0001564590-19-031304 | 10-Q | XBRL Viewer | Medical Properties Trust INC

Common Stock/Partner's Capital

4. Debt

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

	As of June 30, 2019			As of December 31, 2018
Revolving credit facility(A)	$	40,627		$	28,059
Term loan		200,000			200,000
Australian term loan facility(B)		842,400			—
4.000% Senior Unsecured Notes due 2022(C)		568,650			573,350
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(C)		568,650			573,350
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
	$	4,920,327		$	4,074,759
Debt issue costs, net		(42,017	)		(37,370	)
	$	4,878,310		$	4,037,389

(A)	Includes £32 million and £22 million of GBP-denominated borrowings that reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

(B)	This note is Australian dollar-denominated and reflects the exchange rate at June 30, 2019.

(C)	These notes are Euro-denominated and reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

As of June 30, 2019, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2019	$	—
2020		—
2021		40,627
2022		768,650
2023		—
Thereafter		4,111,050
Total	$	4,920,327

On May 23, 2019, we entered into an AUD$1.2 billion term loan facility agreement with Bank of America, N.A., as administrative agent, and several lenders from time to time are parties thereto. The term loan facility matures on May 23, 2024. We used the proceeds under the facility to finance our acquisition of the Healthscope portfolio. The interest rate under the term loan is adjustable based on a pricing grid from 0.85% to 1.65%, dependent on our current senior unsecured credit rating. On June 27, 2019, we entered into an interest rate swap transaction (effective July 3, 2019) to fix the interest rate to approximately 1.20% for the duration of the loan. The current applicable margin for the pricing grid (which can vary based on the Company’s credit rating) is 1.25% for an all-in fixed rate of 2.45%. We paid approximately $8 million in one-time structuring and underwriting fees associated with this term loan facility.

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 revolving credit and term loan agreement (“Credit Facility”) limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations, as defined in the agreements, on a rolling four quarter basis. At June 30, 2019, the dividend restriction was 95% of normalized adjusted funds from operations (“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 June 30, 2019, we were in compliance with all such financial and operating covenants.

Common Stock/Partner's Capital

6 Months Ended

Jun. 30, 2019

Equity [Abstract]

5. Common Stock/Partners’ Capital

Medical Properties Trust, Inc.

In the first half of 2019, we sold 22.6 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $399 million.

MPT Operating Partnership, L.P.

At June 30, 2019, the Company has a 99.9% ownership interest in the Operating Partnership with the remainder owned by two other partners, which are employees.

During the six months ended June 30, 2019, the Operating Partnership issued approximately 22.6 million units in direct response to the common stock offerings by Medical Properties Trust, Inc. during the same period.

Stock Awards

6 Months Ended

Jun. 30, 2019

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock Awards

6. Stock Awards

We adopted the 2019 Equity Incentive Plan (the “Equity Incentive Plan”) during the second quarter of 2019, which authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units and other stock-based awards. The Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors, and we have reserved 12.9 million shares of common stock for future awards. Share-based compensation expense totaled $13.0 million and $6.7 million for the six months ended June 30, 2019 and 2018, respectively.

Fair Value of Financial Instruments

6 Months Ended

Jun. 30, 2019

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

7. 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 loans and other 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 loan 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):

	As of						As of
	June 30, 2019						December 31, 2018
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	24,103		$	23,241		$	25,855		$	24,942
Loans(1)		1,472,073			1,515,485			1,471,520			1,490,758
Debt, net		(4,878,310	)		(5,073,566	)		(4,037,389	)		(3,947,795	)

(1)

Excludes mortgage loans related to Ernest since they are recorded at fair value and discussed below.

Items Measured at Fair Value on a Recurring Basis

Our Ernest mortgage loans are measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method in 2012 when we acquired an equity interest in and made an acquisition loan to Ernest. Such equity interest was sold and the acquisition loan was paid off in October 2018. We elected to account for these investments at fair value due to the size of the investments and because we believe this method was more reflective of current values. We have not made a similar election for other investments existing at June 30, 2019.

At June 30, 2019, these amounts were as follows (in thousands):

Asset Type

Fair

Value

Original

Cost

Asset Type

Classification

Mortgage loans

115,000

Mortgage loans

Our mortgage 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.

During the first half of 2018, we recognized an unrealized loss on our investment in Ernest. There was no gain or loss recorded during the first half of 2019.

- 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

Earnings Per Share

6 Months Ended

Jun. 30, 2019

Earnings Per Share [Abstract]

Earnings Per Share

8. Earnings Per Share

Medical Properties Trust, Inc.

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

	For the Three Months Ended June 30,
	2019			2018
Numerator:
Net income	$	79,920		$	112,017
Non-controlling interests’ share in net income		(482	)		(450	)
Participating securities’ share in earnings		(446	)		(323	)
Net income, less participating securities’ share in earnings	$	78,992		$	111,244
Denominator:
Basic weighted-average common shares		394,574			364,897
Dilutive potential common shares		1,118			644
Dilutive weighted-average common shares		395,692			365,541

	For the Six Months Ended June 30,
	2019			2018
Numerator:
Net income	$	156,211		$	203,060
Non-controlling interests’ share in net income		(951	)		(892	)
Participating securities’ share in earnings		(922	)		(518	)
Net income, less participating securities’ share in earnings	$	154,338		$	201,650
Denominator:
Basic weighted-average common shares		387,563			364,889
Dilutive potential common shares		1,120			553
Dilutive weighted-average common shares		388,683			365,442

MPT Operating Partnership, L.P.

