0000950170-23-020652 | 10-Q | XBRL Viewer | Medical Properties Trust INC

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Document and Entity Information - shares shares in Millions	3 Months Ended
Document and Entity Information - shares shares in Millions	Mar. 31, 2023	May 05, 2023
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST, INC.
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		598.3
Title of 12(b) Security	Common stock, par value $0.001 per share, of Medical Properties Trust, Inc.
Security Exchange Name	NYSE
Entity Shell Company	false
Entity File Number	001-32559
Entity Tax Identification Number	20-0191742
Entity Address, Address Line One	1000 URBAN CENTER DRIVE
Entity Address, Address Line Two	SUITE 501
Entity Address, City or Town	BIRMINGHAM
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	205
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	MD
Document Quarterly Report	true
Document Transition Report	false
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity File Number	333-177186
Entity Tax Identification Number	20-0242069
Entity Address, Address Line One	1000 URBAN CENTER DRIVE
Entity Address, Address Line Two	SUITE 501
Entity Address, City or Town	BIRMINGHAM
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	205
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	DE

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 13,092,510	$ 13,862,415
Investment in financing leases	1,582,416	1,691,323
Real estate held for sale	881,587
Mortgage loans	346,446	364,101
Gross investment in real estate assets	15,902,959	15,917,839
Accumulated depreciation and amortization	(1,207,699)	(1,193,312)
Net investment in real estate assets	14,695,260	14,724,527
Cash and cash equivalents	302,321	235,668
Interest and rent receivables, net	169,511	167,035
Straight-line rent receivables	810,911	787,166
Investments in unconsolidated real estate joint ventures	1,506,474	1,497,903
Investments in unconsolidated operating entities	1,310,460	1,444,872
Other loans	276,367	227,839
Other assets	578,853	572,990
Total Assets	19,650,157	19,658,000
Liabilities
Debt, net	10,438,151	10,268,412
Accounts payable and accrued expenses	595,269	621,324
Deferred revenue	29,391	27,727
Obligations to tenants and other lease liabilities	144,092	146,130
Total Liabilities	11,206,903	11,063,593
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 - 598,302 shares at March 31, 2023 and 597,476 shares at December 31, 2022	598	597
Additional paid-in capital	8,541,414	8,535,140
Retained (deficit) earnings	(25,413)	116,285
Accumulated other comprehensive loss	(74,919)	(59,184)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,441,680	8,592,838
Non-controlling interests	1,574	1,569
Total Equity / Capital	8,443,254	8,594,407
Total Liabilities and Equity / Capital	19,650,157	19,658,000
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	13,092,510	13,862,415
Investment in financing leases	1,582,416	1,691,323
Real estate held for sale	881,587
Mortgage loans	346,446	364,101
Gross investment in real estate assets	15,902,959	15,917,839
Accumulated depreciation and amortization	(1,207,699)	(1,193,312)
Net investment in real estate assets	14,695,260	14,724,527
Cash and cash equivalents	302,321	235,668
Interest and rent receivables, net	169,511	167,035
Straight-line rent receivables	810,911	787,166
Investments in unconsolidated real estate joint ventures	1,506,474	1,497,903
Investments in unconsolidated operating entities	1,310,460	1,444,872
Other loans	276,367	227,839
Other assets	578,853	572,990
Total Assets	19,650,157	19,658,000
Liabilities
Debt, net	10,438,151	10,268,412
Accounts payable and accrued expenses	420,387	444,354
Deferred revenue	29,391	27,727
Obligations to tenants and other lease liabilities	144,092	146,130
Payable due to Medical Properties Trust, Inc.	174,492	176,580
Total Liabilities	11,206,513	11,063,203
Equity / Capital
General Partner - issued and outstanding - [ ] units at March 31, 2023 and 5,976 units at December 31, 2022	85,244	86,599
Limited Partners - issued and outstanding - xxx,xxx units at March 31, 2023 and 591,500 units at December 31, 2022	8,431,745	8,565,813
Accumulated other comprehensive loss	(74,919)	(59,184)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,442,070	8,593,228
Non-controlling interests	1,574	1,569
Total Equity / Capital	8,443,644	8,594,797
Total Liabilities and Equity / Capital	$ 19,650,157	$ 19,658,000

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2023	Dec. 31, 2022
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	598,302,000	597,476,000
Common stock, shares outstanding	598,302,000	597,476,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	5,984,000	5,976,000
General partner, units outstanding	5,984,000	5,976,000
Common Units \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	592,318,000	591,500,000
Limited Partners, units outstanding	592,318,000	591,500,000

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenues
Rent billed	$ 248,157	$ 263,402
Straight-line rent	56,693	61,044
Income from financing leases	13,195	51,776
Interest and other income	32,166	33,578
Total revenues	350,211	409,800
Expenses
Interest	97,654	91,183
Real estate depreciation and amortization	83,860	85,316
Property-related	7,110	8,598
General and administrative	41,724	41,424
Total expenses	230,348	226,521
Other (expense) income
Gain on sale of real estate	62	451,638
Real estate and other impairment charges	(89,538)	(4,875)
Earnings from equity interests	11,352	7,338
Debt refinancing and unutilized financing costs		(8,816)
Other (including fair value adjustments on securities)	(5,166)	14,762
Total other (expense) income	(83,290)	460,047
Income before income tax	36,573	643,326
Income tax expense	(3,543)	(11,379)
Net income	33,030	631,947
Net income attributable to non-controlling interests	(236)	(266)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 32,794	$ 631,681
Earnings per common share (units) basic
Net income attributable to MPT common stockholders (Operating Partnership partners), basic	$ 0.05	$ 1.05
Earnings per common share (units) diluted
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ 0.05	$ 1.05
Weighted average shares (units) outstanding basic	598,302	598,676
Weighted average shares (units) outstanding diluted	598,310	598,932
Dividends declared per common share (unit)	$ 0.29	$ 0.29
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 248,157	$ 263,402
Straight-line rent	56,693	61,044
Income from financing leases	13,195	51,776
Interest and other income	32,166	33,578
Total revenues	350,211	409,800
Expenses
Interest	97,654	91,183
Real estate depreciation and amortization	83,860	85,316
Property-related	7,110	8,598
General and administrative	41,724	41,424
Total expenses	230,348	226,521
Other (expense) income
Gain on sale of real estate	62	451,638
Real estate and other impairment charges	(89,538)	(4,875)
Earnings from equity interests	11,352	7,338
Debt refinancing and unutilized financing costs		(8,816)
Other (including fair value adjustments on securities)	(5,166)	14,762
Total other (expense) income	(83,290)	460,047
Income before income tax	36,573	643,326
Income tax expense	(3,543)	(11,379)
Net income	33,030	631,947
Net income attributable to non-controlling interests	(236)	(266)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 32,794	$ 631,681
Earnings per common share (units) basic
Net income attributable to MPT common stockholders (Operating Partnership partners), basic	$ 0.05	$ 1.05
Earnings per common share (units) diluted
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ 0.05	$ 1.05
Weighted average shares (units) outstanding basic	598,302	598,676
Weighted average shares (units) outstanding diluted	598,310	598,932
Dividends declared per common share (unit)	$ 0.29	$ 0.29

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Net income	$ 33,030	$ 631,947
Other comprehensive income:
Unrealized (loss) gain on interest rate swaps, net of tax	(15,325)	44,932
Foreign currency translation gain (loss)	28,143	(13,215)
Reclassification of interest rate swap gain from AOCI, net of tax	(28,553)
Total comprehensive income	17,295	663,664
Comprehensive income attributable to non-controlling interests	(236)	(266)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	17,059	663,398
MPT Operating Partnership, L.P. [Member]
Net income	33,030	631,947
Other comprehensive income:
Unrealized (loss) gain on interest rate swaps, net of tax	(15,325)	44,932
Foreign currency translation gain (loss)	28,143	(13,215)
Reclassification of interest rate swap gain from AOCI, net of tax	(28,553)
Total comprehensive income	17,295	663,664
Comprehensive income attributable to non-controlling interests	(236)	(266)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 17,059	$ 663,398

- 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

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+ Details

Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	MPT Operating Partnership, L.P. [Member] Limited 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, 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 interests	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, 2022	8,594,407	8,594,797	$ 86,599		$ 597	$ 8,565,813	8,535,140	116,285	(59,184)	(59,184)	1,569	1,569
Beginning balance (in shares) at Dec. 31, 2022			5,976		597,476	591,500
Net income	33,030	33,030	$ 328	$ 32,466				32,794			236	236
Unrealized gain (loss) on interest rate swap, net of tax	(15,325)	(15,325)							(15,325)	(15,325)
Foreign currency translation (loss) gain	28,143	28,143							28,143	28,143
Reclassification of interest rate swap gain to earnings, net of tax	(28,553)	(28,553)							(28,553)	(28,553)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,829	11,829	$ 118	$ 11,711	$ 1		11,828
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			13	1,312	1,325
Stock vesting - satisfaction of tax withholding	5,554	(5,554)	$ (56)	$ (5,498)			5,554
Stock vesting - satisfaction of tax withholding (Shares)			(5)	(494)	(499)
Distributions to non-controlling interests	(231)	(231)									(231)	231
Dividends (Distributions) declared	(174,492)	(174,492)	$ (1,745)	$ (172,747)				(174,492)
Ending balance at Mar. 31, 2023	$ 8,443,254	$ 8,443,644	$ 85,244		$ 598	$ 8,431,745	$ 8,541,414	$ (25,413)	$ (74,919)	$ (74,919)	$ 1,574	$ 1,574
Ending balance (in shares) at Mar. 31, 2023			5,984		598,302	592,318

Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.29	0.29
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Operating activities
Net income	$ 33,030	$ 631,947
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	87,586	88,760
Amortization of deferred financing costs and debt discount	4,014	5,285
Straight-line rent revenue and other	(58,566)	(75,385)
Stock / (Unit)-based compensation expense	11,829	11,804
Gain on sale of real estate	(62)	(451,638)
Real estate and other impairment charges	89,538	4,875
Straight-line rent and other write-off (recovery)	2,192	(2,271)
Debt refinancing and unutilized financing costs		8,816
Tax rate changes	(7,305)
Other adjustments	(8,505)	(1,040)
Changes in:
Interest and rent receivables	(514)	(12,431)
Other assets	(2,493)	(41)
Accounts payable and accrued expenses	(15,696)	(21,648)
Deferred revenue	600	(7,646)
Net cash provided by operating activities	135,648	179,387
Investing activities
Cash paid for acquisitions and other related investments	(72,900)	(724,795)
Net proceeds from sale of real estate	100	1,711,608
Principal received on loans receivable	221,876	6,355
Investment in loans receivable	(50,000)	(10,414)
Construction in progress and other	(13,292)	(36,115)
Capital additions and other investments, net	(68,606)	(67,605)
Net cash provided by investing activities	17,178	879,034
Financing activities
Payments of term debt		(869,606)
Revolving credit facilities, net	95,919	(198,599)
Dividends paid	(176,580)	(176,494)
Lease deposits and other obligations to tenants	(2,691)	15,168
Stock vesting - satisfaction of tax withholdings	(5,554)	(27,919)
Payment of debt refinancing, deferred financing costs, and other financing activities	(219)	(6,366)
Net cash used for financing activities	(89,125)	(1,263,816)
Increase (decrease) in cash, cash equivalents, and restricted cash for period	63,701	(205,395)
Effect of exchange rate changes	2,927	(4,721)
Cash, cash equivalents, and restricted cash at beginning of period	241,538	461,882
Cash, cash equivalents, and restricted cash at end of period	308,166	251,766
Interest paid	116,436	111,012
Supplemental schedule of non-cash financing activities:
Dividends declared, unpaid	174,492	174,018
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	235,668	459,227
Restricted cash, included in Other assets at beginning of period	$ 5,870	$ 2,655
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	$ 241,538	$ 461,882
Cash and cash equivalents at end of period	302,321	248,846
Restricted cash, included in Other assets at end of period	$ 5,845	$ 2,920
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	$ 308,166	$ 251,766
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	33,030	631,947
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	87,586	88,760
Amortization of deferred financing costs and debt discount	4,014	5,285
Straight-line rent revenue and other	(58,566)	(75,385)
Stock / (Unit)-based compensation expense	11,829	11,804
Gain on sale of real estate	(62)	(451,638)
Real estate and other impairment charges	89,538	4,875
Straight-line rent and other write-off (recovery)	2,192	(2,271)
Debt refinancing and unutilized financing costs		8,816
Tax rate changes	(7,305)
Other adjustments	(8,505)	(1,040)
Changes in:
Interest and rent receivables	(514)	(12,431)
Other assets	(2,493)	(41)
Accounts payable and accrued expenses	(15,696)	(21,648)
Deferred revenue	600	(7,646)
Net cash provided by operating activities	135,648	179,387
Investing activities
Cash paid for acquisitions and other related investments	(72,900)	(724,795)
Net proceeds from sale of real estate	100	1,711,608
Principal received on loans receivable	221,876	6,355
Investment in loans receivable	(50,000)	(10,414)
Construction in progress and other	(13,292)	(36,115)
Capital additions and other investments, net	(68,606)	(67,605)
Net cash provided by investing activities	17,178	879,034
Financing activities
Payments of term debt		(869,606)
Revolving credit facilities, net	95,919	(198,599)
Dividends paid	(176,580)	(176,494)
Lease deposits and other obligations to tenants	(2,691)	15,168
Stock vesting - satisfaction of tax withholdings	(5,554)	(27,919)
Payment of debt refinancing, deferred financing costs, and other financing activities	(219)	(6,366)
Net cash used for financing activities	(89,125)	(1,263,816)
Increase (decrease) in cash, cash equivalents, and restricted cash for period	63,701	(205,395)
Effect of exchange rate changes	2,927	(4,721)
Cash, cash equivalents, and restricted cash at beginning of period	241,538	461,882
Cash, cash equivalents, and restricted cash at end of period	308,166	251,766
Interest paid	116,436	111,012
Supplemental schedule of non-cash financing activities:
Dividends declared, unpaid	174,492	174,018
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	235,668	459,227
Restricted cash, included in Other assets at beginning of period	$ 5,870	$ 2,655
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	$ 241,538	$ 461,882
Cash and cash equivalents at end of period	302,321	248,846
Restricted cash, included in Other assets at end of period	$ 5,845	$ 2,920
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	$ 308,166	$ 251,766

Organization

3 Months Ended

Mar. 31, 2023

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 are generally not subject to United States (“U.S.”) federal income tax on our REIT taxable income, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed such 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 healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases, which require the tenant to bear most of the costs associated with the property. The majority of our leased assets are owned 100%; however, we do own some leased assets through joint ventures with other partners that share our view that healthcare facilities are part of the infrastructure of any community, which we refer to as investments in unconsolidated real estate joint ventures. We also may make mortgage loans to healthcare operators collateralized by their real estate. In addition, we may make noncontrolling investments in our tenants (which we refer to as investments in unconsolidated operating entities), 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 March 31, 2023, we have investments in 444 facilities in 31 states in the U.S., in seven countries in Europe, one country in South America, and across Australia. Our properties consist of general acute care hospitals, behavioral health facilities, inpatient physical rehabilitation facilities, long-term acute care hospitals, and freestanding ER/urgent care facilities. We manage our business as a single business segment.

Summary of Significant Accounting Policies	3 Months Ended
Summary of Significant Accounting Policies	Mar. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Unaudited Interim Condensed Consolidated Financial Statements: The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement have been included. Operating results for the three months ended March 31, 2023, are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The condensed consolidated balance sheet at December 31, 2022 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. The preparation of our condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2023 (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 as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2022. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 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 March 31, 2023, we had loans and/or equity investments in certain variable interest entities approximating $425 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities.

Real Estate and Other Activities

3 Months Ended

Mar. 31, 2023

Real Estate [Abstract]

Real Estate and Other Activities

3. Real Estate and Other Activities

New Investments

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


	For the Three Months Ended March 31,
	2023			2022

Land and land improvements	$	9,313		$	9,671
Buildings		11,652			204,829
Intangible lease assets — subject to amortization (weighted-average useful life of 28.8 years for 2023 and 13.2 years for 2022)		1,935			5,461
Investments in unconsolidated real estate joint ventures		—			399,456
Investments in unconsolidated operating entities		50,000			131,105
Liabilities assumed		—			(25,727	)
	$	72,900		$	724,795
Loans repaid(1)		(22,900	)		—
Total net assets acquired	$	50,000		$	724,795

(1)

The 2023 column includes a $23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below.

2023 Activity

Lifepoint Transaction

On February 7, 2023, a subsidiary of Lifepoint Health, Inc. ("Lifepoint") acquired a majority interest in Springstone (the "Lifepoint Transaction") based on an enterprise value of $250 million. As part of the transaction, we received approximately $205 million in full satisfaction of our initial acquisition loan to Springstone, including accrued interest, and we retained our minority equity investment in the operations of Springstone. Separately, and as part of our acquisition in 2021 of Springstone's real estate assets, we converted a mortgage loan into the fee simple ownership of a property in Washington, which will be leased, along with the other 17 behavioral health hospitals already leased to Springstone, under the master lease agreement. In connection with the Lifepoint Transaction, Lifepoint extended its current lease with us on eight existing general acute care hospitals by five years to 2041.

Other Transactions

As part of an expected series of Prospect Medical Holdings, Inc. ("Prospect") capital restructuring transactions, we originated a $50 million convertible loan to PHP Holdings, the managed care business of Prospect, in the first quarter of 2023. The loan is

convertible into equity of PHP Holdings. See subsection titled "Leasing Operations (Lessor)" in this same Note 3 for further information on Prospect.

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 sale of 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. 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 our condensed consolidated balance sheets), which is being accounted for under the equity method of accounting.

In connection with this transaction, we separated the eight Massachusetts-based facilities into a new master lease with terms generally identical to the other master lease, and the initial fixed lease term of both master leases was extended to 2041.

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 purchasing the shares of the real estate holding entities, which 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 Group ("Priory"), of which we funded £96.5 million towards a £100 million participation level in the variable rate loan.

Development Activities

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


Property	Commitment		Costs Incurred as of March 31, 2023		Estimated Rent Commencement Date
Ernest Health, Inc. ("Ernest") (Stockton, California)	$	47,700	$	46,372	2Q 2023
IMED Hospitales ("IMED") (Spain)		51,043		13,323	2Q 2023
Ernest (South Carolina)		22,400		14,469	3Q 2023
IMED (Spain)		45,976		37,568	3Q 2023
Springstone (Texas)		31,600		4,099	1Q 2024
IMED (Spain)		37,193		9,170	3Q 2024
Steward (Texas)		169,408		57,059	1Q 2026
	$	405,320	$	182,060

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 pursuant to an existing long-term master lease.

We continue to fund the redevelopment of our Norwood facility in Massachusetts, and recovery receivables of approximately $150 million associated with the prior storm and flood damage to this facility are included in the "Other assets" line of our condensed consolidated balance sheets.

Disposals

2023 Activity

On March 30, 2023, we entered into a definitive agreement to sell our 11 general acute care facilities located in Australia and operated by Healthscope Ltd. ("Healthscope") (the "Australia Transaction") to affiliates of HMC Capital for cash proceeds of approximately A$1.2 billion. As a result, we designated the Australian portfolio as held for sale and recorded an approximate $79

million net impairment charge, which included $37.4 million of straight-line rent receivables, an estimated $8 million in fees to sell the hospitals, and $13 million of accumulated other comprehensive loss related to foreign currency translation. This impairment charge was partially offset by approximately $29 million of deferred gains from our interest rate swap in accumulated other comprehensive income that was reclassified to earnings as part of this expected transaction. This transaction is expected to close in two phases with the first (and larger) phase expected to close in the second quarter and the full transaction expected to be complete by the end of 2023. We currently plan to use proceeds from the sale to prepay in full the Australian term loan.

