0000950170-24-125623 | 10-Q | XBRL Viewer | Medical Properties Trust INC

Income Taxes	9 Months Ended
Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	5. Income Taxes 2024 Activity In connection with closing the secured term loan facility in the U.K. on May 24, 2024, we realized a gain, for U.K. tax purposes, on the interest rate swap associated with the internal restructuring of the British pound sterling term loan due 2025. This gain resulted in a tax expense of approximately $5 million in the 2024 second quarter. 2023 Activity During the 2023 second quarter, we elected to move a majority of our U.K. assets into a U.K. REIT regime with an effective date of July 1, 2023. With this election, we adjusted the deferred tax liabilities associated with these properties, resulting in a $158 million income tax benefit in the second quarter of 2023. 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.

Income Taxes

9 Months Ended

Sep. 30, 2024

5. Income Taxes

2024 Activity

In connection with closing the secured term loan facility in the U.K. on May 24, 2024, we realized a gain, for U.K. tax purposes, on the interest rate swap associated with the internal restructuring of the British pound sterling term loan due 2025. This gain resulted in a tax expense of approximately $5 million in the 2024 second quarter.

2023 Activity

During the 2023 second quarter, we elected to move a majority of our U.K. assets into a U.K. REIT regime with an effective date of July 1, 2023. With this election, we adjusted the deferred tax liabilities associated with these properties, resulting in a $158 million income tax benefit in the second quarter of 2023.

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

- Definition

The entire disclosure for income tax.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Name Accounting Standards Codification
-Section 50
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-Publisher FASB
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Reference 2: http://www.xbrl.org/2003/role/exampleRef
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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 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/1943274/2147482603/740-30-50-2

+ Details

Debt (Tables)

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Summary of Debt

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


	As of September 30, 2024			As of December 31, 2023
Revolving credit facility(A)	$	397,391		$	1,514,420
Term loan		200,000			200,000
British pound sterling secured term loan due 2024(B)		—			133,484
British pound sterling term loan due 2025(B)		699,512			891,170
British pound sterling secured term loan due 2034(B)		844,470			—
Australian term loan facility(B)		—			320,164
3.325% Senior Unsecured Notes due 2025(B)		556,750			551,950
0.993% Senior Unsecured Notes due 2026(B)		556,750			551,950
2.500% Senior Unsecured Notes due 2026(B)		668,750			636,550
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)		802,500			763,860
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		468,125			445,585
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	9,294,248		$	10,109,133
Debt issue costs and discount, net		(78,497	)		(44,897	)
	$	9,215,751		$	10,064,236

(A)

Includes £- million and £322 million of GBP-denominated borrowings and €303 million and €303 million of Euro-denominated borrowings that reflect the applicable exchange rates at September 30, 2024 and December 31, 2023, respectively.

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at September 30, 2024 and December 31, 2023.

Principal Payments Due on Debt

As of September 30, 2024, 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):


2024	$	—
2025		1,256,262
2026		2,122,891
2027		1,600,000
2028		802,500
Thereafter		3,512,595
Total	$	9,294,248

Real Estate and Other Activities - Investments in Unconsolidated Operating Entities - Additional Information (Detail) - Other [Member] - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Mar. 31, 2024	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition [Line Items]
Unfavorable fair market value adjustment on investment	$ 225.0	$ 498.0
COVID-19 Pandemic [Member]
Business Acquisition [Line Items]
Favorable non-cash fair value adjustment on investment		$ 739.0	$ 48.7

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

Sep. 30, 2024

Dec. 31, 2023

Debt Instrument [Line Items]

Debt

$ 9,294,248

$ 10,109,133

Debt issue costs and discount, net

(78,497)

(44,897)

Debt, net

9,215,751

10,064,236

Revolving Credit Facility [Member]

Debt Instrument [Line Items]

Debt

^[1]

397,391

1,514,420

Term Loan [Member]

Debt Instrument [Line Items]

Debt

200,000

Term Loan [Member] | Australia [Member]

Debt Instrument [Line Items]

Debt

^[2]

320,164

Secured term loan due 2024 | British Pound Sterling [Member]

Debt Instrument [Line Items]

Debt

^[2]

133,484

Term loan due 2025 | British Pound Sterling [Member]

Debt Instrument [Line Items]

Debt

^[2]

699,512

891,170

Secured term loan due 2034 | British Pound Sterling [Member]

Debt Instrument [Line Items]

Debt

^[2]

844,470

3.325% Senior Unsecured Notes due 2025 [Member]

Debt Instrument [Line Items]

Debt

^[2]

556,750

551,950

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

556,750

551,950

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

^[2]

668,750

636,550

5.250% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Debt

500,000

5.000% Senior Unsecured Notes due 2027 [Member]

Debt Instrument [Line Items]

Debt

1,400,000

3.692% Senior Unsecured Notes due 2028 [Member]

Debt Instrument [Line Items]

Debt

^[2]

802,500

763,860

4.625% Senior Unsecured Notes due 2029 [Member]

Debt Instrument [Line Items]

Debt

900,000

3.375% Senior Unsecured Notes due 2030 [Member]

Debt Instrument [Line Items]

Debt

^[2]

468,125

445,585

3.500% Senior Unsecured Notes due 2031 [Member]

Debt Instrument [Line Items]

Debt

$ 1,300,000

[1]	Includes £- million and £322 million of GBP-denominated borrowings and €303 million and €303 million of Euro-denominated borrowings that reflect the applicable exchange rates at September 30, 2024 and December 31, 2023, respectively.
[2]	Non-U.S. dollar denominated debt reflects the exchange rates at September 30, 2024 and December 31, 2023.

Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands	Total	MPT Operating Partnership, L.P. [Member]	MPT Operating Partnership, L.P. [Member] General Partner [Member]	MPT Operating Partnership, L.P. [Member] Limited Partner [Member]	Common Par Value [Member]	Additional Paid-in Capital [Member]	Retained Deficit [Member]	Accumulated Other Comprehensive (Loss) Income [Member]	Accumulated Other Comprehensive (Loss) Income [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, 2022	$ 8,594,407	$ 8,594,797	$ 86,599	$ 8,565,813	$ 597	$ 8,535,140	$ 116,285	$ (59,184)	$ (59,184)	$ 1,569	$ 1,569
Beginning balance (in shares) at Dec. 31, 2022			5,976	591,500	597,476
Net (loss) income	33,030	33,030	$ 328	$ 32,466			32,794			236	236
Unrealized (loss) gain on interest rate hedges, net of tax	(15,325)	(15,325)						(15,325)	(15,325)
Reclassification of interest rate hedge gain to earnings, net of tax	(28,553)	(28,553)						(28,553)	(28,553)
Foreign currency translation gain (loss)	28,143	28,143						28,143	28,143
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,829	11,829	$ 118	$ 11,711	$ 1	11,828
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			13	1,312	1,325
Stock vesting - satisfaction of tax withholding	(5,554)	(5,554)	$ (56)	$ (5,498)		(5,554)
Stock vesting - satisfaction of tax withholding (Shares)			(5)	(494)	(499)
Distributions to non-controlling interests	(231)	(231)								(231)	(231)
Dividends (Distributions) declared	(174,492)	(174,492)	$ (1,745)	$ (172,747)			(174,492)
Ending balance at Mar. 31, 2023	8,443,254	8,443,644	$ 85,244	$ 8,431,745	$ 598	8,541,414	(25,413)	(74,919)	(74,919)	1,574	1,574
Ending balance (in shares) at Mar. 31, 2023			5,984	592,318	598,302
Beginning balance at Dec. 31, 2022	8,594,407	8,594,797	$ 86,599	$ 8,565,813	$ 597	8,535,140	116,285	(59,184)	(59,184)	1,569	1,569
Beginning balance (in shares) at Dec. 31, 2022			5,976	591,500	597,476
Net (loss) income	107,492	107,492
Unrealized (loss) gain on interest rate hedges, net of tax	(9,845)	(9,845)
Reclassification of foreign currency translation loss to earnings	3,234	3,234
Foreign currency translation gain (loss)	34,570	34,570
Ending balance at Sep. 30, 2023	8,285,417	8,285,807	$ 83,521	$ 8,261,177	$ 598	8,558,768	(215,058)	(59,778)	(59,778)	887	887
Ending balance (in shares) at Sep. 30, 2023			5,986	592,458	598,444
Beginning balance at Mar. 31, 2023	8,443,254	8,443,644	$ 85,244	$ 8,431,745	$ 598	8,541,414	(25,413)	(74,919)	(74,919)	1,574	1,574
Beginning balance (in shares) at Mar. 31, 2023			5,984	592,318	598,302
Net (loss) income	(42,433)	(42,433)	$ (420)	$ (41,617)			(42,037)			(396)	(396)
Unrealized (loss) gain on interest rate hedges, 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
Foreign currency translation gain (loss)	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	58	59
Stock vesting - satisfaction of tax withholding	(16)	(16)	$ 0	$ (16)		(16)
Stock vesting - satisfaction of tax withholding (Shares)			0	(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	$ 8,224,373	$ 598	8,547,835	(241,301)	6,680	6,680	902	902
Ending balance (in shares) at Jun. 30, 2023			5,985	592,359	598,344
Net (loss) income	116,895	116,895	$ 1,167	$ 115,543			116,710			185	185
Unrealized (loss) gain on interest rate hedges, net of tax	(12,440)	(12,440)						(12,440)	(12,440)
Foreign currency translation gain (loss)	(54,018)	(54,018)						(54,018)	(54,018)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	11,453	11,453	$ 115	$ 11,338		11,453
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			2	154	156
Stock vesting - satisfaction of tax withholding	(520)	(520)	$ (5)	$ (515)		(520)
Stock vesting - satisfaction of tax withholding (Shares)			(1)	(55)	(56)
Distributions to non-controlling interests	(200)	(200)								(200)	(200)
Dividends (Distributions) declared	(90,467)	(90,467)	$ (905)	$ (89,562)			(90,467)
Ending balance at Sep. 30, 2023	8,285,417	8,285,807	$ 83,521	$ 8,261,177	$ 598	8,558,768	(215,058)	(59,778)	(59,778)	887	887
Ending balance (in shares) at Sep. 30, 2023			5,986	592,458	598,444
Beginning balance at Dec. 31, 2023	7,633,865	7,634,255	$ 75,969	$ 7,513,520	$ 599	8,560,309	(971,809)	42,501	42,501	2,265	2,265
Beginning balance (in shares) at Dec. 31, 2023			5,991	593,000	598,991
Net (loss) income	(875,377)	(875,377)	$ (8,756)	$ (866,869)			(875,625)			248	248
Unrealized (loss) gain on interest rate hedges, net of tax	(2,797)	(2,797)						(2,797)	(2,797)
Foreign currency translation gain (loss)	(58,542)	(58,542)						(58,542)	(58,542)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	7,174	7,174	$ 72	$ 7,102	$ 1	7,173
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			14	1,356	1,370
Stock vesting - satisfaction of tax withholding	(283)	(283)	$ (3)	$ (280)		(283)
Stock vesting - satisfaction of tax withholding (Shares)			(1)	(56)	(57)
Distributions to non-controlling interests	(245)	(245)								(245)	(245)
Dividends declared adjustment	572	572	$ 6	$ 566			572
Ending balance at Mar. 31, 2024	6,704,367	6,704,757	$ 67,288	$ 6,654,039	$ 600	8,567,199	(1,846,862)	(18,838)	(18,838)	2,268	2,268
Ending balance (in shares) at Mar. 31, 2024			6,004	594,300	600,304
Beginning balance at Dec. 31, 2023	7,633,865	7,634,255	$ 75,969	$ 7,513,520	$ 599	8,560,309	(971,809)	42,501	42,501	2,265	2,265
Beginning balance (in shares) at Dec. 31, 2023			5,991	593,000	598,991
Net (loss) income	(1,995,965)	(1,995,965)
Unrealized (loss) gain on interest rate hedges, net of tax	(16,099)	(16,099)
Foreign currency translation gain (loss)	48,066	48,066
Ending balance at Sep. 30, 2024	5,441,099	5,441,489	$ 53,893	$ 5,327,947	$ 600	8,578,355	(3,197,505)	57,114	57,114	2,535	2,535
Ending balance (in shares) at Sep. 30, 2024			6,004	594,225	600,229
Beginning balance at Mar. 31, 2024	6,704,367	6,704,757	$ 67,288	$ 6,654,039	$ 600	8,567,199	(1,846,862)	(18,838)	(18,838)	2,268	2,268
Beginning balance (in shares) at Mar. 31, 2024			6,004	594,300	600,304
Net (loss) income	(319,659)	(319,659)	$ (3,206)	$ (317,429)			(320,635)			976	976
Unrealized (loss) gain on interest rate hedges, net of tax	(3,479)	(3,479)						(3,479)	(3,479)
Reclassification of interest rate hedge gain to earnings, net of tax	(4,005)	(4,005)						(4,005)	(4,005)
Foreign currency translation gain (loss)	(7,588)	(7,588)						(7,588)	(7,588)
Stock (Unit) vesting and amortization of stock (unit)-based compensation	7,013	7,013	$ 70	$ 6,943		7,013
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			3	267	270
Stock vesting - satisfaction of tax withholding	(2,550)	(2,550)	$ (25)	$ (2,525)		(2,550)
Stock vesting - satisfaction of tax withholding (Shares)			(5)	(512)	(517)
Distributions to non-controlling interests	(349)	(349)								(349)	(349)
Dividends (Distributions) declared	(180,673)	(180,673)	$ (1,807)	$ (178,866)			(180,673)
Ending balance at Jun. 30, 2024	6,193,077	6,193,467	$ 62,320	$ 6,162,162	$ 600	8,571,662	(2,348,170)	(33,910)	(33,910)	2,895	2,895
Ending balance (in shares) at Jun. 30, 2024			6,002	594,055	600,057
Net (loss) income	(800,929)	(800,929)	$ (8,012)	$ (793,151)			(801,163)			234	234
Unrealized (loss) gain on interest rate hedges, net of tax	(9,823)	(9,823)						(9,823)	(9,823)
Reclassification of interest rate hedge gain to earnings, net of tax	(13,349)	(13,349)						(13,349)	(13,349)
Foreign currency translation gain (loss)	114,196	114,196						114,196	114,196
Stock (Unit) vesting and amortization of stock (unit)-based compensation	7,112	7,112	$ 71	$ 7,041		7,112
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares)			3	263	266
Stock vesting - satisfaction of tax withholding	(419)	(419)	$ (4)	$ (415)		(419)
Stock vesting - satisfaction of tax withholding (Shares)			(1)	(93)	(94)
Distributions to non-controlling interests	(594)	(594)								(594)	(594)
Dividends declared adjustment	(48,172)						(48,172)
Dividends (Distributions) declared		(48,172)	$ (482)	$ (47,690)
Ending balance at Sep. 30, 2024	$ 5,441,099	$ 5,441,489	$ 53,893	$ 5,327,947	$ 600	$ 8,578,355	$ (3,197,505)	$ 57,114	$ 57,114	$ 2,535	$ 2,535
Ending balance (in shares) at Sep. 30, 2024			6,004	594,225	600,229

Summary of Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

Unaudited Interim Condensed Consolidated Financial Statements

Unaudited Interim Condensed Consolidated Financial Statements: The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement have been included. Operating results for the three and nine months ended September 30, 2024, are not necessarily indicative of the results that may be expected for the year ending December 31, 2024. The condensed consolidated balance sheet at December 31, 2023 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements.

The preparation of our condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of September 30, 2024, (particularly as it relates to our assessments of the recoverability of our real estate, the ability of our tenants/borrowers to make lease/loan payments in accordance with their respective

agreements, the fair value of our equity and loan investments, and the adequacy of our credit loss reserves on loans and financing receivables).

For information about significant accounting policies, and how actual results could differ from estimates, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2023. There have been no material changes to these significant accounting policies.

Reclassifications

Certain amounts in the condensed consolidated financial statements for prior periods have been reclassified to conform to the current period presentation.

Variable Interest Entities

At September 30, 2024, we had loans and/or equity investments in certain variable interest entities ("VIEs"), which may also be tenants of our facilities. We have determined that we were not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs at September 30, 2024 are presented below (in thousands):


VIE Type	Carrying Amount(1)		Asset Type Classification	Maximum Loss Exposure(2)
Loans, net and equity investments	$	201,526	Investments in Unconsolidated Operating Entities	$	201,526
Loans, net		141,464	Mortgage and other loans		141,544

(1)

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

For the VIE types above, we do not consolidate the VIEs 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 September 30, 2024, 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).

Recent Accounting Developments

Segment Reporting

In November 2023, the Financial Accounting Standards Board ("FASB") issued ASU 2023-07, "Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures" ("ASU 2023-07") to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. We are finalizing our assessment of the impact of adopting this standard and expect to have additional disclosures in our Form 10-K for the year ended December 31, 2024.

Income Taxes

In December 2023, the FASB issued ASU 2023-09, "Income Taxes (Topic 740): Improvements to Income Tax Disclosures" ("ASU 2023-09") which focuses on income tax disclosures regarding effective tax rates and cash income taxes paid. This standard requires public entities to disclose (1) specific categories in the rate reconciliation, (2) the income or loss from continuing operations before income tax expense or benefit disaggregated by domestic and foreign, and (3) provide additional information for certain reconciling items at or above a quantitative threshold of 5% of the statutory tax. Additionally, this standard requires disclosure of income taxes paid (net of refunds), separated by international, federal, state, and local jurisdictions. ASU 2023-09 is effective for annual periods beginning after December 15, 2024. We plan to adopt and include the necessary additional required disclosures in our filings in 2025.

Disaggregation of Income Statement Expenses

In November 2024, the FASB issued ASU 2024-03, "Income Statement - Reporting Comprehensive Income - Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses" ("ASU 2024-03") to improve the disclosures about a public company's expenses and address requests from investors for more detailed information about the types of expenses in commonly presented expense captions. ASU 2024-03 is effective for annual periods beginning after December 15, 2026. We are currently evaluating the potential impact of the adoption of this standard on our consolidated financial statements.

Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) £ in Millions, SFr in Millions, $ in Millions			3 Months Ended
	Nov. 03, 2023 USD ($)	Aug. 17, 2023 USD ($)	Sep. 30, 2024 USD ($)	Mar. 31, 2024 GBP (£)	Mar. 31, 2024 USD ($)	Jun. 30, 2023 CHF (SFr)	Sep. 30, 2023 USD ($)
Business Acquisition [Line Items]
Loan impairment charges			$ 425.0
Syndicated Term Loan [Member]
Business Acquisition [Line Items]
Gain (loss) on sale of interest in syndicated term loan				£ (6)	$ (7.8)
Proceed from sale of interest in syndicated term loan				£ 90	$ 115.0
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Repayments of mortgage loan \| SFr						SFr 60
Other investment on secured loan with credit facility collateral							$ 40.0
Repayment received on credit facility availed	$ 2.0
Steward Health Care System LLC [Member] \| Asset Backed Credit Facility [Member]
Business Acquisition [Line Items]
Investments							$ 105.0
Sale of investment		$ 105.0
Global Asset Manager [Member]
Business Acquisition [Line Items]
Sale of investment		$ 100.0

Real Estate and Other Activities- Development Activities - Additional Information (Detail) $ in Millions	Sep. 30, 2024 USD ($) Projects
TEXAS And MASSACHUSETTS [Member]
Business Acquisition [Line Items]
Number of other development projects \| Projects	2
Development project amount spent on combined basis	$ 400
Massachusetts [Member]
Business Acquisition [Line Items]
Redevelopment of recovery received from settlement excess of damage to property	$ 24

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 35,142	$ 45,059
Loans, Book value	694,809	1,302,727
Debt, net Book value	(9,215,751)	(10,064,236)
Interest and rent receivables, Fair value	35,130	45,476
Loans, Fair value	675,683	1,202,383
Debt, net Fair value	$ (8,035,236)	$ (8,256,465)

- Definition

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

+ References + Details

Debt - Additional Information (Detail) $ in Thousands, £ in Millions	3 Months Ended			9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023 GBP (£)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Sep. 30, 2023 USD ($)
Debt Instrument [Line Items]
Debt refinancing and unutilized financing costs	$ 713		$ (862)	$ 3,677	$ (46)
Accelerated amortization debt issue costs							$ 800
Debt	$ 9,294,248			$ 9,294,248		$ 10,109,133
2.550% Senior Unsecured Notes due 2023 [Member]
Debt Instrument [Line Items]
Gain on prepayment of Debt \| £		£ 0.9
Debt \| £		£ 40.0
Senior unsecured notes, interest rate		2.55%					2.55%

- Definition

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.

