0000950170-22-009064 | 10-Q | XBRL Viewer | Medical Properties Trust INC


	As of March 31, 2022							As of December 31, 2021
Asset (Liability)	Book Value				Fair Value			Book Value			Fair Value
Interest and rent receivables	$	65,933			$	66,521		$	56,229		$	56,564
Loans(2)		1,110,719		(1)		1,115,183			991,609			991,954
Debt, net		(10,117,989	)			(9,930,403	)		(11,282,770	)		(11,526,388	)

(1)

Includes $70.2 million of mortgage loans, a $326.6 million shareholder loan included in investments in unconsolidated real estate joint ventures, $650.1 million of loans that are part of our investments in unconsolidated operating entities, and $63.8 million of other loans at March 31, 2022.

(2)

Excludes the acquisition loan and mortgage loan made in October 2021 for our Springstone investment and the acquisition loan made in May 2020 related to our investment in the international joint venture, along with the related subsequent investment in the real estate of three hospitals in Colombia, as these assets are accounted for under the fair value option method, as noted below.

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

At March 31, 2022 and December 31, 2021, the amounts recorded under the fair value option method were as follows (in thousands):


	As of March 31, 2022				As of December 31, 2021
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	154,133	$	154,133	$	143,068	$	143,068	Mortgage loans
Equity investment and other loans		427,419		434,753		409,638		409,638	Investments in unconsolidated operating entities/Other loans

Schedule of Effects of Movement in DLOM by Sensitivity Analysis by Using Basis Point Variations

The DLOM on our Springstone and international joint venture equity investments was 40% at March 31, 2022. In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors, including the percent of control, the nature of the underlying investee’s business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To

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


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(244	)
- 100 basis points		244

Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details) $ in Millions	1 Months Ended	3 Months Ended
	Apr. 30, 2022 USD ($)	Mar. 31, 2022 USD ($) Property	Mar. 31, 2021 USD ($)
Lessor Lease Description [Line Items]
Percentage of properties occupied by tenants		99.00%
Number of properties vacant \| Property		6
Number of vacant facility sold \| Property		1
Proceeds from sale of facilities \| $		$ 48	$ 11
Subsequent Event [Member]
Lessor Lease Description [Line Items]
Proceeds from sale of facilities \| $	$ 45
Minimum [Member]
Lessor Lease Description [Line Items]
Percentage of vacant on leased property		0.50%

Debt - Covenants - Additional Information (Detail)	3 Months Ended
Debt - Covenants - Additional Information (Detail)	Mar. 31, 2022
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%

Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 1,172,338	$ 1,183,855
Estimated residual values	203,818	203,818
Less: Unearned income and allowance for credit loss	(905,874)	(918,584)
Net investment in direct financing leases	470,282	469,089
Other financing leases (net of allowance for credit loss)	1,592,945	1,584,238
Total investment in financing leases	$ 2,063,227	$ 2,053,327

Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Receivables [Abstract]
Balance at beginning of the year	$ 48,527	$ 8,726
Provision for credit loss	5,412
Expected credit losses related to financial instruments sold or repaid	(6)	(4)
Balance at end of year	$ 53,933	$ 8,722

- Definition

Amount of allowance for credit loss on financing receivable. Excludes allowance for financing receivable covered under loss sharing agreement.

+ References + Details

Fair Value of Financial Instruments

3 Months Ended

Mar. 31, 2022

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 March 31, 2022							As of December 31, 2021
Asset (Liability)	Book Value				Fair Value			Book Value			Fair Value
Interest and rent receivables	$	65,933			$	66,521		$	56,229		$	56,564
Loans(2)		1,110,719		(1)		1,115,183			991,609			991,954
Debt, net		(10,117,989	)			(9,930,403	)		(11,282,770	)		(11,526,388	)

(1)

(2)

Items Measured at Fair Value on a Recurring Basis

Our equity investment and related loan to the international joint venture, our loan investment in the real estate of three hospitals operated by subsidiaries of the international joint venture in Colombia, and our equity investment and related loans in Springstone are measured at fair value on a recurring basis as we elected to account for these investments using the fair value option at the point of initial investment. 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.

At March 31, 2022 and December 31, 2021, the amounts recorded under the fair value option method were as follows (in thousands):


	As of March 31, 2022				As of December 31, 2021
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	154,133	$	154,133	$	143,068	$	143,068	Mortgage loans
Equity investment and other loans		427,419		434,753		409,638		409,638	Investments in unconsolidated operating entities/Other loans

Our loans to Springstone and the international joint venture and its subsidiaries are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates at which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investment in Springstone and the international joint venture is recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify our valuations of equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuations require management judgment due to absence of quoted market prices. For the cash flow models, our observable inputs include use of a capitalization rate and discount rate (which is based on a weighted-average cost of capital) and our unobservable input includes an adjustment for a marketability discount (“DLOM”). In regards to the underlying projections used in the discounted cash flow model, such projections are provided by the investees. However, we will modify such projections as needed based on our review and analysis of historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

In the first quarter of 2022, we recorded an unfavorable fair value adjustment to our investments. No fair value adjustment was recorded in the 2021 first quarter.

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


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(244	)
- 100 basis points		244

Items Measured at Fair Value on a Nonrecurring Basis

In addition to items that are measured at fair value on a recurring basis, we have assets and liabilities that are measured, from time-to-time, at fair value on a nonrecurring basis, such as for long-lived asset impairment purposes. In these cases, fair value is based on estimated cash flows discounted at a risk-adjusted rate of interest by using Level 2 inputs.

- 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

Subsequent Events

3 Months Ended

Mar. 31, 2022

Subsequent Events [Abstract]

Subsequent Events

10. Subsequent Events

On May 6, 2022, we received commitments from certain of our credit facility syndicate members to increase the amount of our revolving credit facility by $500 million by exercising the accordion feature of our Credit Facility. Additionally, our revolver and U.S. dollar term loan were modified with SOFR as a replacement reference rate to U.S. dollar LIBOR. The remaining terms of our Credit Facility were unchanged. With the closing of the accordion, our Credit Facility includes a $1.8 billion unsecured revolving loan facility and a $200 million unsecured term loan facility.

Commitments and Contingencies

3 Months Ended

Mar. 31, 2022

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

9. Commitments and Contingencies

Commitments

On September 15, 2021, we entered into definitive agreements to lease five general acute care hospitals, representing 5.7% of our total assets at March 31, 2022, located in Utah to HCA following an agreement by HCA to purchase the operations of these five facilities from Steward. Upon completion of the transaction between HCA and Steward, we will enter into a new master lease with

HCA for these five facilities (the “HCA Transaction”). The consummation of the HCA Transaction, which is subject to regulatory approval, is expected in the first half of 2022.

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.

Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2022 USD ($) Property Lease
Lessor Lease Description [Line Items]
Lease renewal term	5 years
Annual rent escalations	99.00%
Number of properties \| Property	5
Carrying value of lease requiring residual value guarantee \| $	$ 231
Ernest [Member]
Lessor Lease Description [Line Items]
Number of direct financing leases	13
Number of financing leases	5
Prime Healthcare Services, Inc. Facilities [Member]
Lessor Lease Description [Line Items]
Number of direct financing leases	5
Prospect [Member]
Lessor Lease Description [Line Items]
Number of financing leases	13
Minimum [Member]
Lessor Lease Description [Line Items]
Term of lease	15 years

Real Estate and Other Activities - Net Assets Acquired (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Mar. 31, 2021
Business Acquisition [Line Items]
Liabilities assumed	$ (25,424)
Total net assets acquired	724,795	$ 1,778,417
Land and Land Improvements [Member]
Business Acquisition [Line Items]
Total assets acquired	9,671
Building [Member]
Business Acquisition [Line Items]
Total assets acquired	204,526
Intangible Lease Assets
Business Acquisition [Line Items]
Total assets acquired	5,461
Mortgage Loans [Member]
Business Acquisition [Line Items]
Total assets acquired		1,090,400
Investments in Unconsolidated Real Estate Joint Ventures [Member]
Business Acquisition [Line Items]
Total assets acquired	399,456
Investments In Unconsolidated Operating Entities [Member]
Business Acquisition [Line Items]
Total assets acquired	$ 131,105	$ 688,017

Common Stock/Partners' Capital - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended
	Jan. 11, 2021	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Class Of Stock [Line Items]
Common stock, shares issued		598,676,000		596,748,000
Proceeds from sale of common shares / units, net of offering costs			$ 779,241
MPT Operating Partnership, L.P. [Member]
Class Of Stock [Line Items]
Number of units sold			39,900,000
MPT Operating Partnership, L.P. [Member] \| Medical Properties Trust, LLC. [Member]
Class Of Stock [Line Items]
Percentage of ownership of general partner		100.00%
MPT Operating Partnership, L.P. [Member] \| MPT TRS, Inc [Member]
Class Of Stock [Line Items]
Percentage of ownership of general partner		100.00%
MPT Operating Partnership, L.P. [Member] \| Operating Partnership [Member]
Class Of Stock [Line Items]
Percentage of ownership limited partner		100.00%
Public Offering [Member]
Class Of Stock [Line Items]
Common stock, shares issued	36,800,000
Proceeds from sale of common shares / units, net of offering costs	$ 711,000
At-the-Market Equity Offering Program [Member]
Class Of Stock [Line Items]
Proceeds from sale of common shares / units, net of offering costs			$ 68,000
Common Units [Member]
Class Of Stock [Line Items]
Number of share sold			39,949,000
Common Units [Member] \| At-the-Market Equity Offering Program [Member]
Class Of Stock [Line Items]
Number of share sold			3,100,000

