0000950170-23-040734 | 10-Q | XBRL Viewer | Medical Properties Trust INC

4. Debt

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


	As of June 30, 2023			As of December 31, 2022
Revolving credit facility(A)	$	1,211,708		$	929,584
Term loan		200,000			200,000
British pound sterling term loan due 2024(B)		133,191			126,690
British pound sterling term loan due 2025(B)		889,210			845,810
Australian term loan facility(B)		313,208			817,560
2.550% Senior Unsecured Notes due 2023(B)		508,120			483,320
3.325% Senior Unsecured Notes due 2025(B)		545,450			535,250
0.993% Senior Unsecured Notes due 2026(B)		545,450			535,250
2.500% Senior Unsecured Notes due 2026(B)		635,150			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)		762,180			724,980
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		444,605			422,905
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,288,272		$	10,325,499
Debt issue costs and discount, net		(50,714	)		(57,087	)
	$	10,237,558		$	10,268,412

(A)

Includes £119 million of GBP-denominated borrowings and €303 million of Euro-denominated borrowings that reflect the applicable exchange rates at June 30, 2023.

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at June 30, 2023 and December 31, 2022.

As of June 30, 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	$	508,120
2024		446,399
2025		1,434,660
2026		2,892,308
2027		1,600,000
Thereafter		3,406,785
Total	$	10,288,272

2023 Activity

On May 18, 2023, we completed the first phase of the Australia Transaction in which we sold seven of the 11 Australia facilities for A$730 million. We used the proceeds from the first phase of this sale to prepay A$730 million of the A$1.2 billion Australian term loan. As a result of this prepayment, we incurred approximately $0.8 million to accelerate the amortization of related debt issue costs.

2022 Activity

On June 29, 2022, we amended our Credit Facility to extend the maturity date of our $1.8 billion revolving facility to June 30, 2026, with our option to extend for an additional 12 months, and extend the maturity date of our $200 million unsecured term loan facility to June 30, 2027. Additionally, we may request incremental term loan and/or revolving loan commitments in an aggregate amount not to exceed $1 billion. As a result of this amendment, we incurred approximately $0.6 million of debt refinancing costs.

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 June 30, 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 June 30, 2023, we were in compliance with all such financial and operating covenants.

Subsequent Events - Additional Information (Detail) $ in Millions	Sep. 30, 2023 USD ($)
Forecast [Member] \| Steward [Member]
Subsequent Event [Line Items]
Investments	$ 140

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	Jun. 30, 2023	Dec. 31, 2022
Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 136,459	$ 140,260
Original Cost	136,459	140,260
Equity Method Investment and Other Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	898,373	434,609
Original Cost	$ 910,583	$ 441,943

Cost of the investment.

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Fair value of investment in security owned.

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Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended				6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2023	Jun. 30, 2022
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29	$ 0.29	$ 0.29	$ 0.58	$ 0.58
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.29		0.29		$ 0.58	$ 0.58
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.29	$ 0.29	$ 0.29	$ 0.29

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

Jun. 30, 2023

EUR (€)

Jun. 30, 2023

GBP (£)

Jun. 30, 2023

USD ($)

Dec. 31, 2022

USD ($)

GBP-denominated Borrowings [Member]

$ 10,288,272

$ 10,325,499

EURO-denominated Borrowings [Member]

Debt | £

£ 119

2.550% Senior Unsecured Notes due 2023 [Member]

Debt | €

€ 303

2.55%

3.325% Senior Unsecured Notes due 2025 [Member]

^[1]

$ 508,120

$ 483,320

3.325%

0.993% Senior Unsecured Notes due 2026 [Member]

^[1]

$ 545,450

$ 535,250

0.993%

2.500% Senior Unsecured Notes due 2026 [Member]

^[1]

$ 545,450

$ 535,250

2.50%

5.250% Senior Unsecured Notes due 2026 [Member]

^[1]

$ 635,150

$ 604,150

5.25%

5.000% Senior Unsecured Notes due 2027 [Member]

$ 500,000

5.00%

3.692% Senior Unsecured Notes due 2028 [Member]

$ 1,400,000

3.692%

4.625% Senior Unsecured Notes due 2029 [Member]

^[1]

$ 762,180

$ 724,980

4.625%

3.375% Senior Unsecured Notes due 2030 [Member]

$ 900,000

3.375%

3.500% Senior Unsecured Notes due 2031 [Member]

^[1]

$ 444,605

$ 422,905

3.50%

$ 1,300,000

[1]	Non-U.S. dollar denominated debt reflects the exchange rates at June 30, 2023 and December 31, 2022.

Real Estate and Other Activities - Coronavirus (COVID-19) Rent Deferrals - Additional Information (Detail) $ in Millions	Jun. 30, 2023 USD ($)
Business Acquisition [Line Items]
Remaining outstanding deferred rent to be received	$ 9.8

Fair Value of Financial Instruments - Additional Information (Detail)	6 Months Ended
	Jun. 30, 2023 Health_Center
PHP Holdings [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Discount for lack of marketability percentage on Springstone equity investment	9.00%
Fair Value, Recurring [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired	3

Debt - Additional Information (Detail) $ in Millions	6 Months Ended
Debt - Additional Information (Detail) $ in Millions	Jun. 30, 2023 USD ($)
Debt Instrument [Line Items]
Debt refinancing costs	$ 0.6
Waterland Private Equity Fund VII C.V. [Member] \| Interim Credit Facility [Member]
Debt Instrument [Line Items]
Debt refinancing costs	$ 8.8

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]

Real Estate and Other Activities - 2022 Activity - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions									6 Months Ended
	Feb. 07, 2023 Facility	Apr. 29, 2022 EUR (€) Facility	Apr. 25, 2022 USD ($) Facility	Apr. 18, 2022 Facility	Mar. 14, 2022 USD ($) Facility	Mar. 11, 2022 EUR (€) Facility	Mar. 11, 2022 USD ($) Facility	Feb. 16, 2022 GBP (£)	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($) Facility	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Proceeds from sale of facilities										$ 154,000
Gain (loss) on real estate dispositions										31,000
Investments in unconsolidated real estate joint ventures									$ 1,487,118		$ 1,497,903
Acquisition loan									235,187	$ 946,243
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
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		2							5
Purchase price of acquisition			$ 80,000
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
General Acute Care Hospitals [Member] \| Arizona [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility				1
General Acute Care Hospitals [Member] \| Spain [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility		3
Purchase price of acquisition \| €		€ 27
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%

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($)
shares in Thousands, $ in Thousands

3 Months Ended

6 Months Ended

Jun. 30, 2023

Mar. 31, 2023

Jun. 30, 2022

Mar. 31, 2022

Jun. 30, 2023

Jun. 30, 2022

Net (loss) income

$ (42,433)

$ 33,030

$ 190,064

$ 631,947

$ (9,403)

$ 822,011

Non-controlling interests' share in net loss (income)

396

(467)

160

(733)

Participating securities’ share in earnings

(469)

(345)

(984)

(747)

Net (loss) income, less participating securities' share in earnings

$ (42,506)

$ 189,252

$ (10,227)

$ 820,531

Basic weighted-average common shares

598,344

598,827

598,323

598,751

Dilutive potential common shares

^[1]

199

228

Diluted weighted-average common shares

598,344

599,026

598,323

598,979

MPT Operating Partnership, L.P. [Member]

Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]

Net (loss) income

$ (42,433)

$ 33,030

$ 190,064

$ 631,947

$ (9,403)

$ 822,011

Non-controlling interests' share in net loss (income)

396

(467)

160

(733)

Participating securities’ share in earnings

(469)

(345)

(984)

(747)

Net (loss) income, less participating securities' share in earnings

$ (42,506)

$ 189,252

$ (10,227)

$ 820,531

Basic weighted-average common shares

598,344

598,827

598,323

598,751

Dilutive potential common shares

^[1]

199

228

Diluted weighted-average common shares

598,344

599,026

598,323

598,979

[1]	Potential common shares/units are not included in the computation of diluted earnings per share when a loss exists as the effect would be an antidilutive per share amount.

Amount of Net Income (Loss) attributable to noncontrolling interest.

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

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Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Business Acquisition [Line Items]
Revenues	$ 337,395	$ 400,226	$ 687,606	$ 810,026
Real estate depreciation and amortization	(364,403)	(84,334)	(448,263)	(169,650)
Real estate and other impairment charges			(89,538)	(4,875)
Other (expense) income	(10,512)	2,031	(15,678)	16,793
Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Revenues	12,051	18,905	30,928	60,739
Real estate depreciation and amortization		(5,615)	(4,991)	(11,508)
Property-related expenses	(436)	(2,410)	(1,855)	(5,765)
Real estate and other impairment charges			(89,538)
Other (expense) income	(5,382)	8,410	(10,974)	452,678
Income (loss) from real estate dispositions, net	$ 6,233	$ 19,290	$ (76,430)	$ 496,144

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).

Share-Based Payment Arrangement [Abstract]

Commitments and Contingencies - Additional Information (Detail) $ in Millions		6 Months Ended
	Oct. 05, 2022 USD ($) Facility	Jun. 30, 2022 USD ($) Facility
Commitment And Contingencies [Line Items]
Number of facilities sold \| Facility		4
Expected cash proceeds on transaction close		$ 154
Prospect [Member] \| Connecticut [Member]
Commitment And Contingencies [Line Items]
Number of facilities sold \| Facility	3
Expected cash proceeds on transaction close	$ 457
Excepted proceeds in cash	$ 355

Stock Awards

6 Months Ended

Jun. 30, 2023

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 June 30, 2023. Share-based compensation expense totaled $18.3 million and $21.9 million for the six months ended June 30, 2023 and 2022, respectively. The decrease in share-based compensation is a result of a $6.7 million cumulative benefit catch-up from adjusting the payout probability of certain performance awards, partially offset by an incremental $2.3 million of expense from the acceleration of stock awards for a retiring executive officer.

Debt - 2023 Activity - Additional Information (Details) $ in Millions, $ in Millions		6 Months Ended
	May 18, 2023 AUD ($) Facility	Jun. 30, 2022 Facility	May 18, 2023 USD ($)
Debt Instrument [Line Items]
Number of facilities sold \| Facility		4
Accelerated amortization debt issue costs \| $			$ 0.8
Australia Transaction [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility	7
Number of remaining facilities sold \| Facility	11
Proceeds from the sale of first tranche prepay. \| $	$ 730
Term Loan [Member] \| Australia Transaction [Member]
Debt Instrument [Line Items]
Term loan \| $	$ 1,200

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

Summary of Carrying Value and Classification of the Assets and Maximum Exposure

Summary of Significant Accounting Policies (Tables)

6 Months Ended

Jun. 30, 2023

Accounting Policies [Abstract]

The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs at June 30, 2023 are presented below (in thousands):


VIE Type	Carrying Amount(1)		Asset Type Classification	Maximum Loss Exposure(2)
Loans, net	$	805,640	Investments in Unconsolidated Operating Entities	$	805,640
Loans, net		139,266	Mortgage and other loans		176,248
Equity investments		89,809	Investments in Unconsolidated Operating Entities		89,809

(1)

Carrying amount reflects the net book value of our loan or equity investment only in the VIE.