+ References

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+ Details

Earnings Per Share/Unit

9 Months Ended

Sep. 30, 2024

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 September 30,
	2024			2023
Numerator:
Net (loss) income	$	(800,929	)	$	116,895
Non-controlling interests’ share in net income		(234	)		(185	)
Participating securities’ share in earnings		(153	)		(311	)
Net (loss) income, less participating securities’ share in earnings	$	(801,316	)	$	116,399
Denominator:
Basic weighted-average common shares		600,229			598,444
Dilutive potential common shares(1)		—			109
Diluted weighted-average common shares		600,229			598,553


	For the Nine Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(1,995,965	)	$	107,492
Non-controlling interests’ share in net income		(1,458	)		(25	)
Participating securities’ share in earnings		(807	)		(1,295	)
Net (loss) income, less participating securities’ share in earnings	$	(1,998,230	)	$	106,172
Denominator:
Basic weighted-average common shares		600,197			598,363
Dilutive potential common shares(1)		—			43
Diluted weighted-average common shares		600,197			598,406

MPT Operating Partnership, L.P.

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


	For the Three Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(800,929	)	$	116,895
Non-controlling interests’ share in net income		(234	)		(185	)
Participating securities’ share in earnings		(153	)		(311	)
Net (loss) income, less participating securities’ share in earnings	$	(801,316	)	$	116,399
Denominator:
Basic weighted-average units		600,229			598,444
Dilutive potential units(1)		—			109
Diluted weighted-average units		600,229			598,553


	For the Nine Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(1,995,965	)	$	107,492
Non-controlling interests’ share in net income		(1,458	)		(25	)
Participating securities’ share in earnings		(807	)		(1,295	)
Net (loss) income, less participating securities’ share in earnings	$	(1,998,230	)	$	106,172
Denominator:
Basic weighted-average units		600,197			598,363
Dilutive potential units(1)		—			43
Diluted weighted-average units		600,197			598,406

(1)

The above computation of diluted earnings per share/units does not include 37,967 and 18,422 potential common shares/units for the three and nine months ended September 30, 2024, respectively.

Real Estate and Other Activities - Pipeline Health System - Additional Information (Detail) - Pipeline Health System [Member] - USD ($) $ in Millions	Feb. 07, 2023	Sep. 30, 2024
Business Acquisition [Line Items]
Cash rent	$ 6	$ 5
Percentage of defered rent	30.00%

Debt - Covenants - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Billions	9 Months Ended
	Sep. 30, 2024	Aug. 06, 2024	Apr. 12, 2024
Debt Instrument [Line Items]
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%
Credit Facility Amendment [Member]
Debt Instrument [Line Items]
Payment of dividends in cash during modified covenant period		$ 0.08
Credit Facility Amendment [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Permitted ratio			40.00%
Maximum total leverage ratio		65.00%
Unsecured leverage ratio		70.00%
Unsecured interest coverage ratio		1.45
Net worth covenant		$ 6.7
Credit Facility Amendment [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Permitted ratio			25.00%
Maximum total leverage ratio		60.00%
Unsecured leverage ratio		65.00%
Unsecured interest coverage ratio		1.75
Net worth covenant		$ 5.0

Debt

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Debt

4. Debt

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


	As of September 30, 2024			As of December 31, 2023
Revolving credit facility(A)	$	397,391		$	1,514,420
Term loan		200,000			200,000
British pound sterling secured term loan due 2024(B)		—			133,484
British pound sterling term loan due 2025(B)		699,512			891,170
British pound sterling secured term loan due 2034(B)		844,470			—
Australian term loan facility(B)		—			320,164
3.325% Senior Unsecured Notes due 2025(B)		556,750			551,950
0.993% Senior Unsecured Notes due 2026(B)		556,750			551,950
2.500% Senior Unsecured Notes due 2026(B)		668,750			636,550
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)		802,500			763,860
4.625% Senior Unsecured Notes due 2029		900,000			900,000
3.375% Senior Unsecured Notes due 2030(B)		468,125			445,585
3.500% Senior Unsecured Notes due 2031		1,300,000			1,300,000
	$	9,294,248		$	10,109,133
Debt issue costs and discount, net		(78,497	)		(44,897	)
	$	9,215,751		$	10,064,236

(A)

(B)

Non-U.S. dollar denominated debt reflects the exchange rates at September 30, 2024 and December 31, 2023.

As of September 30, 2024, 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):


2024	$	—
2025		1,256,262
2026		2,122,891
2027		1,600,000
2028		802,500
Thereafter		3,512,595
Total	$	9,294,248

Credit Facilities

On April 12, 2024, we amended our unsecured credit facility (the "Credit Facility") and certain other agreements to (i) reduce revolving commitments from $1.8 billion to $1.4 billion, (ii) apply certain proceeds from the Utah Transaction and other asset sales and debt transactions to repay the Australian term loan facility and certain other outstanding obligations, including revolving loans under the Credit Facility to the extent necessary to reduce the outstanding borrowings to no more than the amended $1.4 billion commitment, (iii) amend or waive certain covenants as described under "Covenants" in this same Note 4, and (iv) waive the 10% cap on unencumbered asset value attributable to tenants subject to a bankruptcy event for purposes of determining compliance with the unsecured leverage ratio for the trailing four fiscal quarter periods ended June 30, 2024, and for purposes of determining pro forma compliance with the unsecured leverage ratio for certain asset sale and debt transactions.

On August 6, 2024, we amended the Credit Facility and the British pound sterling term loan due 2025 to (i) further reduce revolving commitments in the Credit Facility from $1.4 billion to $1.28 billion, (ii) increase borrowing spreads to 300 basis points during the Modified Covenant Period (defined in "Covenants" section in this same Note 4) and then to 225 basis points after the Modified Covenant Period, (iii) require that proceeds of certain future asset sales and debt transactions (during the Modified Covenant Period) be applied to repay certain outstanding obligations, including our revolving loans (by 15% of such proceeds but for which the revolving loans can be reborrowed) and our British pound sterling term loan due 2025 (by 50% of such proceeds), and (iv) amend or waive certain covenants as described under "Covenants" in this same Note 4.

Australian Term Loan Facility

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 (approximately $475 million) of the A$1.2 billion Australian term loan. On April 18, 2024, we paid off and terminated the remainder of the A$470 million (approximately $306 million) Australian term loan facility with proceeds from the Utah Transaction described in Note 3.

British Pound Sterling Secured Term Loan due 2034

On May 24, 2024, we closed on a secured loan facility with a consortium of institutional investors that provides for a term loan in aggregate principal amount of approximately £631 million (approximately $800 million) secured by a portfolio of 27 properties located in the U.K. currently leased to affiliates of Circle. The facility carries a fixed rate of 6.877% over its 10-year term, excluding fees and expenses, and is interest-only (payable quarterly in advance) through the maturity date. The facility is secured by first priority mortgages or similar security instruments on the relevant properties, including assignments of rents and security over accounts, and is non-recourse to us. We used the majority of the net proceeds of the facility to pay down portions of our revolving credit facility and British pound sterling term loan due 2025, and to pay off our British pound sterling secured term loan due 2024 (approximately £105 million).

British Pound Sterling Term Loan due 2025

In addition to the £105 million pay down from proceeds of the secured term loan discussed above, we paid down another £72 million of our British pound sterling term loan due 2025 in the 2024 third quarter.

Debt Refinancing and Unutilized Financing Costs

2024 Activity

In the first nine months of 2024, we incurred $3.7 million of debt refinancing and unutilized financing costs. These costs were incurred primarily as a result of the reduction in revolving commitments under our Credit Facility and partial paydown of our British pound sterling term loan due 2025.

2023 Activity

As a result of the prepayment of a portion of the Australian term loan, we incurred approximately $0.8 million to accelerate the amortization of related debt issue costs in the first nine months of 2023. This charge was more than offset by the $0.9 million gain realized on the purchase of approximately £40 million of our 2.550% Senior Unsecured Notes due 2023 at a discount in the 2023 third quarter.

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 agreement 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 agreement, on a rolling four quarter basis to 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 (which was amended on April 12, 2024 to lower the maximum permitted ratio from 40% to 25%), 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.

On August 6, 2024, we entered into an amendment to the Credit Facility and the British pound sterling term loan due 2025 (the “Amendments”) to increase the maximum total leverage ratio covenant from 60% to 65% and the maximum unsecured leverage ratio covenant from 65% to 70% and to decrease the minimum unsecured interest coverage ratio from 1.75:1.00 to 1.45:1.00. These Amendments were effective as of June 30, 2024 and will continue in effect through and including September 30, 2025, unless earlier terminated by us (the “Modified Covenant Period”) at which point the credit agreement provides that covenants will automatically reset to their prior levels. In addition, the Amendments permanently reduced the minimum consolidated adjusted net worth covenant from approximately $6.7 billion to $5 billion, in each case plus the sum of certain equity proceeds. The Amendments also limit the

payment of dividends in cash during the Modified Covenant Period to $0.08 per share in any fiscal quarter, but the Amendments do not provide any additional restrictions on the payment of dividends outside of the Modified Covenant Period.