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

	For the Three Months Ended June 30,
	2019			2018
Numerator:
Net income	$	79,920		$	112,017
Non-controlling interests’ share in net income		(482	)		(450	)
Participating securities’ share in earnings		(446	)		(323	)
Net income, less participating securities’ share in earnings	$	78,992		$	111,244
Denominator:
Basic weighted-average units		394,574			364,897
Dilutive potential units		1,118			644
Diluted weighted-average units		395,692			365,541

	For the Six Months Ended June 30,
	2019			2018
Numerator:
Net income	$	156,211		$	203,060
Non-controlling interests’ share in net income		(951	)		(892	)
Participating securities’ share in earnings		(922	)		(518	)
Net income, less participating securities’ share in earnings	$	154,338		$	201,650
Denominator:
Basic weighted-average units		387,563			364,889
Dilutive potential units		1,120			553
Diluted weighted-average units		388,683			365,442

Commitments and Contingencies

6 Months Ended

Jun. 30, 2019

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

9. Commitments and Contingencies

Commitments

On May 31, 2019, we entered into definitive agreements to acquire the real estate of Watsonville Community Hospital in Watsonville, California for $40.0 million. However, on July 21, 2019, the Pajaro Valley Community Health Trust (“the Trust”) exercised its right of first refusal to acquire the hospital. If the Trust is unable to complete the acquisition of the hospital, we will acquire the hospital and lease it to Halsen Healthcare.

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 those proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

Leases (Lessee)

6 Months Ended

Jun. 30, 2019

Leases [Abstract]

Leases (Lessee)

10. Leases (Lessee)

We have leased land on which certain of our facilities reside, along with corporate office and equipment. Our leases have remaining lease terms of 5 years to 42.3 years, some of which may include options to extend the leases up to, or just beyond, the depreciable life of the properties that occupy the leased land. Renewal options that we are reasonably certain to exercise are recognized in our right-of-use assets and lease liabilities. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at lease commencement date in determining the present value of future payments.

Properties subject to ground leases are subleased to our tenants, except for three Adeptus transition properties.

The following is a summary of our lease expense (in thousands):

	Classification	Three Months Ended June 30, 2019			Six Months Ended June 30, 2019
Operating lease cost (1)	(2)	$	2,466		$	4,562
Finance lease cost:
Amortization of right-of-use assets	Real estate depreciation and amortization		13			26
Interest on lease liabilities	Interest expense		32			53
Sublease income	Interest and other income		(909	)		(1,809	)
Total lease cost		$	1,602		$	2,832

(1)

Includes short-term leases.

(2)

$1.5 million and $3.1 million for the three and six months ended June 30, 2019, respectively, included in Property-related, with the remainder reflected in General and administrative expenses.

Fixed minimum payments due over the remaining lease term under non-cancelable leases of more than one year and amounts to be received in the future from non-cancelable subleases over their remaining lease term at June 30, 2019 are as follows (amounts in thousands):

	Operating leases			Finance leases			Amounts to be received from subleases			Net payments
2019 (1)	$	3,111		$	62		$	(1,693	)	$	1,480
2020		6,341			125			(3,444	)		3,022
2021		6,533			126			(3,561	)		3,098
2022		6,734			128			(3,699	)		3,163
2023		6,800			129			(3,704	)		3,225
Thereafter		196,489			5,045			(95,622	)		105,912	(2)
Total undiscounted minimum lease payments	$	226,008		$	5,615		$	(111,723	)	$	119,900
Less: interest		(145,048	)		(3,685	)
Present value of lease liabilities	$	80,960		$	1,930

(1)

Represents remaining six months of 2019.

(2)

Reflects certain ground leases, in which we are the lessee, that have longer initial 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.

Supplemental balance sheet information is as follows (in thousands, except lease terms and discount rate):

	Classification	June 30, 2019
Right of use assets:
Operating leases - real estate	Land, buildings and improvements, intangible lease assets, and other	$	63,748
Finance leases - real estate	Land, buildings and improvements, intangible lease assets, and other		1,913
Real estate right of use assets, net			65,661
Operating leases - corporate	Other assets		10,651
Total right of use assets, net		$	76,312

Lease liabilities:
Operating leases	Obligations to tenants and other lease liabilities	$	80,960
Financing leases	Obligations to tenants and other lease liabilities		1,930
Total lease liabilities		$	82,890

Weighted average remaining lease term:
Operating leases			32.1
Finance leases			37.4
Weighted average discount rate:
Operating leases			6.3	%
Finance leases			6.6	%

The following is supplemental cash flow information (in thousands):

	Six Months Ended June 30, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	2,929
Operating cash flows from finance leases		52
Financing cash flows from finance leases		10
Right-of-use assets obtained in exchange for lease obligations:
Operating leases		1,042
Finance leases		—

Subsequent Events

6 Months Ended

Jun. 30, 2019

Subsequent Events [Abstract]

Subsequent Events

11. Subsequent Events

Acquisitions

On July 23, 2019, we entered into definitive agreements with Secure Income REIT (“SIR”) to acquire freehold interests in eight private hospitals located throughout England for an aggregate purchase price of approximately £347 million. The hospitals will be leased to Ramsay Health Care (“Ramsay”) pursuant to in-place net leases with an approximate 18-year remaining lease term and include annual fixed and periodic market-based escalations.

On July 10, 2019, we entered into definitive agreements pursuant to which we will invest in a portfolio of 14 acute care hospitals and two behavioral health facilities currently owned and operated by Prospect Medical Holdings, Inc. (“Prospect”) for a combined purchase price of approximately $1.55 billion. Our investment will consist of (i) the acquisition of the real estate of 11 acute care hospitals and two behavioral health facilities for $1.4 billion and the subsequent leasing of such facilities back to Prospect in the form of two master leases; (ii) a $51.3 million mortgage loan, secured by a first mortgage on an acute care hospital; and (iii) a $112.9 million term loan which we expect will be converted into the acquisition of two additional acute care hospitals upon the satisfaction of certain conditions. The master leases, mortgage loan and term loan will be cross-defaulted and cross-collateralized. The master leases and mortgage loan have substantially similar terms, with a 15-year fixed term subject to three extension options, plus annual increases based on inflation.