On March 8, 2023, we received notice that Prime Healthcare Services, Inc. ("Prime") will exercise its right to repurchase from us during the third quarter of 2023 the real estate associated with one master lease for approximately $100 million. As such, we recorded an approximate $11 million non-cash impairment charge in the first quarter of 2023 related to unbilled rent on the three facilities expected to be sold.

Although we currently expect the Australia Transaction and Prime repurchase will occur as planned, no assurances can be given that the transactions will close as described above.

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 same Note 3 for further details on this transaction.

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

Summary of Operations for Disposed (or to be Disposed) Assets in 2023 and 2022

The properties expected to be sold during 2023 and sold during 2022 do not meet the definition of discontinued operations. However, the following represents the operating results from these properties for the periods presented (in thousands):


	For the Three Months Ended March 31,
	2023(1)			2022
Revenues(2)	$	18,877		$	40,579
Real estate depreciation and amortization		(4,991	)		(5,247	)
Property-related expenses		(1,413	)		(3,015	)
Real estate and other impairment charges(3)		(89,538	)		—
Other (expense) income(4)		(7,244	)		444,268
Income from real estate dispositions, net	$	(84,309	)	$	476,585

(1)

The 2023 column consists of assets designated as held for sale in the first quarter of 2023 as a result of the transactions described in the "2023 Activity" subsection above.

(2)

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

(3)

Includes an approximate $79 million net impairment charge (including $37.4 million of straight-line rent write-offs) associated with the Australia Transaction and an approximate $11 million non-cash impairment charge associated with the repurchase of three Prime facilities for the three months ended March 31, 2023.

(4)

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

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 ("CPI") (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. 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.

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 March 31, 2023, we account for all of these leases as operating leases, except where GAAP requires alternative classification, including leases on 13 Ernest 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 March 31, 2023			As of December 31, 2022
Minimum lease payments receivable	$	626,721		$	880,253
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(588,097	)		(731,915	)
Net investment in direct financing leases		242,442			352,156
Other financing leases (net of allowance for credit loss)		1,339,974			1,339,167
Total investment in financing leases	$	1,582,416		$	1,691,323

The decrease in our net investment in direct financing leases since December 31, 2022, is the result of classifying three Prime facilities as held for sale at March 31, 2023. See subsection above titled "Disposals" for further information.

Other Leasing Activities

At March 31, 2023, 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.

As more fully described in “Item 1A. Risk Factors” in our Annual Report on Form 10-K, our tenants’ financial performance and resulting ability to satisfy their lease and loan obligations to us are material to our financial results and our ability to service our debt and make distributions to our stockholders. Our tenants operate in the healthcare industry, which is highly regulated, and changes in regulation (or delays in enacting regulation) may temporarily impact our tenants’ operations until they are able to make the appropriate adjustments to their business. In addition, our tenants may experience operational challenges from time-to-time as a result of many factors, including those external to them, such as public health crises (like the coronavirus ("COVID-19") pandemic), economic issues resulting in high inflation and spikes in labor costs, and adverse market and political conditions. We monitor our tenants' operating results and the potential impact from these challenges. We may elect to provide support to our tenants from time-to-time in the form of short-term rent deferrals to be paid back in full (like as described below under COVID-19 Rent Deferrals and Pipeline Health System), or in the form of temporary loans (like as described below under Prospect Medical Holdings).

COVID-19 Rent Deferrals

Due to COVID-19 and its impact on our tenants' business, we agreed to defer collection of a certain amount of rent for certain tenants. Pursuant to our agreements with these tenants, we expect repayments of previously deferred rent to continue, with the remaining outstanding deferred rent balance of approximately $12.2 million as of March 31, 2023, 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. On February 6, 2023, Pipeline emerged from bankruptcy. Per the bankruptcy settlement, Pipeline's current lease of our California assets remains in place, and we were repaid on February 7, 2023 for all rent that was outstanding at December 31, 2022, along with what was due for the first quarter of 2023. We have agreed to defer $5.6 million, or approximately 30%, of rent in 2023 to be paid in 2024 with interest.

Prospect Medical Holdings

In August 2019, we invested in a portfolio of 14 acute care hospitals in three states (California, Pennsylvania, and Connecticut) operated by and master leased to or mortgaged by Prospect for a combined investment of approximately $1.5 billion. In addition, we originated a $112.9 million term loan cross-defaulted to the master lease and mortgage loan agreements and further secured by a parent guaranty. In the 2022 second quarter, we funded an additional $100 million towards the existing mortgage loan that is secured by a first lien on a California hospital.

Prospect's operations were negatively impacted by the COVID-19 global pandemic commencing in early 2020, but Prospect continued to remain current with respect to contractual rent and interest payments until the fourth quarter of 2022. Accordingly, and due further to termination of certain refinancing negotiations between Prospect and certain third parties, we recorded an approximate $280 million impairment charge in the 2022 fourth quarter. As part of this charge, we reduced the carrying value of the underperforming Pennsylvania properties by approximately $170 million (to approximately $250 million) and reserved all unbilled rent accruals for a total of $112 million. In the first quarter of 2023, we began accounting for Prospect revenue on a cash basis and did not recognize any rent or interest revenue in the quarter.

In late March 2023, Prospect received a binding commitment from several lenders that is expected to provide them with liquidity to pay down certain debt instruments. Along with these commitments from third-party lenders, we agreed to pursue certain transactions with Prospect that would result in the following: a) maintain the master lease covering six California hospitals with no changes in rental rates or escalator provisions, and with the expectation that Prospect will begin making cash payments for approximately 50% of the contractual monthly rent due on these California properties starting in September 2023, b) transition the Pennsylvania properties back to Prospect in return for a well-collateralized mortgage on the facilities, c) provide up to $75 million in a loan secured by a first lien on Prospect's accounts receivable and certain other assets, d) obtain a non-controlling ownership interest in Prospect's managed care business (PHP Holdings) equal in value to unpaid rent and interest, our $112.9 million term loan, and other obligations at the time of such investment, and e) complete the previously disclosed sale of the Connecticut properties to Yale New Haven ("Yale"), as more fully described in Note 9 to the condensed consolidated financial statements. As part of these capital restructuring steps (as discussed under "New Investments" in this same Note 3), we originated a $50 million loan to PHP Holdings in March 2023 that is convertible into equity of PHP Holdings. At March 31, 2023, we believe our remaining investment in the Prospect real estate and other assets are fully recoverable from the collateral available, but no assurances can be given that the transactions described above will occur or that we will not have any further impairments in future periods.

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	Ownership Percentage	As of March 31, 2023		As of December 31, 2022
Median Kliniken S.á.r.l ("MEDIAN")	50%	$	483,706	$	482,735
Swiss Medical Network	70%		461,952		454,083
Steward (Macquarie Transaction)	50%		416,068		417,701
Policlinico di Monza	50%		88,658		86,245
HM Hospitales	45%		56,090		57,139
Total		$	1,506,474	$	1,497,903

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 March 31, 2023		As of December 31, 2022
Steward (loan investment)	$	362,586	$	362,831
International joint venture		230,153		231,402
Priory		159,668		156,575
Swiss Medical Network		158,687		157,145
Steward (equity investment)		125,862		125,862
Prospect		112,701		112,777
Aevis Victoria SA ("Aevis")		77,618		72,904
PHP Holdings		49,895		—
Aspris Children's Services ("Aspris")		16,014		16,023
Springstone		10,933		200,827
Caremax		6,343		8,526
Total	$	1,310,460	$	1,444,872

The change since December 31, 2022 primarily relates to the payoff of the Springstone loan in February 2023, partially offset by the loan made to PHP Holdings. See "2023 Activity" under subsection titled "New Investments" in this same Note 3 for further details.

Pursuant to our approximate 5% stake in Aevis and other investments marked to fair value, we recorded approximately $4 million in favorable non-cash fair value adjustments during the first quarter of 2023 as shown in the "Other (including fair value adjustments on securities)" line of the condensed consolidated statements of net income; whereas, this was an $8.0 million favorable non-cash fair value adjustment for the same period of 2022.

Other Investment Activities

In conjunction with the redevelopment of Steward's Norwood hospital, we advanced $50 million, in the 2023 first quarter, that is secured by, among other things, proceeds from insurance claims in excess of the advance.

Credit Loss Reserves

We apply a forward-looking "expected loss" model to all of our financing receivables, including financing leases and loans, based on historical credit losses of similar instruments.

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


	For the Three Months Ended March 31,
	2023			2022
Balance at beginning of the year	$	121,146		$	48,527
Provision for credit loss, net		986			5,412
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(160	)		(6	)
Balance at end of the period	$	121,972		$	53,933

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. See below for our concentration details (dollars in thousands):

Total Assets by Operator


	As of March 31, 2023					As of December 31, 2022
Operators	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Steward	$	4,800,594		24.4	%	$	4,762,673		24.2	%
Circle Health Ltd ("Circle")		2,092,822		10.7	%		2,062,474		10.5	%
Prospect		1,533,412		7.8	%		1,483,599		7.5	%
Priory		1,310,968		6.7	%		1,290,213		6.6	%
Springstone		796,248		4.0	%		985,959		5.0	%
Other operators		7,406,721		37.7	%		7,461,923		38.0	%
Other assets		1,709,392		8.7	%		1,611,159		8.2	%
Total	$	19,650,157		100.0	%	$	19,658,000		100.0	%

Total Assets by U.S. State and Country


	As of March 31, 2023					As of December 31, 2022
U.S. States and Other Countries	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Texas	$	2,008,146		10.2	%	$	1,967,948		10.0	%
California		1,502,060		7.7	%		1,450,112		7.4	%
Florida		1,319,878		6.7	%		1,324,555		6.8	%
Utah		1,218,883		6.2	%		1,224,484		6.2	%
Massachusetts		763,555		3.9	%		761,694		3.9	%
All other states		4,035,762		20.5	%		4,245,306		21.6	%
Other domestic assets		1,087,136		5.5	%		1,028,946		5.2	%
Total U.S.	$	11,935,420		60.7	%	$	12,003,045		61.1	%
United Kingdom	$	4,145,170		21.1	%	$	4,083,244		20.8	%
Australia		781,585		4.0	%		854,582		4.3	%
Switzerland		763,711		3.9	%		748,947		3.8	%
Germany		666,930		3.4	%		664,900		3.4	%
Spain		226,800		1.1	%		222,316		1.1	%
All other countries		508,285		2.6	%		498,753		2.5	%
Other international assets		622,256		3.2	%		582,213		3.0	%
Total international	$	7,714,737		39.3	%	$	7,654,955		38.9	%
Grand total	$	19,650,157		100.0	%	$	19,658,000		100.0	%

On an individual property basis, we had no investment in any single property greater than 3% of our total assets as of March 31, 2023.