As of September 30, 2024, we are in compliance with all such financial and operating covenants. However, as of September 30, 2024, we would not have been in compliance with certain covenants without the Amendments discussed above. Our ability to maintain compliance with our debt covenants, including the reset leverage and interest coverage requirements, after the end of the Modified Covenant Period depends primarily on reducing debt through asset sales, retention of cash generated from our monthly rent and interest receipts, extending maturities of certain debt instruments, and other access to capital. We expect to continue to comply with these covenants, but if we are not in compliance, including following the expiration of the Modified Covenant Period, we would have to seek additional amendments to our covenants. However, no assurances can be made that such amendments will be approved by our lenders. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable which could have a material adverse impact to the Company.

Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 508,227	$ 1,778,640
PHP Holdings [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	201,526	699,535
Steward Loan Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	0	361,591
International Joint Venture [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	0	225,960
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	185,185	186,113
Priory [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	41,670	163,837
Steward Equity Investment [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	0	35,696
Aevis Victoria SA [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	63,758	77,345
Aspris Children's Services [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	15,958	15,986
Lifepoint Behavioral [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	0	11,429
Caremax [Member]
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated operating entities	$ 130	$ 1,148

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

Sep. 30, 2024

Sep. 30, 2023

Business Acquisition [Line Items]

Total assets acquired

$ 105,618

$ 235,187

Liabilities assumed

(2,290)

Loans repaid

^[1]

(22,900)

Total net assets acquired

105,618

212,287

Land and Land Improvements [Member]

Business Acquisition [Line Items]

Total assets acquired

28,916

Building [Member]

Business Acquisition [Line Items]

Total assets acquired

114,966

Intangible Lease Assets [Member]

Business Acquisition [Line Items]

Total assets acquired

16,305

Other Loans [Member]

Business Acquisition [Line Items]

Total assets acquired

25,000

Investments in Unconsolidated Real Estate Joint Ventures [Member]

Business Acquisition [Line Items]

Total assets acquired

107,908

Investments In Unconsolidated Operating Entities [Member]

Business Acquisition [Line Items]

Total assets acquired

$ 0

$ 50,000

[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.

Organization - Additional Information (Detail)	9 Months Ended
Organization - Additional Information (Detail)	Sep. 30, 2024 Facility Country State
Business Acquisition [Line Items]
Percentage of leased assets owned	100.00%
Number of facilities \| Facility	402
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

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (801,163)	$ 116,710	$ (1,997,423)	$ 107,467

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 65
-Paragraph 1
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Section 65
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-Subparagraph (g)(3)
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482765/220-10-50-6

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 65
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
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-Name Accounting Standards Codification
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-Subparagraph (a)
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-URI https://asc.fasb.org/1943274/2147483443/250-10-50-11

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/exampleRef
-Topic 946
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2003/role/disclosureRef
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Reference 27: http://www.xbrl.org/2003/role/disclosureRef
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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
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Reference 29: http://www.xbrl.org/2003/role/disclosureRef
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Reference 30: http://www.xbrl.org/2003/role/disclosureRef
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Reference 32: http://www.xbrl.org/2003/role/disclosureRef
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Reference 33: http://www.xbrl.org/2003/role/disclosureRef
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Reference 34: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 35: http://www.xbrl.org/2003/role/disclosureRef
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Reference 36: http://www.xbrl.org/2003/role/disclosureRef
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Reference 37: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 942
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-Paragraph 1
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-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

+ Details

Real Estate and Other Activities - Schedule of Real Estate and Other Impairment Charges Net (Parenthetical) (Detail) $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($)
Business Acquisition [Line Items]
Charge	$ 445
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Equity investments percentage	9.90%
Steward Health Care System LLC [Member] \| Earnings (Loss) from Equity Interests [Member]
Business Acquisition [Line Items]
Charge	$ 410

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

Sep. 30, 2024

EUR (€)

Sep. 30, 2024

USD ($)

Dec. 31, 2023

EUR (€)

Dec. 31, 2023

GBP (£)

Dec. 31, 2023

USD ($)

Debt Instrument [Line Items]

Debt

$ 9,294,248

$ 10,109,133

GBP-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt | £

£ 322

EURO-denominated Borrowings [Member]

Debt Instrument [Line Items]

Debt | €

€ 303

3.325% Senior Unsecured Notes due 2025 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.325%

Debt

^[1]

$ 556,750

$ 551,950

0.993% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

0.993%

Debt

^[1]

$ 556,750

$ 551,950

2.500% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

2.50%

Debt

^[1]

$ 668,750

$ 636,550

5.250% Senior Unsecured Notes due 2026 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.25%

Debt

$ 500,000

5.000% Senior Unsecured Notes due 2027 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

5.00%

Debt

$ 1,400,000

3.692% Senior Unsecured Notes due 2028 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.692%

Debt

^[1]

$ 802,500

$ 763,860

4.625% Senior Unsecured Notes due 2029 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

4.625%

Debt

$ 900,000

3.375% Senior Unsecured Notes due 2030 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.375%

Debt

^[1]

$ 468,125

$ 445,585

3.500% Senior Unsecured Notes due 2031 [Member]

Debt Instrument [Line Items]

Senior unsecured notes, interest rate

3.50%

Debt

$ 1,300,000

[1]	Non-U.S. dollar denominated debt reflects the exchange rates at September 30, 2024 and December 31, 2023.

Real Estate and Other Activities - Disposals - 2024 Activity Additional Information (Detail) $ in Thousands, £ in Millions							3 Months Ended					9 Months Ended
	Sep. 18, 2024 Facility	Aug. 14, 2024 USD ($) Freestanding	Jul. 23, 2024 USD ($) Freestanding Bed	Apr. 12, 2024 USD ($) Hospital	Apr. 09, 2024 USD ($) Property	May 01, 2023 USD ($)	Sep. 30, 2024 USD ($)	Mar. 31, 2024 GBP (£)	Mar. 31, 2024 USD ($)	Sep. 30, 2023 USD ($)	Mar. 31, 2023 Facility	Sep. 30, 2024 USD ($) Facility	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Investments in unconsolidated real estate joint ventures							$ 1,242,772					$ 1,242,772		$ 1,474,455
Revolving credit facility amount paid												(662,968)	$ (533,864)
Number of facilities sold \| Facility											3
Real estate held for sale							85,000					85,000		$ 0
Gain (loss) on sale of real estate							91,795			$ (20)		475,196	$ 209
Five Prime Properties
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions												23,000
Straight-line rent write-offs												30,000
Dignity health
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions												65,000
Straight-line rent write-offs												20,000
UCHealth
Debt Instrument [Line Items]
Gain (loss) on real estate dispositions												24,000
Straight-line rent write-offs												16,000
Freestanding emergency departments \| Dignity health
Debt Instrument [Line Items]
Number of facilities sold \| Freestanding			7
Freestanding emergency departments \| UCHealth
Debt Instrument [Line Items]
Number of facilities sold \| Freestanding		11
General hospital and freestanding emergency departments
Debt Instrument [Line Items]
Gain (loss) on sale of real estate		$ 40,000	$ 85,000
Non-cash straight-line rent receivables		16,000	20,000
General hospital and freestanding emergency departments \| Dignity health
Debt Instrument [Line Items]
Proceeds from sale of facilities			$ 160,000
General hospital and freestanding emergency departments \| UCHealth
Debt Instrument [Line Items]
Proceeds from sale of facilities		$ 86,000
Arizona General Hospital \| Dignity health
Debt Instrument [Line Items]
Number of bed sold \| Bed			50
Space Coast Properties \| Florida \| Orlando Health
Debt Instrument [Line Items]
Number of facilities sold \| Facility	3
Real estate held for sale							45,000					45,000
Watsonville Facility \| Pajaro Valley Healthcare District Corporation
Debt Instrument [Line Items]
Gain (loss) on sale of real estate							$ 4,000
Institutional Asset Manager [Member]
Debt Instrument [Line Items]
Number of Utah hospitals sold \| Hospital				5
Agreegate agreed valuation				$ 1,200,000
Percentage of interest sold in venture				75.00%
Percentage of interest retained in venture				25.00%
Investments in unconsolidated real estate joint ventures				$ 108,000
Proceeds from divestiture of interest in joint venture				886,000
Additional cash proceeds of non-recourse secured finance				190,000
Revolving credit facility amount paid				(1,100,000)
Gain (loss) on real estate dispositions				380,000								360,000
Write-off of unbilled straight-line rent receivables				20,000
Prime Healthcare Services, Inc. Facilities [Member]
Debt Instrument [Line Items]
Number of properties sold \| Property					5
Profit (loss) from real estate operations												$ 9,000
Number of facilities sold \| Facility												4
Number of ancillary facilities sold \| Facility												2
Proceeds from sale of facilities					$ 250,000
Gain (loss) on real estate dispositions					53,000							$ 2,000
Proceeds from interest-bearing mortgage loan					100,000
Non-cash straight-line rent write-offs					30,000
Lease purchase option value					238,000
Lease purchase option price reverts					$ 260,000
Prime Healthcare Services, Inc. Facilities [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Inflation-based Percentage for Amended Lease					2.00%
Prime Healthcare Services, Inc. Facilities [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Inflation-based Percentage for Amended Lease					4.00%
Behavioral Health Hospitals [Member]
Debt Instrument [Line Items]
Profit (loss) from real estate operations									$ 35,400
General Acute Care Facility [Member]
Debt Instrument [Line Items]
Profit (loss) from real estate operations								£ 46	$ 49,000
CommonSpirit Health [Member]
Debt Instrument [Line Items]
Leased real estate acquire lease base				1,200,000
Derivative liability				$ 2,300
Straight-line rent write-offs						$ 95,000						$ 20,000
Amortization of Intangible Assets						$ 286,000