(2)

Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investments in VIEs represents the current carrying values of such investments plus any other related assets (such as rent receivables), less any liabilities.

Tabular disclosure of the significant judgments and assumptions made in determining whether a variable interest (as defined) held by the entity requires the variable interest entity (VIE) (as defined) to be consolidated and (or) disclose information about its involvement with the VIE, individually or in aggregate (as applicable); the nature of restrictions, if any, on the consolidated VIE's assets and on the settlement of its liabilities reported by an entity in its statement of financial position, including the carrying amounts of such assets and liabilities; the nature of, and changes in, the risks associated with involvement in the VIE; how involvement with the VIE affects the entity's financial position, financial performance, and cash flows; the lack of recourse if creditors (or beneficial interest holders) of the consolidated VIE have no recourse to the general credit of the primary beneficiary (if applicable); the terms of arrangements, giving consideration to both explicit arrangements and implicit variable interests, if any, that could require the entity to provide financial support to the VIE, including events or circumstances that could expose the entity to a loss; the methodology used by the entity for determining whether or not it is the primary beneficiary of the variable interest entity; the significant factors considered and judgments made in determining that the power to direct the activities of a VIE that most significantly impact the VIE's economic performance are shared (as defined); the carrying amounts and classification of assets and liabilities of the VIE included in the statement of financial position; the entity's maximum exposure to loss, if any, as a result of its involvement with the VIE, including how the maximum exposure is determined and significant sources of the entity's exposure to the VIE; a comparison of the carrying amounts of the assets and liabilities and the entity's maximum exposure to loss; information about any liquidity arrangements, guarantees, and (or) other commitments by third parties that may affect the fair value or risk of the entity's variable interest in the VIE; whether or not the entity has provided financial support or other support (explicitly or implicitly) to the VIE that it was not previously contractually required to provide or whether the entity intends to provide that support, including the type and amount of the support and the primary reasons for providing the support; and supplemental information the entity determines necessary to provide.

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization

6 Months Ended

Jun. 30, 2023

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. Similarly, starting July 1, 2023, the majority of our real estate operations in the United Kingdom operate as a REIT and generally are subject only to a withholding tax on earnings upon distribution out of the REIT. 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. (excluding those assets that are in the United Kingdom REIT starting July 1, 2023), we are subject to the local income and other 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 U.S. 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 June 30, 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 in 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.

Real Estate and Other Activities - Investments in Unconsolidated Operating Entities - Additional Information (Detail) - USD ($) $ in Millions	6 Months Ended	12 Months Ended
	Jun. 30, 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		$ 9.0
Unfavorable non-cash fair value adjustment on investment	$ 4.3

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock / (Unit)-based compensation expense	$ 18,266	$ 21,912
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
Cumulative benefit catchup from adjusting payout probability	$ 6,700
Incremental expense of stock awards	$ 2,300

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Details) - Investments in Unconsolidated Real Estate Joint Ventures [Member]	Jun. 30, 2023
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Maximum [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%

Insider Trading Arrangements	6 Months Ended
Insider Trading Arrangements	Jun. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Business Acquisition [Line Items]
Total Assets	$ 19,204,375		$ 19,204,375		$ 19,658,000
Total Revenues	337,395	$ 400,226	687,606	$ 810,026
Total Gross Assets [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Total Assets	19,204,375		$ 19,204,375		$ 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	2,414,567		$ 2,414,567		$ 1,611,159
Percentage of concentration risk			12.60%		8.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Total Assets	3,656,046		$ 3,656,046		$ 4,762,673
Percentage of concentration risk			19.00%		24.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Total Assets	2,141,517		$ 2,141,517		$ 2,062,474
Percentage of concentration risk			11.20%		10.50%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Priory [Member]
Business Acquisition [Line Items]
Total Assets	1,401,106		$ 1,401,106		$ 1,290,213
Percentage of concentration risk			7.30%		6.60%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Total Assets	1,045,844		$ 1,045,844		$ 1,483,599
Percentage of concentration risk			5.50%		7.50%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Lifepoint Behavioral [Member]
Business Acquisition [Line Items]
Total Assets	799,212		$ 799,212		$ 985,959
Percentage of concentration risk			4.20%		5.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Operators [Member]
Business Acquisition [Line Items]
Total Assets	7,746,083		$ 7,746,083		$ 7,461,923
Percentage of concentration risk			40.20%		38.00%
Total Gross Assets [Member] \| Geographic Concentration [Member]
Business Acquisition [Line Items]
Total Assets	19,204,375		$ 19,204,375		$ 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	1,940,872		$ 1,940,872		$ 1,967,948
Percentage of concentration risk			10.10%		10.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| California [Member]
Business Acquisition [Line Items]
Total Assets	1,211,932		$ 1,211,932		$ 1,450,112
Percentage of concentration risk			6.30%		7.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Florida [Member]
Business Acquisition [Line Items]
Total Assets	1,366,453		$ 1,366,453		$ 1,324,555
Percentage of concentration risk			7.10%		6.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Utah [Member]
Business Acquisition [Line Items]
Total Assets	834,773		$ 834,773		$ 1,224,484
Percentage of concentration risk			4.40%		6.20%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Massachusetts [Member]
Business Acquisition [Line Items]
Total Assets	805,796		$ 805,796		$ 761,694
Percentage of concentration risk			4.20%		3.90%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other States [Member]
Business Acquisition [Line Items]
Total Assets	3,846,670		$ 3,846,670		$ 4,245,306
Percentage of concentration risk			20.00%		21.60%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total U.S. [Member]
Business Acquisition [Line Items]
Total Assets	11,706,182		$ 11,706,182		$ 12,003,045
Percentage of concentration risk			61.00%		61.10%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Total Assets	4,301,199		$ 4,301,199		$ 4,083,244
Percentage of concentration risk			22.40%		20.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Australia [Member]
Business Acquisition [Line Items]
Total Assets	301,125		$ 301,125		$ 854,582
Percentage of concentration risk			1.60%		4.30%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Switzerland [Member]
Business Acquisition [Line Items]
Total Assets	682,069		$ 682,069		$ 748,947
Percentage of concentration risk			3.50%		3.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Germany [Member]
Business Acquisition [Line Items]
Total Assets	746,419		$ 746,419		$ 664,900
Percentage of concentration risk			3.90%		3.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Spain [Member]
Business Acquisition [Line Items]
Total Assets	232,037		$ 232,037		$ 222,316
Percentage of concentration risk			1.20%		1.10%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other Countries [Member]
Business Acquisition [Line Items]
Total Assets	520,463		$ 520,463		$ 498,753
Percentage of concentration risk			2.70%		2.50%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total International [Member]
Business Acquisition [Line Items]
Total Assets	7,498,193		$ 7,498,193		$ 7,654,955
Percentage of concentration risk			39.00%		38.90%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other Domestic Assets [Member]
Business Acquisition [Line Items]
Total Assets	1,699,686		$ 1,699,686		$ 1,028,946
Percentage of concentration risk			8.90%		5.20%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other International Assets [Member]
Business Acquisition [Line Items]
Total Assets	$ 714,881		$ 714,881		$ 582,213
Percentage of concentration risk			3.70%		3.00%
Revenue [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 337,395	$ 400,226
Revenue [Member] \| Operator Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		26.50%
Percentage of concentration risk	(0.10%)
Total Revenues	$ (301)	$ 106,007
Revenue [Member] \| Operator Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	14.40%	11.90%
Total Revenues	$ 48,645	$ 47,539
Revenue [Member] \| Operator Concentration Risk [Member] \| Priory [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	8.00%	4.80%
Total Revenues	$ 26,930	$ 19,179
Revenue [Member] \| Operator Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	20.30%	10.60%
Total Revenues	$ 68,436	$ 42,364
Revenue [Member] \| Operator Concentration Risk [Member] \| Common Spirit [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.80%
Total Revenues	$ 19,568
Revenue [Member] \| Operator Concentration Risk [Member] \| Lifepoint Behavioral [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.70%	5.60%
Total Revenues	$ 19,068	$ 22,250
Revenue [Member] \| Operator Concentration Risk [Member] \| Other Operators [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	45.90%	40.60%
Total Revenues	$ 155,049	$ 162,887
Revenue [Member] \| Geographic Concentration [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 337,395	$ 400,226
Revenue [Member] \| Geographic Concentration [Member] \| Texas [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	14.10%	9.90%
Total Revenues	$ 47,444	$ 39,716
Revenue [Member] \| Geographic Concentration [Member] \| California [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	17.00%	12.00%
Total Revenues	$ 57,367	$ 48,109
Revenue [Member] \| Geographic Concentration [Member] \| Florida [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.50%	6.50%
Total Revenues	$ 35,508	$ 26,051
Revenue [Member] \| Geographic Concentration [Member] \| Pennsylvania [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	6.80%	5.00%
Total Revenues	$ 22,930	$ 19,942
Revenue [Member] \| Geographic Concentration [Member] \| Arizona [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	5.90%	4.10%
Total Revenues	$ 19,721	$ 16,383
Revenue [Member] \| Geographic Concentration [Member] \| All Other States [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.70%	34.40%
Total Revenues	$ 36,204	$ 137,518
Revenue [Member] \| Geographic Concentration [Member] \| Total U.S. [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	65.00%	71.90%
Total Revenues	$ 219,174	$ 287,719
Revenue [Member] \| Geographic Concentration [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	26.20%	19.80%
Total Revenues	$ 88,275	$ 79,415
Revenue [Member] \| Geographic Concentration [Member] \| Germany [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	2.80%	2.10%
Total Revenues	$ 9,517	$ 8,337
Revenue [Member] \| Geographic Concentration [Member] \| All Other Countries [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	6.00%	6.20%
Total Revenues	$ 20,429	$ 24,755
Revenue [Member] \| Geographic Concentration [Member] \| Total International [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	35.00%	28.10%
Total Revenues	$ 118,221	$ 112,507
Revenue [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	100.00%	100.00%
Total Revenues	$ 337,395	$ 400,226
Revenue [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	69.60%	76.30%
Total Revenues	$ 234,917	$ 305,468
Revenue [Member] \| Customer Concentration Risk [Member] \| Behavioral Health Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	16.70%	12.90%
Total Revenues	$ 56,378	$ 51,763
Revenue [Member] \| Customer Concentration Risk [Member] \| Inpatient Rehabilitation Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	9.30%	7.20%
Total Revenues	$ 31,452	$ 28,897
Revenue [Member] \| Customer Concentration Risk [Member] \| Long Term Acute Care Hospital [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	2.50%	2.10%
Total Revenues	$ 8,329	$ 8,270
Revenue [Member] \| Customer Concentration Risk [Member] \| Freestanding ER/Urgent Care Facilities [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	1.90%	1.50%
Total Revenues	$ 6,319	$ 5,828
Pro Forma [Member] \| Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Maximum percentage of entity's assets invested on single property	2.00%		2.00%

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

Jun. 30, 2023

Jun. 30, 2022

Total net assets acquired

$ 235,187

$ 946,243

Liabilities assumed

(25,727)

Loans repaid

^[1]

(22,900)

212,287

946,243

Land and Land Improvements [Member]

28,916

34,204

Building [Member]

Intangible Lease Assets [Member]

114,966

290,256

16,305

16,949

Mortgage Loans [Member]

100,000

Other Loans [Member]

Investments in Unconsolidated Real Estate Joint Ventures [Member]

25,000

Investments In Unconsolidated Operating Entities [Member]

399,456

$ 50,000

$ 131,105

[1]	The 2023 column includes a $23 million mortgage loan that was converted to fee simple ownership of one property as described under Lifepoint Transaction below.

