24	$	0.22	$	0.28	$	0.13
Weighted average shares outstanding — diluted		237,819		239,008		247,468		319,994

MPT Operating Partnership, L.P. [Member]

Unaudited Quarterly Financial Information

The following is a summary of the unaudited quarterly financial information for the years ended December 31, 2017 and 2016: (amounts in thousands, except for per unit data)

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2017 USD ($) Derivative	Dec. 31, 2016	Dec. 31, 2015
Summary Of Significant Accounting Policies [Line Items]
Expected lease-up periods for estimating lost rentals, in months	6 months
Percentage of ordinary taxable income to be distributed for real estate investment trust qualification	90.00%	90.00%	90.00%
Number of years of federal income tax at corporate rates on failure to qualify as REIT	4 years
Number of derivative or hedging activity \| Derivative	0
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock award vesting period in years	10 years
Accounting Standards Update No. 2017-01 [Member] \| Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Decrease normalized funds from operations	$ (1)
Accounting Standards Update No. 2017-01 [Member] \| Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Decrease normalized funds from operations	(2)
Accounting Standards Update 2014-09 [Member]
Summary Of Significant Accounting Policies [Line Items]
Adjustment to retained earnings	$ 2
Consolidated Entities [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method investment, ownership percentage	100.00%
Time-Based Awards [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock award vesting period in years	3 years
Market Conditions Based Awards [Member] \| Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock award vesting period in years	3 years
Market Conditions Based Awards [Member] \| Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Stock award vesting period in years	5 years

Summary of Significant Accounting Policies - Carrying Value and Classification of Related Assets and Maximum Exposure to Loss (Detail)	Dec. 31, 2017 USD ($)
Mortgage and other loans [Member]
Variable Interest Entity [Line Items]
Carrying Amount	$ 234,386,000
Loans, net [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	333,398,000
Equity investments [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 13,367,000

Summary of Significant Accounting Policies - Estimated Useful Lives of Related Real Estate and Other Assets (Detail)	12 Months Ended
	Dec. 31, 2017
Buildings and improvements [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	39 years 1 month 6 days
Tenant lease intangibles [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	26 years 6 months
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	18 years 2 months 12 days
Furniture, equipment and other [Member]
Property, Plant and Equipment [Line Items]
Weighted average useful lives of related real estate and other assets	9 years 9 months 18 days

Real Estate and Loans Receivable - 2017 Activity - Additional Information (Detail) € in Millions							1 Months Ended		3 Months Ended		5 Months Ended	12 Months Ended
	Nov. 29, 2017 EUR (€) Hospital	Sep. 29, 2017 USD ($) Hospital Health_Center	Jun. 22, 2017 EUR (€)	Jun. 01, 2017 USD ($) Bed	May 01, 2017 USD ($) Hospital Bed	Jan. 30, 2017 EUR (€)	Dec. 31, 2016 EUR (€) Property	Jul. 31, 2016 EUR (€) Property	Sep. 30, 2017 EUR (€) Hospital	Jun. 30, 2017 EUR (€) Hospital	Jan. 30, 2017 EUR (€) Hospital	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Business Acquisition [Line Items]
Amount of mortgage loan												$ 717,928,000	$ 612,836,000	$ 380,000,000
