0000950170-22-023957 | 10-Q | XBRL Viewer | Medical Properties Trust INC

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Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 1,428,061	$ 1,289,434
Steward Loan Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	362,825	360,164
International Joint Venture [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	231,402	219,387
Springstone [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	200,827	187,450
Priory [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	144,266	42,315
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	147,189	159,208
Steward Equity Investment [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	112,774	112,283
Aevis Victoria SA [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	73,746	61,271
Aspris Children's Services [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 16,032	$ 8,356

Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Receivables [Abstract]
Balance at beginning of the period	$ 55,250	$ 7,783	$ 48,527	$ 8,726
Provision (recovery) for credit loss	(19,677)	1,829	12,920	890
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied	(26,362)	(85)	(26,396)	(89)
Balance at end of the period	$ 9,211	$ 9,527	$ 9,211	$ 9,527

- Definition

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

+ References + Details

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

Sep. 30, 2022

EUR (€)

Sep. 30, 2022

USD ($)

Dec. 31, 2021

USD ($)

Mar. 26, 2021

Mar. 24, 2021

Debt Instrument [Line Items]

Debt

$ 9,534,541

$ 11,358,826

EURO-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt | €

€ 253

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

2.55%

Debt

^[1]

$ 446,800

$ 541,280

3.325% Senior Unsecured Notes Due 2025 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

3.325%

Debt

^[1]

$ 490,100

$ 568,500

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

^[1]

0.993%

Debt

^[1]

$ 490,100

$ 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%

^[1]

2.50%

Debt

^[1]

$ 558,500

$ 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

^[1]

$ 670,200

$ 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%

^[1]

3.375%

Debt

^[1]

$ 390,950

$ 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 September 30, 2022 and December 31, 2021.

Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,422,010	$ 1,152,927
Median Kliniken S A R L [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	449,226	517,648
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	422,731	476,193
Steward (Macquarie Transaction) [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	419,040
Policlinico di Monza [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	78,057	95,468
HM Hospital [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 52,956	$ 63,618

Subsequent Events - Additional Information (Detail) $ / shares in Units, $ in Millions				9 Months Ended
	Nov. 04, 2022 USD ($) shares	Oct. 09, 2022 USD ($) $ / shares	Oct. 05, 2022 USD ($) Facility	Sep. 30, 2022 USD ($) Facility	Sep. 30, 2021 USD ($) Facility
Subsequent Event [Line Items]
Number of facilities sold \| Facility				15	9
Expected cash proceeds on transaction close				$ 522	$ 67
Subsequent Event [Member]
Subsequent Event [Line Items]
Shares issued price per share \| $ / shares		$ 0.001
Stock repurchase program expiration date		Oct. 10, 2023
Subsequent Event [Member] \| Connecticut [Member] \| Prospect [Member]
Subsequent Event [Line Items]
Number of facilities sold \| Facility			3
Expected cash proceeds on transaction close			$ 457
Subsequent Event [Member] \| Common Stock [Member]
Subsequent Event [Line Items]
Stock repurchase, Shares \| shares	1,300,000
Stock repurchase, Value	$ 14
Subsequent Event [Member] \| Maximum [Member]
Subsequent Event [Line Items]
Stock repurchase program, authorized amount		$ 500

Real Estate and Other Activities - Concentrations of Credit Risk - Additional Information (Detail)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Total Gross Assets [Member] \| Geographic Concentration [Member] \| U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			64.00%		64.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Europe [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			30.00%		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	75.00%		75.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospital and Healthcare System [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		80.00%		80.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Rehabilitation Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	14.00%	10.00%	14.00%	10.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Long Term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	8.00%		8.00%
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%
Revenue [Member] \| Customer Concentration Risk [Member] \| Maximum [Member] \| Freestanding ER/Urgent Care and Long-Term Acute Care Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		10.00%		10.00%
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%	10.00%	10.00%
Revenue [Member] \| Operator Concentration Risk [Member] \| Prospect [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.00%		10.00%
Revenue [Member] \| Operator Concentration Risk [Member] \| Circle [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.00%	10.00%	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	3.00%		3.00%

Real Estate and Other Activities - 2022 Activity - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions										1 Months Ended	3 Months Ended		9 Months Ended
	Jul. 29, 2022 USD ($)	Apr. 29, 2022 EUR (€) Facility	Apr. 25, 2022 USD ($) Facility	Apr. 18, 2022 Facility	Mar. 14, 2022 USD ($) Facility	Mar. 11, 2022 EUR (€) Facility	Mar. 11, 2022 USD ($) Facility	Feb. 16, 2022 GBP (£)	Feb. 16, 2022 USD ($)	Sep. 30, 2022 USD ($) Property	Sep. 30, 2022 USD ($)	Jun. 30, 2022 Facility	Sep. 30, 2022 USD ($) Facility	Sep. 30, 2021 USD ($) Facility	Dec. 31, 2021 USD ($)
Business Acquisition [Line Items]
Number of facilities sold \| Facility													15	9
Number of ancillary properties sold \| Facility													5
Proceeds from sale of facilities													$ 522,000	$ 67,000
Gain (loss) on real estate dispositions														9,000
Straight-line rent write-offs													42,000
Investments in unconsolidated real estate joint ventures										$ 1,422,010	$ 1,422,010		1,422,010		$ 1,152,927
Acquisition loan										$ 972,243	972,243		$ 972,243	$ 4,301,739
Deferred income tax liabilities and other liabilities, incurred							$ 26,000
Syndicated Term Loan [Member]
Business Acquisition [Line Items]
Purchase price of acquisition								£ 96.5	$ 131,000
Acquisition loan \| £								£ 100.0
Loan term								6 years	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
Real Estate Partnership [Member]
Business Acquisition [Line Items]
Percentage of equity investment					50.00%
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility			2										6
Purchase price of acquisition			$ 80,000
General Acute Care Hospitals [Member] \| Spain [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility		3										3
Purchase price of acquisition \| €		€ 27
General Acute Care Hospitals [Member] \| Arizona [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility				1
General Acute Care Hospitals [Member] \| Colombia [Member]
Business Acquisition [Line Items]
Purchase price of acquisition	$ 26,000
General Acute Care Hospitals [Member] \| Finland [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility						4	4
Purchase price of acquisition						€ 178	$ 194,000
Prime Healthcare Services, Inc. Facilities [Member]
Business Acquisition [Line Items]
Number of properties sold \| Property										11
Proceeds from sale of facilities										$ 366,000
Massachusetts-based General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility					8
Purchase price of acquisition					$ 1,700,000
Gain (loss) on real estate dispositions					$ 600,000
Straight-line rent write-offs											$ 125,000		$ 125,000
Nonrecourse secured debt percentage of asset value					55.00%
Proceeds from expected secured debt													$ 1,300,000
Massachusetts-based General Acute Care Hospitals [Member] \| Macquarie Asset Management [Member]
Business Acquisition [Line Items]
Percentage of equity investment					50.00%

Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details)	9 Months Ended
	Sep. 30, 2022 Property
Lessor, Lease, Description [Line Items]
Percentage of properties occupied by tenants	99.00%
Number of properties vacant	5
Minimum [Member]
Lessor, Lease, Description [Line Items]
Percentage of vacant on leased property	0.30%

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 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	598,983,000	596,748,000
Common stock, shares outstanding	598,983,000	596,748,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	5,990	5,968
General partner, units outstanding	5,990	5,968
Common Units \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	592,993	590,780
Limited Partners, units outstanding	592,993	590,780

Real Estate and Other Activities (Tables)

9 Months Ended

Sep. 30, 2022

Real Estate [Abstract]

Net Assets Acquired

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


	For the Nine Months Ended September 30,
	2022			2021

Land and land improvements	$	34,925		$	562,742
Buildings		312,645			1,670,741
Intangible lease assets — subject to amortization (weighted-average useful life of 20.4 years for 2022 and 36.1 years for 2021)		19,839			197,735
Mortgage loans(1)(2)		100,000			1,090,400
Investments in unconsolidated real estate joint ventures		399,456			—
Investments in unconsolidated operating entities		131,105			845,646
Liabilities assumed		(25,727	)		(65,525	)
		972,243			4,301,739
Loans repaid(1)		—			(1,090,400	)
Total net assets acquired	$	972,243		$	3,211,339

(1)

The 2021 column includes an £800 million mortgage loan advanced to the Priory Group ("Priory") in the first quarter of 2021 and converted to fee simple ownership of 35 properties in the second quarter of 2021 as described below.

(2)

In the 2022 second quarter, we increased our mortgage loan to Prospect Medical Holdings, Inc. ("Prospect") that was originated in 2019 and that is secured by a first lien on a California hospital. The loan bears interest at a current market rate plus a component of additional interest upon repayment.

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 September 30, 2022		Estimated Rent Commencement Date
Steward (Texas)	$	169,408	$	57,911	4Q 2025
Ernest (Stockton, California)		47,700		43,785	4Q 2022
IMED (Spain)		46,159		11,809	2Q 2023
IMED (Spain)		41,577		29,182	3Q 2023
Springstone (Texas)		34,600		1,144	1Q 2024
IMED (Spain)		33,635		7,535	3Q 2024
	$	373,079	$	151,366

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 September 30,						For the Nine Months Ended September 30,
	2022			2021			2022			2021
Revenues(1)	$	(27,026	)	$	44,963		$	17,831		$	135,392
Real estate depreciation and amortization(2)		(929	)		(7,245	)		(4,683	)		(26,292	)
Property-related expenses		156			(778	)		(1,752	)		(4,330	)
Other income(3)		68,867			47			536,823			181
Income from real estate dispositions, net	$	41,068		$	36,987		$	548,219		$	104,951

(1)

Includes approximately $35 million and $42 million of straight-line rent and other write-offs associated with the non-Macquarie disposal transactions for the three and nine months ended September 30, 2022, respectively.

(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 $68.8 million and $536.8 million of gains (net of $125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three and nine months ended September 30, 2022, respectively.