Debt - Covenants - Additional Information (Detail)	6 Months Ended
Debt - Covenants - Additional Information (Detail)	Jun. 30, 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%

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Operating activities
Net (loss) income	$ (9,403)	$ 822,011
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	455,554	176,077
Amortization of deferred financing costs and debt discount	8,096	9,219
Straight-line rent revenue and other	(116,466)	(145,725)
Stock / (Unit)-based compensation expense	18,266	21,912
Gain on sale of real estate	(229)	(467,993)
Real estate and other impairment charges	89,538	4,875
Straight-line rent and other write-off	97,834	(328)
Debt refinancing and unutilized financing costs	816	9,435
Tax rate changes and other	(164,535)	(825)
Non-cash revenue from debt and equity securities received	(68,557)
Other adjustments	(8,296)	(13,170)
Changes in:
Interest and rent receivables	(62,132)	(44,224)
Other assets	(9,514)	(6,343)
Accounts payable and accrued expenses	(25,609)	(15,558)
Deferred revenue	6,814	(5,347)
Net cash provided by operating activities	212,177	344,016
Investing activities
Cash paid for acquisitions and other related investments	(235,187)	(946,243)
Net proceeds from sale of real estate	489,420	1,817,642
Principal received on loans receivable	389,385	19,478
Investment in loans receivable	(55,223)	(175,734)
Construction in progress and other	(28,639)	(91,167)
Proceeds from return of equity investments		775
Capital additions and other investments, net	(150,757)	(90,623)
Net cash provided by investing activities	408,999	534,128
Financing activities
Payments of term debt	(485,523)	(869,606)
Revolving credit facility, net	270,863	200,945
Dividends paid	(350,304)	(350,519)
Lease deposits and other obligations to tenants	7,154	3,174
Stock vesting - satisfaction of tax withholdings	(5,570)	(28,799)
Debt refinancing, deferred financing costs, and other financing activities	12,439	(17,917)
Net cash used for financing activities	(550,941)	(1,062,722)
Increase (decrease) in cash, cash equivalents, and restricted cash for period	70,235	(184,578)
Effect of exchange rate changes	18,184	(14,786)
Cash, cash equivalents, and restricted cash at beginning of period	241,538	461,882
Cash, cash equivalents, and restricted cash at end of period	329,957	262,518
Interest paid	227,361	209,445
Supplemental schedule of non-cash investing activities:
Debt and equity securities received for certain obligations, real estate, and revenue	804,520
Certain obligations and receivables satisfied and real estate sold	735,963
Supplemental schedule of non-cash financing activities:
Dividends declared, unpaid	173,851	174,017
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	324,050	257,269
Restricted cash, included in Other assets at end of period	$ 5,907	$ 5,249
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	$ 329,957	$ 262,518
MPT Operating Partnership, L.P. [Member]
Operating activities
Net (loss) income	(9,403)	822,011
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	455,554	176,077
Amortization of deferred financing costs and debt discount	8,096	9,219
Straight-line rent revenue and other	(116,466)	(145,725)
Stock / (Unit)-based compensation expense	18,266	21,912
Gain on sale of real estate	(229)	(467,993)
Real estate and other impairment charges	89,538	4,875
Straight-line rent and other write-off	97,834	(328)
Debt refinancing and unutilized financing costs	816	9,435
Tax rate changes and other	(164,535)	(825)
Non-cash revenue from debt and equity securities received	(68,557)
Other adjustments	(8,296)	(13,170)
Changes in:
Interest and rent receivables	(62,132)	(44,224)
Other assets	(9,514)	(6,343)
Accounts payable and accrued expenses	(25,609)	(15,558)
Deferred revenue	6,814	(5,347)
Net cash provided by operating activities	212,177	344,016
Investing activities
Cash paid for acquisitions and other related investments	(235,187)	(946,243)
Net proceeds from sale of real estate	489,420	1,817,642
Principal received on loans receivable	389,385	19,478
Investment in loans receivable	(55,223)	(175,734)
Construction in progress and other	(28,639)	(91,167)
Proceeds from return of equity investments		775
Capital additions and other investments, net	(150,757)	(90,623)
Net cash provided by investing activities	408,999	534,128
Financing activities
Payments of term debt	(485,523)	(869,606)
Revolving credit facility, net	270,863	200,945
Dividends paid	(350,304)	(350,519)
Lease deposits and other obligations to tenants	7,154	3,174
Stock vesting - satisfaction of tax withholdings	(5,570)	(28,799)
Debt refinancing, deferred financing costs, and other financing activities	12,439	(17,917)
Net cash used for financing activities	(550,941)	(1,062,722)
Increase (decrease) in cash, cash equivalents, and restricted cash for period	70,235	(184,578)
Effect of exchange rate changes	18,184	(14,786)
Cash, cash equivalents, and restricted cash at beginning of period	241,538	461,882
Cash, cash equivalents, and restricted cash at end of period	329,957	262,518
Interest paid	227,361	209,445
Supplemental schedule of non-cash investing activities:
Debt and equity securities received for certain obligations, real estate, and revenue	804,520
Certain obligations and receivables satisfied and real estate sold	735,963
Supplemental schedule of non-cash financing activities:
Dividends declared, unpaid	173,851	174,017
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	324,050	257,269
Restricted cash, included in Other assets at end of period	$ 5,907	$ 5,249
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	$ 329,957	$ 262,518

Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	Common Par Value [Member]	Common Par Value [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member]	Additional Paid-in Capital [Member]	Retained Earnings (Deficit) [Member]	Accumulated Other Comprehensive Income (Loss) [Member]	Accumulated Other Comprehensive Income (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 (loss) 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, 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 (loss) income	822,011	822,011
Unrealized gain (loss) on interest rate swap, net of tax	70,852	70,852
Foreign currency translation (loss) gain	(117,556)	(117,556)
Ending balance at Jun. 30, 2022	8,865,871	8,866,261	$ 89,511	$ 599	$ 8,854,143	8,557,120	385,545	(83,431)	(83,431)	6,038	6,038
Ending balance (in shares) at Jun. 30, 2022			5,988	598,839	592,851
Beginning balance at Mar. 31, 2022	8,919,359	8,919,749	$ 89,263	$ 599	$ 8,829,590	8,547,892	369,972	(5,010)	(5,010)	5,906	5,906
Beginning balance (in shares) at Mar. 31, 2022			5,987	598,676	592,689
Net (loss) income	190,064	190,064	$ 1,896		$ 187,701		189,597			467	467
Unrealized gain (loss) on interest rate swap, net of tax	25,920	25,920						25,920	25,920
Foreign currency translation (loss) gain	(104,341)	(104,341)						(104,341)	(104,341)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	10,108	10,108	$ 101		$ 10,007	10,108
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	204	202
Stock vesting - satisfaction of tax withholding	(880)	(880)	$ (9)		$ (871)	(880)
Stock vesting - satisfaction of tax withholding (Shares)			(1)	(41)	(40)
Distributions to non-controlling interests	(335)	(335)								(335)	(335)
Dividends (Distributions) declared	(174,024)	(174,024)	$ (1,740)		$ (172,284)		(174,024)
Ending balance at Jun. 30, 2022	8,865,871	8,866,261	$ 89,511	$ 599	$ 8,854,143	8,557,120	385,545	(83,431)	(83,431)	6,038	6,038
Ending balance (in shares) at Jun. 30, 2022			5,988	598,839	592,851
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 (loss) 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)
Reclassification of interest rate swap gain to earnings, net of tax	(28,553)	(28,553)						(28,553)	(28,553)
Foreign currency translation (loss) gain	28,143	28,143						28,143	28,143
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,829	11,829	$ 118	$ 1	$ 11,711	11,828
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			13	1,325	1,312
Stock vesting - satisfaction of tax withholding	(5,554)	(5,554)	$ (56)		$ (5,498)	(5,554)
Stock vesting - satisfaction of tax withholding (Shares)			(5)	(499)	(494)
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
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 (loss) income	(9,403)	(9,403)
Unrealized gain (loss) on interest rate swap, net of tax	2,595	2,595
Reclassification of foreign currency translation loss to earnings	3,234	3,234
Foreign currency translation (loss) gain	88,588	88,588
Ending balance at Jun. 30, 2023	8,314,714	8,315,104	$ 83,149	$ 598	$ 8,224,373	8,547,835	(241,301)	6,680	6,680	902	902
Ending balance (in shares) at Jun. 30, 2023			5,985	598,344	592,359
Beginning 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
Beginning balance (in shares) at Mar. 31, 2023			5,984	598,302	592,318
Net (loss) income	(42,433)	(42,433)	$ (420)		$ (41,617)		(42,037)			(396)	(396)
Unrealized gain (loss) on interest rate swap, net of tax	17,920	17,920						17,920	17,920
Reclassification of foreign currency translation loss to earnings	3,234	3,234						3,234	3,234
Foreign currency translation (loss) gain	60,445	60,445						60,445	60,445
Stock (Unit) vesting and amortization of stock (unit)-based compensation	6,437	6,437	$ 64		$ 6,373	6,437
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			1	59	58
Stock vesting - satisfaction of tax withholding	(16)	(16)			$ (16)	(16)
Stock vesting - satisfaction of tax withholding (Shares)				(17)	(17)
Distributions to non-controlling interests	(276)	(276)								(276)	(276)
Dividends (Distributions) declared	(173,851)	(173,851)	$ (1,739)		$ (172,112)		(173,851)
Ending balance at Jun. 30, 2023	$ 8,314,714	$ 8,315,104	$ 83,149	$ 598	$ 8,224,373	$ 8,547,835	$ (241,301)	$ 6,680	$ 6,680	$ 902	$ 902
Ending balance (in shares) at Jun. 30, 2023			5,985	598,344	592,359

Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Receivables [Abstract]
Balance at beginning of the period	$ 121,972	$ 53,933	$ 121,146	$ 48,527
Provision for credit loss, net	362	1,345	1,348	6,757
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied	(35,229)	(28)	(35,389)	(34)
Balance at end of the period	$ 87,105	$ 55,250	$ 87,105	$ 55,250

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

Earnings Per Share/Unit

6 Months Ended

Jun. 30, 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 (in thousands):


	For the Three Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(42,433	)	$	190,064
Non-controlling interests’ share in net loss (income)		396			(467	)
Participating securities’ share in earnings		(469	)		(345	)
Net (loss) income, less participating securities’ share in earnings	$	(42,506	)	$	189,252
Denominator:
Basic weighted-average common shares		598,344			598,827
Dilutive potential common shares(1)		—			199
Diluted weighted-average common shares		598,344			599,026


	For the Six Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(9,403	)	$	822,011
Non-controlling interests’ share in net loss (income)		160			(733	)
Participating securities’ share in earnings		(984	)		(747	)
Net (loss) income, less participating securities’ share in earnings	$	(10,227	)	$	820,531
Denominator:
Basic weighted-average common shares		598,323			598,751
Dilutive potential common shares(1)		—			228
Diluted weighted-average common shares		598,323			598,979

MPT Operating Partnership, L.P.