2017 [Member] \| Business Acquisitions [Member]
Business Acquisition [Line Items]
Revenue contributed by the acquired entity												72,900,000
Income contributed by the acquired entity												57,800,000
Acquisition related costs												24,400,000
2017 [Member] \| Subsidiaries [Member]
Business Acquisition [Line Items]
Equity interest acquired		$ 100,000,000										$ 100,000,000
Combined purchase price and investment amount		1,500,000,000
2017 [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Purchase price of acquisition		700,000,000
2017 [Member] \| Subsidiaries [Member] \| Mortgage [Member]
Business Acquisition [Line Items]
Amount of mortgage loan		$ 700,000,000
Number of mortgage facilities \| Hospital		2
2017 [Member] \| Acute Care Hospital [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities closed \| Hospital		10
2017 [Member] \| Acute Care Hospital [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		8
2017 [Member] \| Acute Care Hospital [Member] \| Alecto Healthcare Services [Member] \| Ohio Valley Medical Center [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed				218
2017 [Member] \| Acute Care Hospital [Member] \| Alecto Healthcare Services [Member] \| East Ohio Regional Hospital [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed				139
2017 [Member] \| Behavioral Health Care Facility [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities closed \| Health_Center		1
2017 [Member] \| Behavioral Health Care Facility [Member] \| Subsidiaries [Member] \| IASIS Healthcare [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Health_Center		1
2017 [Member] \| West Virginia and Ohio [Member] \| Acute Care Hospital [Member] \| Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Purchase price of acquisition				$ 40,000,000
Purchase price of acquisition funded				$ 0
Term of lease				15 years
Percentage of increase in annual rent				2.00%
Number of lease extension options				3
Term of lease extension				5 years
Additional fund committed to the tenant for capital improvements				$ 20,000,000
Ownership interest percentage in operator facility				20.00%
2017 [Member] \| IDAHO, Lewiston \| Acute Care Hospital [Member] \| St. Joseph Regional Medical Center [Member]
Business Acquisition [Line Items]
Purchase price of acquisition					$ 87,500,000
Number of beds acquired \| Bed					145
2017 [Member] \| Germany [Member] \| Acute Care Hospital [Member] \| Median [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| €			€ 19.4
Lease rent increase percentage			1.00%
Lease rate			70.00%
Lease agreement, end date			2042-12
Purchase price of acquisition funded \| €			€ 18.6
Remaining payment period			4 years
2017 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital											6
Purchase price of acquisition \| €						€ 8.4					€ 44.1
2017 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member] \| Third Master Lease [Member]
Business Acquisition [Line Items]
Number of facilities acquired								20	2	11
Acquisition costs \| €								€ 215.7	€ 39.2	€ 127.0
Number of properties closed \| Property							7
Amount of properties closed \| €							€ 49.5
2017 [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member] \| Median [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital	3
Purchase price of acquisition \| €	€ 80.0
Term of lease	27 years
Lease rent increase percentage	1.00%
Lease rate	70.00%
Lease agreement, end date	2044-11
2017 [Member] \| Florida, Ohio, and Pennsylvania [Member] \| Community Health Systems, Inc. [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital					8
Purchase price of acquisition					$ 301,300,000