Total Revenues by Operator


	For the Three Months Ended March 31,
	2023					2022
Operators	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Steward	$	103,494		29.6	%	$	121,244		29.6	%
Circle		47,415		13.5	%		51,212		12.5	%
Prospect		—		0.0	%		38,684		9.4	%
Priory		24,740		7.1	%		19,070		4.7	%
Springstone		20,167		5.8	%		21,664		5.3	%
Other operators		154,395		44.0	%		157,926		38.5	%
Total	$	350,211		100.0	%	$	409,800		100.0	%

Total Revenues by U.S. State and Country


	For the Three Months Ended March 31,
	2023					2022
U.S. States and Other Countries	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Texas	$	44,116		12.6	%	$	34,844		8.5	%
Utah		35,641		10.2	%		33,768		8.2	%
Florida		26,182		7.5	%		25,305		6.2	%
California		19,495		5.6	%		41,291		10.1	%
Massachusetts		6,816		1.8	%		32,631		8.0	%
All other states		99,137		28.4	%		125,907		30.7	%
Total U.S.	$	231,387		66.1	%	$	293,746		71.7	%
United Kingdom	$	84,206		24.0	%	$	83,906		20.5	%
Australia		15,237		4.4	%		17,031		4.1	%
All other countries		19,381		5.5	%		15,117		3.7	%
Total international	$	118,824		33.9	%	$	116,054		28.3	%
Grand total	$	350,211		100.0	%	$	409,800		100.0	%

Total Revenues by Facility Type


	For the Three Months Ended March 31,
	2023					2022
Facility Types	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
General acute care hospitals	$	253,036		72.3	%	$	316,019		77.0	%
Behavioral health facilities		53,658		15.3	%		50,897		12.4	%
Inpatient rehabilitation facilities		29,046		8.3	%		28,906		7.1	%
Long-term acute care hospitals		8,251		2.4	%		8,302		2.1	%
Freestanding ER/urgent care facilities		6,220		1.7	%		5,676		1.4	%
Total	$	350,211		100.0	%	$	409,800		100.0	%

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.

Debt

3 Months Ended

Mar. 31, 2023

Debt Disclosure [Abstract]

Debt

4. Debt

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


	As of March 31, 2023			As of December 31, 2022
Revolving credit facility(A)	$	1,031,037		$	929,584
Term loan		200,000			200,000
British pound sterling term loan due 2024(B)		129,353			126,690
British pound sterling term loan due 2025(B)		863,590			845,810
Australian term loan facility(B)		802,200			817,560
2.550% Senior Unsecured Notes due 2023(B)		493,480			483,320
3.325% Senior Unsecured Notes due 2025(B)		541,950			535,250
0.993% Senior Unsecured Notes due 2026(B)		541,950			535,250
2.500% Senior Unsecured Notes due 2026(B)		616,850			604,150
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)		740,220			724,980
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		431,795			422,905
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,492,425		$	10,325,499
Debt issue costs and discount, net		(54,274	)		(57,087	)
	$	10,438,151		$	10,268,412

(A)

Includes £119 million of GBP-denominated borrowings and €253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023.

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022.

As of March 31, 2023, 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):


2023	$	493,480
2024		931,553
2025		1,405,540
2026		2,689,837
2027		1,600,000
Thereafter		3,372,015
Total	$	10,492,425

On March 15, 2022, we paid off and terminated our $1 billion interim credit facility that was entered into on July 27, 2021 with proceeds from the Macquarie Transaction as more fully described in Note 3 to the condensed consolidated financial statements. As part of this transaction, we incurred approximately $8.8 million of debt refinancing costs.

Covenants

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem, or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. At March 31, 2023, the dividend restriction was 95% of NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of NAFFO, proceeds of equity issuances, and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. The Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations, and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At March 31, 2023, we were in compliance with all such financial and operating covenants.

Income Taxes

3 Months Ended

Mar. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

5. Income Taxes

As a result of the Australia Transaction described in Note 3 to the condensed consolidated financial statements, we recorded a $5 million tax benefit in the first quarter of 2023.

- 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

Stock Awards

3 Months Ended

Mar. 31, 2023

Share-Based Payment Arrangement [Abstract]

Stock Awards

6. 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 awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors, and we have reserved 28.9 million shares of common stock for awards, of which 16.7 million shares remain available for future stock awards as of March 31, 2023. Share-based compensation expense totaled $11.8 million for each of the three months ended March 31, 2023 and 2022.

Fair Value of Financial Instruments

3 Months Ended

Mar. 31, 2023

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

7. Fair Value of Financial Instruments

We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents and accounts payable and accrued expenses approximate their fair values. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as discounting the estimated future cash flows using the current rates at which similar receivables would be made to others with similar credit ratings and for the same remaining maturities. The fair value of our mortgage loans and other loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our revolving credit facility and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt.

Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be a prudent management decision.

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


	As of March 31, 2023							As of December 31, 2022
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables, net	$	169,511			$	160,947		$	167,035			$	163,101
Loans(1)		1,511,182		(2)		1,456,753			1,405,615		(2)		1,360,113
Debt, net		(10,438,151	)			(8,594,584	)		(10,268,412	)			(8,697,042	)

(1)

Excludes 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. In addition for December 31, 2022 only, this excludes the acquisition and mortgage loans made to Springstone, which were satisfied in full in February 2023 as further described in Note 3 to the condensed consolidated financial statements.

(2)

Includes $224.4 million and $223.8 million of mortgage loans, a $319.9 million and $315.9 million shareholder loan included in investments in unconsolidated real estate joint ventures, $693.0 million and $640.4 million of loans that are part of our investments in unconsolidated operating entities, and $273.9 million and $225.5 million of other loans at March 31, 2023 and December 31, 2022, 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 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. For December 31, 2022, our acquisition and mortgage loans to Springstone (which were satisfied in full in February 2023 as described in Note 3 to the condensed consolidated financial statements) were also accounted for under the fair value option method. We elected to account for these investments at fair value due to the size of the investments and because we believe this method was more reflective of current values.

At March 31, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands):


	As of March 31, 2023				As of December 31, 2022
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	122,073	$	122,073	$	140,260	$	140,260	Mortgage loans
Equity investment and other loans		243,561		247,125		434,609		441,943	Investments in unconsolidated operating entities/Other loans

Our loans to the international joint venture and its subsidiaries (as well as the Springstone loans at December 31, 2022) 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 the loans. Our equity investment in Springstone is recorded at fair value based on Level 2 inputs by discounting the estimated cash flows expected to be realized as part of the Lifepoint Transaction described in Note 3 to the condensed consolidated financial statements. Our equity investment in the international joint venture is recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify our valuations of equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuations require management judgment due to absence of quoted market prices. For the cash flow models, our observable inputs include use of a capitalization rate and discount rate (which is based on a weighted-average cost of capital). In regard to the underlying projections used in the discounted cash flow model, such projections are provided

by the investees. However, we will modify such projections as needed based on our review and analysis of historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

In the first quarter of 2023, we had a net favorable adjustment to the investments accounted for under the fair value option method, compared to an unfavorable adjustment in the first quarter of 2022.

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 may be based on estimated cash flows discounted at a risk-adjusted rate of interest by using Level 2 inputs. For our real estate, including for the impairment analysis on our Prospect Pennsylvania real estate, we may use a market approach using Level 2 inputs, whereby we will divide the expected net operating income (i.e. rent revenue less expenses, if any) of the facility by a market capitalization rate.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Earnings Per Share/Unit

3 Months Ended

Mar. 31, 2023

Earnings Per Share [Abstract]

Earnings Per Share/Unit

8. Earnings Per Share/Unit

Medical Properties Trust, Inc.

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


	For the Three Months Ended March 31,
	2023			2022
Numerator:
Net income	$	33,030		$	631,947
Non-controlling interests’ share in earnings		(236	)		(266	)
Participating securities’ share in earnings		(515	)		(402	)
Net income, less participating securities’ share in earnings	$	32,279		$	631,279
Denominator:
Basic weighted-average common shares		598,302			598,676
Dilutive potential common shares		8			256
Diluted weighted-average common shares		598,310			598,932

MPT Operating Partnership, L.P.

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


	For the Three Months Ended March 31,
	2023			2022
Numerator:
Net income	$	33,030		$	631,947
Non-controlling interests’ share in earnings		(236	)		(266	)
Participating securities’ share in earnings		(515	)		(402	)
Net income, less participating securities’ share in earnings	$	32,279		$	631,279
Denominator:
Basic weighted-average units		598,302			598,676
Dilutive potential units		8			256
Diluted weighted-average units		598,310			598,932

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	. Commitments and Contingencies Commitments On October 5, 2022, we entered into definitive agreements to sell three Prospect facilities located in Connecticut to Yale for approximately $457 million, of which we expect to receive the majority in cash and the remainder in equity securities of PHP Holdings. 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. Contingencies During and subsequent to the first quarter of 2023, the Company became party to various lawsuits as further described in Item 1 of Part II of this Quarterly Report on Form 10-Q. We have not recorded a liability related to these lawsuits because, at this time, we are unable to determine whether an unfavorable outcome is probable or to estimate reasonably possible losses. We are a party to various other legal proceedings incidental to our business from time-to-time. 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.