Commitments and Contingencies - Additional Information (Detail) - HCA Healthcare [Member] - Hospital		3 Months Ended
	Sep. 15, 2021	Mar. 31, 2022
Commitment And Contingencies [Line Items]
Number of facilities acquired	5
Percentage of total assets leased		5.70%
Steward Health Care System LLC [Member]
Commitment And Contingencies [Line Items]
Number of facilities acquired	5
Acute Care Hospital [Member]
Commitment And Contingencies [Line Items]
Number of facilities acquired	5

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenues	$ 409,800	$ 362,765
Real estate depreciation and amortization	(85,316)	(75,642)
Other income	9,887	7,794
Disposal Group, Not Discontinued Operations [Member]
Revenues	20,093	30,991
Real estate depreciation and amortization	(100)	(7,403)
Property-related expenses	(204)	(351)
Other income	451,609	72
Income from real estate dispositions, net	$ 471,398	$ 23,309

- Definition

Amount of revenue recognized from goods sold, services rendered, insurance premiums, or other activities that constitute an earning process. Includes, but is not limited to, investment and interest income before deduction of interest expense when recognized as a component of revenue, and sales and trading gain (loss).

+ References

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+ Details

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2022	Dec. 31, 2021
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	598,676,000	596,748,000
Common stock, shares outstanding	598,676,000	596,748,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	5,987	5,968
General partner, units outstanding	5,987	5,968
Common Units \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	592,689	590,780
Limited Partners, units outstanding	592,689	590,780

Fair Value of Financial Instruments - Schedule of Effects of Movement in DLOM by Sensitivity Analysis by Using Basis Point Variations (Details) - Springstone Inc. and International Joint Venture [Member]	3 Months Ended
	Mar. 31, 2022 USD ($)
+ 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ (244)
- 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ 244

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
2022	$ 0
2023	525,520
2024	1,429,259
2025	1,473,010
2026	1,910,250
Thereafter	4,848,110
Total	$ 10,186,149	$ 11,358,826

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]	Cumulative Effect, Period of Adoption, Adjustment [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]	Non-Controlling Interests [Member]	Non-Controlling Interests [Member] MPT Operating Partnership, L.P. [Member]
Beginning balance at Dec. 31, 2020	$ 7,343,857	$ 7,344,247	$ 73,977		$ 541	$ 7,316,269	$ 7,460,726	$ 71,411	$ (51,324)	$ (51,324)	$ 5,325	$ 5,325
Beginning balance (in shares) at Dec. 31, 2020			5,414		541,353	535,939
Net income	163,880	163,880	$ 1,638			$ 162,145		163,783			97	97
Unrealized gain (loss) on interest rate swap, net of tax	15,504	15,504							15,504	15,504
Foreign currency translation gain (loss)	(30,900)	(30,900)							(30,900)	(30,900)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	12,264	12,264	$ 123		$ 2	$ 12,141	12,262
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			17		1,741	1,724
Distributions to non-controlling interests	(193)	(193)									(193)	(193)
Proceeds from offering (net of offering costs)	779,241	779,241	$ 7,792		$ 40	$ 771,449	779,201
Proceeds from offering (net of offering costs) (shares)			399		39,949	39,550
Dividends (Distributions) declared	(163,443)	(163,443)	$ (1,634)			$ (161,809)		(163,443)
Ending balance at Mar. 31, 2021	8,120,210	8,120,600	$ 81,896		$ 583	$ 8,100,195	8,252,189	(71,071)	(66,720)	(66,720)	5,229	5,229
Ending balance (Accounting Standards Update 2016-13) at Mar. 31, 2021				$ (15,504)
Ending balance (in shares) at Mar. 31, 2021			5,830		583,043	577,213
Beginning balance at Dec. 31, 2021	8,445,671	8,446,061	$ 84,847		$ 597	$ 8,392,458	8,564,009	(87,691)	(36,727)	(36,727)	5,483	5,483
Beginning balance (in shares) at Dec. 31, 2021			5,968		596,748	590,780
Net income	631,947	631,947	$ 6,317			$ 625,364		631,681			266	266
Unrealized gain (loss) on interest rate swap, net of tax	44,932	44,932							44,932	44,932
Foreign currency translation gain (loss)	(13,215)	(13,215)							(13,215)	(13,215)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,804	11,804	$ 118		$ 3	$ 11,686	11,801
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			31		3,107	3,076
Acquisition of non-controlling interest	929	929									929	929
Stock vesting - satisfaction of tax withholding	(27,919)	(27,919)	$ (279)		$ (1)	$ (27,640)	(27,918)
Stock vesting - satisfaction of tax withholding (Shares)			(12)		(1,179)	(1,167)
Distributions to non-controlling interests	(772)	(772)									(772)	(772)
Dividends (Distributions) declared	(174,018)	(174,018)	$ (1,740)			$ (172,278)		(174,018)
Ending balance at Mar. 31, 2022	$ 8,919,359	$ 8,919,749	$ 89,263		$ 599	$ 8,829,590	$ 8,547,892	$ 369,972	$ (5,010)	$ (5,010)	$ 5,906	$ 5,906
Ending balance (in shares) at Mar. 31, 2022			5,987		598,676	592,689

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions	Mar. 31, 2022 USD ($)
Accounting Policies [Abstract]
Loans and/or equity investments in variable interest entities	$ 600

Real Estate and Other Activities - Net Assets Acquired (Parenthetical) (Detail)	3 Months Ended
	Mar. 31, 2022
Intangible Lease Assets
Business Acquisition [Line Items]
Weighted-average useful life of acquired intangible lease assets (in years)	13 years 2 months 12 days

Common Stock/Partner's Capital

3 Months Ended

Mar. 31, 2022

Equity [Abstract]

Common Stock/Partner's Capital

5. Common Stock/Partners’ Capital

Medical Properties Trust, Inc.

On January 11, 2021, we completed an underwritten public offering of 36.8 million shares of our common stock, resulting in net proceeds of approximately $711 million, after deducting underwriting discounts and commissions and offering expenses.

In addition, we sold 3.1 million shares of common stock under our at-the-market equity offering program during the 2021 first quarter, resulting in net proceeds of approximately $68 million.

MPT Operating Partnership, L.P.

At March 31, 2022, the Operating Partnership is made up of a general partner, Medical Properties Trust, LLC (“General Partner”) and limited partners, including the Company (which owns 100% of the General Partner) and MPT TRS, Inc. (which is 100% owned by the General Partner). By virtue of its ownership of the General Partner, the Company has a 100% ownership interest in the Operating Partnership. During the three months ended March 31, 2021, the Operating Partnership issued approximately 39.9 million units in direct response to the common stock offerings by Medical Properties Trust, Inc. during the same periods.

Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Mar. 14, 2022	Jan. 08, 2021
Business Acquisition [Line Items]
Passive equity interest			50.00%
COVID-19 Pandemic [Member]
Business Acquisition [Line Items]
Favorable non-cash fair value adjustment on investment	$ 8.0	$ 4.1
Aevis Victoria SA [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the cost method	5.00%
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Passive equity interest				9.90%
Distribution on Steward equity investment		$ 11.0

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 14,029,059	$ 14,062,722
Investment in financing leases	2,063,227	2,053,327
Real estate held for sale		1,096,505
Mortgage loans	224,281	213,211
Gross investment in real estate assets	16,316,567	17,425,765
Accumulated depreciation and amortization	(1,054,361)	(993,100)
Net investment in real estate assets	15,262,206	16,432,665
Cash and cash equivalents	248,846	459,227
Interest and rent receivables	65,933	56,229
Straight-line rent receivables	660,421	728,522
Investments in unconsolidated real estate joint ventures	1,534,514	1,152,927
Investments in unconsolidated operating entities	1,455,842	1,289,434
Other loans	66,963	67,317
Other assets	523,109	333,480
Total Assets	19,817,834	20,519,801
Liabilities
Debt, net	10,117,989	11,282,770
Accounts payable and accrued expenses	595,026	607,792
Deferred revenue	18,834	25,563
Obligations to tenants and other lease liabilities	166,626	158,005
Total Liabilities	10,898,475	12,074,130
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 - 598,676 shares at March 31, 2022 and 596,748 shares at December 31, 2021	599	597
Additional paid-in capital	8,547,892	8,564,009
Retained earnings (deficit)	369,972	(87,691)
Accumulated other comprehensive loss	(5,010)	(36,727)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,913,453	8,440,188
Non-controlling interests	5,906	5,483
Total Equity / Capital	8,919,359	8,445,671
Total Liabilities and Equity / Capital	19,817,834	20,519,801
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	14,029,059	14,062,722
Investment in financing leases	2,063,227	2,053,327
Real estate held for sale		1,096,505
Mortgage loans	224,281	213,211
Gross investment in real estate assets	16,316,567	17,425,765
Accumulated depreciation and amortization	(1,054,361)	(993,100)
Net investment in real estate assets	15,262,206	16,432,665
Cash and cash equivalents	248,846	459,227
Interest and rent receivables	65,933	56,229
Straight-line rent receivables	660,421	728,522
Investments in unconsolidated real estate joint ventures	1,534,514	1,152,927
Investments in unconsolidated operating entities	1,455,842	1,289,434
Other loans	66,963	67,317
Other assets	523,109	333,480
Total Assets	19,817,834	20,519,801
Liabilities
Debt, net	10,117,989	11,282,770
Accounts payable and accrued expenses	420,618	430,908
Deferred revenue	18,834	25,563
Obligations to tenants and other lease liabilities	166,626	158,005
Payable due to Medical Properties Trust, Inc.	174,018	176,494
Total Liabilities	10,898,085	12,073,740
Equity / Capital
General Partner -- issued and outstanding -- 5,987 units at March 31, 2022 and 5,968 units at December 31, 2021	89,263	84,847
Limited Partners -- issued and outstanding -- 592,689 units at March 31, 2022 and 590,780 units at December 31, 2021	8,829,590	8,392,458
Accumulated other comprehensive loss	(5,010)	(36,727)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,913,843	8,440,578
Non-controlling interests	5,906	5,483
Total Equity / Capital	8,919,749	8,446,061
Total Liabilities and Equity / Capital	$ 19,817,834	$ 20,519,801