Real Estate and Loans Receivable - 2015 Activity - Additional Information (Detail) $ in Thousands												1 Months Ended		12 Months Ended
	Dec. 31, 2015 EUR (€) Property Hospital	Dec. 03, 2015 EUR (€) Bed	Nov. 18, 2015 EUR (€) Facility	Oct. 30, 2015 USD ($)	Sep. 30, 2015 USD ($) Hospital	Sep. 09, 2015 EUR (€)	Aug. 31, 2015 USD ($) Investment Bed	Jun. 16, 2015 USD ($) RenewalOptions Property Bed	Apr. 29, 2015 EUR (€) Hospital	Feb. 27, 2015 USD ($) RenewalOptions	Feb. 13, 2015 USD ($) Facility RenewalOptions	Aug. 31, 2015 Investment Property Leases	Jul. 31, 2015 USD ($) Investment	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Business Acquisition [Line Items]
Mortgage financing														$ 717,928	$ 612,836	$ 380,000
Mortgage financing funded															$ 310,000	20,000
2015 [Member] \| Lake Huron Medical Center [Member]
Business Acquisition [Line Items]
Acquisition costs																20,000
Mortgage financing							$ 30,000
Mortgage financing term							5 years
2015 [Member] \| Ernest [Member]
Business Acquisition [Line Items]
Acquisition costs								$ 31,500
Loans provided for acquisition								$ 12,000
Term of lease, years								20 years
Number of lease extension options \| RenewalOptions								3
Term of lease extension, years								5 years
Lease agreement, end date								2035-06
Number of properties acquired \| Property								2
2015 [Member] \| AXA Real Estate [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method						50.00%
2015 [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility			7
Purchase price of acquisition \| €			€ 90,000,000
2015 [Member] \| Acute Care Hospital [Member] \| Ernest [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed								37
2015 [Member] \| Acute Care Hospital [Member] \| AXA Real Estate [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method			50.00%
Estimated total development cost \| €						€ 21,000,000
2015 [Member] \| Acute Care Hospital [Member] \| Kansas [Member]
Business Acquisition [Line Items]
Term of lease, years											10 years
Number of lease extension options \| RenewalOptions											2
Term of lease extension, years											5 years
Lease agreement, end date											2025-02
Number of facilities acquired \| Facility											2
Purchase price of acquisition											$ 110,000
Mortgage financing											$ 40,000
Mortgage financing term											10 years
2015 [Member] \| RHM Rehabilitation Clinic [Member] \| Germany [Member]
Business Acquisition [Line Items]
Acquisition costs \| €		€ 18,700,000
Term of lease, years		27 years
Lease agreement, end date		2040-11
Number of beds acquired \| Bed		266
Cumulative increases in the German consumer price index		70.00%
2015 [Member] \| RHM Rehabilitation Clinic [Member] \| Germany [Member] \| From 2015 through 2017 [Member]
Business Acquisition [Line Items]
Rent escalations percentage		2.00%
2015 [Member] \| RHM Rehabilitation Clinic [Member] \| Germany [Member] \| After 2017 [Member]
Business Acquisition [Line Items]
Rent escalations percentage		0.50%
2015 [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Mortgage financing					$ 100,000
Number of licensed hospitals \| Hospital					3
Number of free-standing emergency department and health center \| Hospital					1
Mortgage financing term					5 years
Mortgage financing funded					$ 15,000
2015 [Member] \| General Acute Care Hospital [Member] \| Lake Huron Medical Center [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed							144
2015 [Member] \| Rehabilitation Hospital with Covenant Health System [Member] \| Ernest [Member]
Business Acquisition [Line Items]
Number of beds acquired \| Bed								60
2015 [Member] \| Inpatient Rehabilitation Hospital [Member] \| Weslaco Texas [Member] \| Ernest [Member]
Business Acquisition [Line Items]
Acquisition costs										$ 10,700
Term of lease, years										20 years
Number of lease extension options \| RenewalOptions										3
Term of lease extension, years										5 years
Lease agreement, end date										2032-02
Payments to fund long-term loans to related parties										$ 5,000
2015 [Member] \| Median [Member]
Business Acquisition [Line Items]
Acquisition costs \| €									€ 688,000,000
Loans provided for acquisition \| €	€ 240,000,000
Term of lease, years									27 years
Number of properties closed \| Property	31
Number of hospitals acquired \| Hospital	32								32
Lease rent increase percentage									70.00%
Lease agreement, end date									2042-03
Value of properties closed \| €	€ 646,000,000
Loan amount outstanding \| €	€ 0
2015 [Member] \| Capella [Member]
Business Acquisition [Line Items]
Combined purchase price and investment amount													$ 900,000
Ownership interests acquired													49.00%
Acquisition costs				$ 25,800									$ 600,000
Loans provided for acquisition				$ 9,200									$ 290,000
Term of lease, years												15 years
Number of lease extension options \| Leases												4
Term of lease extension, years												5 years
Number of properties closed \| Property												6
Increase in consumer price-index, floor rate												2.00%
Increase in consumer price-index, ceiling rate												4.00%
2015 [Member] \| Capella [Member] \| Acute Care Hospital [Member]
Business Acquisition [Line Items]
Number of portfolio investments \| Investment							7					7	7
Number of investment in form of mortgage loan \| Investment							2					2	2
2015 [Member] \| Capella [Member] \| Joint Venture Partner [Member]
Business Acquisition [Line Items]
Fixed interest rate							8.00%					8.00%
2015 [Member] \| Business Acquisitions [Member]
Business Acquisition [Line Items]
Revenue contributed by the acquired entity																102,700
Income contributed by the acquired entity																87,700
Acquisition related costs																$ 58,000