Real Estate and Other Activities - Steward Health Care System - Additional Information (Detail) $ in Thousands		3 Months Ended				9 Months Ended
	Sep. 18, 2024 USD ($) Property	Sep. 30, 2024 USD ($)	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2024 USD ($)	Dec. 31, 2023 USD ($)
Business Acquisition [Line Items]
Net impairment charge			$ 500,000	$ 225,000	$ 79,000
Investments in unconsolidated real estate joint ventures		$ 1,242,772				$ 1,242,772	$ 1,474,455
Received rent						38,000
Real estate and other impairment charges, net		603,000				1,563,000
In-place lease intangibles [Member]
Business Acquisition [Line Items]
Amortization of Intangible Assets		115,000				$ 149,000
Steward Health Care System LLC [Member]
Business Acquisition [Line Items]
Equity investments percentage						9.90%
Loan due from affiliates		362,000				$ 362,000
Number of properties \| Property	23
Bankruptcy claims amount of claims settled	$ 395,000
Proceeds from sale of facilities	$ 40,000
Real estate and other impairment charges, net		$ 600,000				$ 1,600,000

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	Sep. 30, 2024 USD ($)
Investments in Unconsolidated Operating Entities [Member]
Variable Interest Entity [Line Items]
Carrying Amount	$ 201,526
Mortgage and Other Loans [Member]
Variable Interest Entity [Line Items]
Carrying Amount	141,464
Loans, Net And Equity Investments [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	201,526
Loans, Net Two [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 141,544

- Definition

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.

+ References + Details

Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

agreements, the fair value of our equity and loan investments, and the adequacy of our credit loss reserves on loans and financing receivables).

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 and equity investments	$	201,526	Investments in Unconsolidated Operating Entities	$	201,526
Loans, net		141,464	Mortgage and other loans		141,544

(1)

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

(2)

Recent Accounting Developments

Segment Reporting

Income Taxes

Disaggregation of Income Statement Expenses

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

9 Months Ended

Sep. 30, 2023

Sep. 30, 2024

Business Acquisition [Line Items]

Advanced to the mortgage loan

^[1]

$ 22,900

$ 0

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

Business Acquisition [Line Items]

Advanced to the mortgage loan

$ 23,000

Intangible Lease Assets [Member]

Business Acquisition [Line Items]

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

24 years 9 months 18 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.

Real Estate and Other Activities - International Joint Venture - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Mar. 31, 2023
Business Acquisition [Line Items]
Straight-line rent receivables				$ 37.4
Impairment charge	$ 500.0	$ 225.0		$ 79.0
Other Tenant Updates [Member]
Business Acquisition [Line Items]
Percentage of assets representing properties leased and loan to internation joint ventures			1.00%

Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Parenthetical) (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Business Acquisition [Line Items]
Investments in unconsolidated operating entities	$ 508,227	$ 1,778,640
PHP Holdings [Member]
Business Acquisition [Line Items]
Investments in unconsolidated operating entities	201,526	$ 699,535
Other Assets by Operator [Member] \| PHP Holdings [Member]
Business Acquisition [Line Items]
Investments in unconsolidated operating entities	$ 200,000

Summary of Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

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

The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs at September 30, 2024 are presented below (in thousands):


VIE Type	Carrying Amount(1)		Asset Type Classification	Maximum Loss Exposure(2)
Loans, net and equity investments	$	201,526	Investments in Unconsolidated Operating Entities	$	201,526
Loans, net		141,464	Mortgage and other loans		141,544

(1)

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

(2)

- Definition

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.

+ References + Details

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
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	600,229,000	598,991,000
Common stock, shares outstanding	600,229,000	598,991,000
General Partner [Member] \| MPT Operating Partnership, L.P. [Member]
General partner, units issued	6,004,000	5,991,000
General partner, units outstanding	6,004,000	5,991,000
Common Units \| MPT Operating Partnership, L.P. [Member]
Limited Partners, units issued	594,225,000	593,000,000
Limited Partners, units outstanding	594,225,000	593,000,000

Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Business Acquisition [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,242,772	$ 1,474,455
Investments in Unconsolidated Real Estate Joint Ventures [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Capital contributions	$ 40,000
Investments in unconsolidated real estate joint ventures	$ 13,500
Investments in Unconsolidated Real Estate Joint Ventures [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Percentage of equity investment	100.00%
Swiss Medical Network [Member]
Business Acquisition [Line Items]
Percentage of equity investment	70.00%
Investments in unconsolidated real estate joint ventures	$ 515,878	472,434
Common Spirit [Member]
Business Acquisition [Line Items]
Percentage of equity investment	25.00%
Investments in unconsolidated real estate joint ventures	$ 119,708	$ 0

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues
Rent billed	$ 169,721	$ 229,306	$ 552,784	$ 724,954
Straight-line rent	36,602	21,511	119,719	38,875
Income from financing leases	9,798	26,066	53,832	107,729
Interest and other income	9,706	29,693	37,368	122,624
Total revenues	225,827	306,576	763,703	994,182
Expenses
Interest	106,243	106,709	316,358	308,833
Real estate depreciation and amortization	204,875	77,802	382,701	526,065
Property-related	4,994	6,483	17,475	38,269
General and administrative	36,625	38,110	105,300	115,438
Total expenses	352,737	229,104	821,834	988,605
Other (expense) income
Gain (loss) on sale of real estate	91,795	(20)	475,196	209
Real estate and other impairment charges, net	(607,922)	(3,750)	(1,438,429)	(93,288)
Earnings (loss) from equity interests	21,643	11,264	(369,565)	34,840
Debt refinancing and unutilized financing (costs) benefit	(713)	862	(3,677)	46
Other (including fair value adjustments on securities)	(169,790)	41,125	(566,821)	25,447
Total other (expense) income	(664,987)	49,481	(1,903,296)	(32,746)
(Loss) income before income tax	(791,897)	126,953	(1,961,427)	(27,169)
Income tax (expense) benefit	(9,032)	(10,058)	(34,538)	134,661
Net (loss) income	(800,929)	116,895	(1,995,965)	107,492
Net income attributable to non-controlling interests	(234)	(185)	(1,458)	(25)
Net (loss) income attributable to MPT common stockholders	$ (801,163)	$ 116,710	$ (1,997,423)	$ 107,467
Earnings per common share (units) basic
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), basic	$ (1.34)	$ 0.19	$ (3.33)	$ 0.18
Earnings per common share (units) diluted
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ (1.34)	$ 0.19	$ (3.33)	$ 0.18
Weighted average shares (units) outstanding basic	600,229	598,444	600,197	598,363
Weighted average shares (units) outstanding diluted	600,229	598,553	600,197	598,406
Dividends declared per common share (unit)	$ 0.08	$ 0.15	$ 0.38	$ 0.73
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 169,721	$ 229,306	$ 552,784	$ 724,954
Straight-line rent	36,602	21,511	119,719	38,875
Income from financing leases	9,798	26,066	53,832	107,729
Interest and other income	9,706	29,693	37,368	122,624
Total revenues	225,827	306,576	763,703	994,182
Expenses
Interest	106,243	106,709	316,358	308,833
Real estate depreciation and amortization	204,875	77,802	382,701	526,065
Property-related	4,994	6,483	17,475	38,269
General and administrative	36,625	38,110	105,300	115,438
Total expenses	352,737	229,104	821,834	988,605
Other (expense) income
Gain (loss) on sale of real estate	91,795	(20)	475,196	209
Real estate and other impairment charges, net	(607,922)	(3,750)	(1,438,429)	(93,288)
Earnings (loss) from equity interests	21,643	11,264	(369,565)	34,840
Debt refinancing and unutilized financing (costs) benefit	(713)	862	(3,677)	46
Other (including fair value adjustments on securities)	(169,790)	41,125	(566,821)	25,447
Total other (expense) income	(664,987)	49,481	(1,903,296)	(32,746)
(Loss) income before income tax	(791,897)	126,953	(1,961,427)	(27,169)
Income tax (expense) benefit	(9,032)	(10,058)	(34,538)	134,661
Net (loss) income	(800,929)	116,895	(1,995,965)	107,492
Net income attributable to non-controlling interests	(234)	(185)	(1,458)	(25)
Net (loss) income attributable to MPT common stockholders	$ (801,163)	$ 116,710	$ (1,997,423)	$ 107,467
Earnings per common share (units) basic
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), basic	$ (1.34)	$ 0.19	$ (3.33)	$ 0.18
Earnings per common share (units) diluted
Net (loss) income attributable to MPT common stockholders (Operating Partnership partners), diluted	$ (1.34)	$ 0.19	$ (3.33)	$ 0.18
Weighted average shares (units) outstanding basic	600,229	598,444	600,197	598,363
Weighted average shares (units) outstanding diluted	600,229	598,553	600,197	598,406
Dividends declared per common share (unit)	$ 0.08	$ 0.15	$ 0.38	$ 0.73

Real Estate and Other Activities - Prospect - Additional Information) (Detail) - USD ($) $ in Thousands	3 Months Ended					9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition [Line Items]
Net impairment charge		$ 500,000	$ 225,000		$ 79,000
Revenues	$ 225,827			$ 306,576		$ 763,703	$ 994,182
Prospect [Member]
Business Acquisition [Line Items]
Rental revenue						25,000
Interest received on asset-backed loan						3,800
Lease real estate assets						1,000,000
Prospect [Member] \| PHP Holdings [Member]
Business Acquisition [Line Items]
Unfavourable fair value adjustments	(134,000)					(498,000)
Investments	$ 200,000					$ 200,000