Components of Total Investment in Financing Leases

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


	As of September 30, 2022			As of December 31, 2021
Minimum lease payments receivable	$	888,308		$	1,183,855
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(741,083	)		(918,584	)
Net investment in direct financing leases		351,043			469,089
Other financing leases (net of allowance for credit loss)		1,613,978			1,584,238
Total investment in financing leases	$	1,965,021		$	2,053,327

Summary of Investments in Unconsolidated Operating Entities.

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


Operator	As of September 30, 2022		As of December 31, 2021
Median Kliniken S.á.r.l ("MEDIAN")	$	449,226	$	517,648
Swiss Medical Network		422,731		476,193
Steward (Macquarie Transaction)		419,040		—
Policlinico di Monza		78,057		95,468
HM Hospitales		52,956		63,618
Total	$	1,422,010	$	1,152,927

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


Operator	As of September 30, 2022		As of December 31, 2021
Steward (loan investment)	$	362,825	$	360,164
International joint venture		231,402		219,387
Springstone		200,827		187,450
Priory		144,266		42,315
Swiss Medical Network		147,189		159,208
Steward (equity investment)		139,000		139,000
Prospect		112,774		112,283
Aevis Victoria SA ("Aevis")		73,746		61,271
Aspris Children's Services ("Aspris")		16,032		8,356
Total	$	1,428,061	$	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 September 30,
	2022			2021
Balance at beginning of the period	$	55,250		$	7,783
Provision (recovery) for credit loss		(19,677	)		1,829
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(26,362	)		(85	)
Balance at end of the period	$	9,211		$	9,527


	For the Nine Months Ended September 30,
	2022			2021
Balance at beginning of the year	$	48,527		$	8,726
Provision (recovery) for credit loss		(12,920	)		890
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(26,396	)		(89	)
Balance at end of the period	$	9,211		$	9,527

Real Estate and Other Activities - Pipeline Health System - Additional Information (Detail) - Pipeline Health System [Member] - USD ($) $ in Millions	Oct. 02, 2022	Sep. 30, 2022
Business Acquisition [Line Items]
Cash on hand		$ 13
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Subsequent Event [Member]
Business Acquisition [Line Items]
Percentage of total assets	1.00%

Real Estate and Other Activities - Disposals - Additional Information (Detail) $ in Millions		3 Months Ended	9 Months Ended
	Mar. 14, 2022 USD ($) Facility	Sep. 30, 2022 USD ($)	Sep. 30, 2022 USD ($) Facility	Sep. 30, 2021 USD ($) Facility
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions				$ 9
Number of facilities sold \| Facility			15	9
Number of ancillary properties sold \| Facility			5
Proceeds from sale of facilities			$ 522	$ 67
Straight-line rent write-offs			42
Massachusetts-based General Acute Care Hospitals [Member]
Debt Instrument [Line Items]
Number of facilities acquired \| Facility	8
Purchase price of acquisition	$ 1,700
Gain (loss) on real estate dispositions	$ 600
Straight-line rent write-offs		$ 125	125
Prime [Member]
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions			$ 100

Debt - Additional Information (Detail) - Waterland Private Equity Fund VII C.V. [Member] - Interim Credit Facility [Member] - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Debt Instrument [Line Items]
Debt refinancing costs	$ 9.5	$ 2.3
Debt instrument maturity date	Jun. 29, 2022

Fair Value of Financial Instruments

9 Months Ended

Sep. 30, 2022

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

8. 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 September 30, 2022							As of December 31, 2021
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables	$	117,555			$	115,426		$	56,229			$	56,564
Loans(1)		1,274,424		(2)		1,231,734			991,609		(2)		991,954
Debt, net		(9,476,144	)			(8,095,633	)		(11,282,770	)			(11,526,388	)

(1)

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.

(2)

Includes $159.0 million and $70.1 million of mortgage loans, a $289.3 million and $335.6 million shareholder loan included in investments in unconsolidated real estate joint ventures, $628.4 million and $521.4 million of loans that are part of our investments in unconsolidated operating entities, and $197.7 million and $64.5 million of other loans at September 30, 2022 and December 31, 2021, respectively.

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 September 30, 2022 and December 31, 2021, the amounts recorded under the fair value option method were as follows (in thousands):


	As of September 30, 2022				As of December 31, 2021
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	146,482	$	146,482	$	143,068	$	143,068	Mortgage loans
Equity investment and other loans		434,735		442,069		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, while also considering the value of the underlying collateral of each loan. Our equity investments in Springstone and the international joint venture are recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify 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 nine months of 2022, we recorded an unfavorable fair value adjustment to our investments. No fair value adjustment was recorded in the first nine months of 2021.

The DLOM on our Springstone equity investment was 40% at September 30, 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	$	(43	)
- 100 basis points		43

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

Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended						9 Months Ended
	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2022	Sep. 30, 2021
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29	$ 0.29	$ 0.28	$ 0.28	$ 0.28	$ 0.87	$ 0.84
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.29			0.28			$ 0.87	$ 0.84
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29	$ 0.29	$ 0.28	$ 0.28	$ 0.28

Stock Awards

9 Months Ended

Sep. 30, 2022

Share-Based Payment Arrangement [Abstract]

Stock Awards

7. Stock Awards

During the second quarter of 2022, we amended the 2019 Equity Incentive Plan (the “Equity Incentive Plan”), 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. Among other things, the recent amendment increased the number of shares of common stock registered and reserved for stock awards by 16 million to 28.9 million. As of September 30, 2022, 19.3 million shares remain available for future stock awards. Share-based compensation expense totaled $33.0 million and $38.6 million for the nine months ended September 30, 2022 and 2021, respectively.

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

Sep. 30, 2022

Sep. 30, 2021

Business Acquisition [Line Items]

Total assets acquired

$ 972,243

$ 4,301,739

Liabilities assumed

(25,727)

(65,525)

Loans repaid

(1,090,400)

Total net assets acquired

972,243

3,211,339

Land and Land Improvements [Member]

Business Acquisition [Line Items]

Total assets acquired

34,925

562,742

Building [Member]

Business Acquisition [Line Items]

Total assets acquired

312,645

1,670,741

Intangible Lease Assets [Member]

Business Acquisition [Line Items]

Total assets acquired

19,839

197,735

Mortgage Loans [Member]

Business Acquisition [Line Items]

Total assets acquired

^[1],[2]

100,000

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

$ 845,646

[1]	In the 2022 second quarter, we increased our mortgage loan to Prospect Medical Holdings, Inc. ("Prospect") that was originated in 2019 and that is secured by a first lien on a California hospital. The loan bears interest at a current market rate plus a component of additional interest upon repayment.
[2]	The 2021 column includes an £800 million mortgage loan advanced to the Priory Group ("Priory") in the first quarter of 2021 and converted to fee simple ownership of 35 properties in the second quarter of 2021 as described below.

Real Estate and Other Activities - Development Activities - Additional Information (Detail) $ in Thousands, € in Millions			3 Months Ended	9 Months Ended
	Apr. 29, 2022 Facility	Apr. 25, 2022 Facility	Jun. 30, 2022 EUR (€) Facility NewProject	Sep. 30, 2022 USD ($) Facility	Jun. 30, 2022 USD ($)
Business Acquisition [Line Items]
Number of development of new projects \| NewProject			4
Total commitment \| $				$ 373,079
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility		2		6
Spain [Member] \| General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility	3		3
Total commitment \| €			€ 120
Springstone [Member] \| McKinney, Texas [Member]
Business Acquisition [Line Items]
Total commitment \| $					$ 35,000

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

Sep. 30, 2022

Dec. 31, 2021

Debt Instrument [Line Items]

Debt

$ 9,534,541

$ 11,358,826

Debt issue costs and discount, net

(58,397)

(76,056)

Debt, net

9,476,144

11,282,770

Revolving Credit Facility [Member]

Debt Instrument [Line Items]

Debt

^[1]

637,991

730,000

Interim Credit Facility [Member]

Debt Instrument [Line Items]

Debt

869,606

Term Loan [Member]

Debt Instrument [Line Items]

Debt

200,000

Term Loan [Member] | United Kingdom [Member]

Debt Instrument [Line Items]

Debt

^[2]

781,900

947,240

Term Loan [Member] | Australia [Member]

Debt Instrument [Line Items]

Debt

^[2]

768,000

871,560

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Debt

^[2]

446,800

541,280

3.325% Senior Unsecured Notes Due 2025 [Member]

Debt Instrument [Line Items]

Debt

^[2]

490,100

568,500

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

490,100

568,500

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

558,500

676,600

5.250% Senior Unsecured Notes Due 2026 [Member]

Debt Instrument [Line Items]

Debt

500,000

5.000% Senior Unsecured Notes Due 2027 [Member]

Debt Instrument [Line Items]

Debt

1,400,000

3.692% Senior Unsecured Notes due 2028 [Member]

Debt Instrument [Line Items]

Debt

^[2]

670,200

811,920

4.625% Senior Unsecured Notes Due 2029 [Member]

Debt Instrument [Line Items]

Debt

900,000

3.375% Senior Unsecured Notes due 2030 [Member]

Debt Instrument [Line Items]

Debt

^[2]

390,950

473,620

3.500% Senior Unsecured Notes due 2031 [Member]

Debt Instrument [Line Items]

Debt

$ 1,300,000

[1]	Includes €253 million of Euro-denominated borrowings that reflect the exchange rate at September 30, 2022.
[2]	Non-U.S. dollar denominated debt reflects the exchange rate at September 30, 2022 and December 31, 2021.