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 154,133	$ 143,068
Original Cost	154,133	143,068
Equity Method Investment and Other Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	427,419	409,638
Original Cost	$ 434,753	$ 409,638

Real Estate and Other Activities - Disposals - Additional Information (Detail) $ in Millions		3 Months Ended
	Mar. 14, 2022 USD ($) Facility	Mar. 31, 2022 USD ($) Facility	Mar. 31, 2021 USD ($) Facility
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions		$ 15.0	$ 1.0
Number of facilities sold \| Facility		2	1
Proceeds from sale of facilities		$ 48.0	$ 11.0
Massachusetts-based General Acute Care Hospitals [Member]
Debt Instrument [Line Items]
Number of facilities acquired \| Facility	8
Purchase price of acquisition	$ 1,700.0
Gain (loss) on real estate dispositions	$ 600.0

Debt - 2.500% Senior Unsecured Notes Due 2028 - Additional Information (Detail) - 2.500% Senior Unsecured Notes due 2026 [Member] - USD ($)

3 Months Ended

Mar. 26, 2021

Mar. 24, 2021

Mar. 31, 2022

Dec. 31, 2021

^[1]

Debt Instrument [Line Items]

Senior unsecured notes face amount

$ 500,000,000

Percentage of par value on senior notes

99.937%

Senior unsecured notes, payable term

interest on the notes is payable annually on March 24 of each year, commencing on March 24, 2022.

Debt instrument maturity date

Mar. 24, 2026

Senior unsecured notes, interest rate

2.50%

^[1]

2.50%

[1]	Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.

Real Estate and Other Activities (Tables)

3 Months Ended

Mar. 31, 2022

Real Estate [Abstract]

Net Assets Acquired

We acquired or invested in the following net assets (in thousands):


	For the Three Months Ended March 31,
	2022			2021

Land and land improvements	$	9,671		$	—
Buildings		204,526			—
Intangible lease assets — subject to amortization (weighted-average useful life of 13.2 years for 2022)		5,461			—
Mortgage loans		—			1,090,400
Investments in unconsolidated real estate joint ventures		399,456			—
Investments in unconsolidated operating entities		131,105			688,017
Liabilities assumed		(25,424	)		—
Total net assets acquired	$	724,795		$	1,778,417

Summary of Status on Current Development Projects

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


Property	Commitment		Costs Incurred as of March 31, 2022		Estimated Rent Commencement Date
Ernest (Stockton, California)	$	47,700	$	37,104	3Q 2022
Steward (Texarkana, Texas)		169,408		56,890	2Q 2024
	$	217,108	$	93,994

Components of Total Investment in Financing Leases

At March 31, 2022, leases on 13 Ernest facilities and five Prime Healthcare Services, Inc. facilities are accounted for as direct financing leases and leases on 13 of our Prospect Medical Holdings, Inc. (“Prospect”) facilities and five of our Ernest 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, 2022			As of December 31, 2021
Minimum lease payments receivable	$	1,172,338		$	1,183,855
Estimated residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(905,874	)		(918,584	)
Net investment in direct financing leases		470,282			469,089
Other financing leases (net of allowance for credit loss)		1,592,945			1,584,238
Total investment in financing leases	$	2,063,227		$	2,053,327

Summary of Loans (Net of Allowance for Credit Loss)

The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands):


Operator	As of March 31, 2022		As of December 31, 2021
Median Kliniken S.á.r.l ("MEDIAN")	$	505,883	$	517,648
Swiss Medical Network		473,235		476,193
Steward (Macquarie Transaction)		400,367		—
Policlinico di Monza		93,833		95,468
HM Hospitales		61,196		63,618
Total	$	1,534,514	$	1,152,927

Investments in Unconsolidated Operating Entities

Our investments in unconsolidated operating entities are noncontrolling investments that are typically made in conjunction with larger real estate transactions in which the operators are vetted as part of our overall underwriting process. We make these investments from time-to-time in order to enhance our overall return and provide for certain minority rights and protections.

The following is a summary of our investments in unconsolidated operating entities (amounts in thousands):


Operator	As of March 31, 2022		As of December 31, 2021
Steward (loan investment)	$	363,236	$	360,164
International joint venture		231,403		219,387
Springstone, LLC ("Springstone")		192,958		187,450
Priory		167,478		42,315
Swiss Medical Network		157,431		159,208
Steward (equity investment)		139,000		139,000
Prospect		112,319		112,283
Aevis Victoria SA ("Aevis")		76,029		61,271
Aspris Children's Services ("Aspris")		15,988		8,356
Total	$	1,455,842	$	1,289,434

The increase during the 2022 first quarter is primarily due to our investment in the Priory syndicated term loan as described under "New Investments" in this Note 3.

Summary of Operating Results from Properties

The properties sold during 2022 do not meet the definition of discontinued operations. However, the following represents the operating results from these properties for the periods presented (in thousands):


	For the Three Months Ended March 31,
	2022			2021
Revenues(1)	$	20,093		$	30,991
Real estate depreciation and amortization(2)		(100	)		(7,403	)
Property-related expenses		(204	)		(351	)
Other income(3)		451,609			72
Income from real estate dispositions, net	$	471,398		$	23,309

(1)

Includes $4.5 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three months ended March 31, 2022.

(2)

Lower in 2022 as we stopped depreciating the properties making up the Macquarie Transaction once deemed held for sale in September 2021.

(3)

Includes $451.6 million of gains (net of $125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three months ended March 31, 2022.

Summary of Investments in Unconsolidated Operating Entities.

The following is a summary of our investments in unconsolidated operating entities (amounts in thousands):


Operator	As of March 31, 2022		As of December 31, 2021
Steward (loan investment)	$	363,236	$	360,164
International joint venture		231,403		219,387
Springstone, LLC ("Springstone")		192,958		187,450
Priory		167,478		42,315
Swiss Medical Network		157,431		159,208
Steward (equity investment)		139,000		139,000
Prospect		112,319		112,283
Aevis Victoria SA ("Aevis")		76,029		61,271
Aspris Children's Services ("Aspris")		15,988		8,356
Total	$	1,455,842	$	1,289,434

Summary of Activity in Credit Loss reserves

The following table summarizes the activity in our credit loss reserves (in thousands):


	For the Three Months Ended March 31,
	2022			2021
Balance at beginning of the year	$	48,527		$	8,726
Provision for credit loss		5,412			—
Expected credit losses related to financial instruments sold or repaid		(6	)		(4	)
Balance at end of the period	$	53,933		$	8,722

Summary of Significant Accounting Policies	3 Months Ended
Summary of Significant Accounting Policies	Mar. 31, 2022
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, 2022, are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. The condensed consolidated balance sheet at December 31, 2021 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 condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2022 (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). Actual results could differ from these estimates for various reasons including the impact from COVID-19 and other risk factors as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2021. For information about significant accounting policies (including any recent accounting developments), refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2021. There have been no material changes to these significant accounting policies other than the following: Recent Accounting Developments Reference Rate Reform In March 2020, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2020-04, “Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting” (“ASU 2020-04”) to simplify the accounting for contract modifications made to replace the London Interbank Offered Rate ("LIBOR") or other reference rates that are expected to be discontinued because of reference rate reform. The guidance provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criterion are met. The optional expedients and exceptions can be applied to contract modifications made until December 31, 2022. On January 7, 2021, the FASB issued ASU No. 2021-01, “Reference Rate Reform (Topic 848)” (“ASU 2021-01”), which clarifies that certain optional expedients and exceptions in Topic 848 for contract modifications and hedge accounting apply to derivatives that are affected by the transition. We have evaluated our contracts that are referenced to LIBOR or other reference rates expected to be discontinued. Our British pound sterling term loan and corresponding interest rate swap were modified with the Sterling Overnight Index Average Rate as a replacement reference rate during the fourth quarter of 2021, and our unsecured credit facility was modified with the Secured Overnight Financing Rate ("SOFR") during the second quarter of 2022. We accounted for such modifications prospectively using the expedients and exceptions provided for in ASU 2020-04 and ASU 2021-01. We are continuing to evaluate the need to modify other U.S. dollar LIBOR contracts, such as other loans, but the requirement to replace the U.S. dollar LIBOR has been extended to June 30, 2023. Moreover, we do not expect any impact to our Australian dollar term loan and corresponding interest rate swap, as these contracts are not referenced to rates that are expected to be discontinued. Reclassifications Certain amounts in the condensed consolidated financial statements for prior periods have been reclassified to conform to the current period presentation. Variable Interest Entities At March 31, 2022, we had loans and/or equity investments in certain variable interest entities approximating $600 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities.

Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Details)	Mar. 31, 2022	Mar. 14, 2022
Business Acquisition [Line Items]
Percentage of equity investment		50.00%
Investments in Unconsolidated Real Estate Joint Ventures [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Investments in Unconsolidated Real Estate Joint Ventures [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%

Debt

3 Months Ended

Mar. 31, 2022

Debt Disclosure [Abstract]

Debt

4. Debt

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


	As of March 31, 2022			As of December 31, 2021
Revolving credit facility(A)	$	531,419		$	730,000
Interim credit facilities		—			869,606
Term loan		200,000			200,000
British pound sterling term loan(B)		919,660			947,240
Australian term loan facility(B)		897,840			871,560
2.550% Senior Unsecured Notes due 2023(B)		525,520			541,280
3.325% Senior Unsecured Notes due 2025(B)		553,350			568,500
0.993% Senior Unsecured Notes due 2026(B)		553,350			568,500
2.500% Senior Unsecured Notes due 2026(B)		656,900			676,600
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(B)		788,280			811,920
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		459,830			473,620
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,186,149		$	11,358,826
Debt issue costs and discount, net		(68,160	)		(76,056	)
	$	10,117,989		$	11,282,770

(A)

Includes €182 million of Euro-denominated borrowings that reflect the exchange rate at March 31, 2022.

(B)

Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.

As of March 31, 2022, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (amounts in thousands):


2022	$	—
2023		525,520
2024		1,429,259
2025		1,473,010
2026		1,910,250
Thereafter		4,848,110
Total	$	10,186,149

2022 Activity

On March 15, 2022, we paid off and terminated our $1 billion interim credit facility that was entered into on July 27, 2021 ("July 2021 Interim Credit Facility") and paid down our revolving credit facility with proceeds from the Macquarie Transaction as more fully described in Note 3 to the condensed consolidated financial statements.

2021 Activity

Interim Credit Facility

On January 15, 2021, we entered into a $900 million interim credit facility (“January 2021 Interim Credit Facility”), of which we borrowed £500 million to partially fund the Priory Group Transaction. We paid off and terminated this facility on March 26, 2021 with the issuance of the 2.500% Senior Unsecured Notes due 2026 and the 3.375% Senior Unsecured Notes due 2030.

Credit Facility Amendment

On January 15, 2021, we amended our unsecured credit facility (“Credit Facility”). The amendment extended the maturity of our revolving facility to February 1, 2024 and can be extended for an additional 12 months at our option. The maturity date of our term loan facility was extended to February 1, 2026.

Senior Unsecured Notes

On March 24, 2021, we completed an £850 million senior unsecured notes offering in two tranches. See below for details of each tranche:

2.500% Senior Unsecured Notes due 2026

On March 24, 2021, we completed a £500 million senior unsecured notes offering. The notes were issued at 99.937% of par value, and interest on the notes is payable annually on March 24 of each year, commencing on March 24, 2022. The notes pay interest in cash at a rate of 2.500% and mature on March 24, 2026.

3.375% Senior Unsecured Notes due 2030

On March 24, 2021, we completed a £350 million senior unsecured notes offering. The notes were issued at 99.448% of par value, and interest on the notes is payable annually on April 24 of each year, commencing on April 24, 2022. The notes pay interest in cash at a rate of 3.375% and mature on April 24, 2030.

We used proceeds from the £850 million senior unsecured notes offering to payoff the January 2021 Interim Credit Facility and reduce our revolving facility by approximately £340 million on March 26, 2021.

Debt Refinancing and Unutilized Financing Costs

2022 Activity

With proceeds from the Macquarie Transaction on March 14, 2022, we fully paid off our $1 billion interim credit facility. As a result, we incurred $8.8 million of debt refinancing costs in the first quarter of 2022.

2021 Activity

With the amendment of our Credit Facility and the termination of our January 2021 Interim Credit Facility, we incurred approximately $2.3 million of debt refinancing costs in the first quarter of 2021.

Covenants

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem, or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. At March 31, 2022, 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, 2022, we were in compliance with all such financial and operating covenants.

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 65,933	$ 56,229
Loans, Book value	1,110,719	991,609
Debt, net Book value	(10,117,989)	(11,282,770)
Interest and rent receivables, Fair value	66,521	56,564
Loans, Fair value	1,115,183	991,954
Debt, net Fair value	$ (9,930,403)	$ (11,526,388)

- Definition

Amount, after unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but not limited to, notes payable, bonds payable, debentures, mortgage loans and commercial paper. Excludes capital lease obligations.

+ References + Details

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

Mar. 31, 2022

Dec. 31, 2021

Mar. 26, 2021

Mar. 24, 2021

Debt Instrument [Line Items]

Debt

$ 10,186,149

$ 11,358,826

EURO-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt

$ 182,000

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

2.55%

Debt

^[2]

$ 525,520

$ 541,280

3.325% Senior Unsecured Notes Due 2025 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

3.325%

Debt

^[2]

$ 553,350

$ 568,500

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

0.993%

Debt

^[2]

$ 553,350

$ 568,500

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

2.50%

^[1]

2.50%

^[1]

2.50%

Debt

^[2]

$ 656,900

$ 676,600

5.250% Senior Unsecured Notes Due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.25%

Debt

$ 500,000

5.000% Senior Unsecured Notes Due 2027 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.00%

Debt

$ 1,400,000

3.692% Senior Unsecured Notes due 2028 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

3.692%

Debt

^[2]

$ 788,280

$ 811,920

4.625% Senior Unsecured Notes Due 2029 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

4.625%

Debt

$ 900,000

3.375% Senior Unsecured Notes due 2030 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.375%

^[1]

3.375%

^[1]

3.375%

Debt

^[2]

$ 459,830

$ 473,620

3.500% Senior Unsecured Notes due 2031 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.50%

Debt

$ 1,300,000

[1]	Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.
[2]	Includes €182 million of Euro-denominated borrowings that reflect the exchange rate at March 31, 2022.

Earnings Per Share/Unit (Tables)

3 Months Ended

Mar. 31, 2022

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,
	2022			2021
Numerator:
Net income	$	631,947		$	163,880
Non-controlling interests’ share in net income		(266	)		(97	)
Participating securities’ share in earnings		(402	)		(370	)
Net income, less participating securities’ share in earnings	$	631,279		$	163,413
Denominator:
Basic weighted-average common shares		598,676			576,240
Dilutive potential common shares		256			1,301
Diluted weighted-average common shares		598,932			577,541

MPT Operating Partnership, L.P.

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


	For the Three Months Ended March 31,
	2022			2021
Numerator:
Net income	$	631,947		$	163,880
Non-controlling interests’ share in net income		(266	)		(97	)
Participating securities’ share in earnings		(402	)		(370	)
Net income, less participating securities’ share in earnings	$	631,279		$	163,413
Denominator:
Basic weighted-average units		598,676			576,240
Dilutive potential units		256			1,301
Diluted weighted-average units		598,932			577,541

Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.28
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.29	0.28
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.28

Stock Awards

3 Months Ended

Mar. 31, 2022

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 3.2 million shares remain available for future stock awards as of March 31, 2022. Share-based compensation expense totaled $11.8 million and $12.3 million for the three months ended March 31, 2022 and 2021, respectively.

Debt - Interim Credit Facility - Additional Information (Detail)
£ in Millions

Mar. 26, 2021

Mar. 24, 2021

Jan. 15, 2021

GBP (£)

Mar. 31, 2022

^[1]

Mar. 15, 2022

USD ($)

Dec. 31, 2021

^[1]

Jan. 15, 2021

USD ($)

Debt Instrument [Line Items]

Line of credit facility, Borrowing capacity

$ 1,000,000,000

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

2.50%

Debt instrument maturity date

Mar. 24, 2026

3.375% Senior Unsecured Notes due 2030 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.375%

Debt instrument maturity date

Apr. 24, 2030

Waterland Private Equity Fund VII C.V. [Member] | Interim Credit Facility [Member]

Debt Instrument [Line Items]

Line of credit facility, Borrowing capacity

$ 900,000,000

Line of credit | £

£ 500

Line of credit, terminated date

Mar. 26, 2021

[1]	Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.