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


	For the Three Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(42,433	)	$	190,064
Non-controlling interests’ share in net loss (income)		396			(467	)
Participating securities’ share in earnings		(469	)		(345	)
Net (loss) income, less participating securities’ share in earnings	$	(42,506	)	$	189,252
Denominator:
Basic weighted-average units		598,344			598,827
Dilutive potential units(1)		—			199
Diluted weighted-average units		598,344			599,026


	For the Six Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(9,403	)	$	822,011
Non-controlling interests’ share in net loss (income)		160			(733	)
Participating securities’ share in earnings		(984	)		(747	)
Net (loss) income, less participating securities’ share in earnings	$	(10,227	)	$	820,531
Denominator:
Basic weighted-average units		598,323			598,751
Dilutive potential units(1)		—			228
Diluted weighted-average units		598,323			598,979

(1)

Potential common shares/units are not included in the computation of diluted earnings per share when a loss exists as the effect would be an antidilutive per share amount.

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

Jun. 30, 2023

Dec. 31, 2022

Debt issue costs and discount, net

$ 10,288,272

$ 10,325,499

(50,714)

(57,087)

Debt, net

10,237,558

10,268,412

Revolving Credit Facility [Member]

^[1]

1,211,708

929,584

Term Loan [Member]

Term Loan [Member] | Australia [Member]

200,000

Term loan due 2024 | British Pound Sterling [Member]

^[2]

313,208

817,560

Term loan due 2025 | British Pound Sterling [Member]

^[2]

133,191

126,690

2.550% Senior Unsecured Notes due 2023 [Member]

^[2]

889,210

845,810

3.325% Senior Unsecured Notes due 2025 [Member]

^[2]

508,120

483,320

0.993% Senior Unsecured Notes due 2026 [Member]

^[2]

545,450

535,250

2.500% Senior Unsecured Notes due 2026 [Member]

^[2]

545,450

535,250

5.250% Senior Unsecured Notes due 2026 [Member]

^[2]

635,150

604,150

5.000% Senior Unsecured Notes due 2027 [Member]

500,000

3.692% Senior Unsecured Notes due 2028 [Member]

1,400,000

4.625% Senior Unsecured Notes due 2029 [Member]

^[2]

762,180

724,980

3.375% Senior Unsecured Notes due 2030 [Member]

900,000

3.500% Senior Unsecured Notes due 2031 [Member]

^[2]

444,605

422,905

Summary of Status on Current Development Projects

$ 1,300,000

[1]	Includes £119 million of GBP-denominated borrowings and €303 million of Euro-denominated borrowings that reflect the applicable exchange rates at June 30, 2023.
[2]	Non-U.S. dollar denominated debt reflects the exchange rates at June 30, 2023 and December 31, 2022.

Debt - 2022 Activity - Additional Information (Detail) - USD ($) $ in Millions		6 Months Ended
	Jun. 29, 2022	Jun. 30, 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			$ 1,000.0
Debt refinancing costs		$ 0.6
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument amendment extended maturity date description		On June 29, 2022, we amended our Credit Facility to extend the maturity date of our $1.8 billion revolving facility to June 30, 2026, with our option to extend for an additional 12 months
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 1,800.0
Debt instrument maturity date	Jun. 30, 2026
Maximum incremental credit facility	$ 1,000.0
Term Loan [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt	$ 200.0
Debt instrument maturity date	Jun. 30, 2027

Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 621,704	$ 880,253
Estimated unguaranteed residual values	203,818	203,818
Less: Unearned income and allowance for credit loss	(582,215)	(731,915)
Net investment in direct financing leases	243,307	352,156
Other financing leases (net of allowance for credit loss)	988,345	1,339,167
Total investment in financing leases	$ 1,231,652	$ 1,691,323

Real Estate and Other Activities (Tables)

6 Months Ended

Jun. 30, 2023

Real Estate [Abstract]

Net Assets Acquired

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


	For the Six Months Ended June 30,
	2023			2022

Land and land improvements	$	28,916		$	34,204
Buildings		114,966			290,256
Intangible lease assets — subject to amortization (weighted-average useful life of 24.8 years for 2023 and 20.1 years for 2022)		16,305			16,949
Mortgage loans		—			100,000
Investments in unconsolidated real estate joint ventures		—			399,456
Investments in unconsolidated operating entities		50,000			131,105
Other loans		25,000			—
Liabilities assumed		—			(25,727	)
	$	235,187		$	946,243
Loans repaid(1)		(22,900	)		—
Total net assets acquired	$	212,287		$	946,243

(1)

The 2023 column includes a $23 million mortgage loan that was converted to fee simple ownership of one property as described under Lifepoint Transaction below.

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


Property	Commitment		Costs Incurred as of June 30, 2023		Estimated Rent Commencement Date
Ernest Health, Inc. ("Ernest") (South Carolina)	$	22,400	$	18,077	3Q 2023
IMED Hospitales ("IMED") (Spain)		46,273		41,109	3Q 2023
Lifepoint Behavioral Health (Texas)		31,600		11,422	1Q 2024
IMED (Spain)		37,434		10,832	3Q 2024
IMED (Spain)		51,372		14,849	1Q 2025
Steward (Texas)		169,408		57,098	2Q 2026
	$	358,487	$	153,387

Summary of Operating Results from Properties

The properties expected to be sold during 2023 and sold during the first half of 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 June 30,						For the Six Months Ended June 30,
	2023(1)			2022			2023(1)			2022
Revenues(2)	$	12,051		$	18,905		$	30,928		$	60,739
Real estate depreciation and amortization		—			(5,615	)		(4,991	)		(11,508	)
Property-related expenses		(436	)		(2,410	)		(1,855	)		(5,765	)
Real estate and other impairment charges(3)		—			—			(89,538	)		—
Other (expense) income(4)		(5,382	)		8,410			(10,974	)		452,678
Income (loss) from real estate dispositions, net	$	6,233		$	19,290		$	(76,430	)	$	496,144

(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 $1.8 million and $6.3 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three and six months ended June 30, 2022, respectively.

(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 six months ended June 30, 2023.

(4)

Includes $16.4 million and $468.0 million of gains (net of $125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three and six months ended June 30, 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 June 30, 2023			As of December 31, 2022
Minimum lease payments receivable	$	621,704		$	880,253
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(582,215	)		(731,915	)
Net investment in direct financing leases		243,307			352,156
Other financing leases (net of allowance for credit loss)		988,345			1,339,167
Total investment in financing leases	$	1,231,652		$	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 June 30, 2023		As of December 31, 2022
MEDIAN	50%	$	482,710	$	482,735
Swiss Medical Network	70%		440,754		454,083
Steward (Macquarie Transaction)	50%		425,424		417,701
Policlinico di Monza	50%		83,595		86,245
HM Hospitales	45%		54,635		57,139
Total		$	1,487,118	$	1,497,903

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


Operator	As of June 30, 2023		As of December 31, 2022
PHP Holdings	$	654,520	$	—
Steward (loan investment)		362,586		362,831
International joint venture		230,153		231,402
Priory		163,619		156,575
Swiss Medical Network		162,194		157,145
Steward (equity investment)		125,862		125,862
Aevis Victoria SA ("Aevis")		79,121		72,904
Aspris Children's Services ("Aspris")		16,005		16,023
Lifepoint Behavioral		10,767		200,827
Caremax		7,323		8,526
Prospect		—		112,777
Total	$	1,812,150	$	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 June 30,
	2023			2022
Balance at beginning of the period	$	121,972		$	53,933
Provision for credit loss, net		362			1,345
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(35,229	)		(28	)
Balance at end of the period	$	87,105		$	55,250


	For the Six Months Ended June 30,
	2023			2022
Balance at beginning of the year	$	121,146		$	48,527
Provision for credit loss, net		1,348			6,757
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(35,389	)		(34	)
Balance at end of the period	$	87,105		$	55,250

Schedule of Concentrations of Credit Risk

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

Total Assets by Operator


	As of June 30, 2023						As of December 31, 2022
Operators	Total Assets			Percentage of Total Assets			Total Assets		Percentage of Total Assets
Steward	$	3,656,046			19.0	%	$	4,762,673		24.2	%
Circle Health Ltd ("Circle")		2,141,517			11.2	%		2,062,474		10.5	%
Priory		1,401,106			7.3	%		1,290,213		6.6	%
Prospect		1,045,844			5.5	%		1,483,599		7.5	%
Lifepoint Behavioral		799,212			4.2	%		985,959		5.0	%
Other operators		7,746,083			40.2	%		7,461,923		38.0	%
Other assets		2,414,567	(1)		12.6	%		1,611,159		8.2	%
Total	$	19,204,375			100.0	%	$	19,658,000		100.0	%

(1)

Includes our investment in PHP Holdings of $655 million as part of the Prospect Transaction as further described above in this same Note 3.

Total Assets by U.S. State and Country


	As of June 30, 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	$	1,940,872		10.1	%	$	1,967,948		10.0	%
Florida		1,366,453		7.1	%		1,324,555		6.8	%
California		1,211,932		6.3	%		1,450,112		7.4	%
Utah		834,773		4.4	%		1,224,484		6.2	%
Massachusetts		805,796		4.2	%		761,694		3.9	%
All other states		3,846,670		20.0	%		4,245,306		21.6	%
Other domestic assets		1,699,686		8.9	%		1,028,946		5.2	%
Total U.S.	$	11,706,182		61.0	%	$	12,003,045		61.1	%
United Kingdom	$	4,301,199		22.4	%	$	4,083,244		20.8	%
Germany		746,419		3.9	%		664,900		3.4	%
Switzerland		682,069		3.5	%		748,947		3.8	%
Australia		301,125		1.6	%		854,582		4.3	%
Spain		232,037		1.2	%		222,316		1.1	%
All other countries		520,463		2.7	%		498,753		2.5	%
Other international assets		714,881		3.7	%		582,213		3.0	%
Total international	$	7,498,193		39.0	%	$	7,654,955		38.9	%
Grand total	$	19,204,375		100.0	%	$	19,658,000		100.0	%

Total Revenues by Operator


	For the Three Months Ended June 30,
	2023							2022
Operators	Total Revenues				Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Prospect	$	68,436				20.3	%	$	42,364		10.6	%
Circle		48,645				14.4	%		47,539		11.9	%
Priory		26,930				8.0	%		19,179		4.8	%
CommonSpirit		19,568				5.8	%		—		—
Lifepoint Behavioral		19,068				5.7	%		22,250		5.6	%
Steward		(301	)	(1)		-0.1	%		106,007		26.5	%
Other operators		155,049				45.9	%		162,887		40.6	%
Total	$	337,395				100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