Real Estate and Other Activities - 2023 Activity - Additional Information (Detail) $ in Thousands, £ in Millions					1 Months Ended	3 Months Ended						9 Months Ended	12 Months Ended
	May 23, 2023 USD ($)	Apr. 14, 2023 GBP (£) Facility	Apr. 14, 2023 USD ($) Facility	Feb. 07, 2023 USD ($) Facility	Aug. 31, 2019 USD ($) Hospital	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Jun. 30, 2023 GBP (£) Facility	Jun. 30, 2023 USD ($) Facility	Mar. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Sep. 30, 2024 USD ($)	Dec. 31, 2023 USD ($)	Sep. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)
Business Acquisition [Line Items]
Net impairment charge						$ 500,000	$ 225,000			$ 79,000
Additional mortgage loan												$ 105,618		$ 235,187
PHP Holdings [Member]
Business Acquisition [Line Items]
Capital restructuring costs												654,000
Equity investment												68,000
Convertible loan												$ 586,000
Prospect [Member]
Business Acquisition [Line Items]
Purchase price of acquisition					$ 1,500,000
Term loan					$ 112,900
Net impairment charge											$ 280,000
Additional mortgage loan															$ 100,000
Investment, Type [Extensible Enumeration]												Mortgage Loans [Member]
Pay down of debt instruments	$ 375,000
Reconstitution of asset	1,700,000
Prospect [Member] \| Maximum [Member]
Business Acquisition [Line Items]
First lien secured loan	75,000
Prospect [Member] \| Acute Care Campus [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Hospital					14
Prospect [Member] \| Mortgage Loans [Member]
Business Acquisition [Line Items]
First lien secured loan	150,000
Prospect [Member] \| PHP Holdings [Member]
Business Acquisition [Line Items]
Revenue for rent and interest													$ 82,000
Unpaid rent and interest	112,900
Convertible loan										$ 50,000
Prospect [Member] \| PHP Holdings [Member] \| Mortgage Loans [Member]
Business Acquisition [Line Items]
Unpaid rent and interest	$ 151,000
Prospect [Member] \| Pennsylvania [Member]
Business Acquisition [Line Items]
Carrying value of lease requiring residual value guarantee											170,000
Unbilled rent accruals												$ 112,000
Prospect [Member] \| Pennsylvania [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Carrying value of lease requiring residual value guarantee											$ 250,000
General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility				8
Lease extension expiration term				5 years
Lease extension expiration year				2041
Behavioral Health Hospitals [Member]
Business Acquisition [Line Items]
Number of facilities acquired \| Facility		5	5					3	3
Payment for acquisition		£ 44	$ 58,000					£ 70	$ 77,000
Number of leased facilities \| Facility		5	5
Springstone Health Opco, LLC [Member]
Business Acquisition [Line Items]
Purchase price of acquisition				$ 250,000
Sale of minority equity investment							$ 12,000
Additional mortgage loan				$ 205,000

Debt - Credit Facility, Term Loan Facility, Senior Unsecured Notes Due 2023 and Secured Term Loan due 2034 and Term Loan due 2025 - Additional Information (Details)
$ in Thousands, £ in Millions, $ in Millions

3 Months Ended

9 Months Ended

Aug. 06, 2024

USD ($)

May 24, 2024

GBP (£)

Property

Apr. 18, 2024

AUD ($)

Apr. 18, 2024

USD ($)

Apr. 12, 2024

USD ($)

Oct. 10, 2023

Facility

May 18, 2023

AUD ($)

Facility

May 18, 2023

USD ($)

Facility

Sep. 30, 2024

GBP (£)

Sep. 30, 2024

USD ($)

Sep. 30, 2023

GBP (£)

Sep. 30, 2023

USD ($)

Mar. 31, 2023

Facility

Sep. 30, 2024

USD ($)

Sep. 30, 2023

USD ($)

May 24, 2024

USD ($)

Property

Dec. 31, 2023

USD ($)

Jun. 29, 2022

USD ($)

Debt Instrument [Line Items]

Number of facilities sold | Facility

Amount of term loan paid

$ 662,968

$ 533,864

Debt refinancing and unutilized financing costs

$ 713

$ (862)

3,677

$ (46)

Principal amount

9,294,248

$ 10,109,133

Australia Transaction [Member]

Debt Instrument [Line Items]

Number of facilities sold | Facility

Number of remaining facilities sold | Facility

Proceeds from the sale of first tranche prepay

$ 730

$ 475,000

Term loan

$ 1,200

2.550% Senior Unsecured Notes due 2023 [Member]

Debt Instrument [Line Items]

Fixed rate

2.55%

Principal amount | £

£ 40.0

Gain on prepayment of Debt | £

£ 0.9

British Pound Sterling [Member] | Secured term loan due 2034

Debt Instrument [Line Items]

Principal amount

£ 631.0

$ 800,000

Number of properties | Property

Fixed rate

6.877%

Debt insrtument term

10 years

Principal amount

^[1]

$ 844,470

844,470

British Pound Sterling [Member] | Term loan due 2025

Debt Instrument [Line Items]

Debt instrument maturity year

2025

Amount of term loan paid | £

£ 72.0

Principal amount

^[1]

$ 699,512

699,512

891,170

British Pound Sterling [Member] | Secured term loan due 2024

Debt Instrument [Line Items]

Debt instrument maturity year

2024

Line of credit facility, borrowing capacity | £

£ 105.0

Amount of term loan paid | £

£ 105.0

Principal amount

^[1]

$ 0

$ 133,484

Modified Covenant During the Period [Member]

Debt Instrument [Line Items]

Basis Points

3.00%

Percentage of proceeds of future asset sales and debt transactions

15.00%

Modified Covenant During the Period [Member] | British Pound Sterling [Member] | Term loan due 2025

Debt Instrument [Line Items]

Debt instrument maturity year

2025

Percentage of proceeds of future asset sales and debt transactions

50.00%

Modified Covenant After the Period [Member]

Debt Instrument [Line Items]

Basis Points

2.25%

Credit Facility Amendment [Member]

Debt Instrument [Line Items]

Credit facility, current borrowing capacity

$ 1,280,000

$ 1,400,000

$ 1,800,000

Waive percentage cap on unencumbered asset

10.00%

Australian Term Loan Facility [Member]

Debt Instrument [Line Items]

Term loan paid off and terminated with proceeds from Utah transaction

$ 470

$ 306,000

[1]	Non-U.S. dollar denominated debt reflects the exchange rates at September 30, 2024 and December 31, 2023.

Real Estate and Other Activities - Summary of Operating Results from Properties Designated as Held for Sale and Sold (Details) - USD ($) $ in Thousands	3 Months Ended					9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition [Line Items]
Revenues	$ 225,827			$ 306,576		$ 763,703	$ 994,182
Real estate depreciation and amortization	(204,875)			(77,802)		(382,701)	(526,065)
Real estate impairment charges		$ (500,000)	$ (225,000)		$ (79,000)
Other income (expense)	(169,790)			41,125		(566,821)	25,447
Disposal Group, Not Discontinued Operations [Member]
Business Acquisition [Line Items]
Revenues	5,305			64,318		67,672	106,435
Real estate depreciation and amortization	(10,429)			(12,101)		(24,213)	(324,720)
Property-related expenses	134			(600)		(4,017)	(6,252)
Real estate impairment charges	(129,159)					(129,159)
Other income (expense)	91,728			(29)		476,999	(77)
(Expense) income from real estate dispositions, net	$ (42,421)			$ 51,588		$ 387,282	$ (224,614)

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
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-Name Accounting Standards Codification
-Section 55
-Paragraph 48
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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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+ Details

Fair Value of Financial Instruments - Additional Information (Detail)	3 Months Ended				9 Months Ended
	Sep. 30, 2024 USD ($)	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Sep. 30, 2024 USD ($) Health_Center	Sep. 30, 2023 USD ($)	Dec. 31, 2023
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Impairment charge, working capital loans and other secured loans	$ 425,000,000
Real estate impairment charges		$ 500,000,000	$ 225,000,000	$ 79,000,000
PHP Holdings [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Discount rate on investment	25.00%				25.00%		11.00%
Discount for lack of marketability percentage on Springstone equity investment	14.00%				14.00%		8.00%
Springstone Inc and International Joint Venture [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Unfavorable fair market value adjustment on investment					$ 720,000,000
Favorable fair market value adjustment on investment						$ 25,000,000
Steward's Equity [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Equity investments percentage					9.90%
Impairment charge, working capital loans and other secured loans	$ 425,000,000
Wrote down, equity interest value					$ 0
Steward's Equity [Member] \| Equity Securities [Member] \| International Joint Venture [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Remaining equity investment percentage					90.10%
Space Coast Facilities [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Real estate impairment charges	$ 180,000,000
Fair Value, Recurring [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired \| Health_Center					3
Maximum [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Market capitalization percentage					10.00%
Minimum [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Market capitalization percentage					7.00%
Minimum [Member] \| Steward's Equity [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Impairment charge, working capital loans and other secured loans			$ 600,000,000
Level 3 [Member] \| Maximum [Member] \| Discount Rate [Member] \| Steward's Equity [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments measurement input	0.16				0.16
Level 3 [Member] \| Weighted Average [Member] \| Discount Rate [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments measurement input	0.1503				0.1503
Level 3 [Member] \| Minimum [Member] \| Discount Rate [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments measurement input	0.15				0.15

Earnings Per Share/Unit - Calculation of Earnings Per Share (Parenthetical) (Details) - shares	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Potential common shares/units inclusion of shares	37,967	18,422

Real Estate and Other Activities - Other Tenant Matters - Additional Information (Detail) - Other Tenant Updates [Member] - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition [Line Items]
Percentage of assets representing properties leased and loan to internation joint ventures		1.00%
Amortization of Intangible Assets	$ 22
Reserve billed and straight line rent receivables		$ 49

Document and Entity Information - shares shares in Millions	9 Months Ended
Document and Entity Information - shares shares in Millions	Sep. 30, 2024	Nov. 08, 2024
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST, INC.
Entity Central Index Key	0001287865
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		600.4
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	Sep. 30, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	0001524607
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity File Number	333-177186
Entity Tax Identification Number	20-0242069
Entity Address, Address Line One	1000 URBAN CENTER DRIVE
Entity Address, Address Line Two	SUITE 501
Entity Address, City or Town	BIRMINGHAM
Entity Address, State or Province	AL
Entity Address, Postal Zip Code	35242
City Area Code	205
Local Phone Number	969-3755
Entity Incorporation, State or Country Code	DE

Subsequent Events

9 Months Ended

Sep. 30, 2024

Subsequent Events [Abstract]

Subsequent Events

10. Subsequent Events

On October 18, 2024, we sold two facilities located in Texas and previously leased for total proceeds of approximately $5 million.

