SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 1000 URBAN CENTER DRIVE |
| SUITE 501 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
07/07/2005
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3. Issuer Name and Ticker or Trading Symbol
MEDICAL PROPERTIES TRUST INC
[ MPW ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Exec. Vice President, CFO |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock, $.001 par value |
73,804 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
Phil Summerlin, Attorney-in-Fact |
07/07/2005 |
|
** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS
I hereby constitute and appoint each of Michael G. Stewart and Phil
Summerlin, signing individually, as my true and lawful attorney-in-fact to:
1. execute, for and on my behalf, in my capacity as an officer
and/or director of Medical Properties Trust, Inc. (the
"Company"), Forms 3, 4 and 5 in accordance with Section 16(a)
of the Securities Exchange Act of 1934 and the related rules;
2. perform any acts on my behalf which may be necessary or
desirable to complete and execute any such Form 3, 4 or 5 and
to file such forms with the Securities and Exchange
Commission and any stock exchange or similar authority; and
3. take any other action in connection with the foregoing which,
in the opinion of such attorney-in-fact, may be of benefit to
me, in my best interest, or legally required, it being
understood that the documents executed by such
attorney-in-fact on my behalf pursuant to this power of
attorney shall be in such form and contain such terms and
conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
I hereby grant to each such attorney-in-fact full power and authority
to perform any act necessary or proper to be done in the exercise of any of the
rights and powers granted in this power of attorney, as fully as I could do if
personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such attorneys-in-fact, or their substitutes,
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers granted in this power of attorney. I acknowledge that the
foregoing attorneys-in-fact, in serving in such capacity at my request, are not
assuming, nor is the Company assuming, any of my responsibilities to comply
with Section 16 of the Securities and Exchange Act of 1934. This power of
attorney shall remain in full force and effect until I am no longer required to
file Forms 3, 4 and 5 with respect to my holdings of and transactions in the
Company's securities, unless I revoke it earlier in a signed writing delivered
to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, I have executed this power of attorney this 27th
day of June, 2005.
/s/ R. Steven Hamner
- -----------------------------
Print Name: R. Steven Hamner