Although no assurances can be made that these investments will occur, we believe the Prospect and SIR investments will close during the 2019 third quarter.

Financing

On July 18, 2019, we completed an underwritten public offering of 51.75 million shares (including the exercise of the underwriters’ 30-day option to purchase an additional 6.75 million shares) of our common stock, resulting in net proceeds of $858.1 million, after deducting underwriting discounts and commissions and estimated offering expenses.

On July 26, 2019, we completed a $900 million senior unsecured notes offering (“4.625% Senior Unsecured Notes due 2029”). Interest on the notes is payable semi-annually on February 1 and August 1 of each year, commencing on February 1, 2020. The notes were issued at 99.5% of par value, pay interest at a rate of 4.625% per year and mature on August 1, 2029. We may redeem some or all of the notes at any time prior to August 1, 2024 at a “make whole” redemption price. On or after August 1, 2024, 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, 2022, we may redeem up to 40% of the notes at a redemption price equal to 104.625% 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.

We intend to use the net proceeds from the 4.625% Senior Unsecured Notes due 2029 offering along with the proceeds from our July 2019 equity offering to help finance the commitments described above. Furthermore, the completion of the offerings described above resulted in the cancellation of a $1.55 billion senior unsecured bridge loan facility commitment from Barclays Bank PLC that we received on July 10, 2019, to fund our investment in the Prospect portfolio. With this commitment, we paid $3.9 million of underwriting and other fees, which we fully expensed upon the cancellation of the commitment.

Summary of Significant Accounting Policies (Policies)	6 Months Ended
Summary of Significant Accounting Policies (Policies)	Jun. 30, 2019
Accounting Policies [Abstract]
Unaudited Interim Condensed Consolidated Financial Statements	Unaudited Interim Condensed Consolidated Financial Statements: The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the three and six months ended June 30, 2019, are not necessarily indicative of the results that may be expected for the year ending December 31, 2019. The condensed consolidated balance sheet at December 31, 2018 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2018. There have been no material changes to these significant accounting policies other than the following: On January 1, 2019, we adopted Accounting Standards Update (“ASU”) 2016-02, “Leases”, (“ASU 2016-02”). ASU 2016-02 sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). We adopted this standard using the modified retrospective approach and have elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, permits the following: no reassessment of whether existing contracts are or contain a lease; no reassessment of lease classification for existing leases; and no reassessment of initial direct costs for existing leases. Additionally, we made certain elections permitted in accordance with ASU 2018-11, “Leases (Topic 842): – Targeted Improvements.” which (1) permits entities to apply the transition provisions of the new standard at its adoption date instead of at the earliest comparative period presented in its financial statements and (2) permits lessors to account for lease and non-lease components as a single lease component in a contract if certain criteria are met. The 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 (for finance leases) or on a straight-line basis (for operating leases) 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 remain off balance sheet with lease expense recognized on a straight-line basis over the lease term, similar to previous guidance for operating leases. The standard requires lessors to account for leases using an approach that is substantially equivalent to previous guidance for sales-type leases, direct financing leases and operating leases. For our leases in which we are the lessee, including ground leases on which certain of our facilities reside, along with corporate office and equipment leases, we recorded a right-of-use asset and offsetting lease liability of approximately $84 million upon adoption of this standard – resulting in no material cumulative effect adjustment. From a lessor perspective, we did not change the classification or accounting of our existing leases except, we are now grossing up our income statement for certain operating expenses, such as property taxes and insurance, that the tenants of our facilities are required to reimburse us for pursuant to our “triple-net” leases. See Note 10 for additional detail.
Recent Accounting Developments	Recent Accounting Developments: Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model to be used for our financing receivables, including direct financing leases and loan receivables, which the FASB believes will result in more timely recognition of such losses. ASU 2016-13 is effective for us beginning January 1, 2020. We are still evaluating the impact of this standard, but we do not believe such impact will be material.
Reclassifications	Reclassifications Certain amounts in the consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.

Real Estate and Lending Activities (Tables)

6 Months Ended

Jun. 30, 2019

Real Estate [Abstract]

Assets Acquired

We acquired the following assets (in thousands):

	For the Six Months Ended June 30,
	2019		2018
Assets Acquired
Land and land improvements	$	242,682	$	16,121
Building		784,184		232,409
Intangible lease assets — subject to amortization (weighted average useful life 18.5 years for 2019 and 20.0 years for 2018)		91,050		25,198
Equity investments		284,399		—
Total assets acquired	$	1,402,315	$	273,728
Loans repaid(1)		—		(259,378	)
Total net assets acquired	$	1,402,315	$	14,350

(1)

Includes $259.4 million of loans advanced to Steward Health Care System LLC (“Steward”) in 2017 and repaid in 2018 as described more fully below.

Summary of Status Update on Current Development Projects

See table below for a status update on our current development projects (in thousands):

Property	Commitment		Costs Incurred as of June 30, 2019		Estimated Rent Commencement Date
Circle Health (Birmingham, England)	$	45,520	$	34,452	1Q 2020
Circle Health Rehabilitation (Birmingham, England)		20,520		15,564	1Q 2020
Surgery Partners (Idaho Falls, Idaho)		113,468		69,312	1Q 2020
	$	179,508	$	119,328

Summary of Future Minimum Lease Payments to be Received

The following table summarizes future minimum lease payments to be received, excluding operating expense reimbursements, from tenants under noncancelable leases as of June 30, 2019 (in thousands):

	Total Under Operating Leases		Total Under DFLs		Total
2019 (six months only)	$	240,424	$	30,427	$	270,851
2020		488,865		62,072		550,937
2021		497,542		63,313		560,855
2022		503,549		64,579		568,128
2023		512,114		65,871		577,985
Thereafter		10,776,966		1,400,026		12,176,992
	$	13,019,460	$	1,686,288	$	14,705,748