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] $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
+ 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ (43)
- 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ 43

Debt - 2022 Activity - Additional Information (Detail) - USD ($) $ in Millions			9 Months Ended
	Jun. 29, 2022	May 06, 2022	Sep. 30, 2022	Mar. 15, 2022
Debt Instrument [Line Items]
Line of credit , entered date			Jul. 27, 2021
Debt instrument amendment extended maturity date description			The amendment extended the maturity date of our revolving facility to June 30, 2026 with our option to extend for an additional 12 months.
Commitment fee	0.25%
Line of credit facility, Borrowing capacity				$ 1,000
Alternate Base Rate [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.00%
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Increase in amount of credit facility		$ 500
Amount of senior unsecured debt		1,800
Debt instrument maturity date	Jun. 30, 2026
Line of credit facility, Borrowing capacity	$ 1,000
Unsecured Revolving Credit Facility [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Commitment fee	0.125%
Unsecured Revolving Credit Facility [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Commitment fee	0.30%
Unsecured Revolving Credit Facility [Member] \| Alternate Base Rate [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.00%
Unsecured Revolving Credit Facility [Member] \| Alternate Base Rate [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.50%
Unsecured Revolving Credit Facility [Member] \| Term Benchmark Loans or RFR Loans [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.80%
Unsecured Revolving Credit Facility [Member] \| Term Benchmark Loans or RFR Loans [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	1.50%
Term Loan [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 200	$ 200
Debt instrument maturity date	Jun. 30, 2027
Term Loan [Member] \| Alternate Base Rate [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.70%
Term Loan [Member] \| Term Benchmark Loans [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	0.875%
Term Loan [Member] \| Term Benchmark Loans [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Applicable margin for term loan	1.70%

Debt - 2021 Activity - Additional Information (Detail)
£ in Millions

9 Months Ended

Mar. 26, 2021

Mar. 24, 2021

Jan. 15, 2021

GBP (£)

Sep. 30, 2022

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%

^[1]

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%

^[1]

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

Debt instrument maturity date

Jun. 29, 2022

[1]	Non-U.S. dollar denominated debt reflects the exchange rate at September 30, 2022 and December 31, 2021.

Common Stock/Partners' Capital - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended			9 Months Ended
	Jan. 11, 2021	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Class Of Stock [Line Items]
Common stock, shares issued					598,983,000		596,748,000
Proceeds from sale of common shares / units, net of offering costs						$ 1,041,054
MPT Operating Partnership, L.P. [Member]
Class Of Stock [Line Items]
Number of units sold						52,600,000
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						$ 330,000
Common Units [Member]
Class Of Stock [Line Items]
Number of share sold		6,963,000	5,679,000	39,949,000
Common Units [Member] \| At-the-Market Equity Offering Program [Member]
Class Of Stock [Line Items]
Number of share sold						15,800,000

Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail) $ in Millions		9 Months Ended
	Sep. 01, 2022 Property	Sep. 30, 2022 USD ($) Property Lease
Lessor Lease Description [Line Items]
Lease renewal term		5 years
Annual rent escalations		99.00%
Number of properties \| Property		3
Carrying value of lease requiring residual value guarantee \| $		$ 110
Number of properties sold associated with financing leases \| Property	2
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		3
Prospect [Member]
Lessor Lease Description [Line Items]
Number of financing leases		13
Minimum [Member]
Lessor Lease Description [Line Items]
Initial fixed terms of lease		15 years

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 117,555	$ 56,229
Loans, Book value	1,274,424	991,609
Debt, net Book value	(9,476,144)	(11,282,770)
Interest and rent receivables, Fair value	115,426	56,564
Loans, Fair value	1,231,734	991,954
Debt, net Fair value	$ (8,095,633)	$ (11,526,388)

- Definition

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Real Estate and Other Activities - Investments in Unconsolidated Operating Entities - Additional Information (Detail) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Jan. 08, 2021
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Distribution on equity investment		$ 11.0
Steward Health Care System LLC [Member] \| Affiliates of Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Passive equity interest			9.90%
Aevis Victoria SA [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the cost method	5.00%
COVID-19 Pandemic [Member]
Business Acquisition [Line Items]
Favorable non-cash fair value adjustment on investment		$ 2.8
Dividend income	$ 4.0
COVID-19 Pandemic [Member] \| Other [Member]
Business Acquisition [Line Items]
Favorable non-cash fair value adjustment on investment	$ 12.6

Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Details) - Investments in Unconsolidated Real Estate Joint Ventures [Member] $ in Millions	9 Months Ended
	Sep. 30, 2022 USD ($)
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Dividend income	$ 66
Switzerland [Member]
Business Acquisition [Line Items]
Dividend income	$ 27
Maximum [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($) Health_Center	Dec. 31, 2021 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	$ 305,504	$ 213,211
Investments in unconsolidated real estate joint ventures	1,422,010	1,152,927
Investments in unconsolidated operating entities	1,428,061	1,289,434
Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments in unconsolidated operating entities	628,400	521,400
Other loans	197,700	64,500
Shareholder Loan [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	159,000	70,100
Investments in unconsolidated real estate joint ventures	$ 289,300	$ 335,600
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

Organization - Additional Information (Detail)	Sep. 30, 2022 Facility Country State
Business Acquisition [Line Items]
Number of facilities \| Facility	437
Number of states \| State	31
Europe [Member]
Business Acquisition [Line Items]
Number of countries	7
South America [Member]
Business Acquisition [Line Items]
Number of countries	1

Real Estate and Other Activities - 2021 Activity - Additional Information (Detail) £ in Millions, SFr in Millions, $ in Millions								9 Months Ended
	Apr. 25, 2022 USD ($) Facility	Aug. 01, 2021 USD ($) Hospital	Jul. 06, 2021 GBP (£) Hospital	Jul. 06, 2021 USD ($) Hospital	Jun. 25, 2021 GBP (£) Property	Jan. 19, 2021 GBP (£)	Jan. 08, 2021 USD ($)	Sep. 30, 2022 Facility	Apr. 16, 2021 CHF (SFr)
Swiss Medical Network [Member]
Business Acquisition [Line Items]
Equity investment \| SFr									SFr 145
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $	$ 80
Number of facilities acquired \| Facility	2							6
General Acute Care Hospitals [Member] \| Florida [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $		$ 900
Number of facilities acquired \| Hospital		5
Acute Care Hospital [Member] \| Los Angeles, California [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital			4	4
Acute Care Hospital [Member] \| Stirling, Scotland [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| £			£ 15.6
On Campus Medical Office Buildings [Member] \| Los Angeles, California [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital			2	2
Acute Care Hospital and On Campus Medical Office Buildings [Member] \| Los Angeles, California [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| $				$ 215
Waterland Private Equity Fund VII C.V. [Member]
Business Acquisition [Line Items]
Number of real estate assets acquired \| Property					35
Payment for acquisition \| £					£ 800.0
Purchase price of acquisition loan \| £						£ 250.0
Waterland Private Equity Fund VII C.V. [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| £						£ 800.0
Waterland Private Equity Fund VII C.V. [Member] \| Waterland Private Equity Fund VII C.V. Affiliate [Member]
Business Acquisition [Line Items]
Ownership interest						9.90%
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Percentage of interest rate with possible outside returns							4.00%
Other loan to affiliates \| $							$ 335
Initial term of loan							7 years
Steward Health Care System LLC [Member] \| General Acute Care Hospitals [Member] \| Florida [Member]
Business Acquisition [Line Items]
Lease extension expiration year		2041

Summary of Significant Accounting Policies (Policies)	9 Months Ended
Summary of Significant Accounting Policies (Policies)	Sep. 30, 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 and nine months ended September 30, 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 September 30, 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. Except for changes disclosed in our Quarterly Report on Form 10-Q for the period ended March 31, 2022, there have been no material changes to these significant accounting policies.
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 September 30, 2022, we had loans and/or equity investments in certain variable interest entities approximating $625 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.

Debt

9 Months Ended

Sep. 30, 2022

Debt Disclosure [Abstract]

Debt

4. Debt

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


	As of September 30, 2022			As of December 31, 2021
Revolving credit facility(A)	$	637,991		$	730,000
Interim credit facility		—			869,606
Term loan		200,000			200,000
British pound sterling term loan(B)		781,900			947,240
Australian term loan facility(B)		768,000			871,560
2.550% Senior Unsecured Notes due 2023(B)		446,800			541,280
3.325% Senior Unsecured Notes due 2025(B)		490,100			568,500
0.993% Senior Unsecured Notes due 2026(B)		490,100			568,500
2.500% Senior Unsecured Notes due 2026(B)		558,500			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)		670,200			811,920
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		390,950			473,620
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	9,534,541		$	11,358,826
Debt issue costs and discount, net		(58,397	)		(76,056	)
	$	9,476,144		$	11,282,770

(A)

Includes €253 million of Euro-denominated borrowings that reflect the exchange rate at September 30, 2022.

(B)

Non-U.S. dollar denominated debt reflects the exchange rate at September 30, 2022 and December 31, 2021.

As of September 30, 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		446,800
2024		768,000
2025		1,272,000
2026		2,186,591
Thereafter		4,861,150
Total	$	9,534,541

2022 Activity

On May 6, 2022, we increased the amount of our unsecured credit facility ("Credit Facility") by $500 million by exercising the accordion feature. In addition, our revolver and U.S. dollar term loan were modified with Secured Overnight Financing Rate as a replacement reference rate to U.S. dollar LIBOR. Currently, our Credit Facility includes a $1.8 billion unsecured revolving loan facility and a $200 million unsecured term loan facility.

On June 29, 2022, we amended our Credit Facility. The amendment extended the maturity date of our revolving facility to June 30, 2026 with our option to extend for an additional 12 months. The maturity date of our $200 million unsecured term loan facility was extended to June 30, 2027. Additionally, we may request incremental term loan and/or revolving loan commitments in an aggregate amount not to exceed $1 billion.

In addition, the amendment improved interest rate spreads for both facilities. Under the amended Credit Facility and at our election, loans may be made as either ABR Loans or Term Benchmark Loans. The applicable margin for term loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.70% based on current credit rating. The applicable margin for term loans that are Term Benchmark Loans is adjustable on a sliding scale from 0.875% to 1.70% based on current credit rating. The applicable margin for revolving loans that are ABR Loans is adjustable on a sliding scale from 0.00% to 0.50% based on current credit rating. The applicable margin for revolving loans that are Term Benchmark Loans or RFR Loans is adjustable on a sliding scale from 0.80% to 1.50% based on current credit rating. The facility fee is adjustable on a sliding scale from 0.125% to 0.30% (currently 0.25%) based on current credit rating and is payable on the revolving loan facility.

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") with proceeds from the Macquarie Transaction as more fully described in Note 3 to the condensed consolidated financial statements.

2021 Activity

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 proceeds from the issuance of the 2.500% Senior Unsecured Notes due 2026 and the 3.375% Senior Unsecured Notes due 2030.

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.