Total Revenues by U.S. State and Country


	For the Three Months Ended June 30,
	2023						2022
U.S. States and Other Countries	Total Revenues			Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
California	$	57,367			17.0	%	$	48,109		12.0	%
Texas		47,444			14.1	%		39,716		9.9	%
Florida		35,508			10.5	%		26,051		6.5	%
Pennsylvania		22,930			6.8	%		19,942		5.0	%
Arizona		19,721			5.9	%		16,383		4.1	%
All other states		36,204	(1)		10.7	%		137,518		34.4	%
Total U.S.	$	219,174			65.0	%	$	287,719		71.9	%
United Kingdom	$	88,275			26.2	%	$	79,415		19.8	%
Germany		9,517			2.8	%		8,337		2.1	%
All other countries		20,429			6.0	%		24,755		6.2	%
Total international	$	118,221			35.0	%	$	112,507		28.1	%
Grand total	$	337,395			100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

Total Revenues by Facility Type


	For the Three Months Ended June 30,
	2023						2022
Facility Types	Total Revenues			Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
General acute care hospitals	$	234,917	(1)		69.6	%	$	305,468		76.3	%
Behavioral health facilities		56,378			16.7	%		51,763		12.9	%
Inpatient rehabilitation facilities		31,452			9.3	%		28,897		7.2	%
Long-term acute care hospitals		8,329			2.5	%		8,270		2.1	%
Freestanding ER/urgent care facilities		6,319			1.9	%		5,828		1.5	%
Total	$	337,395			100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 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 and six months ended June 30, 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 June 30, 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 June 30, 2023, we had loans and/or equity investments in certain variable interest entities ("VIEs"), which are also tenants of our facilities. 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. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs at June 30, 2023 are presented below (in thousands):


VIE Type	Carrying Amount(1)		Asset Type Classification	Maximum Loss Exposure(2)
Loans, net	$	805,640	Investments in Unconsolidated Operating Entities	$	805,640
Loans, net		139,266	Mortgage and other loans		176,248
Equity investments		89,809	Investments in Unconsolidated Operating Entities		89,809

(1)

Carrying amount reflects the net book value of our loan or equity investment only in the VIE.

(2)

For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE's economic performance. As of June 30, 2023, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which they could be exposed to further losses (e.g. cash short falls).

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Revenues
Rent billed	$ 247,491	$ 241,209	$ 495,648	$ 504,611
Straight-line rent	(39,329)	58,518	17,364	119,562
Income from financing leases	68,468	51,873	81,663	103,649
Interest and other income	60,765	48,626	92,931	82,204
Total revenues	337,395	400,226	687,606	810,026
Expenses
Interest	104,470	87,730	202,124	178,913
Real estate depreciation and amortization	364,403	84,334	448,263	169,650
Property-related	24,676	21,135	31,786	29,733
General and administrative	35,604	38,858	77,328	80,282
Total expenses	529,153	232,057	759,501	458,578
Other income (expense)
Gain on sale of real estate	167	16,355	229	467,993
Real estate and other impairment charges			(89,538)	(4,875)
Earnings from equity interests	12,224	14,785	23,576	22,123
Debt refinancing and unutilized financing costs	(816)	(619)	(816)	(9,435)
Other (including fair value adjustments on securities)	(10,512)	2,031	(15,678)	16,793
Total other income (expense)	1,063	32,552	(82,227)	492,599
(Loss) income before income tax	(190,695)	200,721	(154,122)	844,047
Income tax benefit (expense)	148,262	(10,657)	144,719	(22,036)
Net (loss) income	(42,433)	190,064	(9,403)	822,011
Net loss (income) attributable to non-controlling interests	396	(467)	160	(733)
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners)	$ (42,037)	$ 189,597	$ (9,243)	$ 821,278
Earnings per common share (units) basic
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), basic	$ (0.07)	$ 0.32	$ (0.02)	$ 1.37
Earnings per common share (units) diluted
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ (0.07)	$ 0.32	$ (0.02)	$ 1.37
Weighted average shares (units) outstanding basic	598,344	598,827	598,323	598,751
Weighted average shares (units) outstanding diluted	598,344	599,026	598,323	598,979
Dividends declared per common share (unit)	$ 0.29	$ 0.29	$ 0.58	$ 0.58
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 247,491	$ 241,209	$ 495,648	$ 504,611
Straight-line rent	(39,329)	58,518	17,364	119,562
Income from financing leases	68,468	51,873	81,663	103,649
Interest and other income	60,765	48,626	92,931	82,204
Total revenues	337,395	400,226	687,606	810,026
Expenses
Interest	104,470	87,730	202,124	178,913
Real estate depreciation and amortization	364,403	84,334	448,263	169,650
Property-related	24,676	21,135	31,786	29,733
General and administrative	35,604	38,858	77,328	80,282
Total expenses	529,153	232,057	759,501	458,578
Other income (expense)
Gain on sale of real estate	167	16,355	229	467,993
Real estate and other impairment charges			(89,538)	(4,875)
Earnings from equity interests	12,224	14,785	23,576	22,123
Debt refinancing and unutilized financing costs	(816)	(619)	(816)	(9,435)
Other (including fair value adjustments on securities)	(10,512)	2,031	(15,678)	16,793
Total other income (expense)	1,063	32,552	(82,227)	492,599
(Loss) income before income tax	(190,695)	200,721	(154,122)	844,047
Income tax benefit (expense)	148,262	(10,657)	144,719	(22,036)
Net (loss) income	(42,433)	190,064	(9,403)	822,011
Net loss (income) attributable to non-controlling interests	396	(467)	160	(733)
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners)	$ (42,037)	$ 189,597	$ (9,243)	$ 821,278
Earnings per common share (units) basic
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), basic	$ (0.07)	$ 0.32	$ (0.02)	$ 1.37
Earnings per common share (units) diluted
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ (0.07)	$ 0.32	$ (0.02)	$ 1.37
Weighted average shares (units) outstanding basic	598,344	598,827	598,323	598,751
Weighted average shares (units) outstanding diluted	598,344	599,026	598,323	598,979
Dividends declared per common share (unit)	$ 0.29	$ 0.29	$ 0.58	$ 0.58

Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details)	6 Months Ended
	Jun. 30, 2023 Property
Lessor, Lease, Description [Line Items]
Percentage of properties occupied by tenants	99.00%
Number of properties vacant	5
Percentage of vacant on leased property	0.20%

Debt (Tables)

6 Months Ended

Jun. 30, 2023

Debt Disclosure [Abstract]

Summary of Debt

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


	As of June 30, 2023			As of December 31, 2022
Revolving credit facility(A)	$	1,211,708		$	929,584
Term loan		200,000			200,000
British pound sterling term loan due 2024(B)		133,191			126,690
British pound sterling term loan due 2025(B)		889,210			845,810
Australian term loan facility(B)		313,208			817,560
2.550% Senior Unsecured Notes due 2023(B)		508,120			483,320
3.325% Senior Unsecured Notes due 2025(B)		545,450			535,250
0.993% Senior Unsecured Notes due 2026(B)		545,450			535,250
2.500% Senior Unsecured Notes due 2026(B)		635,150			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)		762,180			724,980
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		444,605			422,905
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	10,288,272		$	10,325,499
Debt issue costs and discount, net		(50,714	)		(57,087	)
	$	10,237,558		$	10,268,412

(A)

Includes £119 million of GBP-denominated borrowings and €303 million of Euro-denominated borrowings that reflect the applicable exchange rates at June 30, 2023.

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at June 30, 2023 and December 31, 2022.

Principal Payments Due on Debt

As of June 30, 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	$	508,120
2024		446,399
2025		1,434,660
2026		2,892,308
2027		1,600,000
Thereafter		3,406,785
Total	$	10,288,272

Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,487,118	$ 1,497,903
MEDIAN [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 482,710	482,735
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	70.00%
Investments in unconsolidated real estate joint ventures	$ 440,754	454,083
Steward (Macquarie Transaction) [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 425,424	417,701
Policlinico di Monza [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 83,595	86,245
HM Hospital [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	45.00%
Investments in unconsolidated real estate joint ventures	$ 54,635	$ 57,139

Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Parenthetical) (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Mar. 31, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 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		$ 1.8		$ 6.3
Massachusetts-based General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs		125.0		125.0
Massachusetts-based General Acute Care Hospitals [Member] \| Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Gains		$ 16.4		$ 468.0
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		$ 11.0

Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail)	6 Months Ended
	Jun. 30, 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 direct financing leases	9
Minimum [Member]
Lessor Lease Description [Line Items]
Term of lease	15 years

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

6 Months Ended

Jun. 30, 2023

Jun. 30, 2022

Dec. 31, 2021

Advanced to the mortgage loan

^[1]

$ 22,900

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

Advanced to the mortgage loan

$ 23,000

Intangible Lease Assets [Member]

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

24 years 9 months 18 days

20 years 1 month 6 days

[1]	The 2023 column includes a $23 million mortgage loan that was converted to fee simple ownership of one property as described under Lifepoint Transaction below.

Common Stock/Partners' Capital - Additional Information (Detail) - shares shares in Thousands	Jun. 30, 2023	Dec. 31, 2022
Class Of Stock [Line Items]
Common stock, shares issued	598,344	597,476

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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Real Estate and Other Activities

Organization - Additional Information (Detail)	6 Months Ended
Organization - Additional Information (Detail)	Jun. 30, 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

Real Estate and Other Activities - Disposals - 2023 Activity Additional Information (Detail) $ in Millions, $ in Millions					3 Months Ended		6 Months Ended
	Jul. 11, 2023 USD ($) Facility	May 18, 2023 AUD ($) Facility	Mar. 29, 2023 Facility	Mar. 08, 2023 USD ($)	Mar. 31, 2023 AUD ($) Facility	Mar. 31, 2023 USD ($) Facility	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($) Facility
Debt Instrument [Line Items]
Number of facilities sold \| Facility								4
Proceeds from sale of facilities								$ 154.0
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	Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, after Tax
Australia Transaction [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility		7
Proceeds from sale of facilities		$ 730			$ 1,200
Proceeds from sale to paydown		$ 730
Australia [Member] \| General Acute Care Facility [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility			11
Prime [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility					3	3
Proceeds from sale of facilities				$ 100.0
Non-cash impairment charge						$ 11.0	$ 11.0
Prime [Member] \| Subsequent Event [Member]
Debt Instrument [Line Items]
Facilities acquired by the Prime	$ 100.0
Number of facilities acquired \| Facility	3