Components of Net Investment in Direct Financing Leases

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

	As of June 30, 2019			As of December 31, 2018
Minimum lease payments receivable	$	2,063,918		$	2,091,504
Estimated residual values		420,733			424,719
Less: Unearned income		(1,798,052	)		(1,832,170	)
Net investment in direct financing leases	$	686,599		$	684,053

Summary of Loans

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

	As of June 30, 2019		As of December 31, 2018
Mortgage loans	$	1,216,442	$	1,213,322
Other loans		370,631		373,198
Total	$	1,587,073	$	1,586,520

Debt (Tables)

6 Months Ended

Jun. 30, 2019

Debt Disclosure [Abstract]

Summary of Debt

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

	As of June 30, 2019			As of December 31, 2018
Revolving credit facility(A)	$	40,627		$	28,059
Term loan		200,000			200,000
Australian term loan facility(B)		842,400			—
4.000% Senior Unsecured Notes due 2022(C)		568,650			573,350
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(C)		568,650			573,350
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
	$	4,920,327		$	4,074,759
Debt issue costs, net		(42,017	)		(37,370	)
	$	4,878,310		$	4,037,389

(A)	Includes £32 million and £22 million of GBP-denominated borrowings that reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

(B)	This note is Australian dollar-denominated and reflects the exchange rate at June 30, 2019.

(C)	These notes are Euro-denominated and reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

Principal Payments Due on Debt

As of June 30, 2019, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2019	$	—
2020		—
2021		40,627
2022		768,650
2023		—
Thereafter		4,111,050
Total	$	4,920,327

Fair Value of Financial Instruments (Tables)

6 Months Ended

Jun. 30, 2019

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):

	As of						As of
	June 30, 2019						December 31, 2018
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	24,103		$	23,241		$	25,855		$	24,942
Loans(1)		1,472,073			1,515,485			1,471,520			1,490,758
Debt, net		(4,878,310	)		(5,073,566	)		(4,037,389	)		(3,947,795	)

(1)

Excludes mortgage loans related to Ernest since they are recorded at fair value and discussed below.

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

At June 30, 2019, these amounts were as follows (in thousands):

Asset Type

Fair

Value

Original

Cost

Asset Type

Classification

Mortgage loans

115,000

Mortgage loans

Earnings Per Share (Tables)

6 Months Ended

Jun. 30, 2019

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 Three Months Ended June 30,
	2019			2018
Numerator:
Net income	$	79,920		$	112,017
Non-controlling interests’ share in net income		(482	)		(450	)
Participating securities’ share in earnings		(446	)		(323	)
Net income, less participating securities’ share in earnings	$	78,992		$	111,244
Denominator:
Basic weighted-average common shares		394,574			364,897
Dilutive potential common shares		1,118			644
Dilutive weighted-average common shares		395,692			365,541

	For the Six Months Ended June 30,
	2019			2018
Numerator:
Net income	$	156,211		$	203,060
Non-controlling interests’ share in net income		(951	)		(892	)
Participating securities’ share in earnings		(922	)		(518	)
Net income, less participating securities’ share in earnings	$	154,338		$	201,650
Denominator:
Basic weighted-average common shares		387,563			364,889
Dilutive potential common shares		1,120			553
Dilutive weighted-average common shares		388,683			365,442

MPT Operating Partnership, L.P.

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

	For the Three Months Ended June 30,
	2019			2018
Numerator:
Net income	$	79,920		$	112,017
Non-controlling interests’ share in net income		(482	)		(450	)
Participating securities’ share in earnings		(446	)		(323	)
Net income, less participating securities’ share in earnings	$	78,992		$	111,244
Denominator:
Basic weighted-average units		394,574			364,897
Dilutive potential units		1,118			644
Diluted weighted-average units		395,692			365,541

	For the Six Months Ended June 30,
	2019			2018
Numerator:
Net income	$	156,211		$	203,060
Non-controlling interests’ share in net income		(951	)		(892	)
Participating securities’ share in earnings		(922	)		(518	)
Net income, less participating securities’ share in earnings	$	154,338		$	201,650
Denominator:
Basic weighted-average units		387,563			364,889
Dilutive potential units		1,120			553
Diluted weighted-average units		388,683			365,442

Leases (Lessee) (Tables)

6 Months Ended

Jun. 30, 2019

Leases [Abstract]

Summary of Lease Expense

The following is a summary of our lease expense (in thousands):

	Classification	Three Months Ended June 30, 2019			Six Months Ended June 30, 2019
Operating lease cost (1)	(2)	$	2,466		$	4,562
Finance lease cost:
Amortization of right-of-use assets	Real estate depreciation and amortization		13			26
Interest on lease liabilities	Interest expense		32			53
Sublease income	Interest and other income		(909	)		(1,809	)
Total lease cost		$	1,602		$	2,832

(1)

Includes short-term leases.

(2)

$1.5 million and $3.1 million for the three and six months ended June 30, 2019, respectively, included in Property-related, with the remainder reflected in General and administrative expenses.

Schedule Of Future Minimum Rental Payments For Leases Sublease Receivable And Net Payments Table Text Block

	Operating leases			Finance leases			Amounts to be received from subleases			Net payments
2019 (1)	$	3,111		$	62		$	(1,693	)	$	1,480
2020		6,341			125			(3,444	)		3,022
2021		6,533			126			(3,561	)		3,098
2022		6,734			128			(3,699	)		3,163
2023		6,800			129			(3,704	)		3,225
Thereafter		196,489			5,045			(95,622	)		105,912	(2)
Total undiscounted minimum lease payments	$	226,008		$	5,615		$	(111,723	)	$	119,900
Less: interest		(145,048	)		(3,685	)
Present value of lease liabilities	$	80,960		$	1,930

(1)

Represents remaining six months of 2019.