Debt Refinancing and Unutilized Financing Costs

2022 Activity

In the first nine months of 2022, we incurred approximately $9.5 million of debt refinancing costs. These costs were incurred as a result of the payoff of our July 2021 Interim Credit Facility with proceeds from the Macquarie Transaction on March 14, 2022, along with the amendment of our Credit Facility on June 29, 2022.

2021 Activity

With the termination of our January 2021 Interim Credit Facility and other debt activity, we incurred approximately $2.3 million of debt refinancing costs in the first nine months 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 September 30, 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 September 30, 2022, we were in compliance with all such financial and operating covenants.

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenues	$ 352,339	$ 390,779	$ 1,162,365	$ 1,135,336
Real estate depreciation and amortization	(81,873)	(85,039)	(251,523)	(237,050)
Other income	23,532	(2,276)	35,450	4,747
Disposal Group, Not Discontinued Operations [Member]
Revenues	(27,026)	44,963	17,831	135,392
Real estate depreciation and amortization	(929)	(7,245)	(4,683)	(26,292)
Property-related expenses	156	(778)	(1,752)	(4,330)
Other income	68,867	47	536,823	181
Income from real estate dispositions, net	$ 41,068	$ 36,987	$ 548,219	$ 104,951

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Subparagraph (a)
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 3
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (f)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Earnings Per Share/Unit (Tables)

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Calculation of Earnings Per Share

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


	For the Three Months Ended September 30,
	2022			2021
Numerator:
Net income	$	222,020		$	171,395
Non-controlling interests’ share in net income		(227	)		(258	)
Participating securities’ share in earnings		(288	)		(328	)
Net income, less participating securities’ share in earnings	$	221,505		$	170,809
Denominator:
Basic weighted-average common shares		598,980			595,119
Dilutive potential common shares		359			2,201
Diluted weighted-average common shares		599,339			597,320


	For the Nine Months Ended September 30,
	2022			2021
Numerator:
Net income	$	1,044,031		$	450,096
Non-controlling interests’ share in net income		(960	)		(611	)
Participating securities’ share in earnings		(1,035	)		(1,088	)
Net income, less participating securities’ share in earnings	$	1,042,036		$	448,397
Denominator:
Basic weighted-average common shares		598,828			586,291
Dilutive potential common shares		271			1,680
Diluted weighted-average common shares		599,099			587,971

MPT Operating Partnership, L.P.

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


	For the Three Months Ended September 30,
	2022			2021
Numerator:
Net income	$	222,020		$	171,395
Non-controlling interests’ share in net income		(227	)		(258	)
Participating securities’ share in earnings		(288	)		(328	)
Net income, less participating securities’ share in earnings	$	221,505		$	170,809
Denominator:
Basic weighted-average units		598,980			595,119
Dilutive potential units		359			2,201
Diluted weighted-average units		599,339			597,320


	For the Nine Months Ended September 30,
	2022			2021
Numerator:
Net income	$	1,044,031		$	450,096
Non-controlling interests’ share in net income		(960	)		(611	)
Participating securities’ share in earnings		(1,035	)		(1,088	)
Net income, less participating securities’ share in earnings	$	1,042,036		$	448,397
Denominator:
Basic weighted-average units		598,828			586,291
Dilutive potential units		271			1,680
Diluted weighted-average units		599,099			587,971

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions	Sep. 30, 2022 USD ($)
Accounting Policies [Abstract]
Loans and/or equity investments in variable interest entities	$ 625

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

9 Months Ended

Mar. 26, 2021

Mar. 24, 2021

Sep. 30, 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 September 30, 2022 and December 31, 2021.

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

9 Months Ended

Mar. 26, 2021

Mar. 24, 2021

Sep. 30, 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 September 30, 2022 and December 31, 2021.

Fair Value of Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2022

Fair Value Disclosures [Abstract]

Summary of Fair Value Information of Financial Instruments

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


	As of September 30, 2022							As of December 31, 2021
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables	$	117,555			$	115,426		$	56,229			$	56,564
Loans(1)		1,274,424		(2)		1,231,734			991,609		(2)		991,954
Debt, net		(9,476,144	)			(8,095,633	)		(11,282,770	)			(11,526,388	)

(1)

(2)

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

At September 30, 2022 and December 31, 2021, the amounts recorded under the fair value option method were as follows (in thousands):


	As of September 30, 2022				As of December 31, 2021
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	146,482	$	146,482	$	143,068	$	143,068	Mortgage loans
Equity investment and other loans		434,735		442,069		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


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(43	)
- 100 basis points		43

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	Sep. 30, 2022	Dec. 31, 2021
Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 146,482	$ 143,068
Original Cost	146,482	143,068
Equity Method Investment and Other Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	434,735	409,638
Original Cost	$ 442,069	$ 409,638

Subsequent Events

9 Months Ended

Sep. 30, 2022

Subsequent Events [Abstract]

Subsequent Events

11. Subsequent Events

On October 9, 2022, the board of directors of the Company authorized a stock repurchase program (the "Stock Repurchase Program") for up to $500 million of common stock, par value $0.001 per share. Through November 4, 2022, we repurchased 1.3 million shares of common stock for approximately $14 million. The Stock Repurchase Program expires on October 10, 2023.

On October 5, 2022, we entered into definitive agreements to sell three Prospect facilities located in Connecticut to Yale New Haven Health ("Yale") for approximately $457 million. This transaction is expected to close in 2023 subject to certain regulatory approvals and the completion of Yale's acquisition of the hospital operations from Prospect. No assurances can be given that this transaction will be consummated as described or at all.

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
2022	$ 0
2023	446,800
2024	768,000
2025	1,272,000
2026	2,186,591
Thereafter	4,861,150
Total	$ 9,534,541	$ 11,358,826

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 13,083,292	$ 14,062,722
Investment in financing leases	1,965,021	2,053,327
Real estate held for sale	0	1,096,505
Mortgage loans	305,504	213,211
Gross investment in real estate assets	15,353,817	17,425,765
Accumulated depreciation and amortization	(1,088,912)	(993,100)
Net investment in real estate assets	14,264,905	16,432,665
Cash and cash equivalents	299,171	459,227
Interest and rent receivables	117,555	56,229
Straight-line rent receivables	710,082	728,522
Investments in unconsolidated real estate joint ventures	1,422,010	1,152,927
Investments in unconsolidated operating entities	1,428,061	1,289,434
Other loans	200,245	67,317
Other assets	601,387	333,480
Total Assets	19,043,416	20,519,801
Liabilities
Debt, net	9,476,144	11,282,770
Accounts payable and accrued expenses	569,017	607,792
Deferred revenue	18,569	25,563
Obligations to tenants and other lease liabilities	146,438	158,005
Total Liabilities	10,210,168	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 - 598,983 shares at September 30, 2022 and 596,748 shares at December 31, 2021	599	597
Additional paid-in capital	8,537,145	8,564,009
Retained earnings (deficit)	433,339	(87,691)
Accumulated other comprehensive loss	(139,301)	(36,727)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,831,782	8,440,188
Non-controlling interests	1,466	5,483
Total Equity / Capital	8,833,248	8,445,671
Total Liabilities and Equity / Capital	19,043,416	20,519,801
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	13,083,292	14,062,722
Investment in financing leases	1,965,021	2,053,327
Real estate held for sale	0	1,096,505
Mortgage loans	305,504	213,211
Gross investment in real estate assets	15,353,817	17,425,765
Accumulated depreciation and amortization	(1,088,912)	(993,100)
Net investment in real estate assets	14,264,905	16,432,665
Cash and cash equivalents	299,171	459,227
Interest and rent receivables	117,555	56,229
Straight-line rent receivables	710,082	728,522
Investments in unconsolidated real estate joint ventures	1,422,010	1,152,927
Investments in unconsolidated operating entities	1,428,061	1,289,434
Other loans	200,245	67,317
Other assets	601,387	333,480
Total Assets	19,043,416	20,519,801
Liabilities
Debt, net	9,476,144	11,282,770
Accounts payable and accrued expenses	394,628	430,908
Deferred revenue	18,569	25,563
Obligations to tenants and other lease liabilities	146,438	158,005
Payable due to Medical Properties Trust, Inc.	173,999	176,494
Total Liabilities	10,209,778	12,073,740
Equity / Capital
General Partner - issued and outstanding - 5,990 units at September 30, 2022 and 5,968 units at December 31, 2021	89,790	84,847
Limited Partners - issued and outstanding - 592,993 units at September 30, 2022 and 590,780 units at December 31, 2021	8,881,683	8,392,458
Accumulated other comprehensive loss	(139,301)	(36,727)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,832,172	8,440,578
Non-controlling interests	1,466	5,483
Total Equity / Capital	8,833,638	8,446,061
Total Liabilities and Equity / Capital	$ 19,043,416	$ 20,519,801

Common Stock/Partner's Capital

9 Months Ended

Sep. 30, 2022

Equity [Abstract]

Common Stock/Partner's Capital

6. 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 15.8 million shares of common stock under our at-the-market equity offering program during the first nine months of 2021, resulting in net proceeds of approximately $330 million.

MPT Operating Partnership, L.P.

At September 30, 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 nine months ended September 30, 2021, the Operating Partnership issued approximately 52.6 million units in direct response to the common stock offerings by Medical Properties Trust, Inc. during the same period.