Debt - 3.375% Senior Unsecured Notes Due 2028 - Additional Information (Detail) - 3.375% Senior Unsecured Notes due 2030 [Member] - USD ($)

3 Months Ended

Mar. 26, 2021

Mar. 24, 2021

Mar. 31, 2022

Dec. 31, 2021

^[1]

Debt Instrument [Line Items]

Senior unsecured notes face amount

$ 350,000,000

Percentage of par value on senior notes

99.448%

Senior unsecured notes, payable term

interest on the notes is payable annually on April 24 of each year, commencing on April 24, 2022.

Debt instrument maturity date

Apr. 24, 2030

Senior unsecured notes, interest rate

3.375%

^[1]

3.375%

[1]	Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.

Earnings Per Share/Unit

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Earnings Per Share/Unit

. 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,
	2022			2021
Numerator:
Net income	$	631,947		$	163,880
Non-controlling interests’ share in net income		(266	)		(97	)
Participating securities’ share in earnings		(402	)		(370	)
Net income, less participating securities’ share in earnings	$	631,279		$	163,413
Denominator:
Basic weighted-average common shares		598,676			576,240
Dilutive potential common shares		256			1,301
Diluted weighted-average common shares		598,932			577,541

MPT Operating Partnership, L.P.

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


	For the Three Months Ended March 31,
	2022			2021
Numerator:
Net income	$	631,947		$	163,880
Non-controlling interests’ share in net income		(266	)		(97	)
Participating securities’ share in earnings		(402	)		(370	)
Net income, less participating securities’ share in earnings	$	631,279		$	163,413
Denominator:
Basic weighted-average units		598,676			576,240
Dilutive potential units		256			1,301
Diluted weighted-average units		598,932			577,541

Subsequent Events - Additional Information (Detail) - Subsequent Event [Member] $ in Millions	May 06, 2022 USD ($)
Unsecured Revolving Credit Facility [Member]
Subsequent Event [Line Items]
Increase in revolving credit facility	$ 500
Amount of senior unsecured debt	1,800
Term Loan [Member]
Subsequent Event [Line Items]
Amount of senior unsecured debt	$ 200

Real Estate and Other Activities

3 Months Ended

Mar. 31, 2022

Real Estate [Abstract]

Real Estate and Other Activities

3. Real Estate and Other Activities

New Investments

We acquired or invested in the following net assets (in thousands):


	For the Three Months Ended March 31,
	2022			2021

Land and land improvements	$	9,671		$	—
Buildings		204,526			—
Intangible lease assets — subject to amortization (weighted-average useful life of 13.2 years for 2022)		5,461			—
Mortgage loans		—			1,090,400
Investments in unconsolidated real estate joint ventures		399,456			—
Investments in unconsolidated operating entities		131,105			688,017
Liabilities assumed		(25,424	)		—
Total net assets acquired	$	724,795		$	1,778,417

2022 Activity

Macquarie Transaction

On March 14, 2022, we completed a transaction with Macquarie Asset Management (“MAM”) to form a partnership (the “Macquarie Transaction”), pursuant to which we contributed eight Massachusetts-based general acute care hospitals that are leased to Steward Health Care System LLC ("Steward") and a fund managed by MAM has acquired, for cash consideration, a 50% interest in the partnership. The transaction valued the portfolio at approximately $1.7 billion, and we recognized a gain on real estate of approximately $600 million from this transaction, partially offset by the write-off of unbilled straight-line rent receivables. The partnership raised nonrecourse secured debt of 55% of asset value, and we received proceeds, including from the secured debt, of approximately $1.3 billion, virtually all of which was used to repay debt. We obtained a 50% interest in the real estate partnership valued at approximately $400 million (included in the "Investments in unconsolidated real estate joint ventures" line of the condensed consolidated balance sheets), which is being accounted for under the equity method of accounting.

Other Transactions

On March 11, 2022, we acquired four general acute care hospitals in Finland for €178 million. These hospitals are leased to Pihlajalinna pursuant to a long-term lease with annual inflation-based escalators. We acquired these facilities by the share purchase of real estate holding entities that included deferred income tax and other liabilities of approximately $25.4 million.

On February 16, 2022, we agreed to participate in an existing syndicated term loan with a term of six years originated on behalf of Priory Group ("Priory"). We funded £96.5 million towards a £100 million participation level in the variable rate loan, reflecting a 3.5% discount.

2021 Activity

Priory Group Transaction

On January 19, 2021, we completed the first of two phases in the Priory transaction in which we funded an £800 million interim mortgage loan on an identified portfolio of Priory real estate assets in the United Kingdom. On June 25, 2021, we completed the second phase of the transaction in which we converted this interim mortgage loan to fee simple ownership in a portfolio of 35 select real estate assets from Priory (which is currently majority-owned by Waterland Private Equity Fund VII C.V. (“Waterland VII”)) in individual sale-and-leaseback transactions. Therefore, the net aggregate purchase price for the real estate assets we acquired from Priory was approximately £800 million, plus customary stamp duty, tax, and other transaction costs.

In addition to the real estate investment, on January 19, 2021, we made a £250 million acquisition loan to Waterland VII, in connection with the closing of Waterland VII’s acquisition of Priory, which was repaid in full plus interest on October 22, 2021.

In addition, we acquired a 9.9% equity interest in the Waterland VII affiliate that indirectly owns Priory.

Other Transactions

On January 8, 2021, we made a $335 million loan to affiliates of Steward, all of the proceeds of which were used to pay to and redeem a similarly sized convertible loan from Steward’s former private equity sponsor. This loan now carries a four percent interest rate with possible additional returns based on the increase in the value of Steward. The initial term of the loan is seven years.

Development Activities

During the 2022 first quarter, we completed construction and began recording rental income on an inpatient rehabilitation facility located in Bakersfield, California. This facility commenced rent on March 1, 2022 and is being leased to Ernest Health, Inc. ("Ernest") pursuant to an existing long-term master lease.

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


Property	Commitment		Costs Incurred as of March 31, 2022		Estimated Rent Commencement Date
Ernest (Stockton, California)	$	47,700	$	37,104	3Q 2022
Steward (Texarkana, Texas)		169,408		56,890	2Q 2024
	$	217,108	$	93,994

Disposals

2022 Activity

On March 14, 2022, we completed the previously described partnership with MAM, in which we sold the real estate of eight Massachusetts-based general acute care hospitals, with a fair value of approximately $1.7 billion. See "New Investments" in this Note 3 for further details on this transaction.

During the first three months of 2022, we also completed the sale of two other facilities and an ancillary property for approximately $48 million, resulting in a gain on real estate of approximately $15 million.

Summary of Operations for Disposed Assets in 2022


	For the Three Months Ended March 31,
	2022			2021
Revenues(1)	$	20,093		$	30,991
Real estate depreciation and amortization(2)		(100	)		(7,403	)
Property-related expenses		(204	)		(351	)
Other income(3)		451,609			72
Income from real estate dispositions, net	$	471,398		$	23,309

(1)

Includes $4.5 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three months ended March 31, 2022.

(2)

Lower in 2022 as we stopped depreciating the properties making up the Macquarie Transaction once deemed held for sale in September 2021.

(3)

Includes $451.6 million of gains (net of $125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three months ended March 31, 2022.

2021 Activity

During the first three months of 2021, we completed the sale of one facility and an ancillary property for approximately $11 million, resulting in a net gain on real estate of approximately $1.0 million.

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 of at least 15 years) and most include renewal options at the election of our tenants, generally in five year increments. Over 99% of our leases provide annual rent escalations based on increases in the Consumer Price Index (or similar indices outside the U.S.) and/or fixed minimum annual rent escalations. 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 $231 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 as noted below, all of our leases are classified as operating leases.


	As of March 31, 2022			As of December 31, 2021
Minimum lease payments receivable	$	1,172,338		$	1,183,855
Estimated residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(905,874	)		(918,584	)
Net investment in direct financing leases		470,282			469,089
Other financing leases (net of allowance for credit loss)		1,592,945			1,584,238
Total investment in financing leases	$	2,063,227		$	2,053,327

COVID-19 Rent Deferrals

Due to the COVID-19 pandemic and its impact on our tenants' business, we agreed to defer collection of a certain amount of rent for a few tenants. Pursuant to our agreements with these tenants, we expect repayments of previously deferred rent to continue, with the remaining outstanding deferred rent balance of approximately $12.4 million as of March 31, 2022, to be paid over specified periods in the future with interest.

Alecto Facilities

As noted in previous filings, we originally leased four acute care facilities to and had a mortgage loan on a fifth property (Olympia Medical Center) with Alecto Healthcare Services LLC (“Alecto”), along with working capital loans. Three of the four leased acute care facilities were sold in prior periods. In the first quarter of 2021, Alecto completed the sale of Olympia Medical Center to the UCLA Health System. Our proceeds of approximately $51 million from this sale were used to pay off the mortgage and working capital loans in full, with the remaining proceeds used to recover certain previously reserved past due receivables. In the first quarter of 2022, we signed a lease amendment on the remaining facility leased to Alecto, and all rent and other payment obligations have been made in accordance with the amended terms. At March 31, 2022, this acute care facility leased to Alecto represents less than 0.1% of our total assets.

