0001564590-20-024264 | 10-Q | XBRL Viewer | Medical Properties Trust INC

Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2020	May 01, 2020
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST, INC.
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		528,332,267
Title of 12(b) Security	Common stock, par value $0.001 per share, of Medical Properties Trust, Inc.
Security Exchange Name	NYSE
Entity Shell Company	false
Entity File Number	001-32559
Entity Tax Identification Number	20-0191742
Entity Address, Address Line One	1000 Urban Center Drive
Entity Address, Address Line Two	Suite 501
Entity Address, City or Town	Birmingham
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	(205)
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	MD
Document Quarterly Report	true
Document Transition Report	false
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity File Number	333-177186
Entity Tax Identification Number	20-0242069
Entity Address, Address Line One	1000 Urban Center Drive
Entity Address, Address Line Two	Suite 501
Entity Address, City or Town	Birmingham
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	(205)
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	DE

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 9,933,444	$ 8,102,754
Investment in financing leases	2,068,166	2,060,302
Mortgage loans	1,275,543	1,275,022
Gross investment in real estate assets	13,277,153	11,438,078
Accumulated depreciation and amortization	(627,467)	(570,042)
Net investment in real estate assets	12,649,686	10,868,036
Cash and cash equivalents	500,213	1,462,286
Interest and rent receivables	38,768	31,357
Straight-line rent receivables	355,424	334,231
Equity investments	834,430	926,990
Other loans	546,691	544,832
Other assets	312,875	299,599
Total Assets	15,238,087	14,467,331
Liabilities
Debt, net	7,684,293	7,023,679
Accounts payable and accrued expenses	428,136	291,489
Deferred revenue	24,001	16,098
Obligations to tenants and other lease liabilities	119,147	107,911
Total Liabilities	8,255,577	7,439,177
Equity / Capital
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding
Common stock, $0.001 par value. Authorized 750,000 shares; issued and outstanding — 522,435 shares at March 31, 2020 and 517,522 shares at December 31, 2019	522	518
Limited Partners:
Additional paid-in capital	7,079,913	7,008,199
Retained earnings	14,025	83,012
Accumulated other comprehensive loss	(111,280)	(62,905)
Treasury shares, at cost	(777)	(777)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	6,982,403	7,028,047
Non-controlling interests	107	107
Total Equity / Capital	6,982,510	7,028,154
Total Liabilities and Equity / Capital	15,238,087	14,467,331
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	9,933,444	8,102,754
Investment in financing leases	2,068,166	2,060,302
Mortgage loans	1,275,543	1,275,022
Gross investment in real estate assets	13,277,153	11,438,078
Accumulated depreciation and amortization	(627,467)	(570,042)
Net investment in real estate assets	12,649,686	10,868,036
Cash and cash equivalents	500,213	1,462,286
Interest and rent receivables	38,768	31,357
Straight-line rent receivables	355,424	334,231
Equity investments	834,430	926,990
Other loans	546,691	544,832
Other assets	312,875	299,599
Total Assets	15,238,087	14,467,331
Liabilities
Debt, net	7,684,293	7,023,679
Accounts payable and accrued expenses	286,142	152,999
Deferred revenue	24,001	16,098
Obligations to tenants and other lease liabilities	119,147	107,911
Payable due to Medical Properties Trust, Inc.	141,604	138,100
Total Liabilities	8,255,187	7,438,787
Limited Partners:
Accumulated other comprehensive loss	(111,280)	(62,905)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	6,982,793	7,028,437
Non-controlling interests	107	107
Total Equity / Capital	6,982,900	7,028,544
Total Liabilities and Equity / Capital	15,238,087	14,467,331
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
Equity / Capital
General Partner — issued and outstanding — [ ] units at March 31, 2020 and 5,176 units at December 31, 2019	70,966	70,939
Limited Partners:
Total Equity / Capital	70,966	70,939
Common Units [Member] \| MPT Operating Partnership, L.P. [Member]
Limited Partners:
Common units — issued and outstanding — 517,210 units at March 31, 2020 and 512,346 units at December 31, 2019	$ 7,023,107	$ 7,020,403

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
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	750,000,000	750,000,000
Common stock, shares issued	522,435,000	517,522,000
Common stock, shares outstanding	522,435,000	517,522,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	5,225,000	5,176,000
General partner, units outstanding	5,225,000	5,176,000
Common Units [Member] \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	517,210,000	512,346,000
Limited Partners, units outstanding	517,210,000	512,346,000
LTIP Units [Member] \| MPT Operating Partnership, L.P. [Member]
LTIP Units, shares issued	232,000	232,000
LTIP Units, shares outstanding	232,000	232,000

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Revenues
Rent billed	$ 171,767	$ 108,598
Straight-line rent	31,421	20,651
Income from financing leases	52,436	17,280
Interest and other income	38,508	33,925
Total revenues	294,132	180,454
Expenses
Interest	80,899	50,551
Real estate depreciation and amortization	60,921	33,352
Property-related	5,572	3,066
General and administrative	33,385	23,451
Total expenses	180,777	110,420
Other income (expense)
Gain on sale of real estate	1,325
Real estate impairment charges	(19,006)
Earnings from equity interests	4,079	3,720
Unutilized financing fees	(611)
Other (including mark-to-market adjustments on equity securities)	(13,975)	204
Total other (expense) income	(28,188)	3,924
Income before income tax	85,167	73,958
Income tax (expense) benefit	(4,010)	2,333
Net income	81,157	76,291
Net income attributable to non-controlling interests	(165)	(469)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 80,992	$ 75,822
Earnings per common share (units) basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.15	$ 0.20
Weighted average shares (units) outstanding basic	521,076	380,551
Weighted average shares (units) outstanding diluted	522,179	381,675
Dividends declared per common share (unit)	$ 0.27	$ 0.25
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 171,767	$ 108,598
Straight-line rent	31,421	20,651
Income from financing leases	52,436	17,280
Interest and other income	38,508	33,925
Total revenues	294,132	180,454
Expenses
Interest	80,899	50,551
Real estate depreciation and amortization	60,921	33,352
Property-related	5,572	3,066
General and administrative	33,385	23,451
Total expenses	180,777	110,420
Other income (expense)
Gain on sale of real estate	1,325
Real estate impairment charges	(19,006)
Earnings from equity interests	4,079	3,720
Unutilized financing fees	(611)
Other (including mark-to-market adjustments on equity securities)	(13,975)	204
Total other (expense) income	(28,188)	3,924
Income before income tax	85,167	73,958
Income tax (expense) benefit	(4,010)	2,333
Net income	81,157	76,291
Net income attributable to non-controlling interests	(165)	(469)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 80,992	$ 75,822
Earnings per common share (units) basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.15	$ 0.20
Weighted average shares (units) outstanding basic	521,076	380,551
Weighted average shares (units) outstanding diluted	522,179	381,675
Dividends declared per common share (unit)	$ 0.27	$ 0.25