Real Estate and Loans Receivable - Schedule of Unaudited Supplemental Pro Forma Operating Data (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Business Acquisition, Pro Forma Information [Abstract]
Total revenues	$ 839,568	$ 836,211
Net income	$ 418,811	$ 427,295
Net income per share/unit-diluted	$ 1.14	$ 1.17

Real Estate and Loans Receivable - Development Activities - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions	1 Months Ended	12 Months Ended
	Apr. 30, 2017 GBP (£)	Dec. 31, 2017 USD ($) Facility	Dec. 31, 2017 EUR (€)	Dec. 31, 2016 USD ($) Facility	Dec. 31, 2015 USD ($) Facility RenewalOptions	Dec. 19, 2017 USD ($)	Aug. 23, 2016 USD ($)
Business Acquisition [Line Items]
Estimated total development cost		$ 185,127
Birmingham, England
Business Acquisition [Line Items]
Purchase price of acquisition \| £	£ 2.7
Term of lease, years	15 years
Total development costs anticipated \| £	£ 30.0
Acute Care Hospital [Member] \| Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Estimated total development cost						$ 113,500
Adeptus Health [Member]
Business Acquisition [Line Items]
Term of lease, years					15 years
Number of lease extension options \| RenewalOptions					3
Term of lease extension, years					5 years
Lease rent increase percentage					2.00%
Ernest [Member] \| Inpatient Rehabilitation Hospital [Member] \| Flagstaff, Arizona [Member]
Business Acquisition [Line Items]
Estimated total development cost							$ 28,100
Ernest [Member] \| Inpatient Rehabilitation Hospital [Member] \| Rehabilitation Hospital of Northwestern Ohio [Member] \| Toledo, OH [Member]
Business Acquisition [Line Items]
Estimated total development cost				$ 18,400
Development Activities [Member] \| Acute Care Facilities [Member]
Business Acquisition [Line Items]
Number of facilities constructed \| Facility				19
Acquisition costs				$ 136,600
Development Activities [Member] \| Adeptus Health [Member] \| Acute Care Facilities [Member]
Business Acquisition [Line Items]
Number of facilities constructed \| Facility		4
Acquisition costs		$ 68,000
Development Activities [Member] \| IMED [Member] \| Acute Care Facilities [Member] \| Spain [Member]
Business Acquisition [Line Items]
Acquisition costs \| €			€ 21
Ownership interests acquired		50.00%
Lessor direct financing lease description		Quarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020.	Quarterly fixed rent payments that started on October 1, 2017 with annual increases of 1% beginning April 1, 2020.
Lease rent increase percentage		1.00%	1.00%
Development Activities [Member] \| Acute Care Facilities [Member] \| 2015 Master Lease [Member]
Business Acquisition [Line Items]
Number of facilities leased \| Facility					17
Estimated total development cost					$ 102,600
Development Activities [Member] \| UAB Medical West [Member]
Business Acquisition [Line Items]
Estimated total development cost					$ 8,600
Term of lease, years					15 years
Term of lease extension, years					5 years
Number of lease extension options in current lease contract \| RenewalOptions					4
Lease rent increase percentage					2.00%

Real Estate and Loans Receivable - Summary of Status on Current Development Projects (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($)
Business Acquisition [Line Items]
Commitment	$ 185,127
Costs Incurred as of 12/31/2017	47,695
Ernest [Member] \| Flagstaff, Arizona [Member]
Business Acquisition [Line Items]
Commitment	28,067
Costs Incurred as of 12/31/2017	$ 21,794
Estimated Completion Date	1Q 2018
Circle [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	$ 43,592
Costs Incurred as of 12/31/2017	$ 14,694
Estimated Completion Date	1Q 2019
Surgery Partners [Member] \| Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Commitment	$ 113,468
Costs Incurred as of 12/31/2017	$ 11,207
Estimated Completion Date	1Q 2020

Real Estate and Loans Receivable - Disposals - Additional Information (Detail) $ in Thousands				12 Months Ended
	Mar. 31, 2017 USD ($)	Aug. 05, 2015 USD ($) Hospital	Jul. 30, 2015 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Debt Instrument [Line Items]
Proceeds from sale of facilities	$ 64,000
Gain on real estate dispositions	7,400
Gain offset by non-cash charges	$ 600
Proceeds from sale of real estate				$ 64,362	$ 198,767	$ 19,175
Texas [Member]
Debt Instrument [Line Items]
Proceeds from sale of real estate			$ 9,700
Gain (loss) on sale of real estate			1,500
Straight line rent receivables write-off			$ 900
United States [Member]
Debt Instrument [Line Items]
Proceeds from sale of real estate		$ 9,500
Number of hospitals sold \| Hospital		6
Gain (loss) on sale of real estate		$ 1,700
Consideration received as note receivable		1,500
Billed rent receivables write-off		$ 900
Amortization of the related lease intangible asset				$ 700

Real Estate and Loans Receivable - Capella Transaction - Additional Information (Detail) $ in Thousands		12 Months Ended
	Apr. 30, 2016 USD ($) Hospital	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Business Acquisition [Line Items]
New loan for hospital property		$ 717,928	$ 612,836	$ 380,000
Capella [Member]
Business Acquisition [Line Items]
Net proceeds from transaction	$ 550,000
Net proceeds from equity investment and loans	492,000
Proceeds from prepayment of mortgage loans	210,000
New loan for hospital property	93,300
Investment on unsecured senior notes	50,000
Transaction costs incurred	$ 6,300
Number of hospital owned \| Hospital	5
Write off of unbilled direct finance lease rent			$ 2,600
Capella [Member] \| Master Lease [Member]
Business Acquisition [Line Items]
Term of lease, years	13 years 6 months
Capella [Member] \| Other Stand-Alone Lease [Member]
Business Acquisition [Line Items]
Term of lease, years	11 years 6 months