(2)

Summary of Supplemental Balance Sheet Information

Supplemental balance sheet information is as follows (in thousands, except lease terms and discount rate):

	Classification	June 30, 2019
Right of use assets:
Operating leases - real estate	Land, buildings and improvements, intangible lease assets, and other	$	63,748
Finance leases - real estate	Land, buildings and improvements, intangible lease assets, and other		1,913
Real estate right of use assets, net			65,661
Operating leases - corporate	Other assets		10,651
Total right of use assets, net		$	76,312

Lease liabilities:
Operating leases	Obligations to tenants and other lease liabilities	$	80,960
Financing leases	Obligations to tenants and other lease liabilities		1,930
Total lease liabilities		$	82,890

Weighted average remaining lease term:
Operating leases			32.1
Finance leases			37.4
Weighted average discount rate:
Operating leases			6.3	%
Finance leases			6.6	%

Summary of Supplemental Cash Flow Information

The following is supplemental cash flow information (in thousands):

	Six Months Ended June 30, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	2,929
Operating cash flows from finance leases		52
Financing cash flows from finance leases		10
Right-of-use assets obtained in exchange for lease obligations:
Operating leases		1,042
Finance leases		—

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Jan. 01, 2019
Accounting Policies [Abstract]
Right of use asset		$ 84,000
Operating lease liabilities	$ 80,960	$ 84,000

Real Estate and Lending Activities - Assets Acquired (Detail) - USD ($)
$ in Thousands

Jun. 30, 2019

Jun. 30, 2018

Total net assets acquired

$ 1,402,315

$ 273,728

Loans repaid

^[1]

(259,378)

1,402,315

14,350

Land and Land Improvements [Member]

242,682

16,121

Building [Member]

Intangible Lease Assets - Subject to Amortization [Member]

784,184

232,409

Equity Investments [Member]

91,050

$ 25,198

$ 284,399

[1]	Includes $259.4 million of loans advanced to Steward Health Care System LLC (“Steward”) in 2017 and repaid in 2018 as described more fully below.

Real Estate and Loans Receivable - Assets Acquired (Parenthetical) (Detail) - USD ($)
$ in Thousands

6 Months Ended

Jun. 30, 2019

Jun. 30, 2018

Steward Health Care System LLC [Member]

Loans repaid

^[1]

$ 259,378

Intangible Lease Assets - Subject to Amortization [Member]

Loans repaid

$ 259,400

Weighted average useful life of acquired intangible lease assets (in years)

18 years 6 months

20 years

[1]	Includes $259.4 million of loans advanced to Steward Health Care System LLC (“Steward”) in 2017 and repaid in 2018 as described more fully below.

Real Estate Activities and Lending Activities - 2019 Activity - Additional Information (Detail) SFr in Millions, $ in Millions, $ in Millions							6 Months Ended
	Jun. 28, 2019 CHF (SFr)	Jun. 10, 2019 USD ($) Hospital RenewalOption	Jun. 06, 2019 AUD ($) Hospital	May 31, 2019 USD ($)	May 27, 2019 CHF (SFr) _Campus	Apr. 03, 2019	Jun. 30, 2019 USD ($) Hospital
Business Acquisition [Line Items]
Term of lease extension, years							5 years
Weighted average remaining lease term					23 years		32 years 1 month 6 days
Other Acquisitions [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $							$ 80.0
Swiss Healthcare Real Estate Company Infracore S A [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| SFr					SFr 236.6
Swiss Healthcare Real Estate Company Infracore S A [Member] \| Joint Venture Partner [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the equity method					46.00%
Aevis Victoria SA [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| SFr	SFr 47.0
Ownership interest in joint venture under the cost method	4.90%
Community Hospital [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		7
Purchase price of acquisition \| $				$ 40.0
Leases fixed escalations		5 years
Lease extension options, description							two five-year extension options
Existence of option to extend		true
Number of lease extension options \| RenewalOption		2
Term of lease extension, years		5 years
Community Hospital [Member] \| Saint Luke’s Health System [Member]
Business Acquisition [Line Items]
Term of lease		14 years
Community Hospital [Member] \| Kansas [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		7
Purchase price of acquisition \| $		$ 145.4
Hospital [Member] \| Healthscope Limited [Member]
Business Acquisition [Line Items]
Term of lease			20 years
Fixed annual escalations			2.50%
Hospital [Member] \| Australia [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital			11
Purchase price of acquisition \| $			$ 1,200.0
Stamp duties and registration fees \| $			$ 66.6
Acute Care Campus [Member] \| Swiss Healthcare Real Estate Company Infracore S A [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| _Campus					13
Additional Properties [Member] \| Switzerland [Member] \| Swiss Healthcare Real Estate Company Infracore S A [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| _Campus					2
Acute Care Hospital [Member] \| Poole, England [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital							2
Acute Care Hospital [Member] \| Poole, England [Member] \| BMI Healthcare [Member]
Business Acquisition [Line Items]
Term of lease						14 years
Fixed annual escalators percentage						2.50%
Inpatient Rehabilitation Hospital [Member] \| Germany [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital							1

Real Estate Activities and Lending Activities - 2018 Activity - Additional Information (Detail) $ in Thousands		1 Months Ended	6 Months Ended
	Jun. 27, 2018 USD ($) Hospital	Oct. 31, 2016 USD ($)	Jun. 30, 2019 USD ($)	Jun. 30, 2018 USD ($)
Business Acquisition [Line Items]
Payment of cash consideration for acquisition			$ 1,402,315	$ 273,728
2018 [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital	2
Mortgage financing		$ 259,400
Payment of cash consideration for acquisition	$ 14,400