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands		3 Months Ended			9 Months Ended
	Apr. 01, 2023	Sep. 30, 2022	Sep. 30, 2021	Jun. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Tax Disclosure [Line Items]
Income tax expense (benefit)		$ 18,579	$ 10,602		$ 40,615	$ 69,141
Watsonville Community Hospital [Member]
Income Tax Disclosure [Line Items]
Income tax expense (benefit)		$ 5,000
United Kingdom [Member]
Income Tax Disclosure [Line Items]
Income tax at the US statutory federal rate				19.00%
Net deferred tax liabilities, adjustment				$ 43,000
Forecast [Member] \| United Kingdom [Member]
Income Tax Disclosure [Line Items]
Income tax at the US statutory federal rate	25.00%

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Debt (Tables)

9 Months Ended

Sep. 30, 2022

Debt Disclosure [Abstract]

Summary of Debt

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


	As of September 30, 2022			As of December 31, 2021
Revolving credit facility(A)	$	637,991		$	730,000
Interim credit facility		—			869,606
Term loan		200,000			200,000
British pound sterling term loan(B)		781,900			947,240
Australian term loan facility(B)		768,000			871,560
2.550% Senior Unsecured Notes due 2023(B)		446,800			541,280
3.325% Senior Unsecured Notes due 2025(B)		490,100			568,500
0.993% Senior Unsecured Notes due 2026(B)		490,100			568,500
2.500% Senior Unsecured Notes due 2026(B)		558,500			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)		670,200			811,920
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		390,950			473,620
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	9,534,541		$	11,358,826
Debt issue costs and discount, net		(58,397	)		(76,056	)
	$	9,476,144		$	11,282,770

(A)

Includes €253 million of Euro-denominated borrowings that reflect the exchange rate at September 30, 2022.

(B)

Non-U.S. dollar denominated debt reflects the exchange rate at September 30, 2022 and December 31, 2021.

Principal Payments Due on Debt

As of September 30, 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		446,800
2024		768,000
2025		1,272,000
2026		2,186,591
Thereafter		4,861,150
Total	$	9,534,541

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 222,020	$ 190,064	$ 631,947	$ 171,395	$ 114,821	$ 163,880	$ 1,044,031	$ 450,096
Non-controlling interests’ share in net income	(227)			(258)			(960)	(611)
Participating securities’ share in earnings	(288)			(328)			(1,035)	(1,088)
Net income, less participating securities’ share in earnings	$ 221,505			$ 170,809			$ 1,042,036	$ 448,397
Basic weighted-average common shares	598,980			595,119			598,828	586,291
Dilutive potential common shares	359			2,201			271	1,680
Diluted weighted-average common shares	599,339			597,320			599,099	587,971
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 222,020	$ 190,064	$ 631,947	$ 171,395	$ 114,821	$ 163,880	$ 1,044,031	$ 450,096
Non-controlling interests’ share in net income	(227)			(258)			(960)	(611)
Participating securities’ share in earnings	(288)			(328)			(1,035)	(1,088)
Net income, less participating securities’ share in earnings	$ 221,505			$ 170,809			$ 1,042,036	$ 448,397
Basic weighted-average common shares	598,980			595,119			598,828	586,291
Dilutive potential common shares	359			2,201			271	1,680
Diluted weighted-average common shares	599,339			597,320			599,099	587,971

- 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

Fair Value of Financial Instruments - Additional Information (Detail) - Springstone Inc. and International Joint Venture [Member] - USD ($)	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2022
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Discount for lack of marketability percentage on Springstone equity investment		40.00%
Equity investments unrealized gain/loss	$ 0

Debt - Covenants - Additional Information (Detail)	9 Months Ended
Debt - Covenants - Additional Information (Detail)	Sep. 30, 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%

Debt - Senior Unsecured Notes - Additional Information (Detail)	Mar. 24, 2021 GBP (£)
Unsecured Debt
Debt Instrument [Line Items]
Senior unsecured notes face amount	£ 850,000,000

Real Estate and Other Activities - Net Assets Acquired (Parenthetical) (Detail) $ in Thousands, £ in Millions	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021 GBP (£) Property	Sep. 30, 2021 USD ($) Property
Business Acquisition [Line Items]
Advanced to the mortgage loan \| $			$ 1,090,400
Priory Group [Member]
Business Acquisition [Line Items]
Number of real estate assets acquired \| Property		35	35
Mortgage Loans [Member] \| Priory Group [Member]
Business Acquisition [Line Items]
Advanced to the mortgage loan \| £		£ 800
Intangible Lease Assets [Member]
Business Acquisition [Line Items]
Weighted-average useful life of acquired intangible lease assets (in years)	20 years 4 months 24 days	36 years 1 month 6 days

Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 888,308	$ 1,183,855
Estimated unguaranteed residual values	203,818	203,818
Less: Unearned income and allowance for credit loss	(741,083)	(918,584)
Net investment in direct financing leases	351,043	469,089
Other financing leases (net of allowance for credit loss)	1,613,978	1,584,238
Total investment in financing leases	$ 1,965,021	$ 2,053,327

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2022	Nov. 04, 2022
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST, INC.
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		598,000,000.0
Title of 12(b) Security	Common stock, par value $0.001 per share, of Medical Properties Trust, Inc.
Security Exchange Name	NYSE
Entity Shell Company	false
Entity File Number	001-32559
Entity Tax Identification Number	20-0191742
Entity Address, Address Line One	1000 URBAN CENTER DRIVE
Entity Address, Address Line Two	SUITE 501
Entity Address, City or Town	BIRMINGHAM
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	205
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	MD
Document Quarterly Report	true
Document Transition Report	false
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity File Number	333-177186
Entity Tax Identification Number	20-0242069
Entity Address, Address Line One	1000 URBAN CENTER DRIVE
Entity Address, Address Line Two	SUITE 501
Entity Address, City or Town	BIRMINGHAM
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	205
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	DE

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenues
Rent billed	$ 232,418	$ 242,211	$ 737,029	$ 672,425
Straight-line rent	26,552	64,637	146,114	174,975
Income from financing leases	51,011	50,667	154,660	151,898
Interest and other income	42,358	33,264	124,562	136,038
Total revenues	352,339	390,779	1,162,365	1,135,336
Expenses
Interest	88,076	94,132	266,989	273,409
Real estate depreciation and amortization	81,873	85,039	251,523	237,050
Property-related	8,265	7,128	37,998	31,265
General and administrative	37,319	36,694	117,601	107,312
Total expenses	215,533	222,993	674,111	649,036
Other income (expense)
Gain on sale of real estate and other, net	68,795	9,294	536,788	8,896
Earnings from equity interests	11,483	7,193	33,606	21,633
Debt refinancing and unutilized financing costs	(17)		(9,452)	(2,339)
Other (including fair value adjustments on securities)	23,532	(2,276)	35,450	4,747
Total other income	103,793	14,211	596,392	32,937
Income before income tax	240,599	181,997	1,084,646	519,237
Income tax expense	(18,579)	(10,602)	(40,615)	(69,141)
Net income	222,020	171,395	1,044,031	450,096
Net income attributable to non-controlling interests	(227)	(258)	(960)	(611)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 221,793	$ 171,137	$ 1,043,071	$ 449,485
Earnings per common share (units) basic
Net income attributable to MPT common stockholders (Operating Partnership partners), basic	$ 0.37	$ 0.29	$ 1.74	$ 0.76
Earnings per common share (units) diluted
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ 0.37	$ 0.29	$ 1.74	$ 0.76
Weighted average shares (units) outstanding basic	598,980	595,119	598,828	586,291
Weighted average shares (units) outstanding diluted	599,339	597,320	599,099	587,971
Dividends declared per common share (unit)	$ 0.29	$ 0.28	$ 0.87	$ 0.84
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 232,418	$ 242,211	$ 737,029	$ 672,425
Straight-line rent	26,552	64,637	146,114	174,975
Income from financing leases	51,011	50,667	154,660	151,898
Interest and other income	42,358	33,264	124,562	136,038
Total revenues	352,339	390,779	1,162,365	1,135,336
Expenses
Interest	88,076	94,132	266,989	273,409
Real estate depreciation and amortization	81,873	85,039	251,523	237,050
Property-related	8,265	7,128	37,998	31,265
General and administrative	37,319	36,694	117,601	107,312
Total expenses	215,533	222,993	674,111	649,036
Other income (expense)
Gain on sale of real estate and other, net	68,795	9,294	536,788	8,896
Earnings from equity interests	11,483	7,193	33,606	21,633
Debt refinancing and unutilized financing costs	(17)		(9,452)	(2,339)
Other (including fair value adjustments on securities)	23,532	(2,276)	35,450	4,747
Total other income	103,793	14,211	596,392	32,937
Income before income tax	240,599	181,997	1,084,646	519,237
Income tax expense	(18,579)	(10,602)	(40,615)	(69,141)
Net income	222,020	171,395	1,044,031	450,096
Net income attributable to non-controlling interests	(227)	(258)	(960)	(611)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 221,793	$ 171,137	$ 1,043,071	$ 449,485
Earnings per common share (units) basic
Net income attributable to MPT common stockholders (Operating Partnership partners), basic	$ 0.37	$ 0.29	$ 1.74	$ 0.76
Earnings per common share (units) diluted
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ 0.37	$ 0.29	$ 1.74	$ 0.76
Weighted average shares (units) outstanding basic	598,980	595,119	598,828	586,291
Weighted average shares (units) outstanding diluted	599,339	597,320	599,099	587,971
Dividends declared per common share (unit)	$ 0.29	$ 0.28	$ 0.87	$ 0.84

Real Estate and Other Activities - Coronavirus (COVID-19) Rent Deferrals - Additional Information (Detail) $ in Millions	Sep. 30, 2022 USD ($)
Business Acquisition [Line Items]
Remaining outstanding deferred rent to be received	$ 15.1

Summary of Significant Accounting Policies	9 Months Ended
Summary of Significant Accounting Policies	Sep. 30, 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 and nine months ended September 30, 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 September 30, 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. Except for changes disclosed in our Quarterly Report on Form 10-Q for the period ended March 31, 2022, there have been no material changes to these significant accounting policies. 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 September 30, 2022, we had loans and/or equity investments in certain variable interest entities approximating $625 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.

Organization

9 Months Ended

Sep. 30, 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 substantially 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 facilities, 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, typically in conjunction with larger real estate transactions with the tenant, which may 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 September 30, 2022, we have investments in 437 facilities in 31 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.

Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) - Steward Health Care System LLC [Member] $ in Millions	3 Months Ended
	Jun. 30, 2022 USD ($)
Business Acquisition [Line Items]
Secured loan amount	$ 150
Secured loan period	5 years

Commitments and Contingencies

9 Months Ended

Sep. 30, 2022

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

10. Commitments and Contingencies

Commitments

On August 26, 2022, a subsidiary of LifePoint Health, Inc. ("LifePoint") agreed to acquire a majority interest in Springstone Health Opco, LLC (the "LifePoint Transaction") based on an enterprise value of $250 million. Pursuant to the anticipated closing of this transaction in the first half of 2023, we expect to be paid approximately $200 million in full satisfaction of our initial acquisition loan to Springstone. We will retain our minority equity interest in the operations of Springstone and will continue to own and lease Springstone's behavioral hospitals. As part of the LifePoint Transaction, LifePoint has agreed to extend the current lease with us on eight existing general acute care hospitals by five years to 2041. The consummation of the LifePoint Transaction is subject to customary closing conditions, and no assurances can be given that the transaction will be consummated as described or at all.

As disclosed in previous filings, we entered into a definitive agreement that would result in the leasing of five general acute care hospitals located in Utah to HCA Healthcare ("HCA") if the agreement by HCA to purchase the operations of these five facilities from Steward occurred. This agreement was terminated in June 2022 following a regulatory ruling, and these five hospitals continue to be leased to Steward.

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 - Watsonville Community Hospital - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Aug. 31, 2022
Business Acquisition [Line Items]
Loans repaid			$ 1,090,400		$ 1,090,400
Provision (recovery) for credit loss		$ (19,677)	$ 1,829	$ 12,920	$ 890
Halsen Healthcare [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Write off of billed and straight-line rent receivables				$ 2,500
Watsonville, California [Member] \| Halsen Healthcare [Member]
Business Acquisition [Line Items]
Loans repaid						$ 32,000
Provision (recovery) for credit loss		$ 20,000
Acute Care Hospital [Member] \| Watsonville, California [Member]
Business Acquisition [Line Items]
Funded for interim mortgage loan	$ 40,000

Income Taxes

9 Months Ended

Sep. 30, 2022

Income Tax Disclosure [Abstract]

Income Taxes

5. Income Taxes

In the 2022 third quarter, we incurred approximately $5 million of income tax expense from the credit loss recovery on loans made to the Watsonville Community Hospital, as more fully described in Note 3.

During the 2021 second quarter, the United Kingdom enacted an increase in its corporate income tax rates from 19% to 25% effective April 1, 2023, which resulted in higher tax expense, from adjusting our net deferred tax liabilities, of approximately $43 million.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 21
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32857-109319

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-URI https://asc.fasb.org/extlink&oid=122134291&loc=d3e330215-122817

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 17
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32809-109319

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-URI https://asc.fasb.org/extlink&oid=122134291&loc=d3e330036-122817

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 14
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32705-109319

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 270
-Section 50
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=6424409&loc=d3e44925-109338

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-URI https://asc.fasb.org/topic&trid=2144680

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 30
-Section 50
-Paragraph 2
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=6424122&loc=d3e41874-109331

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Operating activities
Net income	$ 1,044,031	$ 450,096
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	260,717	246,117
Amortization of deferred financing costs and debt discount	13,123	12,079
Straight-line rent revenue and other	(214,435)	(208,756)
Share / (Unit)-based compensation expense	33,001	38,590
Gain on sale of real estate and other, net	(536,788)	(8,896)
Straight-line rent and other write-off (recovery)	28,411	(1,601)
Debt refinancing and unutilized financing costs	9,452	2,339
Tax rate changes	(825)	42,746
Other adjustments	(2,137)	15,468
Changes in:
Interest and rent receivables	(68,929)	(19,150)
Other assets	(7,551)	516
Accounts payable and accrued expenses	8,030	25,527
Deferred revenue	(8,185)	(17,588)
Net cash provided by operating activities	557,915	577,487
Investing activities
Cash paid for acquisitions and other related investments	(972,243)	(4,279,147)
Net proceeds from sale of real estate	2,185,574	66,891
Principal received on loans receivable	52,317	1,234,839
Investment in loans receivable	(179,542)	(38,921)
Construction in progress and other	(97,783)	(30,291)
Proceeds from return of equity investment	14,295	21,998
Capital additions and other investments, net	(144,307)	(195,298)
Net cash provided by (used for) investing activities	858,311	(3,219,929)
Financing activities
Proceeds from term debt, net of discount		2,489,735
Payments of term debt	(869,606)	(689,450)
Revolving credit facilities, net	(64,055)	80,963
Dividends / Distribution paid	(524,536)	(476,242)
Lease deposits and other obligations to tenants	(2,591)	14,819
Proceeds from sale of common shares, net of offering costs		1,041,054
Unit vesting - satisfaction of tax withholdings	(29,457)
Payment of debt refinancing, deferred financing costs, and other financing activities	(53,444)	(24,245)
Net cash provided by financing activities	(1,543,689)	2,436,634
Decrease in cash, cash equivalents, and restricted cash for period	(127,463)	(205,808)
Effect of exchange rate changes	(29,739)	1,748
Cash, cash equivalents, and restricted cash at beginning of period	461,882	556,369
Cash, cash equivalents, and restricted cash at end of period	304,680	352,309
Interest paid	285,417	256,724
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	173,999	167,231
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	299,171	349,652
Restricted cash, included in Other assets at end of period	$ 5,509	$ 2,657
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	$ 304,680	$ 352,309
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	1,044,031	450,096
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	260,717	246,117
Amortization of deferred financing costs and debt discount	13,123	12,079
Straight-line rent revenue and other	(214,435)	(208,756)
Share / (Unit)-based compensation expense	33,001	38,590
Gain on sale of real estate and other, net	(536,788)	(8,896)
Straight-line rent and other write-off (recovery)	28,411	(1,601)
Debt refinancing and unutilized financing costs	9,452	2,339
Tax rate changes	(825)	42,746
Other adjustments	(2,137)	15,468
Changes in:
Interest and rent receivables	(68,929)	(19,150)
Other assets	(7,551)	516
Accounts payable and accrued expenses	8,030	25,527
Deferred revenue	(8,185)	(17,588)
Net cash provided by operating activities	557,915	577,487
Investing activities
Cash paid for acquisitions and other related investments	(972,243)	(4,279,147)
Net proceeds from sale of real estate	2,185,574	66,891
Principal received on loans receivable	52,317	1,234,839
Investment in loans receivable	(179,542)	(38,921)
Construction in progress and other	(97,783)	(30,291)
Proceeds from return of equity investment	14,295	21,998
Capital additions and other investments, net	(144,307)	(195,298)
Net cash provided by (used for) investing activities	858,311	(3,219,929)
Financing activities
Proceeds from term debt, net of discount		2,489,735
Payments of term debt	(869,606)	(689,450)
Revolving credit facilities, net	(64,055)	80,963
Dividends / Distribution paid	(524,536)	(476,242)
Lease deposits and other obligations to tenants	(2,591)	14,819
Proceeds from sale of units, net of offering costs		1,041,054
Unit vesting - satisfaction of tax withholdings	(29,457)
Payment of debt refinancing, deferred financing costs, and other financing activities	(53,444)	(24,245)
Net cash provided by financing activities	(1,543,689)	2,436,634
Decrease in cash, cash equivalents, and restricted cash for period	(127,463)	(205,808)
Effect of exchange rate changes	(29,739)	(1,748)
Cash, cash equivalents, and restricted cash at beginning of period	461,882	556,369
Cash, cash equivalents, and restricted cash at end of period	304,680	352,309
Interest paid	285,417	256,724
Supplemental schedule of non-cash financing activities:
Dividend / Distributions declared, unpaid	173,999	167,231
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	299,171	349,652
Restricted cash, included in Other assets at end of period	$ 5,509	$ 2,657
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	$ 304,680	$ 352,309

Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	Common Par Value [Member]	Common Par Value [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]	Additional Paid-in Capital [Member]	Retained Earnings (Deficit) [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Other Comprehensive Loss [Member] MPT Operating Partnership, L.P. [Member]	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 (loss) gain	(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 (in shares) at Mar. 31, 2021			5,830	583,043	577,213
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	450,096	450,096
Unrealized gain (loss) on interest rate swap, net of tax	28,558	28,558
Foreign currency translation (loss) gain	(47,077)	(47,077)
Ending balance at Sep. 30, 2021	8,358,734	8,359,124	$ 84,312	$ 596	$ 8,339,256	8,540,315	(117,733)	(69,843)	(69,843)	5,399	5,399
Ending balance (in shares) at Sep. 30, 2021			5,962	596,079	590,117
Beginning 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
Beginning balance (in shares) at Mar. 31, 2021			5,830	583,043	577,213
Net income	114,821	114,821	$ 1,146		$ 113,419		114,565			256	256
Unrealized gain (loss) on interest rate swap, net of tax	4,207	4,207						4,207	4,207
Foreign currency translation (loss) gain	9,014	9,014						9,014	9,014
Stock (Unit) vesting and amortization of stock (unit)-based compensation	12,771	12,771	$ 128		$ 12,643	12,771
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	176	174
Distributions to non-controlling interests	(142)	(142)								(142)	(142)
Proceeds from offering (net of offering costs)	121,333	121,333	$ 1,213	$ 6	$ 120,120	121,327
Proceeds from offering (net of offering costs) (shares)			58	5,679	5,621
Dividends (Distributions) declared	(165,133)	(165,133)	$ (1,651)		$ (163,482)		(165,133)
Ending balance at Jun. 30, 2021	8,217,081	8,217,471	$ 82,732	$ 589	$ 8,182,895	8,386,287	(121,639)	(53,499)	(53,499)	5,343	5,343
Ending balance (in shares) at Jun. 30, 2021			5,890	588,898	583,008
Net income	171,395	171,395	$ 1,711		$ 169,426		171,137			258	258
Unrealized gain (loss) on interest rate swap, net of tax	8,847	8,847						8,847	8,847
Foreign currency translation (loss) gain	(25,191)	(25,191)						(25,191)	(25,191)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	13,555	13,555	$ 136		$ 13,419	13,555
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	218	216
Distributions to non-controlling interests	(202)	(202)								(202)	(202)
Proceeds from offering (net of offering costs)	140,480	140,480	$ 1,405	$ 7	$ 139,075	140,473
Proceeds from offering (net of offering costs) (shares)			70	6,963	6,893
Dividends (Distributions) declared	(167,231)	(167,231)	$ (1,672)		$ (165,559)		(167,231)
Ending balance at Sep. 30, 2021	8,358,734	8,359,124	$ 84,312	$ 596	$ 8,339,256	8,540,315	(117,733)	(69,843)	(69,843)	5,399	5,399
Ending balance (in shares) at Sep. 30, 2021			5,962	596,079	590,117
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 (loss) gain	(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
Issuance 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
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	1,044,031	1,044,031
Unrealized gain (loss) on interest rate swap, net of tax	123,827	123,827
Foreign currency translation (loss) gain	(226,401)	(226,401)
Ending balance at Sep. 30, 2022	8,833,248	8,833,638	$ 89,790	$ 599	$ 8,881,683	8,537,145	433,339	(139,301)	(139,301)	1,466	1,466
Ending balance (in shares) at Sep. 30, 2022			5,990	598,983	592,993
Beginning 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
Beginning balance (in shares) at Mar. 31, 2022			5,987	598,676	592,689
Net income	190,064	190,064	$ 1,896		$ 187,701		189,597			467	467
Unrealized gain (loss) on interest rate swap, net of tax	25,920	25,920						25,920	25,920
Foreign currency translation (loss) gain	(104,341)	(104,341)						(104,341)	(104,341)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	10,108	10,108	$ 101		$ 10,007	10,108
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	204	202
Stock vesting - satisfaction of tax withholding	(880)	(880)	$ (9)		$ (871)	(880)
Stock vesting - satisfaction of tax withholding (Shares)			(1)	(41)	(40)
Distributions to non-controlling interests	(335)	(335)								(335)	(335)
Dividends (Distributions) declared	(174,024)	(174,024)	$ (1,740)		$ (172,284)		(174,024)
Ending balance at Jun. 30, 2022	8,865,871	8,866,261	$ 89,511	$ 599	$ 8,854,143	8,557,120	385,545	(83,431)	(83,431)	6,038	6,038
Ending balance (in shares) at Jun. 30, 2022			5,988	598,839	592,851
Net income	222,020	222,020	$ 2,218		$ 219,575		221,793			227	227
Unrealized gain (loss) on interest rate swap, net of tax	52,975	52,975						52,975	52,975
Foreign currency translation (loss) gain	(108,845)	(108,845)						(108,845)	(108,845)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,089	11,089	$ 111		$ 10,978	11,089
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	185	183
Acquisition of non-controlling interest	(35,022)	(35,022)	$ (304)		$ (30,124)	(30,428)				(4,594)	(4,594)
Stock vesting - satisfaction of tax withholding	(636)	(636)	(6)		$ (630)	(636)
Stock vesting - satisfaction of tax withholding (Shares)				41	(41)
Distributions to non-controlling interests	(205)	(205)								205	(205)
Dividends (Distributions) declared	(173,999)	(173,999)	(1,740)		$ (172,259)		173,999
Ending balance at Sep. 30, 2022	$ 8,833,248	$ 8,833,638	$ 89,790	$ 599	$ 8,881,683	$ 8,537,145	$ 433,339	$ (139,301)	$ (139,301)	$ 1,466	$ 1,466
Ending balance (in shares) at Sep. 30, 2022			5,990	598,983	592,993

Real Estate and Other Activities

9 Months Ended

Sep. 30, 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 Nine Months Ended September 30,
	2022			2021

Land and land improvements	$	34,925		$	562,742
Buildings		312,645			1,670,741
Intangible lease assets — subject to amortization (weighted-average useful life of 20.4 years for 2022 and 36.1 years for 2021)		19,839			197,735
Mortgage loans(1)(2)		100,000			1,090,400
Investments in unconsolidated real estate joint ventures		399,456			—
Investments in unconsolidated operating entities		131,105			845,646
Liabilities assumed		(25,727	)		(65,525	)
		972,243			4,301,739
Loans repaid(1)		—			(1,090,400	)
Total net assets acquired	$	972,243		$	3,211,339

(1)

(2)

2022 Activity

Macquarie Transaction

On March 14, 2022, we completed a transaction with Macquarie Asset Management (“MAM”), an unrelated party, 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 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 ($194 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 $26 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. We funded £96.5 million ($131 million) towards a £100 million participation level in the variable rate loan, reflecting a 3.5% discount.

Other acquisitions in the first nine months of 2022 included six general acute care facilities. Three general acute care facilities, located throughout Spain, were acquired on April 29, 2022 for €27 million and are leased to GenesisCare pursuant to a long-term lease with annual inflation-based escalators. Two general acute care facilities, one in Arizona and the other in Florida, were acquired on April 18 and 25, 2022, respectively, for approximately $80 million and are leased to Steward pursuant to an already existing master lease agreement with annual inflation-based escalators. The other general acute care facility, located in Colombia, was acquired on July 29, 2022 for $26 million and is leased to Fundación Cardiovascular de Colombia pursuant to a long-term lease with inflation-based escalators.

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 interim 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 August 1, 2021, we completed the acquisition of five general acute care hospitals located in South Florida for approximately $900 million, plus closing and other transaction costs. These hospitals are leased to Steward pursuant to a master lease that has an initial fixed term ending in 2041 with annual inflation-based escalators.

On July 6, 2021, we acquired four acute care hospitals and two on-campus medical office buildings in Los Angeles, California for $215 million. These hospitals are leased to Pipeline Health System ("Pipeline") pursuant to a long-term lease with annual inflation-based escalators.

On July 6, 2021, we also acquired an acute care hospital in Stirling, Scotland for £15.6 million. This hospital is leased to Circle Health Ltd. ("Circle") pursuant to a long-term lease with annual inflation-based escalators.

On April 16, 2021, we made a CHF 145 million investment in Swiss Medical Network, our tenant via our Infracore SA ("Infracore") equity investment.

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 second quarter, we agreed to finance the development of four new projects. One of these development projects is a behavioral health facility in McKinney, Texas with a total budget of approximately $35 million. This facility will be leased to Springstone, LLC ("Springstone") pursuant to the existing long-term master lease. In addition, we agreed to finance the development of and lease three general acute care facilities located throughout Spain for a total commitment of approximately €120 million. These facilities will be leased to our existing tenant, IMED Hospitales ("IMED"), under a long-term master lease agreement.

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 September 30, 2022		Estimated Rent Commencement Date
Steward (Texas)	$	169,408	$	57,911	4Q 2025
Ernest (Stockton, California)		47,700		43,785	4Q 2022
IMED (Spain)		46,159		11,809	2Q 2023
IMED (Spain)		41,577		29,182	3Q 2023
Springstone (Texas)		34,600		1,144	1Q 2024
IMED (Spain)		33,635		7,535	3Q 2024
	$	373,079	$	151,366

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 nine months of 2022, we also completed the sale of 15 other facilities (including 11 properties sold on September 1, 2022 related to the Prime Healthcare Services, Inc. ("Prime") repurchase option for proceeds of $366 million) and five ancillary properties for total proceeds of approximately $522 million and recognized a gain on real estate of approximately $100 million, along with a $42 million write-off of straight-line rent receivables due to the early termination of certain properties' expected lease terms.

Summary of Operations for Disposed Assets in 2022


	For the Three Months Ended September 30,						For the Nine Months Ended September 30,
	2022			2021			2022			2021
Revenues(1)	$	(27,026	)	$	44,963		$	17,831		$	135,392
Real estate depreciation and amortization(2)		(929	)		(7,245	)		(4,683	)		(26,292	)
Property-related expenses		156			(778	)		(1,752	)		(4,330	)
Other income(3)		68,867			47			536,823			181
Income from real estate dispositions, net	$	41,068		$	36,987		$	548,219		$	104,951

(1)

(2)

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

(3)

2021 Activity

During the first nine months of 2021, we completed the sale of nine facilities and an ancillary property for approximately $67 million, resulting in a net gain on real estate of approximately $9 million.

Leasing Operations (Lessor)

We acquire and develop healthcare facilities and lease the facilities to healthcare operating companies. The initial fixed lease terms of these infrastructure-type assets are typically 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 initial investment. For three properties with a carrying value of approximately $110 million at September 30, 2022, 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 our assets are being maintained properly and in compliance with the terms of our leases.

For all of our properties subject to lease, we are the legal owner of the property and the tenant's right to use and possess such property is guided by the terms of a lease. At September 30, 2022, we account for all of these leases as operating leases, except where GAAP requires alternative classification, including leases on 13 Ernest facilities and three Prime facilities that are accounted for as direct financing leases and leases on 13 of our Prospect facilities and five of our Ernest facilities that are accounted for as a financing. The components of our total investment in financing leases consisted of the following (in thousands):


	As of September 30, 2022			As of December 31, 2021
Minimum lease payments receivable	$	888,308		$	1,183,855
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(741,083	)		(918,584	)
Net investment in direct financing leases		351,043			469,089
Other financing leases (net of allowance for credit loss)		1,613,978			1,584,238
Total investment in financing leases	$	1,965,021		$	2,053,327

The decrease in the total investment in financing leases during the first nine months of 2022 is primarily related to financing leases associated with two properties sold on September 1, 2022 associated with the Prime repurchase transaction.

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 $15.1 million as of September 30, 2022, to be paid over specified periods in the future with interest.

Pipeline Health System

On October 2, 2022, Pipeline filed for reorganization relief under Chapter 11 protection of the United States Bankruptcy Code in the Southern District of Texas, while keeping its hospitals open to continue providing care to the communities served. As mentioned above in this same Note 3, all of the facilities we lease to Pipeline are located in California, representing 1% of our total assets. At September 30, 2022, Pipeline has made all of its required rental payments, and we have on-hand cash deposits of approximately $13 million. We believe our investment in these facilities is fully recoverable at this time, but no assurances can be given that we will not have any write-offs or impairments in future periods.

Watsonville Community Hospital

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 the COVID-19 pandemic. During this time, we increased the loan in an effort to support the operator of this facility, allowing it to continue serving the community's needs. On December 5, 2021, Halsen Healthcare filed Chapter 11 bankruptcy in order to reorganize, while keeping the hospital open. As such, we recorded a credit loss reserve against the estimated uncollectible portion of the loan and wrote off approximately $2.5 million of billed and straight-line rent receivables.