Subsequent Events

3 Months Ended

Mar. 31, 2023

Subsequent Events [Abstract]

Subsequent Events

10. Subsequent Events

On April 14, 2023, we acquired five behavioral health hospitals located in the United Kingdom for approximately £44 million. These hospitals are leased to Priory pursuant to five separate lease agreements with annual inflation-based escalators.

On April 19, 2023, we acquired two behavioral health hospitals and have a signed definitive agreement to acquire an additional facility, located in Germany, for a total of approximately €70 million. These hospitals will be leased to MEDIAN pursuant to a long-term master lease with annual inflation-based escalators.

On May 1, 2023, Catholic Health Initiatives Colorado ("CHIC"), a wholly owned subsidiary of CommonSpirit Health ("CommonSpirit"), acquired the Utah hospital operations of five general acute care facilities previously operated by Steward. As a result of this transaction, we expect to receive $150 million of proceeds from Steward to pay down outstanding loans, $100 million of which we received on May 1, 2023. The new lease with CHIC for these Utah assets will have an initial fixed term of 15 years with annual escalation provisions. As part of this transaction, we severed these facilities from the master lease with Steward, and accordingly will accelerate the amortization of the associated in-place lease intangibles (approximately $288 million at March 31, 2023) and write-off approximately $94 million of straight-line rent receivables. With this transaction, we expect to lower our overall asset concentration with Steward by approximately 4% and our revenue concentration by approximately 8%.

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2023
Accounting Policies [Abstract]
Unaudited Interim Condensed Consolidated Financial Statements	Unaudited Interim Condensed Consolidated Financial Statements: The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement have been included. Operating results for the three months ended March 31, 2023, are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The condensed consolidated balance sheet at December 31, 2022 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. The preparation of our condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2023 (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 as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2022. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 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 March 31, 2023, we had loans and/or equity investments in certain variable interest entities approximating $425 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities.

Real Estate and Other Activities (Tables)

3 Months Ended

Mar. 31, 2023

Real Estate [Abstract]

Net Assets Acquired

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


	For the Three Months Ended March 31,
	2023			2022

Land and land improvements	$	9,313		$	9,671
Buildings		11,652			204,829
Intangible lease assets — subject to amortization (weighted-average useful life of 28.8 years for 2023 and 13.2 years for 2022)		1,935			5,461
Investments in unconsolidated real estate joint ventures		—			399,456
Investments in unconsolidated operating entities		50,000			131,105
Liabilities assumed		—			(25,727	)
	$	72,900		$	724,795
Loans repaid(1)		(22,900	)		—
Total net assets acquired	$	50,000		$	724,795

(1)

The 2023 column includes a $23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below.

Summary of Status on Current Development Projects

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


Property	Commitment		Costs Incurred as of March 31, 2023		Estimated Rent Commencement Date
Ernest Health, Inc. ("Ernest") (Stockton, California)	$	47,700	$	46,372	2Q 2023
IMED Hospitales ("IMED") (Spain)		51,043		13,323	2Q 2023
Ernest (South Carolina)		22,400		14,469	3Q 2023
IMED (Spain)		45,976		37,568	3Q 2023
Springstone (Texas)		31,600		4,099	1Q 2024
IMED (Spain)		37,193		9,170	3Q 2024
Steward (Texas)		169,408		57,059	1Q 2026
	$	405,320	$	182,060

Summary of Operating Results from Properties


	For the Three Months Ended March 31,
	2023(1)			2022
Revenues(2)	$	18,877		$	40,579
Real estate depreciation and amortization		(4,991	)		(5,247	)
Property-related expenses		(1,413	)		(3,015	)
Real estate and other impairment charges(3)		(89,538	)		—
Other (expense) income(4)		(7,244	)		444,268
Income from real estate dispositions, net	$	(84,309	)	$	476,585

(1)

The 2023 column consists of assets designated as held for sale in the first quarter of 2023 as a result of the transactions described in the "2023 Activity" subsection above.

(2)

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

(3)

(4)

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

Components of Total Investment in Financing Leases

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


	As of March 31, 2023			As of December 31, 2022
Minimum lease payments receivable	$	626,721		$	880,253
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(588,097	)		(731,915	)
Net investment in direct financing leases		242,442			352,156
Other financing leases (net of allowance for credit loss)		1,339,974			1,339,167
Total investment in financing leases	$	1,582,416		$	1,691,323

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	Ownership Percentage	As of March 31, 2023		As of December 31, 2022
Median Kliniken S.á.r.l ("MEDIAN")	50%	$	483,706	$	482,735
Swiss Medical Network	70%		461,952		454,083
Steward (Macquarie Transaction)	50%		416,068		417,701
Policlinico di Monza	50%		88,658		86,245
HM Hospitales	45%		56,090		57,139
Total		$	1,506,474	$	1,497,903

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


Operator	As of March 31, 2023		As of December 31, 2022
Steward (loan investment)	$	362,586	$	362,831
International joint venture		230,153		231,402
Priory		159,668		156,575
Swiss Medical Network		158,687		157,145
Steward (equity investment)		125,862		125,862
Prospect		112,701		112,777
Aevis Victoria SA ("Aevis")		77,618		72,904
PHP Holdings		49,895		—
Aspris Children's Services ("Aspris")		16,014		16,023
Springstone		10,933		200,827
Caremax		6,343		8,526
Total	$	1,310,460	$	1,444,872

Summary of Activity in Credit Loss reserves

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


	For the Three Months Ended March 31,
	2023			2022
Balance at beginning of the year	$	121,146		$	48,527
Provision for credit loss, net		986			5,412
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(160	)		(6	)
Balance at end of the period	$	121,972		$	53,933

Schedule of Concentrations of Credit Risk

See below for our concentration details (dollars in thousands):

Total Assets by Operator


	As of March 31, 2023					As of December 31, 2022
Operators	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Steward	$	4,800,594		24.4	%	$	4,762,673		24.2	%
Circle Health Ltd ("Circle")		2,092,822		10.7	%		2,062,474		10.5	%
Prospect		1,533,412		7.8	%		1,483,599		7.5	%
Priory		1,310,968		6.7	%		1,290,213		6.6	%
Springstone		796,248		4.0	%		985,959		5.0	%
Other operators		7,406,721		37.7	%		7,461,923		38.0	%
Other assets		1,709,392		8.7	%		1,611,159		8.2	%
Total	$	19,650,157		100.0	%	$	19,658,000		100.0	%

Total Assets by U.S. State and Country


	As of March 31, 2023					As of December 31, 2022
U.S. States and Other Countries	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Texas	$	2,008,146		10.2	%	$	1,967,948		10.0	%
California		1,502,060		7.7	%		1,450,112		7.4	%
Florida		1,319,878		6.7	%		1,324,555		6.8	%
Utah		1,218,883		6.2	%		1,224,484		6.2	%
Massachusetts		763,555		3.9	%		761,694		3.9	%
All other states		4,035,762		20.5	%		4,245,306		21.6	%
Other domestic assets		1,087,136		5.5	%		1,028,946		5.2	%
Total U.S.	$	11,935,420		60.7	%	$	12,003,045		61.1	%
United Kingdom	$	4,145,170		21.1	%	$	4,083,244		20.8	%
Australia		781,585		4.0	%		854,582		4.3	%
Switzerland		763,711		3.9	%		748,947		3.8	%
Germany		666,930		3.4	%		664,900		3.4	%
Spain		226,800		1.1	%		222,316		1.1	%
All other countries		508,285		2.6	%		498,753		2.5	%
Other international assets		622,256		3.2	%		582,213		3.0	%
Total international	$	7,714,737		39.3	%	$	7,654,955		38.9	%
Grand total	$	19,650,157		100.0	%	$	19,658,000		100.0	%

Total Revenues by Operator


	For the Three Months Ended March 31,
	2023					2022
Operators	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Steward	$	103,494		29.6	%	$	121,244		29.6	%
Circle		47,415		13.5	%		51,212		12.5	%
Prospect		—		0.0	%		38,684		9.4	%
Priory		24,740		7.1	%		19,070		4.7	%
Springstone		20,167		5.8	%		21,664		5.3	%
Other operators		154,395		44.0	%		157,926		38.5	%
Total	$	350,211		100.0	%	$	409,800		100.0	%

Total Revenues by U.S. State and Country


	For the Three Months Ended March 31,
	2023					2022
U.S. States and Other Countries	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Texas	$	44,116		12.6	%	$	34,844		8.5	%
Utah		35,641		10.2	%		33,768		8.2	%
Florida		26,182		7.5	%		25,305		6.2	%
California		19,495		5.6	%		41,291		10.1	%
Massachusetts		6,816		1.8	%		32,631		8.0	%
All other states		99,137		28.4	%		125,907		30.7	%
Total U.S.	$	231,387		66.1	%	$	293,746		71.7	%
United Kingdom	$	84,206		24.0	%	$	83,906		20.5	%
Australia		15,237		4.4	%		17,031		4.1	%
All other countries		19,381		5.5	%		15,117		3.7	%
Total international	$	118,824		33.9	%	$	116,054		28.3	%
Grand total	$	350,211		100.0	%	$	409,800		100.0	%

Total Revenues by Facility Type


	For the Three Months Ended March 31,
	2023					2022
Facility Types	Total Revenues		Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
General acute care hospitals	$	253,036		72.3	%	$	316,019		77.0	%
Behavioral health facilities		53,658		15.3	%		50,897		12.4	%
Inpatient rehabilitation facilities		29,046		8.3	%		28,906		7.1	%
Long-term acute care hospitals		8,251		2.4	%		8,302		2.1	%
Freestanding ER/urgent care facilities		6,220		1.7	%		5,676		1.4	%
Total	$	350,211		100.0	%	$	409,800		100.0	%

Debt (Tables)

3 Months Ended

Mar. 31, 2023

Debt Disclosure [Abstract]

Summary of Debt

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


	As of March 31, 2023			As of December 31, 2022
Revolving credit facility(A)	$	1,031,037		$	929,584
Term loan		200,000			200,000
British pound sterling term loan due 2024(B)		129,353			126,690
British pound sterling term loan due 2025(B)		863,590			845,810
Australian term loan facility(B)		802,200			817,560
2.550% Senior Unsecured Notes due 2023(B)		493,480			483,320
3.325% Senior Unsecured Notes due 2025(B)		541,950			535,250
0.993% Senior Unsecured Notes due 2026(B)		541,950			535,250
2.500% Senior Unsecured Notes due 2026(B)		616,850			604,150
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)		740,220			724,980
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		431,795			422,905
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,492,425		$	10,325,499
Debt issue costs and discount, net		(54,274	)		(57,087	)
	$	10,438,151		$	10,268,412

(A)

Includes £119 million of GBP-denominated borrowings and €253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023.