Real Estate and Lending Activities - Summary of Status Update on Current Development Projects (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2019 USD ($)
Business Acquisition [Line Items]
Commitment	$ 179,508
Costs Incurred as of June 30, 2019	119,328
Circle Health [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	45,520
Costs Incurred as of June 30, 2019	$ 34,452
Estimated Rent Commencement Date	1Q 2020
Circle Health Rehabilitation [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	$ 20,520
Costs Incurred as of June 30, 2019	$ 15,564
Estimated Rent Commencement Date	1Q 2020
Surgery Partners [Member] \| Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Commitment	$ 113,468
Costs Incurred as of June 30, 2019	$ 69,312
Estimated Rent Commencement Date	1Q 2020

Real Estate and Lending Activities - Development Activities - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2018 USD ($)
Ernest [Member] \| Development Activities [Member]
Business Acquisition [Line Items]
Estimated total development cost	$ 25.5

Real Estate and Lending Activities - Disposals - Additional Information (Detail) $ in Thousands			6 Months Ended
	Jun. 04, 2018 USD ($) Hospital	Mar. 01, 2018 USD ($)	Jun. 30, 2019 USD ($)	Jun. 30, 2018 USD ($)	Dec. 31, 2018 USD ($)
Debt Instrument [Line Items]
Loans, Balance			$ 1,587,073		$ 1,586,520
Net proceeds from sale of real estate			3,449	$ 221,931
Steward Health Care System LLC [Member] \| Houston, Texas [Member] \| St. Joseph Medical Center [Member]
Debt Instrument [Line Items]
Gain on real estate dispositions		$ 1,500
Gain offset by non-cash charges		1,700
Net proceeds from sale of real estate		$ 148,000
Mortgage Loans [Member]
Debt Instrument [Line Items]
Loans, Balance			$ 1,216,442		$ 1,213,322
California, Texas, and Oregon [Member] \| Vibra Healthcare, LLC [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities	$ 53,300
Gain on real estate dispositions	24,200
Gain offset by non-cash charges	5,100
California, Texas, and Oregon [Member] \| Working Capital Loans [Member] \| Vibra Healthcare, LLC [Member]
Debt Instrument [Line Items]
Loans, Balance	1,500
California, Texas, and Oregon [Member] \| Mortgage Loans [Member] \| Vibra Healthcare, LLC [Member]
Debt Instrument [Line Items]
Loans, Balance	$ 18,300
California, Texas, and Oregon [Member] \| Long-term Acute Care Hospital [Member] \| Vibra Healthcare, LLC [Member]
Debt Instrument [Line Items]
Number of properties sold \| Hospital	3

Real Estate and Lending Activities - Leasing Operations (Lessor) - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2019 USD ($) Property
Lessor Lease Description [Line Items]
Lease renewal term	5 years
Annual rent escalations	95.00%
Number of properties \| Property	5
Carrying value of lease requiring residual value guarantee \| $	$ 210
Minimum [Member]
Lessor Lease Description [Line Items]
Term of lease	10 years
Fixed minimum annual escalations	0.50%
Maximum [Member]
Lessor Lease Description [Line Items]
Term of lease	15 years
Fixed minimum annual escalations	3.00%

Real Estate and Lending Activities - Summary of Future Minimum Lease Payments to be Received (Detail) - Minimum [Member] $ in Thousands	Jun. 30, 2019 USD ($)
Lessor Lease Description [Line Items]
2019 (six months only)	$ 270,851
2020	550,937
2021	560,855
2022	568,128
2023	577,985
Thereafter	12,176,992
Future minimum lease payments to be received	14,705,748
Operating Leases [Member]
Lessor Lease Description [Line Items]
2019 (six months only)	240,424
2020	488,865
2021	497,542
2022	503,549
2023	512,114
Thereafter	10,776,966
Future minimum lease payments to be received	13,019,460
Direct Financing Leases [Member]
Lessor Lease Description [Line Items]
2019 (six months only)	30,427
2020	62,072
2021	63,313
2022	64,579
2023	65,871
Thereafter	1,400,026
Future minimum lease payments to be received	$ 1,686,288

Real Estate and Lending Activities - Direct Financing Leases - Additional Information (Detail) $ in Millions		6 Months Ended
	Mar. 15, 2018 USD ($)	Jun. 30, 2019 Lease
Ernest [Member]
Direct Financing Lease Income [Line Items]
Number of direct financing leases		14
Prime Facilities [Member]
Direct Financing Lease Income [Line Items]
Number of direct financing leases		10
Alecto Healthcare Services [Member]
Direct Financing Lease Income [Line Items]
Number of direct financing leases		2
Vibra Healthcare, LLC [Member] \| Acute Care Hospital [Member]
Direct Financing Lease Income [Line Items]
Term of lease	15 years
Existence of option to extend	true
Number of lease extension options		with three extension options of five years each
Term of lease extension, years	5 years
Write off of unbilled direct finance lease rent \| $	$ 1.5

Real Estate and Lending Activities - Components of Net Investment in Direct Financing Leases (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 2,063,918	$ 2,091,504
Estimated residual values	420,733	424,719
Less: Unearned income	(1,798,052)	(1,832,170)
Net investment in direct financing leases	$ 686,599	$ 684,053

Real Estate and Lending Activities - Twelve Oaks Facility - Additional Information (Detail)		6 Months Ended
	Apr. 11, 2019 RenewalOption Facility	Jun. 30, 2019
Business Acquisition [Line Items]
Term of lease extension, years		5 years
Oaks Facility [Member] \| Advanced Diagnostics [Member]
Business Acquisition [Line Items]
Number of re-leased facilities \| Facility	12
Term of lease	10 years
Lease extension options, description		four additional five-year extension options
Existence of option to extend	true
Number of lease extension options \| RenewalOption	4
Term of lease extension, years	5 years