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Net income	$ 81,157	$ 76,291
Other comprehensive income:
Unrealized loss on interest rate swap	(25,103)	(3,772)
Foreign currency translation loss	(23,272)	(5,918)
Total comprehensive income	32,782	66,601
Comprehensive income attributable to non-controlling interests	(165)	(469)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	32,617	66,132
MPT Operating Partnership, L.P. [Member]
Net income	81,157	76,291
Other comprehensive income:
Unrealized loss on interest rate swap	(25,103)	(3,772)
Foreign currency translation loss	(23,272)	(5,918)
Total comprehensive income	32,782	66,601
Comprehensive income attributable to non-controlling interests	(165)	(469)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 32,617	$ 66,132

- Definition

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

+ References

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+ Details

Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	Common Par Value [Member]	Common Par Value [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]	Additional Paid-in Capital [Member]	Retained Earnings (Deficit) [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Other Comprehensive Loss [Member] MPT Operating Partnership, L.P. [Member]	Treasury Shares [Member]	Non-Controlling Interests [Member]	Non-Controlling Interests [Member] MPT Operating Partnership, L.P. [Member]	Long Term Incentive Plan [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]
Beginning balance at Dec. 31, 2018	$ 4,560,938	$ 4,561,328	$ 46,084	$ 371	$ 4,559,616	$ 4,442,948	$ 162,768	$ (58,202)	$ (58,202)	$ (777)	$ 13,830	$ 13,830
Beginning balance (in shares) at Dec. 31, 2018			3,706	370,637	366,931								232
Net income	76,291	76,291	$ 758		$ 75,064		75,822				469	469
Unrealized loss on interest rate swap, net of tax	(3,772)	(3,772)						(3,772)	(3,772)
Foreign currency translation loss	(5,918)	(5,918)						(5,918)	(5,918)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	6,715	6,715	$ 68	$ 1	$ 6,647	6,714
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			11	1,055	1,044
Distributions to non-controlling interests	(645)	(645)									(645)	(645)
Proceeds from offering (net of offering costs)	354,030	354,030	$ 3,540	$ 20	$ 350,490	354,010
Proceeds from offering (net of offering costs) (shares)			201	20,147	19,946
Dividends (Distributions) declared ($0.25 in 2019 and $0.27 in 2020 per common share/ unit)	(97,163)	(97,163)	$ (972)		$ (96,191)		(97,163)
Ending balance at Mar. 31, 2019	4,890,476	4,890,866	$ 49,478	$ 392	$ 4,895,626	4,803,672	141,427	(67,892)	(67,892)	(777)	13,654	13,654
Ending balance (in shares) at Mar. 31, 2019			3,918	391,839	387,921								232
Beginning balance at Dec. 31, 2019	7,028,154	7,028,544	$ 70,939	$ 518	$ 7,020,403	7,008,199	83,012	(62,905)	(62,905)	(777)	107	107
Beginning balance (in shares) at Dec. 31, 2019			5,176	517,522	512,346								232
Net income	81,157	81,157	$ 810		$ 80,182		80,992				165	165
Cumulative effect of change in accounting principles	(8,399)	(8,399)	(84)		(8,315)		(8,399)
Unrealized loss on interest rate swap, net of tax	(25,103)	(25,103)						(25,103)	(25,103)
Foreign currency translation loss	(23,272)	(23,272)						(23,272)	(23,272)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	10,036	10,036	$ 100	$ 2	$ 9,936	10,034
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			23	2,312	2,289
Distributions to non-controlling interests	(165)	(165)									(165)	(165)
Proceeds from offering (net of offering costs)	61,682	61,682	$ 617	$ 2	$ 61,065	61,680
Proceeds from offering (net of offering costs) (shares)			26	2,601	2,575
Dividends (Distributions) declared ($0.25 in 2019 and $0.27 in 2020 per common share/ unit)	(141,580)	(141,580)	$ (1,416)		$ (140,164)		(141,580)
Ending balance at Mar. 31, 2020	$ 6,982,510	$ 6,982,900	$ 70,966	$ 522	$ 7,023,107	$ 7,079,913	$ 14,025	$ (111,280)	$ (111,280)	$ (777)	$ 107	$ 107
Ending balance (in shares) at Mar. 31, 2020			5,225	522,435	517,210								232

Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Dividends (Distributions) declared per common share / unit	$ 0.27	$ 0.25
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.27	0.25
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	0.27	0.25
Retained Earnings (Deficit) [Member]
Dividends (Distributions) declared per common share / unit	0.27	0.25
Common Par Value [Member] \| MPT Operating Partnership, L.P. [Member] \| Limited Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.27	$ 0.25