Real Estate and Loans Receivable - Post Acute Transaction - Additional Information (Detail) $ in Millions	Mar. 31, 2017 USD ($)	Jun. 17, 2016 USD ($)	May 23, 2016 USD ($) Property
Business Acquisition [Line Items]
Proceeds from sale of real estate	$ 64.0
Gain on real estate dispositions	$ 7.4
Post Acute [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			5
Outstanding loans paid in full			$ 4.0
Proceeds from sale of real estate		$ 28.0	71.0
Gain on real estate dispositions			$ 15.0
Post Acute [Member] \| Texas [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			3
Post Acute [Member] \| Louisiana [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property			2

Real Estate and Loans Receivable - Summary of Operations for Disposed Assets in 2016 (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015
Disposal Group, Including Discontinued Operation, Income Statement Disclosures [Abstract]
Revenues	$ 7,851	$ 18,112
Real estate depreciation and amortization	(1,754)	(3,795)
Property-related expenses	(114)	(121)
Other income (expense)	(23)	1,079
Income from real estate dispositions, net	$ 5,960	$ 15,275

Real Estate and Loans Receivable - Amortization Expense from Existing Lease Intangible Assets (Detail) $ in Thousands	Dec. 31, 2017 USD ($)
Business Combinations [Abstract]
2018	$ 17,707
2019	17,654
2020	17,440
2021	17,373
2022	$ 17,359

Real Estate and Loans Receivable - Leasing Operations - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2017
Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of direct financing leases	2
Ernest [Member]
Business Acquisition [Line Items]
Number of direct financing leases	15
Prime Facilities [Member]
Business Acquisition [Line Items]
Number of direct financing leases	10

Real Estate and Loans Receivable - Components of Net Investment in Direct Financing Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Business Combinations [Abstract]
Minimum lease payments receivable	$ 2,294,081	$ 2,207,625
Estimated residual values	448,339	407,647
Less unearned income	(2,043,693)	(1,967,170)
Net investment in direct financing leases	$ 698,727	$ 648,102

Real Estate and Loans Receivable - Minimum Rental Payments Due under Operating Leases with Non-Cancelable Terms (Detail) $ in Thousands	Dec. 31, 2017 USD ($)
Leases User Charges And Commitments [Line Items]
2018	$ 8,210
2019	8,753
2020	8,967
2021	8,063
2022	8,121
Thereafter	191,457
Minimum rental payments, total	233,571
Minimum [Member]
Leases User Charges And Commitments [Line Items]
2018	563,815
2019	568,201
2020	572,469
2021	581,554
2022	576,673
Thereafter	12,206,566
Minimum rental payments, total	15,069,278
Minimum [Member] \| Operating Leases [Member]
Leases User Charges And Commitments [Line Items]
2018	496,379
2019	499,417
2020	502,309
2021	509,991
2022	503,679
Thereafter	10,472,481
Minimum rental payments, total	12,984,256
Minimum [Member] \| Direct Financing Leases [Member]
Leases User Charges And Commitments [Line Items]
2018	67,436
2019	68,784
2020	70,160
2021	71,563
2022	72,994
Thereafter	1,734,085
Minimum rental payments, total	$ 2,085,022

Real Estate and Loans Receivable - Adeptus Health - Additional Information (Detail) $ in Millions					12 Months Ended
	Dec. 07, 2017 USD ($) Leases	Oct. 18, 2017 RenewalOptions	Sep. 29, 2017 USD ($) Facility	Mar. 31, 2017 USD ($)	Dec. 31, 2017 USD ($)	Dec. 31, 2015 RenewalOptions	Apr. 04, 2017 USD ($)
Business Acquisition [Line Items]
Gain offset by non-cash charges				$ 0.6
Louisiana [Member] \| Ochsner [Member]
Business Acquisition [Line Items]
Total budgeted investment							$ 24.5
Term of lease, years		15 years
Number of lease extension options \| RenewalOptions		3
Term of lease extension, years		5 years
Average minimum lease rate on development and construction cost		9.20%
Gain offset by non-cash charges					$ 0.5
Colorado [Member] \| University of Colorado Hospital [Member]
Business Acquisition [Line Items]
Number of leased properties \| Leases	11
Total budgeted investment	$ 58.6
Term of lease, years	15 years
Number of lease extension options \| Leases	3
Term of lease extension, years	5 years
Lease rent increase percentage	2.00%
Adeptus Health [Member]
Business Acquisition [Line Items]
Date plan of reorganization confirmed			Sep. 29, 2017
Date plan of reorganization confirmed effective			Oct. 02, 2017
Number of facilities expected to sell re-lease or sell \| Facility			16
Number of leased properties \| Facility			56
Amortization of straight line rent receivable			$ 4.2
Number of lease extension options \| RenewalOptions						3
Term of lease extension, years						5 years
Lease rent increase percentage						2.00%