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022.

Principal Payments Due on Debt

As of March 31, 2023, 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):


2023	$	493,480
2024		931,553
2025		1,405,540
2026		2,689,837
2027		1,600,000
Thereafter		3,372,015
Total	$	10,492,425

Fair Value of Financial Instruments (Tables)

3 Months Ended

Mar. 31, 2023

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 March 31, 2023							As of December 31, 2022
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables, net	$	169,511			$	160,947		$	167,035			$	163,101
Loans(1)		1,511,182		(2)		1,456,753			1,405,615		(2)		1,360,113
Debt, net		(10,438,151	)			(8,594,584	)		(10,268,412	)			(8,697,042	)

(1)

(2)

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

At March 31, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands):


	As of March 31, 2023				As of December 31, 2022
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	122,073	$	122,073	$	140,260	$	140,260	Mortgage loans
Equity investment and other loans		243,561		247,125		434,609		441,943	Investments in unconsolidated operating entities/Other loans

Earnings Per Share/Unit (Tables)

3 Months Ended

Mar. 31, 2023

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 March 31,
	2023			2022
Numerator:
Net income	$	33,030		$	631,947
Non-controlling interests’ share in earnings		(236	)		(266	)
Participating securities’ share in earnings		(515	)		(402	)
Net income, less participating securities’ share in earnings	$	32,279		$	631,279
Denominator:
Basic weighted-average common shares		598,302			598,676
Dilutive potential common shares		8			256
Diluted weighted-average common shares		598,310			598,932

MPT Operating Partnership, L.P.

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


	For the Three Months Ended March 31,
	2023			2022
Numerator:
Net income	$	33,030		$	631,947
Non-controlling interests’ share in earnings		(236	)		(266	)
Participating securities’ share in earnings		(515	)		(402	)
Net income, less participating securities’ share in earnings	$	32,279		$	631,279
Denominator:
Basic weighted-average units		598,302			598,676
Dilutive potential units		8			256
Diluted weighted-average units		598,310			598,932

Organization - Additional Information (Detail)	3 Months Ended
Organization - Additional Information (Detail)	Mar. 31, 2023 Facility Country State
Business Acquisition [Line Items]
Percentage of leased assets owned	100.00%
Number of facilities \| Facility	444
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

Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions	Mar. 31, 2023 USD ($)
Accounting Policies [Abstract]
Loans and/or equity investments in variable interest entities	$ 425

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

Mar. 31, 2023

Mar. 31, 2022

Business Acquisition [Line Items]

Total assets acquired

$ 72,900

$ 724,795

Liabilities assumed

(25,727)

Loans repaid

^[1]

(22,900)

Total net assets acquired

50,000

724,795

Land and Land Improvements [Member]

Business Acquisition [Line Items]

Total assets acquired

9,313

9,671

Building [Member]

Business Acquisition [Line Items]

Total assets acquired

11,652

204,829

Intangible Lease Assets [Member]

Business Acquisition [Line Items]

Total assets acquired

1,935

5,461

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

$ 50,000

$ 131,105

[1]	The 2023 column includes a $23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below.

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

3 Months Ended

Mar. 31, 2023

Mar. 31, 2022

Dec. 31, 2021

Business Acquisition [Line Items]

Advanced to the mortgage loan

^[1]

$ 22,900

Mortgage Loans [Member] | Springstone Health Opco, LLC [Member]

Business Acquisition [Line Items]

Advanced to the mortgage loan

$ 23,000

Intangible Lease Assets [Member]

Business Acquisition [Line Items]

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

28 years 9 months 18 days

13 years 2 months 12 days

[1]	The 2023 column includes a $23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below.

Real Estate and Other Activities - 2023 Activity - Additional Information (Detail) $ in Thousands		1 Months Ended
	Feb. 07, 2023 USD ($) Facility	Aug. 31, 2019 USD ($)	Mar. 31, 2023 USD ($)	Mar. 31, 2022 USD ($)
Business Acquisition [Line Items]
Acquisition loan			$ 72,900	$ 724,795
Prospect [Member]
Business Acquisition [Line Items]
Purchase price of acquisition		$ 1,500,000
Prospect [Member] \| PHP Holdings [Member]
Business Acquisition [Line Items]
Convertible loan			$ 50,000
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility	8
Lease extension expiration term	5 years
Lease extension expiration year	2041
Springstone Health Opco, LLC [Member]
Business Acquisition [Line Items]
Purchase price of acquisition	$ 250,000
Acquisition loan	$ 205,000
Springstone Health Opco, LLC [Member] \| Behavioral Health Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility	17

Real Estate and Other Activities - 2022 Activity - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions						3 Months Ended
	Feb. 07, 2023 Facility	Mar. 14, 2022 USD ($) Facility	Mar. 11, 2022 EUR (€) Facility	Mar. 11, 2022 USD ($) Facility	Feb. 16, 2022 GBP (£)	Mar. 31, 2023 USD ($)	Mar. 31, 2022 USD ($)	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Proceeds from sale of facilities							$ 48,000
Gain (loss) on real estate dispositions							15,000
Investments in unconsolidated real estate joint ventures						$ 1,506,474		$ 1,497,903
Acquisition loan						72,900	$ 724,795
Deferred income tax liabilities and other liabilities, incurred				$ 26,000
Syndicated Term Loan [Member]
Business Acquisition [Line Items]
Purchase price of acquisition \| £					£ 96.5
Acquisition loan \| £					£ 100.0
Loan term					6 years
Corporate Joint Venture [Member]
Business Acquisition [Line Items]
Investments in unconsolidated real estate joint ventures		$ 400,000
Massachusetts [Member]
Business Acquisition [Line Items]
Redevelopment recovery receivables of prior storm and flood damage						150,000
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	8
Lease extension expiration year	2041
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
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
Nonrecourse secured debt percentage of asset value		55.00%
Proceeds from expected secured debt						$ 1,300,000
Lease extension expiration year		2041
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 - 2021 Activity - Additional Information (Detail) - General Acute Care Hospitals [Member]	Feb. 07, 2023 Facility
Business Acquisition [Line Items]
Number of facilities acquired	8
Lease extension expiration year	2041

Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($)
Business Acquisition [Line Items]
Commitment	$ 405,320
Costs Incurred as of March 31, 2023	182,060
Steward [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	169,408
Costs Incurred as of March 31, 2023	$ 57,059
Estimated Rent Commencement Date	1Q 2026
Ernest [Member] \| Stockton, California [Member]
Business Acquisition [Line Items]
Commitment	$ 47,700
Costs Incurred as of March 31, 2023	$ 46,372
Estimated Rent Commencement Date	2Q 2023
Ernest [Member] \| South Carolina [Member]
Business Acquisition [Line Items]
Commitment	$ 22,400
Costs Incurred as of March 31, 2023	$ 14,469
Estimated Rent Commencement Date	3Q 2023
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 51,043
Costs Incurred as of March 31, 2023	$ 13,323
Estimated Rent Commencement Date	2Q 2023
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 45,976
Costs Incurred as of March 31, 2023	$ 37,568
Estimated Rent Commencement Date	3Q 2023
Springstone [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 31,600
Costs Incurred as of March 31, 2023	$ 4,099
Estimated Rent Commencement Date	1Q 2024
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 37,193
Costs Incurred as of March 31, 2023	$ 9,170
Estimated Rent Commencement Date	3Q 2024

Real Estate and Other Activities - Disposals - 2023 Activity Additional Information (Detail) $ in Millions, $ in Billions		3 Months Ended
	Mar. 29, 2023 AUD ($) Facility	Mar. 31, 2023 USD ($)	Mar. 31, 2022 USD ($)
Debt Instrument [Line Items]
Proceeds from sale of facilities			$ 48.0
Net impairment charge		$ 79.0
Straight-line rent receivables		37.4
Estimated fees to sell the hospitals		8.0
Accumulated other comprehensive income (loss), foreign currency translation adjustment, net of tax		13.0
Deferred gains from our interest rate swap in AOCI		$ 29.0
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration]		Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, after Tax
Australia Transaction [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities	$ 1.2
Australia [Member] \| General Acute Care Facility [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility	11
Prime [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities		$ 100.0
Non-cash impairment charge		$ 11.0

Real Estate and Other Activities - Disposals - Summary of Assets Designated as Held for Sale (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Real estate held for sale	$ 881,587
Other assets,net	578,853	$ 572,990
Total Assets	$ 19,650,157	$ 19,658,000

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

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+ Details

Real Estate and Other Activities - Disposals - 2022 Activity - Additional Information (Detail) $ in Millions		3 Months Ended
	Mar. 14, 2022 USD ($) Facility	Mar. 31, 2023 USD ($)	Mar. 31, 2022 USD ($)
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions			$ 15
Proceeds from sale of facilities			48
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
Prime [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities		$ 100

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Business Acquisition [Line Items]
Revenues	$ 350,211	$ 409,800
Real estate depreciation and amortization	(83,860)	(85,316)
Real estate and other impairment charges	(89,538)	(4,875)
Other (expense) income	(5,166)	14,762
Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Revenues	18,877	40,579
Real estate depreciation and amortization	(4,991)	(5,247)
Property-related expenses	(1,413)	(3,015)
Real estate and other impairment charges	(89,538)
Other (expense) income	(7,244)	444,268
Income from real estate dispositions, net	$ (84,309)	$ 476,585

- 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).