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Operating activities
Net income	$ 81,157	$ 76,291
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	63,833	34,675
Amortization of deferred financing costs and debt discount	3,210	1,827
Straight-line rent revenue and other	(47,846)	(26,296)
Share / (Unit)-based compensation expense	10,036	6,715
Gain from sale of real estate and other	(1,325)
Impairment charges	19,006
Straight-line rent and other write-off, net of tax	7,717	2,596
Unutilized financing costs	611
Other adjustments	(27,401)	2,249
Changes in:
Interest and rent receivables	2,137	(1,193)
Accounts payable and accrued expenses	(4,221)	(9,940)
Net cash provided by operating activities	106,914	86,924
Investing activities
Cash paid for acquisitions and other related investments	(1,973,661)	(6,492)
Net proceeds from sale of real estate	9,597
Principal received on loans receivable		420
Investment in loans receivable	(2,307)	(1,185)
Other investments, net	71,582	(160,736)
Net cash used for investing activities	(1,894,789)	(167,993)
Financing activities
Proceeds from term debt	915,950
Revolving credit facilities, net		9,097
Dividends / Distribution paid	(138,074)	(95,419)
Lease deposits and other obligations to tenants	2,348	3,677
Proceeds from sale of common shares, net of offering costs	61,682	354,030
Payment of deferred financing costs and other financing activities	(6,687)	(677)
Net cash provided by financing activities	835,219	270,708
(Decrease) increase in cash, cash equivalents, and restricted cash for period	(952,656)	189,639
Effect of exchange rate changes	(9,157)	(11,450)
Cash, cash equivalents, and restricted cash at beginning of period	1,467,991	822,425
Cash, cash equivalents, and restricted cash at end of period	506,178	1,000,614
Interest paid	80,721	51,296
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	141,667	97,163
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	1,462,286	820,868
Restricted cash, included in Other assets at beginning of period	$ 5,705	$ 1,557
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents, and restricted cash at beginning of period	$ 1,467,991	$ 822,425
Cash and cash equivalents at end of period	500,213	995,548
Restricted cash, included in Other assets at end of period	$ 5,965	$ 5,066
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents, and restricted cash at end of period	$ 506,178	$ 1,000,614
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	81,157	76,291
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	63,833	34,675
Amortization of deferred financing costs and debt discount	3,210	1,827
Straight-line rent revenue and other	(47,846)	(26,296)
Share / (Unit)-based compensation expense	10,036	6,715
Gain from sale of real estate and other	(1,325)
Impairment charges	19,006
Straight-line rent and other write-off, net of tax	7,717	2,596
Unutilized financing costs	611
Other adjustments	(27,401)	2,249
Changes in:
Interest and rent receivables	2,137	(1,193)
Accounts payable and accrued expenses	(4,221)	(9,940)
Net cash provided by operating activities	106,914	86,924
Investing activities
Cash paid for acquisitions and other related investments	(1,973,661)	(6,492)
Net proceeds from sale of real estate	9,597
Principal received on loans receivable		420
Investment in loans receivable	(2,307)	(1,185)
Other investments, net	71,582	(160,736)
Net cash used for investing activities	(1,894,789)	(167,993)
Financing activities
Proceeds from term debt	915,950
Revolving credit facilities, net		9,097
Dividends / Distribution paid	(138,074)	(95,419)
Lease deposits and other obligations to tenants	2,348	3,677
Proceeds from sale of units, net of offering costs	61,682	354,030
Payment of deferred financing costs and other financing activities	(6,687)	(677)
Net cash provided by financing activities	835,219	270,708
(Decrease) increase in cash, cash equivalents, and restricted cash for period	(952,656)	189,639
Effect of exchange rate changes	(9,157)	(11,450)
Cash, cash equivalents, and restricted cash at beginning of period	1,467,991	822,425
Cash, cash equivalents, and restricted cash at end of period	506,178	1,000,614
Interest paid	80,721	51,296
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	141,667	97,163
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	1,462,286	820,868
Restricted cash, included in Other assets at beginning of period	$ 5,705	$ 1,557
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents, and restricted cash at beginning of period	$ 1,467,991	$ 822,425
Cash and cash equivalents at end of period	500,213	995,548
Restricted cash, included in Other assets at end of period	$ 5,965	$ 5,066
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Cash, cash equivalents, and restricted cash at end of period	$ 506,178	$ 1,000,614

Organization

3 Months Ended

Mar. 31, 2020

Organization Consolidation And Presentation Of Financial Statements [Abstract]

Organization

1. Organization

Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the Maryland General Corporation Law for the purpose of engaging in the business of investing in, owning, and leasing commercial real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., (the “Operating Partnership”) 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. Certain non-real estate activities we undertake are conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRS”). Our TRS entities are subject to both U.S. federal and state income taxes. For our properties, located outside the U.S., we are subject to the local taxes of the jurisdictions where our properties reside and/or legal entities are domiciled; however, we do not expect to incur additional taxes in the U.S. as the majority of such income flows through our REIT.

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, and long-term acute care hospitals. 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.

Our business model facilitates acquisitions and recapitalizations, and allows operators of healthcare facilities to unlock the value of their real estate to fund facility improvements, technology upgrades, and other investments in operations. At March 31, 2020, we have investments in 389 facilities in 34 states in the U.S., in six countries in Europe, and across Australia. We manage our business as a single business segment.

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2020

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

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 statement have been included. Operating results for the three months ended March 31, 2020, are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. The condensed consolidated balance sheet at December 31, 2019 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.

The preparation of our consolidated financial statements in conformity with GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. During the first quarter of 2020, there was a global outbreak of a novel coronavirus, or COVID-19, which has spread all over the world including countries where we own and lease facilities. The World Health Organization has designated COVID-19 as a pandemic, and numerous countries, including the United States, have declared national emergencies with respect to COVID-19. As the global impact of the outbreak has evolved, many countries have reacted by instituting quarantines and restrictions on travel, closing financial markets and/or restricting trade- including requiring elective surgeries at hospitals to be deferred. We believe the estimates and assumptions underlying our consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2020 (particularly as it relates to our assessments of the recoverability of our real estate and the adequacy of our credit loss reserves on loans and financing receivables). However, the ultimate impact to our tenants’ results of operations and liquidity and their ability to pay our rent and interest due to the impact of COVID-19 is somewhat uncertain and cannot be predicted with an abundance of confidence, particularly given we do not yet know the full scope, severity, and duration of the pandemic nor the actions needed to contain the pandemic or mitigate its impact. This makes any estimates and assumptions as of March 31, 2020 inherently less certain than they would be absent the current and potential impact of COVID-19. Actual results may ultimately differ from our estimates.

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, 2019. There have been no material changes to these significant accounting policies other than the following:

On January 1, 2020, we adopted Accounting Standards Update (“ASU”) No. 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model measured over the contractual life of an asset that considers forecasts of future economic conditions, as well as past and current events, to be used for our financing receivables, including financing leases and loans, which the Financial Accounting Standards Board believes will result in more timely recognition of such losses. Additionally, we have made the accounting policy election to exclude interest receivables from the credit loss reserve analysis and will continue to timely reserve or write-off such short-term receivables.