On February 23, 2022, the bankruptcy court approved the bid by Pajaro Valley Healthcare District Corporation ("Pajaro") to purchase the operations of the Watsonville Community Hospital and lease the real estate from us. On August 31, 2022, Pajaro completed this purchase of the operations of the Watsonville Community Hospital. As a result of this transaction, we were repaid

approximately $32 million of the loans previously provided to the hospital. This loan repayment resulted in a credit loss recovery of approximately $20 million in the 2022 third quarter as shown in the "Other (including fair value adjustments on securities)" line of the condensed consolidated statements of net income. To date, Pajaro has been current on its monthly rental payments to us.

Other Leasing Activities

At September 30, 2022, 99% of our properties are occupied by tenants, leaving five properties as vacant, representing less than 0.3% of total assets. We are in various stages of either releasing or selling these vacant properties, for one of which we received and recorded a significant termination fee in 2019.

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 investment. 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 and carry a similar risk profile 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 September 30, 2022		As of December 31, 2021
Median Kliniken S.á.r.l ("MEDIAN")	$	449,226	$	517,648
Swiss Medical Network		422,731		476,193
Steward (Macquarie Transaction)		419,040		—
Policlinico di Monza		78,057		95,468
HM Hospitales		52,956		63,618
Total	$	1,422,010	$	1,152,927

For the increase in our investments in unconsolidated real estate joint ventures since December 31, 2021, see "New Investments" section in this same Note 3 for a discussion of the Macquarie Transaction. Through the first nine months of 2022, we received approximately $66 million of dividends from these real estate joint ventures, including approximately $27 million of annual dividends from our joint venture in Switzerland.

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. In many cases, we would not be able to acquire the larger real estate portfolio without such investments in operators. These investments also offer the opportunity 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 September 30, 2022		As of December 31, 2021
Steward (loan investment)	$	362,825	$	360,164
International joint venture		231,402		219,387
Springstone		200,827		187,450
Priory		144,266		42,315
Swiss Medical Network		147,189		159,208
Steward (equity investment)		139,000		139,000
Prospect		112,774		112,283
Aevis Victoria SA ("Aevis")		73,746		61,271
Aspris Children's Services ("Aspris")		16,032		8,356
Total	$	1,428,061	$	1,289,434

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

Pursuant to our approximate 5% stake in Aevis and other investments marked to fair value, we recorded a $12.6 million favorable non-cash fair value adjustment during the first nine months of 2022 as shown in the "Other (including fair value adjustments on securities)" line of the condensed consolidated statements of net income; whereas, this was a $2.8 million favorable non-cash fair value adjustment for the same period of 2021. We also earned approximately $4 million of dividend income from our Switzerland investments during the first nine months of 2022.

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

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 financing receivables 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 September 30,
	2022			2021
Balance at beginning of the period	$	55,250		$	7,783
Provision (recovery) for credit loss		(19,677	)		1,829
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(26,362	)		(85	)
Balance at end of the period	$	9,211		$	9,527


	For the Nine Months Ended September 30,
	2022			2021
Balance at beginning of the year	$	48,527		$	8,726
Provision (recovery) for credit loss		(12,920	)		890
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(26,396	)		(89	)
Balance at end of the period	$	9,211		$	9,527

Other Investment Activities

In the 2022 second quarter, we loaned $150 million to Steward pursuant to a five-year secured loan. The loan bears interest at a current market rate (comparable to recent lease rates) plus a component of additional interest upon repayment. The loan is prepayable without penalty and is mandatorily prepayable upon certain sales of Steward assets and operations.

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 September 30, 2022, our largest single property represented approximately 3.0% of our total assets, similar to December 31, 2021.

Operator concentration – For the three and nine months ended September 30, 2022, revenue from each of Steward, Circle, and Prospect individually represented more than 10% of our total revenues. In comparison, Steward and Circle, individually, represented more than 10% of our total revenues for the three and nine months ended September 30, 2021.

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

Facility type concentration – For the three and nine months ended September 30, 2022, approximately 75% of our revenues were generated from our general acute care facilities, while revenues from our behavioral and rehabilitation facilities made up 14% and 8%, respectively. Freestanding ER/urgent care facilities and long-term acute care facilities combined to make up the remaining 3%. In comparison, general acute care and rehabilitation facilities made up 80% and 10%, respectively, of our total revenues for the three and nine months ended September 30, 2021, while revenues from our behavioral health, freestanding ER/urgent care, and long-term acute care facilities combined to make up approximately 10% of our revenues for the same periods.

(For geographic and facility type concentration metrics above, we allocate our investments in operating entities pro rata based on the gross book value of the real estate. Such pro rata allocations are subject to change from period to period.)

Earnings Per Share/Unit

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Earnings Per Share/Unit

9. 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 September 30,
	2022			2021
Numerator:
Net income	$	222,020		$	171,395
Non-controlling interests’ share in net income		(227	)		(258	)
Participating securities’ share in earnings		(288	)		(328	)
Net income, less participating securities’ share in earnings	$	221,505		$	170,809
Denominator:
Basic weighted-average common shares		598,980			595,119
Dilutive potential common shares		359			2,201
Diluted weighted-average common shares		599,339			597,320


	For the Nine Months Ended September 30,
	2022			2021
Numerator:
Net income	$	1,044,031		$	450,096
Non-controlling interests’ share in net income		(960	)		(611	)
Participating securities’ share in earnings		(1,035	)		(1,088	)
Net income, less participating securities’ share in earnings	$	1,042,036		$	448,397
Denominator:
Basic weighted-average common shares		598,828			586,291
Dilutive potential common shares		271			1,680
Diluted weighted-average common shares		599,099			587,971

MPT Operating Partnership, L.P.

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


	For the Three Months Ended September 30,
	2022			2021
Numerator:
Net income	$	222,020		$	171,395
Non-controlling interests’ share in net income		(227	)		(258	)
Participating securities’ share in earnings		(288	)		(328	)
Net income, less participating securities’ share in earnings	$	221,505		$	170,809
Denominator:
Basic weighted-average units		598,980			595,119
Dilutive potential units		359			2,201
Diluted weighted-average units		599,339			597,320


	For the Nine Months Ended September 30,
	2022			2021
Numerator:
Net income	$	1,044,031		$	450,096
Non-controlling interests’ share in net income		(960	)		(611	)
Participating securities’ share in earnings		(1,035	)		(1,088	)
Net income, less participating securities’ share in earnings	$	1,042,036		$	448,397
Denominator:
Basic weighted-average units		598,828			586,291
Dilutive potential units		271			1,680
Diluted weighted-average units		599,099			587,971

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share / (Unit)-based compensation expense	$ 33,001	$ 38,590
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	28,900,000
Reserved an additional shares of common stock for awards under the Equity Incentive Plan	16,000,000
Common stock remaining for future stock awards transferred to the equity incentive plan	19,300,000

Commitments and Contingencies - Additional Information (Detail) $ in Millions		9 Months Ended
	Aug. 26, 2022 USD ($) Hospital	Sep. 30, 2022 Hospital
HCA Healthcare [Member]
Commitment And Contingencies [Line Items]
Number of facilities acquired		5
HCA Healthcare [Member] \| Steward Health Care System LLC [Member]
Commitment And Contingencies [Line Items]
Number of facilities acquired		5
Acute Care Hospital [Member] \| HCA Healthcare [Member]
Commitment And Contingencies [Line Items]
Number of facilities acquired		5
Lifepoint Transaction [Member] \| Springstone Health Opco, LLC [Member]
Commitment And Contingencies [Line Items]
Purchase price of acquisition \| $	$ 250
Initial acquisition loan commitment \| $	$ 200
Lifepoint Transaction [Member] \| Acute Care Hospital [Member] \| Springstone Health Opco, LLC [Member]
Commitment And Contingencies [Line Items]
Number of years to extend current lease	five years
Number of business agreed to extend current lease	8
Lease extension expiration year	2041

Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Business Acquisition [Line Items]
Commitment	$ 373,079
Costs Incurred as of September 30, 2022	151,366
Steward [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	169,408
Costs Incurred as of September 30, 2022	$ 57,911
Estimated Rent Commencement Date	4Q 2025
Ernest [Member] \| Stockton, California [Member]
Business Acquisition [Line Items]
Commitment	$ 47,700
Costs Incurred as of September 30, 2022	$ 43,785
Estimated Rent Commencement Date	4Q 2022
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 46,159
Costs Incurred as of September 30, 2022	$ 11,809
Estimated Rent Commencement Date	2Q 2023
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 41,577
Costs Incurred as of September 30, 2022	$ 29,182
Estimated Rent Commencement Date	3Q 2023
Springstone [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 34,600
Costs Incurred as of September 30, 2022	$ 1,144
Estimated Rent Commencement Date	1Q 2024
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 33,635
Costs Incurred as of September 30, 2022	$ 7,535
Estimated Rent Commencement Date	3Q 2024

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Net income	$ 222,020	$ 171,395	$ 1,044,031	$ 450,096
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	52,975	8,847	123,827	28,558
Foreign currency translation loss	(108,845)	(25,191)	(226,401)	(47,077)
Total comprehensive income	166,150	155,051	941,457	431,577
Comprehensive income attributable to non-controlling interests	(227)	(258)	(960)	(611)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	165,923	154,793	940,497	430,966
MPT Operating Partnership, L.P. [Member]
Net income	222,020	171,395	1,044,031	450,096
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	52,975	8,847	123,827	28,558
Foreign currency translation loss	(108,845)	(25,191)	(226,401)	(47,077)
Total comprehensive income	166,150	155,051	941,457	431,577
Comprehensive income attributable to non-controlling interests	(227)	(258)	(960)	(611)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 165,923	$ 154,793	$ 940,497	$ 430,966

- 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 - Summary of Operating Results from Properties Sold (Parenthetical) (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2022
Straight-line rent write-offs		$ 42.0
Disposal Group, Not Discontinued Operations [Member]
Straight line rent and other write offs	$ 35.0	42.0
Massachusetts-based General Acute Care Hospitals [Member]
Straight-line rent write-offs	125.0	125.0
Massachusetts-based General Acute Care Hospitals [Member] \| Disposal Group, Not Discontinued Operations [Member]
Gains	$ 68.8	$ 536.8