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 13,133,651	$ 13,862,415
Investment in financing leases	1,231,652	1,691,323
Real estate held for sale	401,125
Mortgage loans	299,326	364,101
Gross investment in real estate assets	15,065,754	15,917,839
Accumulated depreciation and amortization	(1,251,165)	(1,193,312)
Net investment in real estate assets	13,814,589	14,724,527
Cash and cash equivalents	324,050	235,668
Interest and rent receivables, net	177,643	167,035
Straight-line rent receivables	779,584	787,166
Investments in unconsolidated real estate joint ventures	1,487,118	1,497,903
Investments in unconsolidated operating entities	1,812,150	1,444,872
Other loans	199,360	227,839
Other assets	609,881	572,990
Total Assets	19,204,375	19,658,000
Liabilities
Debt, net	10,237,558	10,268,412
Accounts payable and accrued expenses	444,926	621,324
Deferred revenue	49,766	27,727
Obligations to tenants and other lease liabilities	157,411	146,130
Total Liabilities	10,889,661	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 - 598,344 shares at June 30, 2023 and 597,476 shares at December 31, 2022	598	597
Additional paid-in capital	8,547,835	8,535,140
Retained (deficit) earnings	(241,301)	116,285
Accumulated other comprehensive income (loss)	6,680	(59,184)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,313,812	8,592,838
Non-controlling interests	902	1,569
Total Equity / Capital	8,314,714	8,594,407
Total Liabilities and Equity / Capital	19,204,375	19,658,000
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	13,133,651	13,862,415
Investment in financing leases	1,231,652	1,691,323
Real estate held for sale	401,125
Mortgage loans	299,326	364,101
Gross investment in real estate assets	15,065,754	15,917,839
Accumulated depreciation and amortization	(1,251,165)	(1,193,312)
Net investment in real estate assets	13,814,589	14,724,527
Cash and cash equivalents	324,050	235,668
Interest and rent receivables, net	177,643	167,035
Straight-line rent receivables	779,584	787,166
Investments in unconsolidated real estate joint ventures	1,487,118	1,497,903
Investments in unconsolidated operating entities	1,812,150	1,444,872
Other loans	199,360	227,839
Other assets	609,881	572,990
Total Assets	19,204,375	19,658,000
Liabilities
Debt, net	10,237,558	10,268,412
Accounts payable and accrued expenses	269,920	444,354
Deferred revenue	49,766	27,727
Obligations to tenants and other lease liabilities	157,411	146,130
Payable due to Medical Properties Trust, Inc.	174,616	176,580
Total Liabilities	10,889,271	11,063,203
Equity / Capital
General Partner - issued and outstanding - 5,985 units at June 30, 2023 and 5,976 units at December 31, 2022	83,149	86,599
Limited Partners - issued and outstanding - 592,359 units at June 30, 2023 and 591,500 units at December 31, 2022	8,224,373	8,565,813
Accumulated other comprehensive income (loss)	6,680	(59,184)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	8,314,202	8,593,228
Non-controlling interests	902	1,569
Total Equity / Capital	8,315,104	8,594,797
Total Liabilities and Equity / Capital	$ 19,204,375	$ 19,658,000

Real Estate and Other Activities

6 Months Ended

Jun. 30, 2023

Real Estate [Abstract]

3. Real Estate and Other Activities

New Investments

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


	For the Six Months Ended June 30,
	2023			2022

Land and land improvements	$	28,916		$	34,204
Buildings		114,966			290,256
Intangible lease assets — subject to amortization (weighted-average useful life of 24.8 years for 2023 and 20.1 years for 2022)		16,305			16,949
Mortgage loans		—			100,000
Investments in unconsolidated real estate joint ventures		—			399,456
Investments in unconsolidated operating entities		50,000			131,105
Other loans		25,000			—
Liabilities assumed		—			(25,727	)
	$	235,187		$	946,243
Loans repaid(1)		(22,900	)		—
Total net assets acquired	$	212,287		$	946,243

(1)

The 2023 column includes a $23 million mortgage loan that was converted to fee simple ownership of one property as described under Lifepoint Transaction below.

2023 Activity

Prospect Transaction

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 Medical Holdings, Inc. ("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 was secured by a first lien on a California hospital. Prospect's operations were negatively impacted by the coronavirus ("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 the termination of certain refinancing negotiations between Prospect and certain third parties in early 2023, 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.

However, Prospect continued to pursue a recapitalization plan; and, in late March 2023, Prospect received a binding commitment from several lenders to provide liquidity to pay down certain debt instruments. Along with these commitments from third-party lenders, we agreed to pursue certain transactions with Prospect as part of their recapitalization plan, including originating a $50 million convertible loan to PHP Holdings, the managed care business of Prospect, in the first quarter of 2023.

On May 23, 2023, Prospect completed its recapitalization plan, which included receiving $375 million in new financing from several lenders. Along with this new debt capital from third-party lenders, we agreed to the following restructuring of our $1.7 billion investment in Prospect including: a) maintaining 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 a substantial portion 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 first lien 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, of which we funded $25 million on May 23, 2023, d) 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, and e) obtain a non-controlling ownership interest in PHP Holdings of approximately $654 million, after applying a discount for lack of marketability, consisting of an approximate $68 million equity investment and $586 million loan convertible into equity of PHP Holdings (collectively, the "Prospect Transaction"). This non-controlling ownership interest was received in exchange for unpaid rent and interest through December 2022, previously unrecorded rent and interest revenue in 2023 totaling approximately $68 million, our $151 million mortgage loan on a California property, our $112.9 million term loan, and other obligations at the time of such investment.

At June 30, 2023, we believe our remaining investment in the Prospect real estate and other assets are fully recoverable, but no assurances can be given that we will not have any further impairments in future periods.

Lifepoint Transaction

On February 7, 2023, a subsidiary of Lifepoint Health, Inc. ("Lifepoint") acquired a majority interest in Springstone (now Lifepoint Behavioral Health, "Lifepoint Behavioral") (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, including accrued interest, and we retained our minority equity investment in the operations of Lifepoint Behavioral. Separately, we converted a mortgage loan (as part of our initial acquisition in 2021) into the fee simple ownership of a property in Washington, which will be leased, along with the other 18 behavioral health hospitals already leased to Lifepoint Behavioral, 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

In the second quarter of 2023, we acquired three inpatient rehabilitation facilities for a total of approximately €70 million. These hospitals are leased to Median Kliniken S.á.r.l ("MEDIAN") pursuant to a long-term master lease with annual inflation-based escalators.

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 Group ("Priory") pursuant to five separate lease agreements with annual inflation-based escalators.

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, of which we funded £96.5 million towards a £100 million participation level in the variable rate loan.

Other acquisitions in the first half of 2022 included five general acute care facilities. Three general acute care facilities, located throughout Spain, were acquired on April 29, 2022 for €27 million and are leased to GenesisCare pursuant to a long-term lease with annual inflation-based escalators. The other two general acute care facilities, one in Arizona and the other in Florida, were acquired on April 18 and 25, 2022, respectively, for approximately $80 million and are leased to Steward pursuant to an already existing master lease agreement with annual inflation-based escalators.

Development Activities

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


Property	Commitment		Costs Incurred as of June 30, 2023		Estimated Rent Commencement Date
Ernest Health, Inc. ("Ernest") (South Carolina)	$	22,400	$	18,077	3Q 2023
IMED Hospitales ("IMED") (Spain)		46,273		41,109	3Q 2023
Lifepoint Behavioral Health (Texas)		31,600		11,422	1Q 2024
IMED (Spain)		37,434		10,832	3Q 2024
IMED (Spain)		51,372		14,849	1Q 2025
Steward (Texas)		169,408		57,098	2Q 2026
	$	358,487	$	153,387

2023 Activity

During the 2023 second quarter, we completed construction and began recording rental income on an inpatient rehabilitation facility located in Stockton, California. This facility commenced rent on May 1, 2023, and is being leased to Ernest pursuant to an existing long-term master lease.

We continue to fund the redevelopment of and defer rent on our Norwood facility in Massachusetts. Recovery receivables of approximately $130 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. In conjunction with the redevelopment of Steward's Norwood hospital, we advanced $50 million, in the first half of 2023, that is secured by, among other things, proceeds from insurance claims in excess of the advance.

2022 Activity

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.

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 in the first quarter of 2023 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 was set to close in two phases. The first phase closed on May 18, 2023, in which we sold seven of the 11 facilities for A$730 million, with the final phase currently expected to be complete by early fourth quarter of 2023. We used the A$730 million proceeds from the first phase of the sale to pay down the Australian term loan.

Although we currently expect the final phase of the Australia Transaction to occur as planned, no assurances can be given that the transaction will close as described above.

On March 8, 2023, we received notice that Prime Healthcare Services, Inc. ("Prime") planned to exercise its right to repurchase from us 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 that were sold. On July 11, 2023, Prime acquired the three facilities for $100 million.

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 half of 2022, we also completed the sale of four other facilities and two ancillary properties for approximately $154 million, resulting in a gain on real estate of approximately $31 million.

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


	For the Three Months Ended June 30,						For the Six Months Ended June 30,
	2023(1)			2022			2023(1)			2022
Revenues(2)	$	12,051		$	18,905		$	30,928		$	60,739
Real estate depreciation and amortization		—			(5,615	)		(4,991	)		(11,508	)
Property-related expenses		(436	)		(2,410	)		(1,855	)		(5,765	)
Real estate and other impairment charges(3)		—			—			(89,538	)		—
Other (expense) income(4)		(5,382	)		8,410			(10,974	)		452,678
Income (loss) from real estate dispositions, net	$	6,233		$	19,290		$	(76,430	)	$	496,144

(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 $1.8 million and $6.3 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three and six months ended June 30, 2022, respectively.

(3)

(4)

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 June 30, 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 nine 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 June 30, 2023			As of December 31, 2022
Minimum lease payments receivable	$	621,704		$	880,253
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(582,215	)		(731,915	)
Net investment in direct financing leases		243,307			352,156
Other financing leases (net of allowance for credit loss)		988,345			1,339,167
Total investment in financing leases	$	1,231,652		$	1,691,323

The decrease in our investment in financing leases since December 31, 2022, is the result of classifying three Prime facilities as held for sale in the first quarter of 2023, and the sale of four Pennsylvania properties as part of the Prospect Transaction.

Other Leasing Activities

At June 30, 2023, 99% of our properties are occupied by tenants, leaving five properties as vacant, representing approximately 0.2% 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 lease 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 cybersecurity attacks or public health crises (like the 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 above in the Prospect Transaction).

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 $9.8 million as of June 30, 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. As of June 30, 2023, Pipeline was in compliance with all terms of the bankruptcy settlement and the lease.

Steward Health Care System

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 (the "Steward Transaction"). As a result of this transaction, we received $100 million on May 1, 2023, of the $150 million loan made in the 2022 second quarter. The new lease with CHIC for these Utah assets has an initial fixed term of 15 years with annual escalation provisions, along with early lessee purchase options at the greater of fair market value or our gross investment. As part of this transaction, we severed these facilities from the master lease with Steward, and accordingly accelerated the amortization of the associated in-place lease intangibles (approximately $286 million) and wrote-off approximately $95 million of straight-line rent receivables.

Alecto Healthcare Services LLC

On June 16, 2023, Alecto Healthcare Services LLC ("Alecto") filed for Chapter 11 bankruptcy in Delaware. At the time, we leased one property to Alecto in Sherman, Texas with a net book value of approximately $12 million. As a result of this bankruptcy, we have entered into a restructuring agreement involving the Sherman facility and American Healthcare Systems, the new tenant of the facility. We believe this agreement will be finalized in the third quarter of 2023, but no assurances can be given that the transaction will close or any impairment will not be needed.