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+ Details

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Parenthetical) (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Business Acquisition [Line Items]
Net impairment charge	$ 79.0
Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs		$ 4.5
Massachusetts-based General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs		125.0
Massachusetts-based General Acute Care Hospitals [Member] \| Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Gains		$ 451.6
Australia Transaction [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs	37.4
Net impairment charge	79.0
Prime [Member]
Business Acquisition [Line Items]
Non-cash impairment charge	$ 11.0

Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2023 Lease
Lessor Lease Description [Line Items]
Lease renewal term	5 years
Annual rent escalations	99.00%
Ernest [Member]
Lessor Lease Description [Line Items]
Number of direct financing leases	13
Number of financing leases	5
Prospect [Member]
Lessor Lease Description [Line Items]
Number of financing leases	13
Minimum [Member]
Lessor Lease Description [Line Items]
Term of lease	15 years

Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 626,721	$ 880,253
Estimated unguaranteed residual values	203,818	203,818
Less: Unearned income and allowance for credit loss	(588,097)	(731,915)
Net investment in direct financing leases	242,442	352,156
Other financing leases (net of allowance for credit loss)	1,339,974	1,339,167
Total investment in financing leases	$ 1,582,416	$ 1,691,323

Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details)	3 Months Ended
	Mar. 31, 2023 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%

Real Estate and Other Activities - Coronavirus (COVID-19) Rent Deferrals - Additional Information (Detail) $ in Millions	Mar. 31, 2023 USD ($)
Business Acquisition [Line Items]
Remaining outstanding deferred rent to be received	$ 12.2

Real Estate and Other Activities - Pipeline Health System - Additional Information (Detail) - Pipeline Health System [Member] $ in Millions	Feb. 07, 2023 USD ($)
Business Acquisition [Line Items]
Cash rent	$ 5.6
Percentage of defered rent	30.00%

Real Estate and Other Activities - Watsonville Community Hospital - Additional Information (Details)
$ in Thousands

Mar. 31, 2023

USD ($)

Business Acquisition [Line Items]

Loans repaid

$ 22,900

^[1]

[1]	The 2023 column includes a $23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below.

Real Estate and Other Activities - Prospect Medical Holdings Additional Information (Detail) $ in Thousands	1 Months Ended		3 Months Ended
	Mar. 31, 2023 USD ($)	Aug. 31, 2019 USD ($) Hospital	Mar. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Mar. 31, 2022 USD ($)
Business Acquisition [Line Items]
Additional mortgage loan	$ 72,900		$ 72,900		$ 724,795
Net impairment charge			79,000
Prospect [Member]
Business Acquisition [Line Items]
Purchase price of acquisition		$ 1,500,000
Term loan		$ 112,900
Net impairment charge				$ 280,000
Percentage of cash payments	50.00%
Prospect [Member] \| Maximum [Member]
Business Acquisition [Line Items]
First lien secured loan	$ 75,000
Prospect [Member] \| Pennsylvania
Business Acquisition [Line Items]
Carrying value of lease requiring residual value guarantee				170,000
Unbilled rent accruals					$ 112,000
Prospect [Member] \| Pennsylvania \| Maximum [Member]
Business Acquisition [Line Items]
Carrying value of lease requiring residual value guarantee				$ 250,000
Prospect [Member] \| Acute Care Campus [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital		14
PHP Holdings [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Convertible loan	50,000		50,000
Unpaid rent and interest	112,900
Capital restructuring costs	50,000
Mortgage Loans [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Additional mortgage loan	$ 100,000		$ 100,000

Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Details) - Investments in Unconsolidated Real Estate Joint Ventures [Member]	Mar. 31, 2023
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Maximum [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%

Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,506,474	$ 1,497,903
Median Kliniken S A R L [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 483,706	482,735
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	70.00%
Investments in unconsolidated real estate joint ventures	$ 461,952	454,083
Steward (Macquarie Transaction) [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 416,068	417,701
Policlinico di Monza [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 88,658	86,245
HM Hospital [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	45.00%
Investments in unconsolidated real estate joint ventures	$ 56,090	$ 57,139

Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 1,310,460	$ 1,444,872
Steward Loan Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	362,586	362,831
International Joint Venture [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	230,153	231,402
Priory [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	159,668	156,575
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	158,687	157,145
Steward Equity Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	125,862	125,862
Prospect [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	112,701	112,777
Aevis Victoria SA [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	77,618	72,904
PHP Holdings [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	49,895
Aspris Children's Services [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	16,014	16,023
Springstone [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	10,933	200,827
Caremax [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 6,343	$ 8,526

Real Estate and Other Activities - Investments in Unconsolidated Operating Entities - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Aevis Victoria SA [Member]
Business Acquisition [Line Items]
Ownership interest in joint venture under the cost method	5.00%
COVID-19 Pandemic [Member] \| Other [Member]
Business Acquisition [Line Items]
Favorable non-cash fair value adjustment on investment	$ 4.0	$ 8.0

Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) $ in Millions	Mar. 31, 2023 USD ($)
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Real Estate Secured Advanced Loan	$ 50

Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Receivables [Abstract]
Balance at beginning of the year	$ 121,146	$ 48,527
Provision for credit loss, net	986	5,412
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied	(160)	(6)
Balance at end of the period	$ 121,972	$ 53,933

- Definition

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

+ References + Details

Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Business Acquisition [Line Items]
Total Assets	$ 19,650,157		$ 19,658,000
Total Revenues	350,211	$ 409,800
Total Gross Assets [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Total Assets	$ 19,650,157		$ 19,658,000
Percentage of concentration risk	100.00%		100.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Assets [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,709,392		$ 1,611,159
Percentage of concentration risk	8.70%		8.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Total Assets	$ 4,800,594		$ 4,762,673
Percentage of concentration risk	24.40%		24.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Total Assets	$ 2,092,822		$ 2,062,474
Percentage of concentration risk	10.70%		10.50%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,533,412		$ 1,483,599
Percentage of concentration risk	7.80%		7.50%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Priory [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,310,968		$ 1,290,213
Percentage of concentration risk	6.70%		6.60%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Springstone [Member]
Business Acquisition [Line Items]
Total Assets	$ 796,248		$ 985,959
Percentage of concentration risk	4.00%		5.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Operators [Member]
Business Acquisition [Line Items]
Total Assets	$ 7,406,721		$ 7,461,923
Percentage of concentration risk	37.70%		38.00%
Total Gross Assets [Member] \| Geographic Concentration [Member]
Business Acquisition [Line Items]
Total Assets	$ 19,650,157		$ 19,658,000
Percentage of concentration risk	100.00%		100.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Texas [Member]
Business Acquisition [Line Items]
Total Assets	$ 2,008,146		$ 1,967,948
Percentage of concentration risk	10.20%		10.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| California [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,502,060		$ 1,450,112
Percentage of concentration risk	7.70%		7.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Florida [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,319,878		$ 1,324,555
Percentage of concentration risk	6.70%		6.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Utah [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,218,883		$ 1,224,484
Percentage of concentration risk	6.20%		6.20%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Massachusetts [Member]
Business Acquisition [Line Items]
Total Assets	$ 763,555		$ 761,694
Percentage of concentration risk	3.90%		3.90%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other States [Member]
Business Acquisition [Line Items]
Total Assets	$ 4,035,762		$ 4,245,306
Percentage of concentration risk	20.50%		21.60%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total U.S. [Member]
Business Acquisition [Line Items]
Total Assets	$ 11,935,420		$ 12,003,045
Percentage of concentration risk	60.70%		61.10%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Total Assets	$ 4,145,170		$ 4,083,244
Percentage of concentration risk	21.10%		20.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Total Assets	$ 781,585		$ 854,582
Percentage of concentration risk	4.00%		4.30%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Switzerland [Member]
Business Acquisition [Line Items]
Total Assets	$ 763,711		$ 748,947
Percentage of concentration risk	3.90%		3.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Germany [Member]
Business Acquisition [Line Items]
Total Assets	$ 666,930		$ 664,900
Percentage of concentration risk	3.40%		3.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Spain [Member]
Business Acquisition [Line Items]
Total Assets	$ 226,800		$ 222,316
Percentage of concentration risk	1.10%		1.10%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other Countries [Member]
Business Acquisition [Line Items]
Total Assets	$ 508,285		$ 498,753
Percentage of concentration risk	2.60%		2.50%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total International [Member]
Business Acquisition [Line Items]
Total Assets	$ 7,714,737		$ 7,654,955
Percentage of concentration risk	39.30%		38.90%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other Domestic Assets [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,087,136		$ 1,028,946
Percentage of concentration risk	5.50%		5.20%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other International Assets [Member]
Business Acquisition [Line Items]
Total Assets	$ 622,256		$ 582,213
Percentage of concentration risk	3.20%		3.00%
Revenue [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 350,211	$ 409,800
Revenue [Member] \| Operator Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	29.60%	29.60%
Total Revenues	$ 103,494	$ 121,244
Revenue [Member] \| Operator Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	13.50%	12.50%
Total Revenues	$ 47,415	$ 51,212
Revenue [Member] \| Operator Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	0.00%	9.40%
Total Revenues		$ 38,684
Revenue [Member] \| Operator Concentration Risk [Member] \| Priory [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	7.10%	4.70%
Total Revenues	$ 24,740	$ 19,070
Revenue [Member] \| Operator Concentration Risk [Member] \| Springstone [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.80%	5.30%
Total Revenues	$ 20,167	$ 21,664
Revenue [Member] \| Operator Concentration Risk [Member] \| Other Operators [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	44.00%	38.50%
Total Revenues	$ 154,395	$ 157,926
Revenue [Member] \| Geographic Concentration [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 350,211	$ 409,800
Revenue [Member] \| Geographic Concentration [Member] \| Texas [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	12.60%	8.50%
Total Revenues	$ 44,116	$ 34,844
Revenue [Member] \| Geographic Concentration [Member] \| California [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.60%	10.10%
Total Revenues	$ 19,495	$ 41,291
Revenue [Member] \| Geographic Concentration [Member] \| Florida [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	7.50%	6.20%
Total Revenues	$ 26,182	$ 25,305
Revenue [Member] \| Geographic Concentration [Member] \| Utah [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.20%	8.20%
Total Revenues	$ 35,641	$ 33,768
Revenue [Member] \| Geographic Concentration [Member] \| Massachusetts [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	1.80%	8.00%
Total Revenues	$ 6,816	$ 32,631
Revenue [Member] \| Geographic Concentration [Member] \| All Other States [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	28.40%	30.70%
Total Revenues	$ 99,137	$ 125,907
Revenue [Member] \| Geographic Concentration [Member] \| Total U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	66.10%	71.70%
Total Revenues	$ 231,387	$ 293,746
Revenue [Member] \| Geographic Concentration [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	24.00%	20.50%
Total Revenues	$ 84,206	$ 83,906
Revenue [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	4.40%	4.10%
Total Revenues	$ 15,237	$ 17,031
Revenue [Member] \| Geographic Concentration [Member] \| All Other Countries [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.50%	3.70%
Total Revenues	$ 19,381	$ 15,117
Revenue [Member] \| Geographic Concentration [Member] \| Total International [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	33.90%	28.30%
Total Revenues	$ 118,824	$ 116,054
Revenue [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 350,211	$ 409,800
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	72.30%	77.00%
Total Revenues	$ 253,036	$ 316,019
Revenue [Member] \| Customer Concentration Risk [Member] \| Behavioral Health Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	15.30%	12.40%
Total Revenues	$ 53,658	$ 50,897
Revenue [Member] \| Customer Concentration Risk [Member] \| Inpatient Rehabilitation Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	8.30%	7.10%
Total Revenues	$ 29,046	$ 28,906
Revenue [Member] \| Customer Concentration Risk [Member] \| Long Term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	2.40%	2.10%
Total Revenues	$ 8,251	$ 8,302
Revenue [Member] \| Customer Concentration Risk [Member] \| Freestanding ER/Urgent Care Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	1.70%	1.40%
Total Revenues	$ 6,220	$ 5,676
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%