Pursuant to ASU 2016-13, we grouped our financial instruments into two primary pools of similar credit risk: secured and unsecured. The secured instruments include investment in financing leases and mortgage loans, as all are secured by underlying real estate among other collateral. The unsecured instruments include acquisition, working capital, and shareholder loans. Within these two major pools, we further grouped our instruments into sub-pools based on several tenant/borrower characteristics, including years of experience in the healthcare industry and in a particular market or region and overall capitalization. We then determined a credit loss percentage per pool based on our history of credit losses incurred on similar instruments. We used an historical period of time in determining such loss rates that closely matches the remaining terms of the financial instruments being analyzed in the respective pools, since our underwriting process has been consistent over this time. Finally, we made specific modifications for current trends, as appropriate.

Upon adoption of this standard, we recorded a credit loss reserve of $8.4 million with the effect recorded in equity as a cumulative effect of a change in accounting principle.

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

3 Months Ended

Mar. 31, 2020

Real Estate [Abstract]

Real Estate and Lending Activities

3. Real Estate and Lending Activities

Acquisitions

We acquired the following net assets (in thousands):

	For the Three Months Ended March 31,
	2020			2019
Net Assets Acquired
Land and land improvements	$	265,991		$	169
Buildings		1,608,771			5,327
Intangible lease assets — subject to amortization (weighted- average useful life 30.8 years for 2020 and 26.6 years for 2019 )		231,774			996
Other assets		1,328			—
Liabilities assumed		(134,203	)		—
Total net assets acquired	$	1,973,661		$	6,492

2020 Activity

On January 8, 2020, we acquired a portfolio of 30 acute care hospitals located throughout the United Kingdom for approximately £1.5 billion from affiliates of BMI Healthcare, Inc. (“BMI”). In a related transaction, affiliates of Circle Health Ltd. (“Circle”) entered into definitive agreements to acquire BMI and assume operations of its 52 facilities in the United Kingdom subject to customary regulatory conditions. As part of our acquisition, we inherited 30 existing leases with the operator that had initial fixed terms ending in 2050, with no renewal options but with annual inflation-based escalators. Once final regulatory approval is received (which we expect in the 2020 second quarter after receiving initial approval on April 29, 2020), these 30 leases with Circle will be amended to include 30-year initial fixed terms with two five-year renewal options and improved annual inflation-based escalators. These 30 leases will be cross-defaulted and guaranteed by Circle.

2019 Activity

On February 8, 2019, we acquired an inpatient rehabilitation hospital in Germany for €5.7 million (including real estate transfer taxes). This acquisition was the final property to close as part of a four-hospital portfolio that we agreed to purchase for an aggregate amount of €23 million. The property is leased to affiliates of Median Kliniken S.à.r.l. (“MEDIAN”), pursuant to a 27-year master lease with annual inflation-based escalators.

Development Activities

During the 2020 first quarter, we completed construction and began recording rental income on a general acute care facility located in Idaho Falls, Idaho. This facility commenced rent on January 21, 2020 and is being leased to Surgery Partners, Inc. pursuant to an existing long-term lease.

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

Property	Commitment		Costs Incurred as of March 31, 2020		Estimated Rent Commencement Date
Circle (Birmingham, England)	$	44,531	$	41,207	3Q 2020
Circle Rehabilitation (Birmingham, England)		20,074		17,097	3Q 2020
NeuroPsychiatric Hospitals (Houston, Texas)		27,500		13,169	4Q 2020
	$	92,105	$	71,473

Leasing Operations (Lessor)

We acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases (typical initial fixed terms ranging from 10 to 15 years) and most include renewal options at the election of our tenants, generally in five year increments. More than 97% of our leases provide annual rent escalations based on increases in Consumer Price Index (or similar index outside the U.S.) and/or fixed minimum annual rent escalations ranging from 0.5% to 3.0%. Many of our domestic leases contain purchase options with pricing set at various terms but in no case less than our total investment. For five properties with a carrying value of $210 million, our leases require a residual value guarantee from the tenant. Our leases typically require the tenant to handle and bear most of the costs associated with our properties including repair/maintenance, property taxes, and insurance. We routinely inspect our properties to ensure the residual value of each of our assets is being maintained. Except for leases classified as financing leases, all of our leases are classified as operating leases.

At March 31, 2020, leases on 14 Ernest Health, Inc. (“Ernest”) facilities and ten Prime Healthcare Services, Inc. (“Prime”) facilities are accounted for as direct financing leases and leases on 13 of our Prospect Medical Holdings, Inc. (“Prospect”) facilities are accounted for as a financing. The components of our total investment in financing leases consisted of the following (in thousands):

	As of March 31, 2020			As of December 31, 2019
Minimum lease payments receivable	$	1,869,444		$	1,884,921
Estimated residual values		394,195			394,195
Less: Unearned income and allowance for credit loss		(1,601,658	)		(1,618,252	)
Net investment in direct financing leases		661,981			660,864
Other financing leases (net of allowance for credit loss)		1,406,185			1,399,438
Total investment in financing leases	$	2,068,166		$	2,060,302

Adeptus Health

As noted in previous filings, we had 16 properties transition away from Adeptus Health, Inc. (“Adeptus”) in stages over a two year period as part of Adeptus’ confirmed plan of reorganization under Chapter 11 of the Bankruptcy Code in 2017. At March 31, 2020, 14 of these 16 properties have been re-leased to other tenants or sold, with the remaining two properties representing less than $3 million.

At March 31, 2020, we own 21 facilities that are leased to Adeptus. Due to a decline in operating results at 15 of these freestanding emergency facilities caused by a decline in volumes from COVID-19 and other factors, we agreed to amend our lease with Adeptus in April 2020, whereby we would sever these 15 facilities from our lease and in return, we would increase rent on the remaining six facilities and draw on a $9.1 million letter of credit. As a result, we recorded a charge to write-off straight-line rent and other receivables, partially offset by the letter of credit in the 2020 first quarter. Additionally, we recorded a $9.9 million real estate impairment charge on these severed facilities. Although no assurances can be given, we believe our investment in these 15 facilities (representing 0.3% of our total assets) is fully recoverable at March 31, 2020.