Real Estate and Loans Receivable - Twelve Oaks Facility - Additional Information (Detail) - USD ($) $ in Millions		3 Months Ended	12 Months Ended
	Mar. 31, 2017	Sep. 30, 2015	Dec. 31, 2015	Sep. 30, 2016
Business Acquisition [Line Items]
Gain offset by non-cash charges	$ 0.6
Twelve Oaks Facility [Member]
Business Acquisition [Line Items]
Outstanding amount receivable from tenant past due including interest				$ 2.5
Gain offset by non-cash charges		$ 1.9
Amortization of leased intangible assets			$ 0.5

Real Estate and Loans Receivable - Summary of Loans (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Loans [Line Items]
Loans, Balance	$ 1,928,524	$ 1,216,121
Mortgage Loans [Member]
Loans [Line Items]
Loans, Balance	$ 1,778,316	$ 1,060,400
Loans, Weighted Average Interest Rate	8.30%	8.80%
Acquisition Loans [Member]
Loans [Line Items]
Loans, Balance	$ 118,448	$ 121,464
Loans, Weighted Average Interest Rate	13.80%	13.70%
Working Capital and Other Loans [Member]
Loans [Line Items]
Loans, Balance	$ 31,760	$ 34,257
Loans, Weighted Average Interest Rate	7.60%	9.00%

Real Estate and Loans Receivable - Loans - Additional Information (Detail) $ in Thousands	Dec. 31, 2017 USD ($) Property Operator	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)	Dec. 31, 2014 USD ($)
Business Acquisition [Line Items]
Existing mortgage loans	$ 1,778,264	$ 1,060,336	$ 757,500	$ 397,500
Ernest Transaction and Other Acquisitions [Member]
Business Acquisition [Line Items]
Existing mortgage loans	$ 114,000
Mortgage Loans [Member] \| Steward [Member]
Business Acquisition [Line Items]
Number of Real Estate Properties \| Property	14
Number Of Operators \| Operator	4
Existing mortgage loans	$ 700,000

Real Estate and Loans Receivable - Schedule of Revenue from External Customers by Geographic Areas (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 204,961	$ 176,580	$ 166,807	$ 156,397	$ 153,283	$ 126,555	$ 126,300	$ 134,999	$ 704,745	$ 541,137	$ 441,878
Revenue [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 704,745	$ 541,137
Percentage of Total Revenue									100.00%	100.00%
Revenue [Member] \| Massachusetts [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 107,195	$ 26,098
Percentage of Total Revenue									15.20%	4.80%
Revenue [Member] \| Texas [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 102,926	$ 96,992
Percentage of Total Revenue									14.60%	17.90%
Revenue [Member] \| California [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 66,241	$ 66,197
Percentage of Total Revenue									9.40%	12.20%
Revenue [Member] \| Utah [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 28,831	$ 9,942
Percentage of Total Revenue									4.10%	1.80%
Revenue [Member] \| Arizona [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 36,393	$ 23,798
Percentage of Total Revenue									5.20%	4.40%
Revenue [Member] \| Other states [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 235,545	$ 216,505
Percentage of Total Revenue									33.40%	40.10%
Revenue [Member] \| United States [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 577,131	$ 439,532
Percentage of Total Revenue									81.90%	81.20%
Revenue [Member] \| Germany [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 123,453	$ 97,382
Percentage of Total Revenue									17.50%	18.00%
Revenue [Member] \| United Kingdom, Italy, and Spain [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 4,161	$ 4,223
Percentage of Total Revenue									0.60%	0.80%
Revenue [Member] \| International [Member] \| Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue									$ 127,614	$ 101,605
Percentage of Total Revenue									18.10%	18.80%