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

Mar. 31, 2023

Dec. 31, 2022

Debt Instrument [Line Items]

Debt

$ 10,492,425

$ 10,325,499

Debt issue costs and discount, net

(54,274)

(57,087)

Debt, net

10,438,151

10,268,412

Revolving Credit Facility [Member]

Debt Instrument [Line Items]

Debt

^[1]

1,031,037

929,584

Term Loan [Member]

Debt Instrument [Line Items]

Debt

200,000

Term Loan [Member] | Australia [Member]

Debt Instrument [Line Items]

Debt

^[2]

802,200

817,560

Term loan due 2024 | British Pound Sterling [Member]

Debt Instrument [Line Items]

Debt

^[2]

129,353

126,690

Term loan due 2025 | British Pound Sterling [Member]

Debt Instrument [Line Items]

Debt

^[2]

863,590

845,810

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Debt

^[2]

493,480

483,320

3.325% Senior Unsecured Notes due 2025 [Member]

Debt Instrument [Line Items]

Debt

^[2]

541,950

535,250

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

541,950

535,250

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

616,850

604,150

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]

740,220

724,980

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]

431,795

422,905

3.500% Senior Unsecured Notes due 2031 [Member]

Debt Instrument [Line Items]

Debt

$ 1,300,000

[1]	Includes £119 million of GBP-denominated borrowings and €253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023.
[2]	Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022.

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

Mar. 31, 2023

Dec. 31, 2022

Debt Instrument [Line Items]

Debt

$ 10,492,425

$ 10,325,499

GBP-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt

119,000

EURO-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt

$ 253,000

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

2.55%

Debt

^[1]

$ 493,480

$ 483,320

3.325% Senior Unsecured Notes due 2025 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.325%

Debt

^[1]

$ 541,950

$ 535,250

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

0.993%

Debt

^[1]

$ 541,950

$ 535,250

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

2.50%

Debt

^[1]

$ 616,850

$ 604,150

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

3.692%

Debt

^[1]

$ 740,220

$ 724,980

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%

Debt

^[1]

$ 431,795

$ 422,905

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 rates at March 31, 2023 and December 31, 2022.

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
2023	$ 493,480
2024	931,553
2025	1,405,540
2026	2,689,837
2027	1,600,000
Thereafter	3,372,015
Total	$ 10,492,425	$ 10,325,499

Debt - 2022 Activity - Additional Information (Detail) - USD ($) $ in Billions	3 Months Ended
	Mar. 31, 2023	Mar. 15, 2022
Debt Instrument [Line Items]
Line of credit , entered date	Jul. 27, 2021
Line of credit, terminated date	Mar. 15, 2022
Line of credit facility, Borrowing capacity		$ 1

Debt - Additional Information (Detail) $ in Millions	3 Months Ended
Debt - Additional Information (Detail) $ in Millions	Mar. 31, 2023 USD ($)
Waterland Private Equity Fund VII C.V. [Member] \| Interim Credit Facility [Member]
Debt Instrument [Line Items]
Debt refinancing costs	$ 8.8

Debt - Covenants - Additional Information (Detail)	3 Months Ended
Debt - Covenants - Additional Information (Detail)	Mar. 31, 2023
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%

Income Taxes - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2023 USD ($)
Income Tax Disclosure [Abstract]
Income tax benefit related to the initial loan impairment	$ 5

Common Stock/Partners' Capital - Additional Information (Detail) - shares shares in Thousands	Mar. 31, 2023	Dec. 31, 2022
Class Of Stock [Line Items]
Common stock, shares issued	598,302	597,476

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock / (Unit)-based compensation expense	$ 11,829	$ 11,804
Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reserved shares of new common stock for awards under the Equity Incentive Plan	28,900,000
Common stock remaining for future stock awards transferred to the equity incentive plan	16,700,000

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 169,511	$ 167,035
Loans, Book value	1,511,182	1,405,615
Debt, net Book value	(10,438,151)	(10,268,412)
Interest and rent receivables, Fair value	160,947	163,101
Loans, Fair value	1,456,753	1,360,113
Debt, net Fair value	$ (8,594,584)	$ (8,697,042)

- Definition

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

+ References + Details

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2023 USD ($) Health_Center	Dec. 31, 2022 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	$ 346,446	$ 364,101
Investments in unconsolidated real estate joint ventures	1,506,474	1,497,903
Investments in unconsolidated operating entities	1,310,460	1,444,872
Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments in unconsolidated operating entities	693,000	640,400
Other loans	273,900	225,500
Shareholder Loan [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	224,400	223,800
Investments in unconsolidated real estate joint ventures	$ 319,900	$ 315,900
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

Fair Value of Financial Instruments - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2023 Health_Center
Fair Value, Recurring [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired	3

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 122,073	$ 140,260
Original Cost	122,073	140,260
Equity Method Investment and Other Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	243,561	434,609
Original Cost	$ 247,125	$ 441,943

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 33,030	$ 631,947
Non-controlling interests' share in earnings	(236)	(266)
Participating securities’ share in earnings	(515)	(402)
Net income, less participating securities’ share in earnings	$ 32,279	$ 631,279
Basic weighted-average common shares	598,302	598,676
Dilutive potential common shares	8	256
Diluted weighted-average common shares	598,310	598,932
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 33,030	$ 631,947
Non-controlling interests' share in earnings	(236)	(266)
Participating securities’ share in earnings	(515)	(402)
Net income, less participating securities’ share in earnings	$ 32,279	$ 631,279
Basic weighted-average common shares	598,302	598,676
Dilutive potential common shares	8	256
Diluted weighted-average common shares	598,310	598,932

- Definition

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

+ References

+ Details

Commitments and Contingencies - Additional Information (Detail) $ in Millions		3 Months Ended
	Oct. 05, 2022 USD ($) Facility	Mar. 31, 2022 USD ($)
Commitment And Contingencies [Line Items]
Expected cash proceeds on transaction close		$ 48
Prospect [Member] \| Connecticut [Member]
Commitment And Contingencies [Line Items]
Number of facilities sold \| Facility	3
Expected cash proceeds on transaction close	$ 457

Subsequent Events - Additional Information (Detail) € in Millions, £ in Millions, $ in Millions					3 Months Ended
	May 01, 2023 USD ($)	Apr. 19, 2023 EUR (€) Facility	Apr. 14, 2023 GBP (£) Facility	Feb. 07, 2023 Facility	Mar. 31, 2023 USD ($)	Mar. 31, 2022
In-place lease intangibles [Member]
Subsequent Event [Line Items]
Amortization of intangibles					$ 288
General Acute Care Hospitals [Member]
Subsequent Event [Line Items]
Number of facilities acquired \| Facility				8
Customer Concentration Risk [Member] \| Revenue [Member]
Subsequent Event [Line Items]
Percentage of concentration risk					100.00%	100.00%
Subsequent Event [Member] \| Steward [Member]
Subsequent Event [Line Items]
Proceeds to paydown outstanding loan	$ 150
Proceeds received to paydown outstanding loan	100
Straight-line rent write-offs	$ 94
Overall concentration percentage	4.00%
Subsequent Event [Member] \| Behavioral Health Hospitals [Member]
Subsequent Event [Line Items]
Number of leased facilities \| Facility			5
Payment for acquisition		€ 70	£ 44
Number of facilities acquired \| Facility		2	5
Subsequent Event [Member] \| Utah [Member] \| Catholic Health Initiatives Colorado [Member]
Subsequent Event [Line Items]
Initial lease term	15 years
Subsequent Event [Member] \| Customer Concentration Risk [Member] \| Revenue [Member] \| Steward [Member]
Subsequent Event [Line Items]
Percentage of concentration risk	8.00%