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 June 30, 2023		As of December 31, 2022
MEDIAN	50%	$	482,710	$	482,735
Swiss Medical Network	70%		440,754		454,083
Steward (Macquarie Transaction)	50%		425,424		417,701
Policlinico di Monza	50%		83,595		86,245
HM Hospitales	45%		54,635		57,139
Total		$	1,487,118	$	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 June 30, 2023		As of December 31, 2022
PHP Holdings	$	654,520	$	—
Steward (loan investment)		362,586		362,831
International joint venture		230,153		231,402
Priory		163,619		156,575
Swiss Medical Network		162,194		157,145
Steward (equity investment)		125,862		125,862
Aevis Victoria SA ("Aevis")		79,121		72,904
Aspris Children's Services ("Aspris")		16,005		16,023
Lifepoint Behavioral		10,767		200,827
Caremax		7,323		8,526
Prospect		—		112,777
Total	$	1,812,150	$	1,444,872

The change since December 31, 2022 primarily relates to the payoff of the Lifepoint Behavioral loan in February 2023, partially offset by our investment in PHP Holdings, as more fully described above in the Prospect Transaction.

Pursuant to our approximate 5% stake in Aevis and other investments marked to fair value, we recorded approximately $4.3 million in unfavorable non-cash fair value adjustments during the first half 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 a $9.0 million favorable non-cash fair value adjustment for the same period of 2022.

Other Investment Activities

In the first half of 2023, we received repayment of the CHF 60 million mortgage loan from Infracore SA ("Infracore") that was originally made in the fourth quarter of 2022.

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 June 30,
	2023			2022
Balance at beginning of the period	$	121,972		$	53,933
Provision for credit loss, net		362			1,345
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(35,229	)		(28	)
Balance at end of the period	$	87,105		$	55,250


	For the Six Months Ended June 30,
	2023			2022
Balance at beginning of the year	$	121,146		$	48,527
Provision for credit loss, net		1,348			6,757
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied		(35,389	)		(34	)
Balance at end of the period	$	87,105		$	55,250

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 June 30, 2023						As of December 31, 2022
Operators	Total Assets			Percentage of Total Assets			Total Assets		Percentage of Total Assets
Steward	$	3,656,046			19.0	%	$	4,762,673		24.2	%
Circle Health Ltd ("Circle")		2,141,517			11.2	%		2,062,474		10.5	%
Priory		1,401,106			7.3	%		1,290,213		6.6	%
Prospect		1,045,844			5.5	%		1,483,599		7.5	%
Lifepoint Behavioral		799,212			4.2	%		985,959		5.0	%
Other operators		7,746,083			40.2	%		7,461,923		38.0	%
Other assets		2,414,567	(1)		12.6	%		1,611,159		8.2	%
Total	$	19,204,375			100.0	%	$	19,658,000		100.0	%

(1)

Includes our investment in PHP Holdings of $655 million as part of the Prospect Transaction as further described above in this same Note 3.

Total Assets by U.S. State and Country


	As of June 30, 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	$	1,940,872		10.1	%	$	1,967,948		10.0	%
Florida		1,366,453		7.1	%		1,324,555		6.8	%
California		1,211,932		6.3	%		1,450,112		7.4	%
Utah		834,773		4.4	%		1,224,484		6.2	%
Massachusetts		805,796		4.2	%		761,694		3.9	%
All other states		3,846,670		20.0	%		4,245,306		21.6	%
Other domestic assets		1,699,686		8.9	%		1,028,946		5.2	%
Total U.S.	$	11,706,182		61.0	%	$	12,003,045		61.1	%
United Kingdom	$	4,301,199		22.4	%	$	4,083,244		20.8	%
Germany		746,419		3.9	%		664,900		3.4	%
Switzerland		682,069		3.5	%		748,947		3.8	%
Australia		301,125		1.6	%		854,582		4.3	%
Spain		232,037		1.2	%		222,316		1.1	%
All other countries		520,463		2.7	%		498,753		2.5	%
Other international assets		714,881		3.7	%		582,213		3.0	%
Total international	$	7,498,193		39.0	%	$	7,654,955		38.9	%
Grand total	$	19,204,375		100.0	%	$	19,658,000		100.0	%

On an individual property basis, our largest investment in any single property was approximately 2% of our total assets as of June 30, 2023.

Total Revenues by Operator


	For the Three Months Ended June 30,
	2023							2022
Operators	Total Revenues				Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
Prospect	$	68,436				20.3	%	$	42,364		10.6	%
Circle		48,645				14.4	%		47,539		11.9	%
Priory		26,930				8.0	%		19,179		4.8	%
CommonSpirit		19,568				5.8	%		—		—
Lifepoint Behavioral		19,068				5.7	%		22,250		5.6	%
Steward		(301	)	(1)		-0.1	%		106,007		26.5	%
Other operators		155,049				45.9	%		162,887		40.6	%
Total	$	337,395				100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

Total Revenues by U.S. State and Country


	For the Three Months Ended June 30,
	2023						2022
U.S. States and Other Countries	Total Revenues			Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
California	$	57,367			17.0	%	$	48,109		12.0	%
Texas		47,444			14.1	%		39,716		9.9	%
Florida		35,508			10.5	%		26,051		6.5	%
Pennsylvania		22,930			6.8	%		19,942		5.0	%
Arizona		19,721			5.9	%		16,383		4.1	%
All other states		36,204	(1)		10.7	%		137,518		34.4	%
Total U.S.	$	219,174			65.0	%	$	287,719		71.9	%
United Kingdom	$	88,275			26.2	%	$	79,415		19.8	%
Germany		9,517			2.8	%		8,337		2.1	%
All other countries		20,429			6.0	%		24,755		6.2	%
Total international	$	118,221			35.0	%	$	112,507		28.1	%
Grand total	$	337,395			100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

Total Revenues by Facility Type


	For the Three Months Ended June 30,
	2023						2022
Facility Types	Total Revenues			Percentage of Total Revenues			Total Revenues		Percentage of Total Revenues
General acute care hospitals	$	234,917	(1)		69.6	%	$	305,468		76.3	%
Behavioral health facilities		56,378			16.7	%		51,763		12.9	%
Inpatient rehabilitation facilities		31,452			9.3	%		28,897		7.2	%
Long-term acute care hospitals		8,329			2.5	%		8,270		2.1	%
Freestanding ER/urgent care facilities		6,319			1.9	%		5,828		1.5	%
Total	$	337,395			100.0	%	$	400,226		100.0	%

(1)

Includes $95 million straight-line rent write-off as a result of the Steward Transaction as further described above in this same Note 3.

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.

Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) $ in Millions	6 Months Ended
	Jun. 30, 2023 USD ($)
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Repayments of mortgage loan	$ 60

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
2023	$ 508,120
2024	446,399
2025	1,434,660
2026	2,892,308
2027	1,600,000
Thereafter	3,406,785
Total	$ 10,288,272	$ 10,325,499

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($) Health_Center	Dec. 31, 2022 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	$ 299,326	$ 364,101
Investments in unconsolidated real estate joint ventures	1,487,118	1,497,903
Investments in unconsolidated operating entities	1,812,150	1,444,872
Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments in unconsolidated operating entities	535,200	640,400
Other loans	196,600	225,500
Shareholder Loan [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	162,900	223,800
Investments in unconsolidated real estate joint ventures	$ 321,900	$ 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

Subsequent Events

6 Months Ended

Jun. 30, 2023

Subsequent Events [Abstract]

Subsequent Events

10. Subsequent Events

In the third quarter of 2023, we invested approximately $140 million for a minority participation in Steward's syndicated asset-backed credit facility. The four-year facility was underwritten and sized based on Steward's accounts receivable from government and commercial payors.

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended			6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Taxes [Line Items]
Income tax expense (benefit)	$ (148,262)		$ 10,657	$ (144,719)	$ 22,036
Income tax benefit related to the initial loan impairment		$ 5,000
Foreign Tax Authority [Member]
Income Taxes [Line Items]
Income tax expense (benefit)	(158,000)
Quarterly reduction in income tax expense (benefit)	$ (2,000)

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

Real Estate and Other Activities - Alecto Healthcare Services LLC -Additional Information (Details) - Alecto Healthcare Services LLC [Member] - Texas [Member] $ in Millions	Jun. 16, 2023 USD ($) Property
Business Acquisition [Line Items]
Number of properties leased \| Property	1
Net book value of leased property \| $	$ 12

Summary of Significant Accounting Policies - Summary of Carrying Value and Classification of the Assets and Maximum Exposure (Details) - Variable Interest Entity, Not Primary Beneficiary [Member] $ in Thousands	Jun. 30, 2023 USD ($)
Loans, Net One [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 805,640
Loans, Net Two [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	176,248
Investments in Unconsolidated Operating Entities [Member]
Variable Interest Entity [Line Items]
Carrying Amount	805,640
Equity Investments	89,809
Equity Investments Carrying Amount	89,809
Mortgage and Other Loans [Member]
Variable Interest Entity [Line Items]
Carrying Amount	$ 139,266

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%

Income Taxes

6 Months Ended

Jun. 30, 2023

Income Tax Disclosure [Abstract]

Income Taxes

5. Income Taxes

During the 2023 second quarter, we elected to move a majority of our United Kingdom assets into a United Kingdom REIT regime with an effective date of July 1, 2023. As substantially all necessary activities had been completed to enter the United Kingdom REIT regime by June 30, 2023, we adjusted the deferred tax liabilities associated with these properties, resulting in a $158 million income tax benefit in the second quarter of 2023. We expect to reduce our quarterly tax expense going forward by approximately $2 million.

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.

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.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Real Estate and Other Activities - Steward Health Care System - Additional Information (Details) $ in Millions		3 Months Ended		6 Months Ended	12 Months Ended
	May 01, 2023 USD ($) Facility	Jun. 30, 2023	Jun. 30, 2022 USD ($)	Jun. 30, 2023	Dec. 31, 2022
Total Gross Assets [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk				100.00%	100.00%
Revenue [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		100.00%	100.00%
Revenue [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		100.00%	100.00%
Catholic Health Initiatives Colorado [Member]
Business Acquisition [Line Items]
Initial lease term	15 years
In-place lease intangibles [Member]
Business Acquisition [Line Items]
Amortization of intangibles	$ 286
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility	5
Proceeds received to paydown outstanding loan	$ 100
Proceeds to paydown of actual outstanding loan			$ 150
Straight-line rent write-offs	$ 95

Real Estate and Other Activities - Disposals - 2022 Activity - Additional Information (Detail) $ in Millions			3 Months Ended		6 Months Ended
	Mar. 08, 2023 USD ($)	Mar. 14, 2022 USD ($) Facility	Mar. 31, 2023 Facility	Jun. 30, 2022 USD ($)	Jun. 30, 2022 USD ($) Facility Property
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions					$ 31
Number of facilities sold \| Facility					4
Number of ancillary properties sold \| Property					2
Proceeds from sale of facilities					$ 154
Massachusetts-based General Acute Care Hospitals [Member]
Debt Instrument [Line Items]
Number of facilities acquired \| Facility		8
Purchase price of acquisition		$ 1,700
Gain (loss) on real estate dispositions		$ 600
Straight-line rent write-offs				$ 125	$ 125
Prime [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility			3
Proceeds from sale of facilities	$ 100

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ (42,037)	$ 189,597	$ (9,243)	$ 821,278

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Unaudited Interim Condensed Consolidated Financial Statements

Summary of Significant Accounting Policies (Policies)

6 Months Ended

Jun. 30, 2023

Accounting Policies [Abstract]

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


VIE Type	Carrying Amount(1)		Asset Type Classification	Maximum Loss Exposure(2)
Loans, net	$	805,640	Investments in Unconsolidated Operating Entities	$	805,640
Loans, net		139,266	Mortgage and other loans		176,248
Equity investments		89,809	Investments in Unconsolidated Operating Entities		89,809

(1)

Carrying amount reflects the net book value of our loan or equity investment only in the VIE.