Debt - Credit Facility - Additional Information (Detail) € in Millions	Feb. 01, 2017 USD ($)	Dec. 31, 2017 USD ($)	Feb. 01, 2017 EUR (€)	Dec. 31, 2016 USD ($)
Debt Instrument [Line Items]
Aggregate committed amount of credit facility	$ 500,000,000
Minimum [Member]
Debt Instrument [Line Items]
Commitment fee	0.125%
Maximum [Member]
Debt Instrument [Line Items]
Commitment fee	0.30%
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 1,300,000,000
Debt instrument, maturity date	Feb. 28, 2021
Aggregate committed amount of credit facility		$ 500,000,000
Credit facilities, amount outstanding		$ 840,800,000		$ 290,000,000
Credit facilities, weighted average interest rate		2.40%		2.00%
Term Loans [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 200,000,000		€ 200
Debt instrument, maturity date	Feb. 01, 2022
Decrease in unsecured debt from previous facility	$ 50,000,000
Aggregate committed amount of credit facility		$ 1,000,000,000
Interest rate at end of period		2.98%		2.36%
Alternate Base Rate [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin	0.00%
Applicable margin for revolving loans	0.00%
Alternate Base Rate [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin	0.95%
Applicable margin for revolving loans	0.65%
Eurodollar Loans [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin	0.90%
Applicable margin for revolving loans	0.875%
Eurodollar Loans [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin	1.95%
Applicable margin for revolving loans	1.65%
Euro [Member] \| Term Loans [Member]
Debt Instrument [Line Items]
Debt instrument, maturity date	Jan. 31, 2020

Debt - Term Loan - Northland Mortgage - Additional Information (Detail) - Mortgage Loans [Member] - Northland LTACH Hospital [Member] - USD ($) $ in Millions			12 Months Ended
	Sep. 29, 2017	Feb. 14, 2011	Dec. 31, 2017
Debt Instrument [Line Items]
Liabilities acquired		$ 14.6
Amortization period			30 years
Interest rate			6.20%
Debt instrument, maturity date			Jan. 01, 2018
Term of loan to pay without penalty			120 days
Prepayment of mortgage loans	$ 12.9

Debt - 6.375% Senior Unsecured Notes Due 2022 - Additional Information (Detail) - 6.375% Senior Unsecured Notes Due 2022 [Member] - USD ($)				12 Months Ended
	Oct. 07, 2017	Aug. 20, 2013	Feb. 17, 2012	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Senior unsecured notes face amount		$ 150,000,000	$ 200,000,000
Senior unsecured notes, maturity date			Feb. 15, 2022
Senior unsecured notes, interest rate			6.375%	6.375%	6.375%
Debt instrument redemption price		102.00%
Debt instrument effective rate		5.998%
Senior notes frequency of periodic payment				Interest on these notes was payable semi-annually on February 15 and August 15 of each year
Senior unsecured notes, redemption description				Offered a redemption option to redeem some or all of the notes at a premium that decreased over time, plus accrued and unpaid interest to, but not including, the redemption date.
Redemption Premium	$ 11,200,000

Debt - 5.750% Senior Unsecured Notes Due 2020 - Additional Information (Detail) - 5.750% Senior Unsecured Notes Due 2020 [Member] € in Millions, $ in Millions				12 Months Ended
	Mar. 04, 2017 USD ($)	Mar. 04, 2017 EUR (€)	Oct. 10, 2013 EUR (€)	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Senior unsecured notes, value of offering			€ 200
Senior unsecured notes, interest rate	5.75%	5.75%	5.75%	5.75%	5.75%
Debt instrument, maturity date			Oct. 01, 2020
Senior unsecured notes, payable term				Interest on the notes was payable semi-annually on April 1 and October 1 of each year.
Amount of senior unsecured debt redeemed		€ 200
Senior notes, redemption date	Mar. 04, 2017	Mar. 04, 2017
Senior unsecured notes, redemption description				We redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020 and incurred a redemption premium of approximately $9 million.
Redemption Premium \| $	$ 9

Debt - 4.000% Senior Unsecured Notes Due 2022 - Additional Information (Detail) - 4.000% Senior Unsecured Notes Due 2022 [Member] - EUR (€)		12 Months Ended
	Aug. 19, 2015	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes face amount	€ 500,000,000
Senior unsecured notes, interest rate	4.00%
Senior unsecured notes, payable term		Interest on the notes is payable annually on August 19 of each year.
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, maturity date	Aug. 19, 2022
Senior unsecured notes, redemption period	90 days
Senior unsecured notes, redemption description		Notes are redeemed prior to 90 days before maturity, the redemption price will be 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 4.000% Senior Unsecured Notes due 2022 are fully and unconditionally guaranteed on an unsecured basis by the Company. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of the purchase.
Redeemed Prior to 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%
Redeemed Beginning on or After 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%