Halsen Healthcare

On September 30, 2019, we acquired the real estate of Watsonville Community Hospital in Watsonville, California for $40 million, which was then leased to Halsen Healthcare. In addition, we made a working capital loan to Halsen Healthcare. The hospital operator faced significant financial challenges over a two-year period that were worsened by revenue losses during the COVID-19 pandemic. During this time, we increased the loan in an effort to support the operator of this facility. On December 5, 2021, Halsen Healthcare filed Chapter 11 bankruptcy in order to reorganize, while keeping the hospital open. As such, we have recorded a credit loss reserve and have written off approximately $2.5 million of billed and straight-line rent receivables.

On February 23, 2022, the bankruptcy court approved the Pajaro Valley Healthcare District's bid to purchase the operations of the Watsonville Community Hospital and lease the real estate from us. Although there are regulatory and other hurdles still to be met, this transaction is otherwise expected to close by August 31, 2022. At March 31, 2022, we believe our total investment in the Watsonville property, representing less than 0.5% of total assets, is fully recoverable, but no assurances can be given that we will not have any further write-offs or impairments in future periods.

Other Leasing Activities

At March 31, 2022, 99% of our properties are occupied by tenants, leaving only six properties as vacant, representing less than 0.5% of total assets. One of these vacant facilities was sold in April 2022 for $45 million.

Investments in Unconsolidated Entities

Investments in Unconsolidated Real Estate Joint Ventures

Our primary business strategy is to acquire real estate and lease to providers of healthcare services. Typically, we directly own 100% of such fee simple real estate. However, from time-to-time, we will co-invest with other investors that share a similar view that hospital real estate is a necessary infrastructure-type asset in communities. In these types of investments, we will own undivided interests of less than 100% of the real estate and share control over the assets through unconsolidated real estate joint ventures. The underlying real estate and leases in these unconsolidated real estate joint ventures are structured similarly to the rest of our real estate portfolio.

The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands):


Operator	As of March 31, 2022		As of December 31, 2021
Median Kliniken S.á.r.l ("MEDIAN")	$	505,883	$	517,648
Swiss Medical Network		473,235		476,193
Steward (Macquarie Transaction)		400,367		—
Policlinico di Monza		93,833		95,468
HM Hospitales		61,196		63,618
Total	$	1,534,514	$	1,152,927

Investments in Unconsolidated Operating Entities

The following is a summary of our investments in unconsolidated operating entities (amounts in thousands):


Operator	As of March 31, 2022		As of December 31, 2021
Steward (loan investment)	$	363,236	$	360,164
International joint venture		231,403		219,387
Springstone, LLC ("Springstone")		192,958		187,450
Priory		167,478		42,315
Swiss Medical Network		157,431		159,208
Steward (equity investment)		139,000		139,000
Prospect		112,319		112,283
Aevis Victoria SA ("Aevis")		76,029		61,271
Aspris Children's Services ("Aspris")		15,988		8,356
Total	$	1,455,842	$	1,289,434

The increase during the 2022 first quarter is primarily due to our investment in the Priory syndicated term loan as described under "New Investments" in this Note 3.

Credit Loss Reserves

Upon the adoption of Accounting Standards Update ("ASU") No. 2016-13 "Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13") on January 1, 2020, we began applying a forward-looking "expected loss" model to all of our financing receivables, including financing leases and loans. We are using ASU 2016-13 to establish credit loss reserves on all outstanding loans based on historical credit losses of similar instruments.

The following table summarizes the activity in our credit loss reserves (in thousands):


	For the Three Months Ended March 31,
	2022			2021
Balance at beginning of the year	$	48,527		$	8,726
Provision for credit loss		5,412			—
Expected credit losses related to financial instruments sold or repaid		(6	)		(4	)
Balance at end of the period	$	53,933		$	8,722

Other Investment Activities

Pursuant to our approximate 5% stake in Aevis and other investments marked to fair value, we recorded an $8.0 million favorable non-cash fair value adjustment during the first quarter of 2022; whereas, this was a $4.1 million favorable non-cash fair value adjustment for the same period of 2021.

Pursuant to our existing 9.9% equity interest in Steward, we received an $11 million cash distribution during the first quarter of 2021, which was accounted for as a return of capital.

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, 2022, our largest single property represented approximately 2.8% of our total assets, similar to December 31, 2021.

Operator concentration – For the three months ended March 31, 2022, revenue from Steward and Circle Health Ltd. ("Circle") individually represented more than 10% of our total revenues. In comparison, Steward, Circle, and Prospect individually represented more than 10% of our total revenues for the three months ended March 31, 2021.

Geographic concentration – At March 31, 2022, investments in the U.S., Europe, Australia, and South America represented approximately 63%, 31%, 5%, and 1%, respectively, of our total assets compared to 64%, 30%, 5%, and 1%, respectively, of our total assets at December 31, 2021.

Facility type concentration – For the three months ended March 31, 2022, approximately 77% of our revenues were generated from our general acute care facilities, while revenues from our behavioral and rehabilitation facilities made up 13% and 7%, respectively. Freestanding ER/urgent care facilities and long-term acute care facilities combined to make up the remaining 3%. In comparison, general acute care, rehabilitation, and behavioral health facilities made up 83%, 8%, and 5%, respectively, of our total revenues for the three months ended March 31, 2021, while freestanding ER/urgent care facilities and long-term acute care facilities combined to make up the remaining 4%.

Debt - 2022 Activity - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Mar. 15, 2022
Debt Instrument [Line Items]
Proceeds from term debt, net of discount		$ 1,839,735
Line of credit , entered date	Jul. 27, 2021
Line of credit facility, Borrowing capacity			$ 1,000,000

Real Estate and Other Activities - Concentrations of Credit Risk - Additional Information (Detail)	3 Months Ended		12 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Total Gross Assets [Member] \| Geographic Concentration [Member] \| U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	63.00%		64.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Europe [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	31.00%		30.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.00%		5.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| South America [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	1.00%		1.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	77.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		83.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Rehabilitation Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	13.00%	8.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Behavioral Health Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		5.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Long Term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	7.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Freestanding ER/Urgent Care and Long-Term Acute Care Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	3.00%	4.00%
Revenue [Member] \| Operator Concentration Risk [Member] \| Steward Health Care System LLC [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.00%	10.00%
Revenue [Member] \| Operator Concentration Risk [Member] \| Prospect [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		10.00%
Revenue [Member] \| Operator Concentration Risk [Member] \| Circle [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.00%	10.00%
Pro Forma [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Maximum percentage of entity's assets invested on single property	2.80%

Organization - Additional Information (Detail)	Mar. 31, 2022 Facility Country State
Business Acquisition [Line Items]
Number of facilities \| Facility	440
Number of states \| State	32
Europe [Member]
Business Acquisition [Line Items]
Number of countries	7
South America [Member]
Business Acquisition [Line Items]
Number of countries	1

Debt - Additional Information (Detail) - Waterland Private Equity Fund VII C.V. [Member] - Interim Credit Facility [Member] - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Debt Instrument [Line Items]
Termination of credit facility	$ 1,000.0
Debt refinancing costs	$ 8.8	$ 2.3

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2022
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, 2022, are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. The condensed consolidated balance sheet at December 31, 2021 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 condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2022 (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). Actual results could differ from these estimates for various reasons including the impact from COVID-19 and other risk factors as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2021. For information about significant accounting policies (including any recent accounting developments), refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2021. There have been no material changes to these significant accounting policies other than the following:
Recent Accounting Developments	Recent Accounting Developments Reference Rate Reform In March 2020, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2020-04, “Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting” (“ASU 2020-04”) to simplify the accounting for contract modifications made to replace the London Interbank Offered Rate ("LIBOR") or other reference rates that are expected to be discontinued because of reference rate reform. The guidance provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criterion are met. The optional expedients and exceptions can be applied to contract modifications made until December 31, 2022. On January 7, 2021, the FASB issued ASU No. 2021-01, “Reference Rate Reform (Topic 848)” (“ASU 2021-01”), which clarifies that certain optional expedients and exceptions in Topic 848 for contract modifications and hedge accounting apply to derivatives that are affected by the transition. We have evaluated our contracts that are referenced to LIBOR or other reference rates expected to be discontinued. Our British pound sterling term loan and corresponding interest rate swap were modified with the Sterling Overnight Index Average Rate as a replacement reference rate during the fourth quarter of 2021, and our unsecured credit facility was modified with the Secured Overnight Financing Rate ("SOFR") during the second quarter of 2022. We accounted for such modifications prospectively using the expedients and exceptions provided for in ASU 2020-04 and ASU 2021-01. We are continuing to evaluate the need to modify other U.S. dollar LIBOR contracts, such as other loans, but the requirement to replace the U.S. dollar LIBOR has been extended to June 30, 2023. Moreover, we do not expect any impact to our Australian dollar term loan and corresponding interest rate swap, as these contracts are not referenced to rates that are expected to be discontinued.
Reclassifications	Reclassifications Certain amounts in the condensed consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.
Variable Interest Entities	Variable Interest Entities At March 31, 2022, we had loans and/or equity investments in certain variable interest entities approximating $600 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities.

Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022 USD ($)
Business Acquisition [Line Items]
Commitment	$ 217,108
Costs Incurred as of March 31, 2022	93,994
Ernest Health Inc [Member] \| Stockton, California [Member]
Business Acquisition [Line Items]
Commitment	47,700
Costs Incurred as of March 31, 2022	$ 37,104
Estimated Rent Commencement Date	3Q 2022
Ernest Health Inc [Member] \| Texarkana, Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 169,408
Costs Incurred as of March 31, 2022	$ 56,890
Estimated Rent Commencement Date	2Q 2024

Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,534,514	$ 1,152,927
MEDIAN [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	505,883	517,648
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	473,235	476,193
Steward (Macquarie Transaction) [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	400,367
Policlinico di Monza [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	93,833	95,468
HM Hospital [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 61,196	$ 63,618

Debt - Credit Facility Amendment - Additional Information (Detail)	Jan. 15, 2021
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument maturity date	Feb. 01, 2024
Term Loan [Member]
Debt Instrument [Line Items]
Debt instrument maturity date	Feb. 01, 2026

Fair Value of Financial Instruments - Additional Information (Detail) - USD ($)	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2022	Mar. 14, 2022
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Percentage of equity investment			50.00%
Springstone Inc. and International Joint Venture [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Percentage of equity investment		40.00%
Equity investments unrealized gain/loss	$ 0

Debt - British Pound Sterling Term Loan - Additional Information (Detail) $ in Billions	Mar. 15, 2022 USD ($)
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 1

Organization

3 Months Ended

Mar. 31, 2022

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 healthcare 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. At present, we own all of the 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 operate as a real estate investment trust (“REIT”). 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, of a significant nature, in the U.S. from foreign-based income 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, behavioral health facilities, inpatient physical rehabilitation hospitals, long-term acute care hospitals, and freestanding ER/urgent care facilities. We also make mortgage loans to healthcare operators collateralized by their real estate. In addition, we may make noncontrolling investments in our tenants, from time-to-time, in order to enhance our overall return and provide for certain minority rights and protections.

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, 2022, we have investments in 440 facilities in 32 states in the U.S., in seven countries in Europe, one country in South America, and across Australia. We manage our business as a single business segment.

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenues
Rent billed	$ 263,402	$ 213,344
Straight-line rent	61,044	54,873
Income from financing leases	51,776	50,894
Interest and other income	33,578	43,654
Total revenues	409,800	362,765
Expenses
Interest	91,183	86,972
Real estate depreciation and amortization	85,316	75,642
Property-related	8,598	5,453
General and administrative	41,424	36,073
Total expenses	226,521	204,140
Other income (expense)
Gain on sale of real estate and other, net	451,638	989
Earnings from equity interests	7,338	7,101
Debt refinancing and unutilized financing costs	(8,816)	(2,269)
Other (including fair value adjustments on securities)	9,887	7,794
Total other income	460,047	13,615
Income before income tax	643,326	172,240
Income tax expense	(11,379)	(8,360)
Net income	631,947	163,880
Net income attributable to non-controlling interests	(266)	(97)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 631,681	$ 163,783
Earnings per common share (units) basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 1.05	$ 0.28
Weighted average shares (units) outstanding basic	598,676	576,240
Weighted average shares (units) outstanding diluted	598,932	577,541
Dividends declared per common share (unit)	$ 0.29	$ 0.28
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 263,402	$ 213,344
Straight-line rent	61,044	54,873
Income from financing leases	51,776	50,894
Interest and other income	33,578	43,654
Total revenues	409,800	362,765
Expenses
Interest	91,183	86,972
Real estate depreciation and amortization	85,316	75,642
Property-related	8,598	5,453
General and administrative	41,424	36,073
Total expenses	226,521	204,140
Other income (expense)
Gain on sale of real estate and other, net	451,638	989
Earnings from equity interests	7,338	7,101
Debt refinancing and unutilized financing costs	(8,816)	(2,269)
Other (including fair value adjustments on securities)	9,887	7,794
Total other income	460,047	13,615
Income before income tax	643,326	172,240
Income tax expense	(11,379)	(8,360)
Net income	631,947	163,880
Net income attributable to non-controlling interests	(266)	(97)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 631,681	$ 163,783
Earnings per common share (units) basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 1.05	$ 0.28
Weighted average shares (units) outstanding basic	598,676	576,240
Weighted average shares (units) outstanding diluted	598,932	577,541
Dividends declared per common share (unit)	$ 0.29	$ 0.28

Debt (Tables)

3 Months Ended

Mar. 31, 2022

Debt Disclosure [Abstract]

Summary of Debt

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


	As of March 31, 2022			As of December 31, 2021
Revolving credit facility(A)	$	531,419		$	730,000
Interim credit facilities		—			869,606
Term loan		200,000			200,000
British pound sterling term loan(B)		919,660			947,240
Australian term loan facility(B)		897,840			871,560
2.550% Senior Unsecured Notes due 2023(B)		525,520			541,280
3.325% Senior Unsecured Notes due 2025(B)		553,350			568,500
0.993% Senior Unsecured Notes due 2026(B)		553,350			568,500
2.500% Senior Unsecured Notes due 2026(B)		656,900			676,600
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(B)		788,280			811,920
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		459,830			473,620
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,186,149		$	11,358,826
Debt issue costs and discount, net		(68,160	)		(76,056	)
	$	10,117,989		$	11,282,770

(A)

Includes €182 million of Euro-denominated borrowings that reflect the exchange rate at March 31, 2022.

(B)

Non-U.S. dollar denominated debt reflects the exchange rate at March 31, 2022 and December 31, 2021.

Principal Payments Due on Debt

As of March 31, 2022, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (amounts in thousands):


2022	$	—
2023		525,520
2024		1,429,259
2025		1,473,010
2026		1,910,250
Thereafter		4,848,110
Total	$	10,186,149

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (parenthetical) (Details) $ in Millions	3 Months Ended
	Mar. 31, 2022 USD ($)
Disposal Group, Not Discontinued Operations [Member]
Straight-line rent write-offs	$ 4.5
Gains	451.6
Massachusetts-based General Acute Care Hospitals [Member]
Straight-line rent write-offs	$ 125.0

Real Estate and Other Activities - Alecto Facilities - Additional Information (Detail) - Alecto Healthcare Services [Member] $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2022 USD ($) Property	Dec. 31, 2021 Lease
Business Acquisition [Line Items]
Number of leased properties \| Property	4
Number of properties sold \| Lease		3
Proceeds from sale of mortgage loans \| $	$ 51
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of total assets	0.10%

Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 1,455,842	$ 1,289,434
Steward Loan [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	363,236	360,164
International Joint Venture [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	231,403	219,387
Springstone [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	192,958	187,450
Priory [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	167,478	42,315
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	157,431	159,208
Steward Equity Interest [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	139,000	139,000
Prospect [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	112,319	112,283
Aevis Victoria SA [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	76,029	61,271
Aspris Children's Services [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 15,988	$ 8,356

Debt - Senior Unsecured Notes - Additional Information (Detail) - Unsecured Debt - GBP (£)	Mar. 26, 2021	Mar. 24, 2021
Debt Instrument [Line Items]
Senior unsecured notes face amount		£ 850,000,000
Interim Credit Facility [Member]
Debt Instrument [Line Items]
Payoff of credit facility	£ 850,000,000
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of credit	£ 340,000,000

- Definition

The carrying value as of the balance sheet date of the current and noncurrent portions of long-term obligations drawn from a line of credit, which is a bank's commitment to make loans up to a specific amount. Examples of items that might be included in the application of this element may consist of letters of credit, standby letters of credit, and revolving credit arrangements, under which borrowings can be made up to a maximum amount as of any point in time conditional on satisfaction of specified terms before, as of and after the date of drawdowns on the line. Includes short-term obligations that would normally be classified as current liabilities but for which (a) postbalance sheet date issuance of a long term obligation to refinance the short term obligation on a long term basis, or (b) the enterprise has entered into a financing agreement that clearly permits the enterprise to refinance the short-term obligation on a long term basis and the following conditions are met (1) the agreement does not expire within 1 year and is not cancelable by the lender except for violation of an objectively determinable provision, (2) no violation exists at the BS date, and (3) the lender has entered into the financing agreement is expected to be financially capable of honoring the agreement.