Real Estate and Lending Activities - Adeptus Health Transition Properties - Additional Information (Detail) - Adeptus Health Transition Properties [Member]		1 Months Ended	6 Months Ended
	Oct. 01, 2019 Property	Jul. 31, 2019 Property	Jun. 30, 2019 Property Facility
Business Acquisition [Line Items]
Number of facilities transitioned			16
Number of re-leased facilities			9
Number of transitioned facilities not re-leased \| Facility			5
Percentage of investment in remaining transition facilities on total assets			0.50%
Subsequent Event [Member]
Business Acquisition [Line Items]
Number of properties sold		2
Scenario, Forecast [Member]
Business Acquisition [Line Items]
Number of remaining properties to be transitioned	4

Real Estate and Lending Activities - Gilbert and Florence Facilities - Additional Information (Detail)	6 Months Ended
	Jun. 30, 2019
Gilbert Facility [Member] \| Total Gross Assets [Member] \| Credit Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of Total Gross Assets	0.20%

Real Estate and Lending Activities - Alecto Facilities - Additional Information (Detail) - Alecto Healthcare Services [Member] $ in Millions	6 Months Ended
	Jun. 30, 2019 Property	Aug. 07, 2019 USD ($) Facility
Business Acquisition [Line Items]
Number of leased properties \| Property	4
Number of facilities closed \| Facility		2
Investment in closed facilities \| $		$ 30
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of Total Gross Assets	1.00%

Real Estate and Lending Activities - Summary of Loans (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Loans [Line Items]
Loans, Balance	$ 1,587,073	$ 1,586,520
Mortgage Loans [Member]
Loans [Line Items]
Loans, Balance	1,216,442	1,213,322
Other Loans [Member]
Loans [Line Items]
Loans, Balance	$ 370,631	$ 373,198

Real Estate and Lending Activities - Loans - Additional Information (Detail) € in Millions	Jun. 30, 2019 EUR (€)
Primotop Holdings S.a.r.l. [Member]
Loans [Line Items]
Shareholder loan to joint venture	€ 290

Real Estate and Lending Activities - Concentrations of Credit Risk - Additional Information (Detail) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2019 USD ($) Investment	Jun. 30, 2018 USD ($)	Jun. 30, 2019 USD ($) Investment	Jun. 30, 2018 USD ($)	Dec. 31, 2018 Investment
Business Acquisition [Line Items]
Revenue from affiliates of total revenue	$ 192,549	$ 201,902	$ 373,003	$ 406,948
Total Gross Assets [Member] \| Geographic Concentration [Member] \| U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			75.00%		80.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Europe [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			18.00%		20.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			7.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			86.00%	86.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			10.00%	10.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Long-term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			4.00%	4.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Steward and Prime [Member]
Business Acquisition [Line Items]
Maximum percentage of entity's revenue invested	4.00%		4.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Revenue from affiliates of total revenue			$ 176,300	$ 147,900
Revenue [Member] \| Credit Concentration Risk [Member] \| Prime [Member]
Business Acquisition [Line Items]
Revenue from affiliates of total revenue			$ 64,000	63,600
Revenue [Member] \| Credit Concentration Risk [Member] \| MEDIAN [Member]
Business Acquisition [Line Items]
Revenue from affiliates of total revenue				$ 57,300
Pro Forma [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Number of investment in property \| Investment	0		0		0
Maximum percentage of entity's assets invested on single property	4.00%		4.00%		4.00%

Debt - Summary of Debt (Detail) - USD ($)
$ in Thousands

Jun. 30, 2019

Dec. 31, 2018

Revolving Credit Facility [Member]

$ 4,920,327

Debt issue costs, net

(42,017)

$ (37,370)

Debt, net

4,878,310

4,037,389

^[1]

40,627

28,059

Term Loan [Member]

Term Loan [Member] | Australia [Member]

200,000

4.000% Senior Unsecured Notes due 2022 [Member]

^[2]

842,400

5.500% Senior Unsecured Notes Due 2024 [Member]

^[3]

568,650

573,350

6.375% Senior Unsecured Notes due 2024 [Member]

300,000

3.325% Senior Unsecured Notes Due 2025 [Member]

500,000

5.250% Senior Unsecured Notes Due 2026 [Member]

^[3]

568,650

573,350

5.000% Senior Unsecured Notes Due 2027 [Member]

500,000

Senior Unsecured Debt [Member]

1,400,000

$ 4,920,327

$ 4,074,759

[1]	Includes £32 million and £22 million of GBP-denominated borrowings that reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.
[2]	This note is Australian dollar-denominated and reflects the exchange rate at June 30, 2019.
[3]	These notes are Euro-denominated and reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

Debt - Summary of Debt (Parenthetical) (Detail)
$ in Thousands, £ in Millions

Jun. 30, 2019

USD ($)

Jun. 30, 2019

GBP (£)

Dec. 31, 2018

USD ($)

Dec. 31, 2018

GBP (£)

4.000% Senior Unsecured Notes due 2022 [Member]

$ 4,920,327

^[1]

4.00%

5.500% Senior Unsecured Notes Due 2024 [Member]

^[1]

$ 568,650

$ 573,350

5.50%

6.375% Senior Unsecured Notes due 2024 [Member]

$ 300,000

300,000

6.375%

3.325% Senior Unsecured Notes Due 2025 [Member]

$ 500,000

500,000

^[1]

3.325%

5.000% Senior Unsecured Notes Due 2027 [Member]

^[1]

$ 568,650

573,350

5.00%

5.250% Senior Unsecured Notes Due 2026 [Member]

$ 1,400,000

1,400,000

5.25%

GBP-denominated Borrowings [Member]

$ 500,000

Lessee Lease Description [Line Items]

Debt | £

£ 32

£ 22

[1]	These notes are Euro-denominated and reflect the exchange rate at June 30, 2019 and December 31, 2018, respectively.