(2)

Real Estate and Other Activities - Disposals - Summary of Assets Designated as Held for Sale (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Real estate held for sale	$ 401,125
Other assets,net	609,881	$ 572,990
Total Assets	$ 19,204,375	$ 19,658,000

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.

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Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 177,643	$ 167,035
Loans, Book value	1,216,625	1,405,615
Debt, net Book value	(10,237,558)	(10,268,412)
Interest and rent receivables, Fair value	142,420	163,101
Loans, Fair value	1,140,594	1,360,113
Debt, net Fair value	$ (8,568,002)	$ (8,697,042)

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

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

6 Months Ended

Jun. 30, 2023

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 $355 million in cash and have received the remainder in equity-like securities of PHP Holdings - part of the Prospect Transaction. 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

In 2023, we 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.

Earnings Per Share/Unit (Tables)

6 Months Ended

Jun. 30, 2023

Earnings Per Share [Abstract]

Calculation of Earnings Per Share

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


	For the Three Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(42,433	)	$	190,064
Non-controlling interests’ share in net loss (income)		396			(467	)
Participating securities’ share in earnings		(469	)		(345	)
Net (loss) income, less participating securities’ share in earnings	$	(42,506	)	$	189,252
Denominator:
Basic weighted-average common shares		598,344			598,827
Dilutive potential common shares(1)		—			199
Diluted weighted-average common shares		598,344			599,026


	For the Six Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(9,403	)	$	822,011
Non-controlling interests’ share in net loss (income)		160			(733	)
Participating securities’ share in earnings		(984	)		(747	)
Net (loss) income, less participating securities’ share in earnings	$	(10,227	)	$	820,531
Denominator:
Basic weighted-average common shares		598,323			598,751
Dilutive potential common shares(1)		—			228
Diluted weighted-average common shares		598,323			598,979

MPT Operating Partnership, L.P.

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


	For the Three Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(42,433	)	$	190,064
Non-controlling interests’ share in net loss (income)		396			(467	)
Participating securities’ share in earnings		(469	)		(345	)
Net (loss) income, less participating securities’ share in earnings	$	(42,506	)	$	189,252
Denominator:
Basic weighted-average units		598,344			598,827
Dilutive potential units(1)		—			199
Diluted weighted-average units		598,344			599,026


	For the Six Months Ended June 30,
	2023			2022
Numerator:
Net (loss) income	$	(9,403	)	$	822,011
Non-controlling interests’ share in net loss (income)		160			(733	)
Participating securities’ share in earnings		(984	)		(747	)
Net (loss) income, less participating securities’ share in earnings	$	(10,227	)	$	820,531
Denominator:
Basic weighted-average units		598,323			598,751
Dilutive potential units(1)		—			228
Diluted weighted-average units		598,323			598,979

(1)

Potential common shares/units are not included in the computation of diluted earnings per share when a loss exists as the effect would be an antidilutive per share amount.

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Net (loss) income	$ (42,433)	$ 190,064	$ (9,403)	$ 822,011
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	17,920	25,920	2,595	70,852
Reclassification of interest rate swap gain from AOCI, net of tax			(28,553)
Foreign currency translation gain (loss)	60,445	(104,341)	88,588	(117,556)
Reclassification of foreign currency translation loss from AOCI	3,234		3,234
Total comprehensive income	39,166	111,643	56,461	775,307
Comprehensive loss (income) attributable to non-controlling interests	396	(467)	160	(733)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	39,562	111,176	56,621	774,574
MPT Operating Partnership, L.P. [Member]
Net (loss) income	(42,433)	190,064	(9,403)	822,011
Other comprehensive income:
Unrealized gain on interest rate swaps, net of tax	17,920	25,920	2,595	70,852
Reclassification of interest rate swap gain from AOCI, net of tax			(28,553)
Foreign currency translation gain (loss)	60,445	(104,341)	88,588	(117,556)
Reclassification of foreign currency translation loss from AOCI	3,234		3,234
Total comprehensive income	39,166	111,643	56,461	775,307
Comprehensive loss (income) attributable to non-controlling interests	396	(467)	160	(733)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 39,562	$ 111,176	$ 56,621	$ 774,574

Fair Value of Financial Instruments - Schedule of Effects of Movement in DLOM by Sensitivity Analysis by Using Basis Point Variations (Details) - PHP Holdings [Member] $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
+ 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ (7,216)
- 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ 7,216

Fair Value of Financial Instruments (Tables)

6 Months Ended

Jun. 30, 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 June 30, 2023							As of December 31, 2022
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables, net	$	177,643			$	142,420		$	167,035			$	163,101
Loans(1)		1,216,625		(2)		1,140,594			1,405,615		(2)		1,360,113
Debt, net		(10,237,558	)			(8,568,002	)		(10,268,412	)			(8,697,042	)

(1)

Excludes the convertible loan made in May 2023 to PHP Holdings and the acquisition loan made in May 2020 related to our investment in the international joint venture, along with the related subsequent investment in the real estate of three hospitals in Colombia, as these assets are accounted for under the fair value option method, as noted below. In addition for December 31, 2022 only, this excludes the acquisition and mortgage loans made to Lifepoint Behavioral, which were satisfied in full in February 2023 as further described in Note 3 to the condensed consolidated financial statements.

(2)

Includes $162.9 million and $223.8 million of mortgage loans, a $321.9 million and $315.9 million shareholder loan included in investments in unconsolidated real estate joint ventures, $535.2 million and $640.4 million of loans that are part of our investments in unconsolidated operating entities, and $196.6 million and $225.5 million of other loans at June 30, 2023 and December 31, 2022, respectively.

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

At June 30, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands):


	As of June 30, 2023				As of December 31, 2022
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	136,459	$	136,459	$	140,260	$	140,260	Mortgage loans
Equity investment and other loans		898,373		910,583		434,609		441,943	Investments in unconsolidated operating entities/Other loans

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

The DLOM on our investment in PHP Holdings was approximately 9% at June 30, 2023. In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors, including the percent of control, the nature of the underlying investee's business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using full basis point variations (in thousands):


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(7,216	)
- 100 basis points		7,216

Document and Entity Information - shares shares in Millions	6 Months Ended
Document and Entity Information - shares shares in Millions	Jun. 30, 2023	Aug. 04, 2023
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
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		598.4
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	Jun. 30, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
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 (Parenthetical) - $ / shares	Jun. 30, 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	598,344,000	597,476,000
Common stock, shares outstanding	598,344,000	597,476,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	5,985,000	5,976,000
General partner, units outstanding	5,985,000	5,976,000
Common Units \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	592,359,000	591,500,000
Limited Partners, units outstanding	592,359,000	591,500,000

Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Business Acquisition [Line Items]
Commitment	$ 358,487
Costs Incurred as of June 30, 2023	153,387
Ernest [Member] \| South Carolina [Member]
Business Acquisition [Line Items]
Commitment	22,400
Costs Incurred as of June 30, 2023	$ 18,077
Estimated Rent Commencement Date	3Q 2023
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 46,273
Costs Incurred as of June 30, 2023	$ 41,109
Estimated Rent Commencement Date	3Q 2023
Lifepoint Behavioral Health [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 31,600
Costs Incurred as of June 30, 2023	$ 11,422
Estimated Rent Commencement Date	1Q 2024
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 37,434
Costs Incurred as of June 30, 2023	$ 10,832
Estimated Rent Commencement Date	3Q 2024
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 51,372
Costs Incurred as of June 30, 2023	$ 14,849
Estimated Rent Commencement Date	1Q 2025
Steward [Member] \| Texas [Member]
Business Acquisition [Line Items]
Commitment	$ 169,408
Costs Incurred as of June 30, 2023	$ 57,098
Estimated Rent Commencement Date	2Q 2026

Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 1,812,150	$ 1,444,872
PHP Holdings [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	654,520
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	163,619	156,575
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	162,194	157,145
Steward Equity Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	125,862	125,862
Aevis Victoria SA [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	79,121	72,904
Aspris Children's Services [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	16,005	16,023
Lifepoint Behavioral [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	10,767	200,827
Caremax [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 7,323	8,526
Prospect [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities		$ 112,777

Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Parenthetical) (Details) - Steward [Member] - Revenue [Member] $ in Millions	3 Months Ended
	Jun. 30, 2023 USD ($)
Business Acquisition [Line Items]
Straight-line rent write-offs	$ 95
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs	95
All Other States [Member]
Business Acquisition [Line Items]
Straight-line rent write-offs	$ 95

Fair Value of Financial Instruments

6 Months Ended

Jun. 30, 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 June 30, 2023							As of December 31, 2022
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables, net	$	177,643			$	142,420		$	167,035			$	163,101
Loans(1)		1,216,625		(2)		1,140,594			1,405,615		(2)		1,360,113
Debt, net		(10,237,558	)			(8,568,002	)		(10,268,412	)			(8,697,042	)

(1)

(2)

Items Measured at Fair Value on a Recurring Basis

Our equity investment and related loan to the international joint venture, our loan investment in the real estate of three hospitals operated by subsidiaries of the international joint venture in Colombia, our equity investment in Lifepoint Behavioral, and our convertible loan and equity investment in PHP Holdings 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 Lifepoint Behavioral (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 June 30, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands):


	As of June 30, 2023				As of December 31, 2022
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	136,459	$	136,459	$	140,260	$	140,260	Mortgage loans
Equity investment and other loans		898,373		910,583		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 Lifepoint Behavioral 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 Lifepoint Behavioral 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 and our convertible loan and equity investment in PHP Holdings are recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify our valuations of equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuations require management judgment due to the absence of quoted market prices. For the cash flow models, our observable inputs include use of a capitalization rate and discount rate (which is based on a weighted-average cost of capital) and our unobservable input includes an adjustment for a marketability discount ("DLOM"). In 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 half of 2023 and 2022, we had a net unfavorable adjustment to the investments accounted for under the fair value option method.


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(7,216	)
- 100 basis points		7,216

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, 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.

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.