Alecto Facilities

At March 31, 2020, we own four acute care facilities and have a mortgage loan on a fifth property, representing less than 0.5% of our total assets. In response to conditions created by the COVID-19 pandemic, we have offered to donate one of these facilities that was closed during 2019 to a local municipality, resulting in a $9.1 million real estate impairment charge in the first quarter of 2020.

Loans

The following is a summary of our loans (net of allowance for credit loss in 2020):

(in thousands)	As of March 31, 2020		As of December 31, 2019
Mortgage loans	$	1,275,543	$	1,275,022
Acquisition loans		123,105		123,893
Other loans		423,586		420,939
Total	$	1,822,234	$	1,819,854

Other loans consist of loans to our tenants for working capital and other purposes and include our shareholder loan made to the joint venture with Primotop Holdings S.à.r.l. (“Primotop”) in the amount of €290 million.

Concentrations of Credit Risk

We monitor concentration risk in several ways due to the nature of our real estate assets that are vital to the communities in which they are located and given our history of being able to replace inefficient operators of our facilities, if needed, with more effective operators:

Facility concentration – At March 31, 2020, we had no investment in any single property greater than 2.5% of our total assets, compared to 2.6% at December 31, 2019.

Operator concentration – For the three months ended March 31, 2020, revenue from Steward Health Care System LLC (“Steward”), Prospect, Circle and Prime represented 31%, 13%, 11% and 11% of our total revenues, respectively. In comparison, Steward and Prime represented 48% and 18%, respectively, of our total revenues for the 2019 first quarter, while Prospect and Circle, collectively, represented less than 1%. At March 31, 2020 and December 31, 2019, our lease concentration in any one tenant was less than 20% of our total assets.

Geographic concentration – At March 31, 2020, investments in the U.S., Europe, and Australia represented approximately 70%, 25%, and 5% respectively, of our total assets, compared to 74%, 20%, and 6%, respectively, at December 31, 2019.

Facility type concentration – For the three months ended March 31, 2020, approximately 88% of our revenues are from our general acute care facilities, while rehabilitation and long-term acute care facilities make up 9% and 3%, respectively. These percentages are similar to those for the first three months of 2019.

Debt

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Debt

4. Debt

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

	As of March 31, 2020			As of December 31, 2019
Revolving credit facility	$	—		$	—
Term loan		200,000			200,000
British pound sterling term loan(A)		869,400			—
Australian term loan facility(A)		735,720			842,520
4.000% Senior Unsecured Notes due 2022(A)		551,550			560,650
2.550% Senior Unsecured Notes due 2023(A)		496,800			530,280
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(A)		551,550			560,650
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
3.692% Senior Unsecured Notes due 2028(A)		745,200			795,420
4.625% Senior Unsecured Notes due 2029		900,000			900,000
	$	7,750,220		$	7,089,520
Debt issue costs and discount, net		(65,927	)		(65,841	)
	$	7,684,293		$	7,023,679

(A)

Non-U.S. dollar denominated debt that reflects the exchange rate at March 31, 2020 and December 31, 2019, respectively.

As of March 31, 2020, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2020	$	—
2021		—
2022		751,550
2023		496,800
2024		1,535,720
Thereafter		4,966,150
Total	$	7,750,220

British Pound Sterling Term Loan

On January 6, 2020, we entered into a £700 million unsecured sterling-denominated term loan facility 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 January 15, 2025. We used the proceeds under the facility to help finance our acquisition of the Circle transaction described in Note 3. The applicable margin under the term loan is adjustable based on a pricing grid from 0.85% to 1.65% dependent on our current credit rating. On March 4, 2020, we entered into an interest rate swap transaction (effective March 6, 2020) to fix the interest rate to approximately 0.70% for the duration of the loan. The current applicable margin for the pricing grid (which can vary based on our credit rating) is 1.25% for an all-in fixed rate of 1.95%.

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 (“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. At March 31, 2020, 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. The 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 March 31, 2020, we were in compliance with all such financial and operating covenants.

Common Stock/Partner's Capital

3 Months Ended

Mar. 31, 2020

Equity [Abstract]

Common Stock/Partner's Capital

5. Common Stock/Partners’ Capital

Medical Properties Trust, Inc.

In the 2020 first quarter, we sold 2.6 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $62 million; while, in the 2019 first quarter, we sold 20.1 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $354 million.

Subsequent to March 31, 2020, we sold an additional 5.7 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $102.5 million.

MPT Operating Partnership, L.P.

At March 31, 2020, the company has a 99.9% ownership interest in the Operating Partnership, with the remainder owned by two other partners, who are employees.

During the three months ended March 31, 2020 and 2019, the Operating Partnership issued approximately 2.6 million and 20.1 million units, respectfully, in direct response to the common stock at-the-market offerings by Medical Properties Trust, Inc. during the same periods.

Stock Awards

3 Months Ended

Mar. 31, 2020

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 awards, out of which 8.8 million shares remain available for future stock awards as of March 31, 2020. Share-based compensation expense totaled $10.0 million and $6.7 million for the three months ended March 31, 2020 and 2019, respectively.

Fair Value of Financial Instruments

3 Months Ended

Mar. 31, 2020

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 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 a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):

	As of						As of
	March 31, 2020						December 31, 2019
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	38,768		$	37,944		$	31,357		$	30,472
Loans(1)		1,707,234			1,751,212			1,704,854			1,742,153
Debt, net		(7,684,293	)		(7,513,806	)		(7,023,679	)		(7,331,816	)

(1)

Excludes $115 million of mortgage loans related to Ernest that are recorded at fair value (which is equal to their book 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.

- 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/Unit

3 Months Ended

Mar. 31, 2020

Earnings Per Share [Abstract]

Earnings Per Share/Unit

8. Earnings Per Share/Unit

Medical Properties Trust, Inc.

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

	For the Three Months Ended March 31,
	2020			2019
Numerator:
Net income	$	81,157		$	76,291
Non-controlling interests’ share in net income		(165	)		(469	)
Participating securities’ share in earnings		(464	)		(476	)
Net income, less participating securities’ share in earnings	$	80,528		$	75,346
Denominator:
Basic weighted-average common shares		521,076			380,551
Dilutive potential common shares		1,103			1,124
Dilutive weighted-average common shares		522,179			381,675

MPT Operating Partnership, L.P.