Debt - 5.500% Senior Unsecured Notes Due 2024 - Additional Information (Detail) - 5.500% Senior Unsecured Notes Due 2024 [Member] - USD ($)		12 Months Ended
	Apr. 17, 2014	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 300,000,000
Senior unsecured notes, maturity date	May 01, 2024
Senior unsecured notes, interest rate	5.50%	5.50%	5.50%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, payable term		Interest on the notes is payable semi-annually on May 1 and November 1 of each year.
Senior notes, earliest redemption date	May 01, 2019
Senior unsecured notes, redemption description		We may redeem some or all of the notes at any time prior to May 1, 2019 at a “make-whole” redemption price. On or after May 1, 2019, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to May 1, 2017, we may redeem up to 35% of the aggregate principal amount of the notes using the proceeds of one or more equity offerings. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Maximum [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	35.00%

Debt - 6.375% Senior Unsecured Notes Due 2024 - Additional Information (Detail) - 6.375% Senior Unsecured Notes Due 2024 [Member] - Revolving Credit Facility [Member] - USD ($)		12 Months Ended
	Feb. 22, 2016	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 500,000,000
Senior unsecured notes, maturity date	Mar. 01, 2024
Senior unsecured notes, interest rate	6.375%
Debt instrument, redemption price percentage	106.375%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, payable term		Interest on the notes is payable on March 1 and September 1 of each year.
Senior notes, earliest redemption date	Mar. 01, 2019
Senior unsecured notes, redemption description		We may redeem up to 35% of the notes at a redemption price equal to 106.375% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Maximum [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	35.00%

Debt - 3.325% Senior Unsecured Notes Due 2025 - Additional Information (Detail) - 3.325% Senior Unsecured Notes Due 2025 [Member] - EUR (€)		12 Months Ended
	Mar. 24, 2017	Dec. 31, 2017
Debt Instrument [Line Items]
Senior unsecured notes face amount	€ 500,000,000
Senior unsecured notes, interest rate	3.325%
Senior unsecured notes, payable term		Interest on the notes is payable annually on March 24 of each year.
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Senior unsecured notes, maturity date	Mar. 24, 2025
Senior unsecured notes, redemption period	90 days
Senior unsecured notes, redemption description		Notes are redeemed prior to 90 days before maturity, the redemption price will be equal to 100% of their principal amount, plus a make-whole premium, plus accrued and unpaid interest up to, but excluding, the applicable redemption date. Within the period beginning on or after 90 days before maturity, the notes may be redeemed, in whole or in part, at a redemption price equal to 100% of their principal amount, plus accrued and unpaid interest to, but excluding, the applicable redemption date. The 3.325% Senior Unsecured Notes due 2025 are fully and unconditionally guaranteed on a senior unsecured basis by us. In the event of a change of control, each holder of the notes may require us to repurchase some or all of our notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest up to, but excluding, the date of the purchase.
Redeemed Prior to 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%
Redeemed Beginning on or After 90 Days [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption price percentage	100.00%

Debt - 5.250% Senior Unsecured Notes Due 2026 - Additional Information (Detail) - 5.250% Senior Unsecured Notes Due 2026 [Member] - USD ($)		12 Months Ended
	Jul. 22, 2016	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		5.25%	5.25%
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Senior unsecured notes face amount	$ 500,000,000
Senior unsecured notes, payable term		Interest on the notes is payable on February 1 and August 1 of each year.
Senior unsecured notes, interest rate	5.25%
Senior unsecured notes, maturity date	Aug. 01, 2026
Senior notes, earliest redemption date	Aug. 01, 2021
Senior unsecured notes, redemption description		We may redeem some or all of the notes at any time prior to August 1, 2021 at a “make whole” redemption price. On or after August 1, 2021, we may redeem some or all of the notes at a premium that will decrease over time. In addition, at any time prior to August 1, 2019, we may redeem up to 35% of the notes at a redemption price equal to 105.25% of the aggregate principal amount thereof, plus accrued and unpaid interest thereon, using proceeds from one or more equity offerings. In the event of a change in control, each holder of the notes may require us to repurchase some or all of the notes at a repurchase price equal to 101% of the aggregate principal amount of the notes plus accrued and unpaid interest to the date of purchase.
Debt instrument, redemption price percentage	105.25%
Senior notes, repurchased price percentage on principal amount plus accrued and unpaid interest	101.00%
Revolving Credit Facility [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Senior unsecured notes, redemption percentage on principal amount	35.00%