On November 8, 2024, Astrana Health entered into a binding agreement to purchase the majority of PHP Holdings for approximately $745 million and the assumption of certain liabilities. After satisfaction of certain obligations, we expect to receive approximately $200 million in total proceeds. We expect to receive the majority of these proceeds in the first half of 2025, while a $50 million payment is expected by 2027.

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 136,192	$ 146,892
Original Cost	136,192	146,892
Equity Method Investment and Other Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	206,798	939,903
Original Cost	$ 909,726	$ 912,999

- Definition

Cost of the investment.

+ References

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+ Details

- Definition

Fair value of investment in security owned.

+ References

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+ Details

Stock Awards

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

Stock Awards

6. Stock Awards

During the second quarter of 2022, we amended the 2019 Equity Incentive Plan (the “Equity Incentive Plan”), which authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units, and awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors, and we have reserved 28.9 million shares of common stock for awards, of which 8.8 million shares remain available for future stock awards as of September 30, 2024. Share-based compensation expense totaled $30.6 million (including $9.3 million related to certain grants in 2024 with cash-settlement features) and $29.7 million for the nine months ended September 30, 2024 and 2023, respectively.

Real Estate and Other Activities (Tables)

9 Months Ended

Sep. 30, 2024

Real Estate [Abstract]

Net Assets Acquired

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


	For the Nine Months Ended September 30,
	2024			2023

Land and land improvements	$	—		$	28,916
Buildings		—			114,966
Intangible lease assets — subject to amortization (weighted-average useful life of 24.8 years for 2023)		—			16,305
Investments in unconsolidated real estate joint ventures		107,908			—
Investments in unconsolidated operating entities		—			50,000
Other loans		—			25,000
Liabilities assumed		(2,290	)		—
	$	105,618		$	235,187
Loans repaid(1)		—			(22,900	)
Total net assets acquired	$	105,618		$	212,287

(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.

Summary of Status on Current Development Projects

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


Property	Commitment		Costs Incurred as of September 30, 2024		Estimated Rent Commencement Date
IMED Hospitales ("IMED") (Spain)	$	38,974	$	31,445	3Q 2025
IMED (Spain)		53,427		21,594	3Q 2026
	$	92,401	$	53,039

Summary of Operating Results from Properties

The following represents the operating results from the five properties sold as part of the Utah Transaction, the five Prime properties sold in April 2024, the eight properties sold to Dignity Health, the 11 properties sold to UCHealth, and the properties designated as held for sale at September 30, 2024 (in thousands):


	For the Three Months Ended September 30,						For the Nine Months Ended September 30,
	2024			2023			2024			2023
Revenues(1)	$	5,305		$	64,318		$	67,672		$	106,435
Real estate depreciation and amortization(2)		(10,429	)		(12,101	)		(24,213	)		(324,720	)
Property-related expenses		134			(600	)		(4,017	)		(6,252	)
Real estate impairment charges(3)		(129,159	)		—			(129,159	)		—
Other income (expense)(4)		91,728			(29	)		476,999			(77	)
(Expense) income from real estate dispositions, net	$	(42,421	)	$	51,588		$	387,282		$	(224,614	)

(1)

The nine month 2023 column includes an approximate $95 million write-off of straight-line rent receivables related to the hospital operations of the five Utah facilities that were acquired by CommonSpirit on May 1, 2023.

(2)

The nine month 2023 column includes approximately $286 million of lease intangible amortization acceleration related to the hospital operations of the five Utah facilities that were acquired by CommonSpirit on May 1, 2023.

(3)

Includes the charge associated with the three Space Coast facilities in the third quarter of 2024 due to the global settlement reached with Steward and its lenders.

(4)

The 2024 columns include approximately $24 million of gains (net of approximately $16 million write-off of straight line receivables) related to the UCHealth disposal and $65 million of gains (net of approximately $20 million write-off of straight-line rent receivables) related to the Dignity disposal. In addition, the nine month 2024 column includes $360 million of gains (net of approximately $20 million write-off of straight-line rent receivables) related to the Utah Transaction and $23 million of gains (net of $30 million write-off of straight-line rent receivables) related to the sale of five Prime properties.

Components of Total Investment in Financing Leases

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


	As of September 30, 2024			As of December 31, 2023
Minimum lease payments receivable	$	596,274		$	611,669
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(553,772	)		(571,059	)
Net investment in direct financing leases		246,320			244,428
Other financing leases (net of allowance for credit loss)		938,672			987,202
Total investment in financing leases	$	1,184,992		$	1,231,630

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 September 30, 2024		As of December 31, 2023
Swiss Medical Network	70%	$	515,878	$	472,434
MEDIAN	50%		472,179		471,336
CommonSpirit (Utah partnership)	25%		119,708		—
Policlinico di Monza	50%		81,785		80,562
HM Hospitales	45%		53,222		56,071
Steward (Macquarie partnership)	50%		—		394,052
Total		$	1,242,772	$	1,474,455

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


Operator	As of September 30, 2024		As of December 31, 2023
PHP Holdings	$	201,526	$	699,535
Swiss Medical Network		185,185		186,113
Aevis Victoria SA ("Aevis")		63,758		77,345
Priory		41,670		163,837
Aspris Children's Services ("Aspris")		15,958		15,986
Caremax		130		1,148
Steward (loan investment)		—		361,591
International joint venture		—		225,960
Steward (equity investment)		—		35,696
Lifepoint Behavioral		—		11,429
Total	$	508,227	$	1,778,640

Summary of Activity in Credit Loss reserves

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


	For the Three Months Ended September 30,
	2024				2023
Balance at beginning of the period	$	538,534			$	87,105
Provision for credit loss, net		438,154		(1)		165
Expected credit loss reserve written off or related to financial instruments sold, repaid, or satisfied		(825,548	)	(3)		(63	)
Balance at end of the period	$	151,140			$	87,207


	For the Nine Months Ended September 30,
	2024				2023
Balance at beginning of the year	$	96,001			$	121,146
Provision for credit loss, net		880,687		(1)(2)		1,513
Expected credit loss reserve written off or related to financial instruments sold, repaid, or satisfied		(825,548	)	(3)		(35,452	)
Balance at end of the period	$	151,140			$	87,207

(1)

Includes charges and reserves related to our investments in cash basis tenants.

(2)

Includes the charge related to the $362 million loan to Steward, as further described under "Steward Health Care System" subheading of this Note 3.

(3)

Includes write-offs in the third quarter of 2024 of previously reserved loans to Steward as further described under "Steward Health Care System" subheading of this Note 3.

Schedule of Real Estate and Other Impairment Charges, Net

which included the following (in millions):


Description	For the Three Months Ended September 30, 2024			For the Nine Months Ended September 30, 2024
Working capital and other loans	$	425		$	787
Real estate, primarily Space Coast facilities		180			277
Investment in Massachusetts partnership(1)		—			445
9.9% equity investment in Steward		—			36
Property taxes, insurance and other, net		(2	)		18
Total real estate and other impairment charges, net	$	603		$	1,563

(1)

$410 million of this charge was recorded in the "Earnings (loss) from equity interests" line of our condensed consolidated statements of net income.

Schedule of Concentrations of Credit Risk

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

Total Assets by Operator


	As of September 30, 2024						As of December 31, 2023
Operators	Total Assets (1)			Percentage of Total Assets			Total Assets (1)		Percentage of Total Assets
Circle Health Ltd ("Circle")	$	2,179,805			14.3	%	$	2,119,392		11.6	%
Priory		1,325,408			8.7	%		1,391,005		7.6	%
Healthcare Systems of America		1,176,533			7.7	%		—		0.0	%
Prospect		1,042,343			6.8	%		1,092,974		6.0	%
Lifepoint Behavioral		815,439			5.4	%		813,527		4.4	%
Steward		—			0.0	%		3,518,537		19.2	%
Other operators		7,059,205			46.3	%		7,352,012		40.2	%
Other assets		1,637,423	(2)		10.8	%		2,017,397		11.0	%
Total	$	15,236,156			100.0	%	$	18,304,844		100.0	%

(1)

Total assets by operator are generally comprised of real estate assets, mortgage loans, investments in unconsolidated real estate joint ventures, investments in unconsolidated operating entities, and other loans.

(2)

Includes our investment in PHP Holdings of approximately $200 million as part of the Prospect Transaction and tenant update described previously in this same Note 3.