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

	For the Three Months Ended March 31,
	2020			2019
Numerator:
Net income	$	81,157		$	76,291
Non-controlling interests’ share in net income		(165	)		(469	)
Participating securities’ share in earnings		(464	)		(476	)
Net income, less participating securities’ share in earnings	$	80,528		$	75,346
Denominator:
Basic weighted-average units		521,076			380,551
Dilutive potential units		1,103			1,124
Diluted weighted-average units		522,179			381,675

Contingencies

3 Months Ended

Mar. 31, 2020

Commitments And Contingencies Disclosure [Abstract]

Contingencies

9. Contingencies

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.

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2020
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 statement have been included. Operating results for the three months ended March 31, 2020, are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. The condensed consolidated balance sheet at December 31, 2019 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. The preparation of our consolidated financial statements in conformity with GAAP requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. During the first quarter of 2020, there was a global outbreak of a novel coronavirus, or COVID-19, which has spread all over the world including countries where we own and lease facilities. The World Health Organization has designated COVID-19 as a pandemic, and numerous countries, including the United States, have declared national emergencies with respect to COVID-19. As the global impact of the outbreak has evolved, many countries have reacted by instituting quarantines and restrictions on travel, closing financial markets and/or restricting trade- including requiring elective surgeries at hospitals to be deferred. We believe the estimates and assumptions underlying our consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2020 (particularly as it relates to our assessments of the recoverability of our real estate and the adequacy of our credit loss reserves on loans and financing receivables). However, the ultimate impact to our tenants’ results of operations and liquidity and their ability to pay our rent and interest due to the impact of COVID-19 is somewhat uncertain and cannot be predicted with an abundance of confidence, particularly given we do not yet know the full scope, severity, and duration of the pandemic nor the actions needed to contain the pandemic or mitigate its impact. This makes any estimates and assumptions as of March 31, 2020 inherently less certain than they would be absent the current and potential impact of COVID-19. Actual results may ultimately differ from our estimates. 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, 2019. There have been no material changes to these significant accounting policies other than the following: On January 1, 2020, we adopted Accounting Standards Update (“ASU”) No. 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model measured over the contractual life of an asset that considers forecasts of future economic conditions, as well as past and current events, to be used for our financing receivables, including financing leases and loans, which the Financial Accounting Standards Board believes will result in more timely recognition of such losses. Additionally, we have made the accounting policy election to exclude interest receivables from the credit loss reserve analysis and will continue to timely reserve or write-off such short-term receivables. Pursuant to ASU 2016-13, we grouped our financial instruments into two primary pools of similar credit risk: secured and unsecured. The secured instruments include investment in financing leases and mortgage loans, as all are secured by underlying real estate among other collateral. The unsecured instruments include acquisition, working capital, and shareholder loans. Within these two major pools, we further grouped our instruments into sub-pools based on several tenant/borrower characteristics, including years of experience in the healthcare industry and in a particular market or region and overall capitalization. We then determined a credit loss percentage per pool based on our history of credit losses incurred on similar instruments. We used an historical period of time in determining such loss rates that closely matches the remaining terms of the financial instruments being analyzed in the respective pools, since our underwriting process has been consistent over this time. Finally, we made specific modifications for current trends, as appropriate. Upon adoption of this standard, we recorded a credit loss reserve of $8.4 million with the effect recorded in equity as a cumulative effect of a change in accounting principle.
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)

3 Months Ended

Mar. 31, 2020

Real Estate [Abstract]

Net Assets Acquired

We acquired the following net assets (in thousands):

	For the Three Months Ended March 31,
	2020			2019
Net Assets Acquired
Land and land improvements	$	265,991		$	169
Buildings		1,608,771			5,327
Intangible lease assets — subject to amortization (weighted- average useful life 30.8 years for 2020 and 26.6 years for 2019 )		231,774			996
Other assets		1,328			—
Liabilities assumed		(134,203	)		—
Total net assets acquired	$	1,973,661		$	6,492

Summary of Status on Current Development Projects

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

Property	Commitment		Costs Incurred as of March 31, 2020		Estimated Rent Commencement Date
Circle (Birmingham, England)	$	44,531	$	41,207	3Q 2020
Circle Rehabilitation (Birmingham, England)		20,074		17,097	3Q 2020
NeuroPsychiatric Hospitals (Houston, Texas)		27,500		13,169	4Q 2020
	$	92,105	$	71,473

Components of Total Investment in Financing Leases

The components of our total investment in financing leases consisted of the following (in thousands):

	As of March 31, 2020			As of December 31, 2019
Minimum lease payments receivable	$	1,869,444		$	1,884,921
Estimated residual values		394,195			394,195
Less: Unearned income and allowance for credit loss		(1,601,658	)		(1,618,252	)
Net investment in direct financing leases		661,981			660,864
Other financing leases (net of allowance for credit loss)		1,406,185			1,399,438
Total investment in financing leases	$	2,068,166		$	2,060,302

Summary of Loans (Net of Allowance for Credit Loss)

The following is a summary of our loans (net of allowance for credit loss in 2020):

(in thousands)	As of March 31, 2020		As of December 31, 2019
Mortgage loans	$	1,275,543	$	1,275,022
Acquisition loans		123,105		123,893
Other loans		423,586		420,939
Total	$	1,822,234	$	1,819,854

Debt (Tables)

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Summary of Debt

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

	As of March 31, 2020			As of December 31, 2019
Revolving credit facility	$	—		$	—
Term loan		200,000			200,000
British pound sterling term loan(A)		869,400			—
Australian term loan facility(A)		735,720			842,520
4.000% Senior Unsecured Notes due 2022(A)		551,550			560,650
2.550% Senior Unsecured Notes due 2023(A)		496,800			530,280
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(A)		551,550			560,650
5.250% Senior Unsecured Notes due 2026		500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000
3.692% Senior Unsecured Notes due 2028(A)		745,200			795,420
4.625% Senior Unsecured Notes due 2029		900,000			900,000
	$	7,750,220		$	7,089,520
Debt issue costs and discount, net		(65,927	)		(65,841	)
	$	7,684,293		$	7,023,679

(A)

Non-U.S. dollar denominated debt that reflects the exchange rate at March 31, 2020 and December 31, 2019, respectively.