+ References + Details

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 631,947	$ 163,880
Non-controlling interests’ share in net income	(266)	(97)
Participating securities’ share in earnings	(402)	(370)
Net income, less participating securities’ share in earnings	$ 631,279	$ 163,413
Basic weighted-average common shares	598,676	576,240
Dilutive potential common shares	256	1,301
Diluted weighted-average common shares	598,932	577,541
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 631,947	$ 163,880
Non-controlling interests’ share in net income	(266)	(97)
Participating securities’ share in earnings	(402)	(370)
Net income, less participating securities’ share in earnings	$ 631,279	$ 163,413
Basic weighted-average common shares	598,676	576,240
Dilutive potential common shares	256	1,301
Diluted weighted-average common shares	598,932	577,541

- 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

Real Estate and Other Activities - Halsen Healthcare - Additional Information (Details) - USD ($) $ in Millions		3 Months Ended
	Sep. 30, 2019	Mar. 31, 2022
Halsen Healthcare [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Write off of billed and straight-line rent receivables		$ 2.5
Watsonville, California [Member] \| Halsen Healthcare [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of assets fully recoverable		0.50%
Acute Care Hospital [Member] \| Watsonville, California [Member]
Business Acquisition [Line Items]
Purchase price of acquisition	$ 40.0

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Operating activities
Net income	$ 631,947	$ 163,880
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	88,760	78,606
Amortization of deferred financing costs and debt discount	5,285	3,817
Straight-line rent revenue and other	(75,385)	(65,333)
Share / (Unit)-based compensation expense	11,804	12,264
Gain on sale of real estate and other, net	(451,638)	(989)
Straight-line rent and other write-off (recovery)	2,604	(5,238)
Debt refinancing and unutilized financing costs	8,816	2,269
Other adjustments	(1,040)	(2,923)
Changes in:
Interest and rent receivables	(12,431)	13,396
Other assets	(41)	(652)
Accounts payable and accrued expenses	(21,648)	5,062
Deferred revenue	(7,646)	(15,429)
Net cash provided by operating activities	179,387	188,730
Investing activities
Cash paid for acquisitions and other related investments	(724,795)	(1,778,417)
Net proceeds from sale of real estate	1,711,608	10,905
Principal received on loans receivable	6,355	40,937
Investment in loans receivable	(10,414)	(23,935)
Construction in progress and other	(36,115)	(9,774)
Proceeds from sale and return of equity investment		11,000
Capital additions and other investments, net	(67,605)	(32,276)
Net cash provided by (used for) investing activities	879,034	(1,781,560)
Financing activities
Proceeds from term debt, net of discount		1,839,735
Payments of term debt	(869,606)	(689,450)
Revolving credit facilities, net	(198,599)	8,910
Dividends / Distribution paid	(176,494)	(147,666)
Lease deposits and other obligations to tenants	15,168	12,900
Proceeds from sale of common shares, net of offering costs		779,241
Unit vesting - satisfaction of tax withholdings	(27,919)
Payment of debt refinancing, deferred financing costs, and other financing activities	(6,366)	(18,479)
Net cash provided by financing activities	(1,263,816)	1,785,191
(Decrease) increase in cash, cash equivalents, and restricted cash for period	(205,395)	192,361
Effect of exchange rate changes	(4,721)	4,356
Cash, cash equivalents, and restricted cash at beginning of period	461,882	556,369
Cash, cash equivalents, and restricted cash at end of period	251,766	753,086
Interest paid	111,012	82,471
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	174,018	163,443
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	459,227	549,884
Restricted cash, included in Other assets at beginning of period	$ 2,655	$ 6,485
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	Other Assets	Other Assets
Cash, cash equivalents, and restricted cash at beginning of period	$ 461,882	$ 556,369
Cash and cash equivalents at end of period	248,846	746,753
Restricted cash, included in Other assets at end of period	$ 2,920	$ 6,333
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	Other Assets	Other Assets
Cash, cash equivalents, and restricted cash at end of period	$ 251,766	$ 753,086
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	631,947	163,880
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	88,760	78,606
Amortization of deferred financing costs and debt discount	5,285	3,817
Straight-line rent revenue and other	(75,385)	(65,333)
Share / (Unit)-based compensation expense	11,804	12,264
Gain on sale of real estate and other, net	(451,638)	(989)
Straight-line rent and other write-off (recovery)	2,604	(5,238)
Debt refinancing and unutilized financing costs	8,816	2,269
Other adjustments	(1,040)	(2,923)
Changes in:
Interest and rent receivables	(12,431)	13,396
Other assets	(41)	(652)
Accounts payable and accrued expenses	(21,648)	5,062
Deferred revenue	(7,646)	(15,429)
Net cash provided by operating activities	179,387	188,730
Investing activities
Cash paid for acquisitions and other related investments	(724,795)	(1,778,417)
Net proceeds from sale of real estate	1,711,608	10,905
Principal received on loans receivable	6,355	40,937
Investment in loans receivable	(10,414)	(23,935)
Construction in progress and other	(36,115)	(9,774)
Proceeds from sale and return of equity investment		11,000
Capital additions and other investments, net	(67,605)	(32,276)
Net cash provided by (used for) investing activities	879,034	(1,781,560)
Financing activities
Proceeds from term debt, net of discount		1,839,735
Payments of term debt	(869,606)	(689,450)
Revolving credit facilities, net	(198,599)	8,910
Dividends / Distribution paid	(176,494)	(147,666)
Lease deposits and other obligations to tenants	15,168	12,900
Proceeds from sale of units, net of offering costs		779,241
Unit vesting - satisfaction of tax withholdings	(27,919)
Payment of debt refinancing, deferred financing costs, and other financing activities	(6,366)	(18,479)
Net cash provided by financing activities	(1,263,816)	1,785,191
(Decrease) increase in cash, cash equivalents, and restricted cash for period	(205,395)	192,361
Effect of exchange rate changes	(4,721)	4,356
Cash, cash equivalents, and restricted cash at beginning of period	461,882	556,369
Cash, cash equivalents, and restricted cash at end of period	251,766	753,086
Interest paid	111,012	82,471
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	174,018	163,443
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	459,227	549,884
Restricted cash, included in Other assets at beginning of period	$ 2,655	$ 6,485
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	Other Assets	Other Assets
Cash, cash equivalents, and restricted cash at beginning of period	$ 461,882	$ 556,369
Cash and cash equivalents at end of period	248,846	746,753
Restricted cash, included in Other assets at end of period	$ 2,920	$ 6,333
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List]	Other Assets	Other Assets
Cash, cash equivalents, and restricted cash at end of period	$ 251,766	$ 753,086

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share / (Unit)-based compensation expense	$ 11,804	$ 12,264
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	3,200,000

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Net income	$ 631,947	$ 163,880
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	44,932	15,504
Foreign currency translation loss	(13,215)	(30,900)
Total comprehensive income	663,664	148,484
Comprehensive income attributable to non-controlling interests	(266)	(97)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	663,398	148,387
MPT Operating Partnership, L.P. [Member]
Net income	631,947	163,880
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	44,932	15,504
Foreign currency translation loss	(13,215)	(30,900)
Total comprehensive income	663,664	148,484
Comprehensive income attributable to non-controlling interests	(266)	(97)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 663,398	$ 148,387

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income (loss) and other comprehensive income (loss), attributable to noncontrolling interests. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

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

+ References

+ Details

Real Estate and Other Activities - Coronavirus (COVID-19) Rent Deferrals - Additional Information (Detail) $ in Millions	Mar. 31, 2022 USD ($)
Business Acquisition [Line Items]
Remaining outstanding deferred rent to be received	$ 12.4

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2022 USD ($) Health_Center	Dec. 31, 2021 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	$ 224,281	$ 213,211
Investments in unconsolidated real estate joint ventures	1,534,514	1,152,927
Investments in unconsolidated operating entities	1,455,842	$ 1,289,434
Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	70,200
Investments in unconsolidated operating entities	650,100
Other loans	63,800
Shareholder Loan [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments in unconsolidated real estate joint ventures	$ 326,600
Fair Value, Recurring [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired \| Health_Center	3
Fair Value, Recurring [Member] \| Acquisition Loans [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired \| Health_Center	3

Real Estate and Other Activities - 2021 Activity - Additional Information (Detail) £ in Millions, $ in Millions	Jun. 25, 2021 GBP (£) Property	Jan. 19, 2021 GBP (£)	Jan. 08, 2021 USD ($)	Mar. 14, 2022
Business Acquisition [Line Items]
Ownership interest				50.00%
Waterland Private Equity Fund VII C.V. [Member]
Business Acquisition [Line Items]
Number of real estate assets acquired \| Property	35
Payment for acquisition	£ 800
Purchase price of acquisition loan		£ 250
Ownership interest		9.90%
Waterland Private Equity Fund VII C.V. [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Purchase price of acquisition		£ 800
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Ownership interest			9.90%
Percentage of interest rate with possible outside returns			4.00%
Other loan to affiliates \| $			$ 335
Initial term of loan			7 years

Real Estate and Other Activities - 2022 Activity - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions				3 Months Ended
	Mar. 14, 2022 USD ($) Facility	Mar. 11, 2022 EUR (€) Facility	Feb. 16, 2022 GBP (£)	Mar. 31, 2022 USD ($)	Mar. 31, 2021 USD ($)	Mar. 11, 2022 USD ($)	Dec. 31, 2021 USD ($)
Business Acquisition [Line Items]
Percentage of equity investment	50.00%
Gain (loss) on real estate dispositions				$ 15,000	$ 1,000
Investments in unconsolidated real estate joint ventures				1,534,514			$ 1,152,927
Deferred income tax liabilities and other liabilities, incurred						$ 25,400
Syndicated Term Loan [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| £			£ 96.5
Acquisition loan \| £			£ 100.0
Loan term			6 years
Percentage of discount on investment			3.50%
Joint Venture [Member]
Business Acquisition [Line Items]
Investments in unconsolidated real estate joint ventures	$ 400,000
General Acute Care Hospitals [Member] \| Finland [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility		4
Purchase price of acquisition \| €		€ 178
Massachusetts-based General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Percentage of equity investment	50.00%
Number of facilities acquired \| Facility	8
Purchase price of acquisition	$ 1,700,000
Gain (loss) on real estate dispositions	$ 600,000
Nonrecourse secured debt percentage of asset value	55.00%
Proceeds from expected secured debt				$ 1,300,000