Debt - Principal Payments Due for Debt (Detail) $ in Thousands	Jun. 30, 2019 USD ($)
Debt Disclosure [Abstract]
2021	$ 40,627
2022	768,650
Thereafter	4,111,050
Total	$ 4,920,327

Debt - Additional Information (Detail) $ in Thousands	Jun. 27, 2019	May 23, 2019 AUD ($)	Jun. 30, 2019 USD ($)	Dec. 31, 2018 USD ($)
Debt Instrument [Line Items]
One-time structuring and underwriting fees associated term loan facility			$ 42,017	$ 37,370
Australia [Member] \| Term Loan [Member] \| Bank of America, N.A
Debt Instrument [Line Items]
Maximum borrowing capacity		$ 1,200,000,000
Debt instrument maturity date		May 23, 2024
Debt instrument effective date	Jul. 03, 2019
Effective interest rate	1.20%
Interest rate			2.45%
One-time structuring and underwriting fees associated term loan facility			$ 8,000
Australia [Member] \| Term Loan [Member] \| Credit Rating \| Bank of America, N.A
Debt Instrument [Line Items]
Variable interest rate			1.25%
Australia [Member] \| Term Loan [Member] \| Minimum [Member] \| Bank of America, N.A
Debt Instrument [Line Items]
Interest rate adjustable based on pricing grid, percentage		0.85%
Australia [Member] \| Term Loan [Member] \| Maximum [Member] \| Bank of America, N.A
Debt Instrument [Line Items]
Interest rate adjustable based on pricing grid, percentage		1.65%

Debt - Covenants - Additional Information (Detail)	6 Months Ended
Debt - Covenants - Additional Information (Detail)	Jun. 30, 2019
Debt Disclosure [Abstract]
Percentage of dividends which could be paid from adjusted operating funds	95.00%
Percentage of dividends which could be paid from operation funds	95.00%
Maximum percentage of total unencumbered assets	150.00%

Common Stock/Partners' Capital - Additional Information (Detail) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019 shares	Mar. 31, 2019 shares	Jun. 30, 2019 USD ($) Employee shares
Class Of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs \| $			$ 399,353
Employee [Member]
Class Of Stock [Line Items]
Number of partners shared remaining ownership percentage \| Employee			2
MPT Operating Partnership, L.P. [Member]
Class Of Stock [Line Items]
Number of units sold			22,600
MPT Operating Partnership, L.P. [Member] \| Medical Properties Trust, Inc. [Member]
Class Of Stock [Line Items]
Ownership interest in equity	99.90%		99.90%
Common Par Value [Member]
Class Of Stock [Line Items]
Number of share sold	2,467	20,147	22,600

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share / (Unit)-based compensation expense	$ 13,032	$ 6,725
Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reserved shares of common stock for awards under the Equity Incentive Plan	12,900,000

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 24,103	$ 25,855
Loans, Book value	1,472,073	1,471,520
Debt, net Book value	(4,878,310)	(4,037,389)
Interest and rent receivables, Fair value	23,241	24,942
Loans, Fair value	1,515,485	1,490,758
Debt, net Fair value	$ (5,073,566)	$ (3,947,795)

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - Fair Value Measurements, Recurring [Member] - Mortgage Loans [Member] $ in Thousands	Jun. 30, 2019 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 115,000
Original Cost	$ 115,000

Fair Value of Financial Instruments - Additional information (Detail)	6 Months Ended
	Jun. 30, 2019 USD ($)
Ernest [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Unrealized gain/loss on investments	$ 0

Earnings Per Share - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Jun. 30, 2018
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 79,920	$ 76,291	$ 112,017	$ 91,043	$ 156,211	$ 203,060
Non-controlling interests’ share in net income	(482)		(450)		(951)	(892)
Participating securities’ share in earnings	(446)		(323)		(922)	(518)
Net income, less participating securities’ share in earnings	$ 78,992		$ 111,244		$ 154,338	$ 201,650
Basic weighted-average common shares	394,574		364,897		387,563	364,889
Dilutive potential common shares	1,118		644		1,120	553
Dilutive weighted-average common shares	395,692		365,541		388,683	365,442
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 79,920	$ 76,291	$ 112,017	$ 91,043	$ 156,211	$ 203,060
Non-controlling interests’ share in net income	(482)		(450)		(951)	(892)
Participating securities’ share in earnings	(446)		(323)		(922)	(518)
Net income, less participating securities’ share in earnings	$ 78,992		$ 111,244		$ 154,338	$ 201,650
Basic weighted-average common shares	394,574		364,897		387,563	364,889
Dilutive potential common shares	1,118		644		1,120	553
Dilutive weighted-average common shares	395,692		365,541		388,683	365,442

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

+ References

+ Details

Commitments and Contingencies - Additional Information (Detail) $ in Millions	May 31, 2019 USD ($)
Community Hospital [Member]
Commitment And Contingencies [Line Items]
Purchase price of acquisition	$ 40.0

Leases (Lessee) - Additional Information (Detail)	6 Months Ended
Leases (Lessee) - Additional Information (Detail)	Jun. 30, 2019
Minimum [Member]
Lessee Lease Description [Line Items]
Lessee, operating and finance leases remaining lease term	5 years
Maximum [Member]
Lessee Lease Description [Line Items]
Lessee, operating and finance leases remaining lease term	42 years 3 months 18 days

Leases (Lessee) - Summary of Lease Expense (Detail) - USD ($)
$ in Thousands

3 Months Ended

6 Months Ended

Jun. 30, 2019

Operating lease cost

^[1],[2]

$ 2,466

$ 4,562

Real Estate Depreciation and Amortization [Member]

Total lease cost

1,602

2,832

Amortization of right-of-use assets

Interest Expense [Member]

Interest on lease liabilities

Interest and Other Income [Member]