Principal Payments Due on Debt

As of March 31, 2020, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2020	$	—
2021		—
2022		751,550
2023		496,800
2024		1,535,720
Thereafter		4,966,150
Total	$	7,750,220

Fair Value of Financial Instruments (Tables)

3 Months Ended

Mar. 31, 2020

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
	March 31, 2020						December 31, 2019
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	38,768		$	37,944		$	31,357		$	30,472
Loans(1)		1,707,234			1,751,212			1,704,854			1,742,153
Debt, net		(7,684,293	)		(7,513,806	)		(7,023,679	)		(7,331,816	)

(1)

Earnings Per Share/Unit (Tables)

3 Months Ended

Mar. 31, 2020

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 March 31,
	2020			2019
Numerator:
Net income	$	81,157		$	76,291
Non-controlling interests’ share in net income		(165	)		(469	)
Participating securities’ share in earnings		(464	)		(476	)
Net income, less participating securities’ share in earnings	$	80,528		$	75,346
Denominator:
Basic weighted-average common shares		521,076			380,551
Dilutive potential common shares		1,103			1,124
Dilutive weighted-average common shares		522,179			381,675

MPT Operating Partnership, L.P.

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

	For the Three Months Ended March 31,
	2020			2019
Numerator:
Net income	$	81,157		$	76,291
Non-controlling interests’ share in net income		(165	)		(469	)
Participating securities’ share in earnings		(464	)		(476	)
Net income, less participating securities’ share in earnings	$	80,528		$	75,346
Denominator:
Basic weighted-average units		521,076			380,551
Dilutive potential units		1,103			1,124
Diluted weighted-average units		522,179			381,675

Organization - Additional Information (Detail)	Mar. 31, 2020 Facility State Country
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Number of facilities \| Facility	389
Number of states \| State	34
Number of countries \| Country	6

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions	Jan. 01, 2020 USD ($)
ASU 2016-13 [Member]
Credit loss reserve expected	$ 8.4

Real Estate and Lending Activities - Net Assets Acquired (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Mar. 31, 2019
Business Acquisition [Line Items]
Liabilities assumed	$ (134,203)
Total net assets acquired	1,973,661	$ 6,492
Land and Land Improvements [Member]
Business Acquisition [Line Items]
Total assets acquired	265,991	169
Building [Member]
Business Acquisition [Line Items]
Total assets acquired	1,608,771	5,327
Intangible Lease Assets - Subject to Amortization [Member]
Business Acquisition [Line Items]
Total assets acquired	231,774	$ 996
Other Assets [Member]
Business Acquisition [Line Items]
Total assets acquired	$ 1,328

Real Estate and Lending Activities - Net Assets Acquired (Parenthetical) (Detail)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Intangible Lease Assets - Subject to Amortization [Member]
Business Acquisition [Line Items]
Weighted-average useful life of acquired intangible lease assets (in years)	30 years 9 months 18 days	26 years 7 months 6 days

Real Estate and Lending Activities - 2020 Activity - Additional Information (Detail) € in Billions			3 Months Ended
	Apr. 29, 2020 RenewalOption	Jan. 08, 2020 EUR (€) Hospital	Mar. 31, 2020
Business Acquisition [Line Items]
Term of lease extension, years			5 years
Acute Care Hospital [Member] \| United Kingdom [Member] \| BMI [Member]
Business Acquisition [Line Items]
Number of facilities acquired		30
Purchase price of acquisition \| €		€ 1.5
Number of leased properties		52
Initial fixed term of lease		2050
Existence of option to extend		false
Lease extension options, description			two five-year renewal options
Acute Care Hospital [Member] \| United Kingdom [Member] \| BMI [Member] \| Subsequent Event [Member]
Business Acquisition [Line Items]
Existence of option to extend	true
Term of lease	30 years
Number of lease extension options \| RenewalOption	2
Term of lease extension, years	5 years

Real Estate and Lending Activities - 2019 Activity - Additional Information (Detail) € in Millions		3 Months Ended
	Feb. 08, 2019 EUR (€)	Dec. 31, 2018 EUR (€) Hospital	Mar. 31, 2020
Germany [Member]
Business Acquisition [Line Items]
Purchase price of acquisition	€ 5.7
Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Purchase price of acquisition		€ 23.0
Number of facilities acquired \| Hospital		4
MEDIAN [Member] \| Germany [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Term of lease	27 years
Minimum [Member]
Business Acquisition [Line Items]
Term of lease			10 years
Maximum [Member]
Business Acquisition [Line Items]
Term of lease			15 years

Real Estate and Lending Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2020 USD ($)
Business Acquisition [Line Items]
Commitment	$ 92,105
Costs Incurred as of March 31, 2020	71,473
Circle [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	44,531
Costs Incurred as of March 31, 2020	$ 41,207
Estimated Rent Commencement Date	3Q 2020
Circle Rehabilitation [Member] \| Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	$ 20,074
Costs Incurred as of March 31, 2020	$ 17,097
Estimated Rent Commencement Date	3Q 2020
NeuroPsychiatric Hospitals [Member] \| Houston, Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 27,500
Costs Incurred as of March 31, 2020	$ 13,169
Estimated Rent Commencement Date	4Q 2020

Real Estate and Lending Activities - Leasing Operations (Lessor) - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2020 USD ($) Property Lease
Lessor Lease Description [Line Items]
Lease renewal term	5 years
Annual rent escalations	97.00%
Number of properties \| Property	5
Carrying value of lease requiring residual value guarantee \| $	$ 210
Ernest [Member]
Lessor Lease Description [Line Items]
Number of direct financing leases	14
Prime Facilities [Member]
Lessor Lease Description [Line Items]
Number of direct financing leases	10
Prospect [Member]
Lessor Lease Description [Line Items]
Number of financing leases	13
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 - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 1,869,444	$ 1,884,921
Estimated residual values	394,195	394,195
Net investment in direct financing leases	661,981	660,864
Less: Unearned income and allowance for credit loss	(1,601,658)	(1,618,252)
Other financing leases (net of allowance for credit loss)	1,406,185	1,399,438
Total investment in financing leases	$ 2,068,166	$ 2,060,302

Real Estate and Lending Activities - Adeptus Health - Additional Information (Detail) - Adeptus Health [Member] $ in Millions	3 Months Ended
	Mar. 31, 2020 USD ($) Facility Property
Business Acquisition [Line Items]
Number of facilities transitioned \| Property	16
Number of transitioned facilities re-leased or sold to other tenants	14
Number of transitioned facilities remaining \| Property	2
Remaining transitioned facilities, value \| $	$ 3.0
Number of leased properties	21
Number of facilities sever decline in operating results	15
Number of facilities rent increased due to decline in operating results	6
Real estate impairment charge \| $	$ 9.9
Maximum [Member]
Business Acquisition [Line Items]
Percentage of investment in remaining transition facilities on total assets	0.30%
Letter of Credit [Member]
Business Acquisition [Line Items]
Proceeds from lease payments \| $	$ 9.1

Real Estate and Lending Activities - Alecto Facilities - Additional Information (Detail) - Alecto Healthcare Services [Member] $ in Millions	3 Months Ended
	Mar. 31, 2020 USD ($) Facility Property
Business Acquisition [Line Items]
Number of leased properties \| Property	4
Number of facilities donated \| Facility	1
Real estate impairment charge \| $	$ 9.1
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of total assets	0.50%

Real Estate and Lending Activities - Summary of Loans (Net of Allowance for Credit Loss) (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Business Combinations [Abstract]
Mortgage loans	$ 1,275,543	$ 1,275,022
Acquisition loans	123,105	123,893
Other loans	423,586	420,939
Total	$ 1,822,234	$ 1,819,854

Real Estate and Lending Activities - Loans - Additional Information (Detail) € in Millions	Mar. 31, 2020 EUR (€)
Primotop Holdings S.a.r.l. [Member]
Loans [Line Items]
Shareholder loan to joint venture	€ 290

Real Estate and Lending Activities - Concentration of Credit Risks and Related Party Transactions - Additional Information (Detail) - Investment	3 Months Ended		12 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Total Gross Assets [Member] \| Geographic Concentration [Member] \| U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	70.00%		74.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Europe [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	25.00%		20.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.00%		6.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	88.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Rehabilitation Hospital with Covenant Health System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	9.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Long-term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	3.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	31.00%	48.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	13.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Prime [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	11.00%	18.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	11.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Prospect and Circle [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		1.00%
Revenue [Member] \| Credit Concentration Risk [Member] \| Lease Concentration [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	20.00%		20.00%
Pro Forma [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Number of investment in property	0		0
Maximum percentage of entity's assets invested on single property	2.50%		2.60%

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

Mar. 31, 2020

Dec. 31, 2019

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Disclosure [Abstract]
2022	$ 751,550
2023	496,800
2024	1,535,720
Thereafter	4,966,150
Total	$ 7,750,220	$ 7,089,520

Debt - British Pound Sterling Term Loan - Additional Information (Detail) - Term Loan [Member] - Bank of America, N.A - British Pound Sterling [Member] - EUR (€)	Mar. 04, 2020	Jan. 06, 2020	Mar. 31, 2020
Debt Instrument [Line Items]
Maximum borrowing capacity		€ 700,000,000
Debt instrument maturity date		Jan. 15, 2025
Debt instrument effective date	Mar. 06, 2020
Effective interest rate	0.70%
Senior unsecured notes, interest rate			1.95%
Minimum [Member]
Debt Instrument [Line Items]
Applicable margin adjustable based on pricing grid, percentage		0.85%
Maximum [Member]
Debt Instrument [Line Items]
Applicable margin adjustable based on pricing grid, percentage		1.65%
Credit Rating
Debt Instrument [Line Items]
Variable interest rate			1.25%

Debt - Covenants - Additional Information (Detail)	3 Months Ended
Debt - Covenants - Additional Information (Detail)	Mar. 31, 2020
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	1 Months Ended	3 Months Ended
	May 08, 2020 USD ($) shares	Mar. 31, 2020 USD ($) Employee shares	Mar. 31, 2019 USD ($) shares
Class Of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs \| $		$ 61,682	$ 354,030
MPT Operating Partnership, L.P. [Member]
Class Of Stock [Line Items]
Number of units sold		2,600	20,100
MPT Operating Partnership, L.P. [Member] \| Employee [Member]
Class Of Stock [Line Items]
Number of partners shared remaining ownership percentage \| Employee		2
MPT Operating Partnership, L.P. [Member] \| Operating Partnership [Member]
Class Of Stock [Line Items]
Percentage of ownership limited partner		99.90%
Common Units [Member]
Class Of Stock [Line Items]
Number of share sold		2,601	20,147
At-the-Market Equity Offering Program [Member]
Class Of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs \| $		$ 62,000	$ 354,000
At-the-Market Equity Offering Program [Member] \| Subsequent Event [Member]
Class Of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs \| $	$ 102,500
At-the-Market Equity Offering Program [Member] \| Common Units [Member]
Class Of Stock [Line Items]
Number of share sold		2,600	20,100
At-the-Market Equity Offering Program [Member] \| Common Units [Member] \| Subsequent Event [Member]
Class Of Stock [Line Items]
Number of share sold	5,700

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share / (Unit)-based compensation expense	$ 10,036	$ 6,715
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
Common stock remaining for future stock awards transferred to the equity incentive plan	8,800,000

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) - Fair Value Measurements, Recurring [Member] - Mortgage Loans [Member] - USD ($) $ in Millions	Mar. 31, 2020	Dec. 31, 2019
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair value	$ 115	$ 115
Book value	$ 115	$ 115

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 81,157	$ 76,291
Non-controlling interests’ share in net income	(165)	(469)
Participating securities’ share in earnings	(464)	(476)
Net income, less participating securities’ share in earnings	$ 80,528	$ 75,346
Basic weighted-average common shares	521,076	380,551
Dilutive potential common shares	1,103	1,124
Dilutive weighted-average common shares	522,179	381,675
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 81,157	$ 76,291
Non-controlling interests’ share in net income	(165)	(469)
Participating securities’ share in earnings	(464)	(476)
Net income, less participating securities’ share in earnings	$ 80,528	$ 75,346
Basic weighted-average common shares	521,076	380,551
Dilutive potential common shares	1,103	1,124
Dilutive weighted-average common shares	522,179	381,675