Total Assets by U.S. State and Country (1)


	As of September 30, 2024					As of December 31, 2023
U.S. States and Other Countries	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Texas	$	1,367,932		9.0	%	$	1,891,482		10.3	%
California		1,051,443		6.9	%		1,252,674		6.8	%
Florida		890,879		5.8	%		1,348,210		7.4	%
Pennsylvania		455,757		3.0	%		470,562		2.6	%
Arizona		380,756		2.5	%		547,789		3.0	%
All other states		2,890,763		19.0	%		4,264,392		23.3	%
Other domestic assets		858,750		5.7	%		1,397,170		7.6	%
Total U.S.	$	7,896,280		51.9	%	$	11,172,279		61.0	%
United Kingdom	$	4,283,890		28.1	%	$	4,261,944		23.3	%
Switzerland		764,821		5.0	%		735,891		4.0	%
Germany		732,489		4.8	%		734,630		4.0	%
Spain		265,574		1.7	%		252,529		1.4	%
All other countries		514,429		3.4	%		527,344		2.9	%
Other international assets		778,673		5.1	%		620,227		3.4	%
Total international	$	7,339,876		48.1	%	$	7,132,565		39.0	%
Grand total	$	15,236,156		100.0	%	$	18,304,844		100.0	%

Total Assets by Facility Type (1)


	As of September 30, 2024					As of December 31, 2023
Facility Types	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
General acute care hospitals	$	9,308,236		61.1	%	$	11,764,151		64.3	%
Behavioral health facilities		2,487,861		16.3	%		2,576,983		14.1	%
Post acute care facilities		1,676,426		11.0	%		1,716,248		9.4	%
Freestanding ER/urgent care facilities		126,210		0.8	%		230,065		1.2	%
Other assets		1,637,423		10.8	%		2,017,397		11.0	%
Total	$	15,236,156		100.0	%	$	18,304,844		100.0	%

(1)

For geographic and facility type concentration metrics in the tables above, we allocate our investments in unconsolidated 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 - Summary of Activity in Credit Loss Reserves (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Receivables [Abstract]
Balance at beginning of the period	$ 538,534	$ 87,105	$ 96,001	$ 121,146
Provision for credit loss, net	438,154	165	880,687	1,513
Expected credit loss reserve written off or related to financial instruments sold, repaid, or satisfied	(825,548)	(63)	(825,548)	(35,452)
Balance at end of the period	$ 151,140	$ 87,207	$ 151,140	$ 87,207

- Definition

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

+ References + Details

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended					9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Taxes [Line Items]
Income tax expense (benefit)	$ 9,032		$ 10,058			$ 34,538	$ (134,661)
Income tax benefit related to the initial loan impairment					$ 5,000
Foreign Tax Jurisdiction [Member]
Income Taxes [Line Items]
Income tax expense (benefit)		$ 5,000		$ (158,000)

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-12

Reference 4: http://www.xbrl.org/2003/role/exampleRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 231
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482663/740-10-55-231

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-9

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 6.I.7)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479360/740-10-S99-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 8
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-8

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Name Accounting Standards Codification
-Section 50
-Paragraph 10
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-URI https://asc.fasb.org/1943274/2147482685/740-10-50-10

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(9))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477250/944-220-S99-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Subparagraph (a)
-SubTopic 20
-Topic 740
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482659/740-20-45-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h))
-SubTopic 10
-Topic 235
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

+ Details

Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares	3 Months Ended					9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Dividends (Distributions) declared per common share / unit	$ 0.08	$ 0.3	$ 0.15	$ 0.29	$ 0.29	$ 0.38	$ 0.73
MPT Operating Partnership, L.P. [Member]
Dividends (Distributions) declared per common share / unit	0.08		0.15			$ 0.38	$ 0.73
MPT Operating Partnership, L.P. [Member] \| General Partner [Member]
Dividends (Distributions) declared per common share / unit	$ 0.08	$ 0.3	$ 0.15	$ 0.29	$ 0.29

Subsequent Events (Additional Information) (Details) $ in Millions				3 Months Ended
	Nov. 08, 2024 USD ($)	Oct. 18, 2024 USD ($) Facility	Sep. 18, 2024 USD ($)	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($) Facility
Subsequent Event [Line Items]
Number of facilities sold \| Facility						3
Real estate impairment charges				$ 500	$ 225	$ 79
Subsequent Event [Member]
Subsequent Event [Line Items]
Proceeds received from certain obligations	$ 200
Payment of certain obligations	50
Texas [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Number of facilities sold \| Facility		2
Proceeds from sale of facilities		$ 5
Steward [Member]
Subsequent Event [Line Items]
Proceeds from sale of facilities			$ 40
Php Holdings [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Assumption of certain liabilities	$ 745

Real Estate and Other Activities - Common Spirit Additional Information (Detail) $ in Millions		3 Months Ended		9 Months Ended
	May 01, 2023 USD ($) Facility	Sep. 30, 2024 USD ($)	Jun. 30, 2022 USD ($)	Sep. 30, 2024 USD ($)
Common Spirit [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
Amortization of Intangible Assets	286
Straight-line rent write-offs	$ 95			$ 20
Catholic Health Initiatives Colorado [Member] \| Common Spirit [Member]
Business Acquisition [Line Items]
Initial lease term	15 years
In-place lease intangibles [Member]
Business Acquisition [Line Items]
Amortization of Intangible Assets		$ 115		$ 149
In-place lease intangibles [Member] \| Common Spirit [Member]
Business Acquisition [Line Items]
Amortization of Intangible Assets	$ 286

Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Parenthetical) (Detail) $ in Millions	Sep. 30, 2024 USD ($)
Steward [Member]
Financing Receivable, Allowance for Credit Loss [Line Items]
Loan due from affiliates	$ 362

Real Estate and Other Activities - Re-tenanting Activity - Additional Information (Detail) - Retenanting Activity [Member] - Property	Oct. 01, 2024	Sep. 18, 2024
Business Acquisition [Line Items]
Number of properties		23
Number of operators		5
Subsequent Event [Member]
Business Acquisition [Line Items]
Number of leased facilities	17
Number of properties sold	4
Percentage of net book value of total assets re-tenanted or sold	1.00%

Real Estate and Other Activities - Disposals - 2023 Activity Additional Information (Detail) $ in Millions, $ in Millions						3 Months Ended					9 Months Ended
	Sep. 18, 2024 USD ($)	Oct. 10, 2023 AUD ($) Facility	May 18, 2023 AUD ($) Facility	Mar. 29, 2023 Facility	Mar. 08, 2023 USD ($)	Sep. 30, 2024 USD ($)	Jun. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 AUD ($) Facility	Mar. 31, 2023 USD ($) Facility	Sep. 30, 2024 USD ($)
Debt Instrument [Line Items]
Number of facilities sold \| Facility									3	3
Estimated Fees To Sell The Hospitals										$ 8.0
Net impairment charge							$ 500.0	$ 225.0		79.0
Straight-line rent receivable writeoffs										37.4
Estimated fees to sell the hospitals										8.0
Gains from our interest rate swap in AOCI										$ 16.0
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
In-place lease intangibles [Member]
Debt Instrument [Line Items]
Amortization of Intangible Assets						$ 115.0					$ 149.0
Steward Health Care System LLC [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities	$ 40.0
General Acute Care Facility [Member] \| Australia [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility				11
Australia Transaction [Member]
Debt Instrument [Line Items]
Number of facilities sold \| Facility			7
Proceeds from sale of facilities		$ 470	$ 730						$ 1,200
Number of remaining facilities sold \| Facility		4	11
Prime [Member]
Debt Instrument [Line Items]
Proceeds from sale of facilities					$ 100.0
Non-cash impairment charge										$ 11.0

Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Business Acquisition [Line Items]
Commitment	$ 92,401
Costs Incurred as of June 30, 2024	53,039
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	38,974
Costs Incurred as of June 30, 2024	$ 31,445
Estimated Rent Commencement Date	3Q 2025
IMED [Member] \| Spain [Member]
Business Acquisition [Line Items]
Commitment	$ 53,427
Costs Incurred as of June 30, 2024	$ 21,594
Estimated Rent Commencement Date	3Q 2026

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 11,653,954	$ 13,237,187
Investment in financing leases	1,184,992	1,231,630
Real estate held for sale	85,000	0
Mortgage loans	298,221	309,315
Gross investment in real estate assets	13,222,167	14,778,132
Accumulated depreciation and amortization	(1,423,702)	(1,407,971)
Net investment in real estate assets	11,798,465	13,370,161
Cash and cash equivalents	275,616	250,016
Interest and rent receivables	35,142	45,059
Straight-line rent receivables	685,742	635,987
Investments in unconsolidated real estate joint ventures	1,242,772	1,474,455
Investments in unconsolidated operating entities	508,227	1,778,640
Other loans	155,889	292,615
Other assets	534,303	457,911
Total Assets	15,236,156	18,304,844
Liabilities
Debt, net	9,215,751	10,064,236
Accounts payable and accrued expenses	418,339	412,178
Deferred revenue	24,332	37,962
Obligations to tenants and other lease liabilities	136,635	156,603
Total Liabilities	9,795,057	10,670,979
Equity / Capital
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding	0	0
Common stock, $0.001 par value. Authorized 750,000 shares; issued and outstanding - 600,229 shares at September 30, 2024 and 598,991 shares at December 31, 2023December 31, 2023	600	599
Additional paid-in capital	8,578,355	8,560,309
Retained deficit	(3,197,505)	(971,809)
Accumulated other comprehensive income	57,114	42,501
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	5,438,564	7,631,600
Non-controlling interests	2,535	2,265
Total Equity / Capital	5,441,099	7,633,865
Total Liabilities and Equity / Capital	15,236,156	18,304,844
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	11,653,954	13,237,187
Investment in financing leases	1,184,992	1,231,630
Real estate held for sale	85,000	0
Mortgage loans	298,221	309,315
Gross investment in real estate assets	13,222,167	14,778,132
Accumulated depreciation and amortization	(1,423,702)	(1,407,971)
Net investment in real estate assets	11,798,465	13,370,161
Cash and cash equivalents	275,616	250,016
Interest and rent receivables	35,142	45,059
Straight-line rent receivables	685,742	635,987
Investments in unconsolidated real estate joint ventures	1,242,772	1,474,455
Investments in unconsolidated operating entities	508,227	1,778,640
Other loans	155,889	292,615
Other assets	534,303	457,911
Total Assets	15,236,156	18,304,844
Liabilities
Debt, net	9,215,751	10,064,236
Accounts payable and accrued expenses	369,777	318,980
Deferred revenue	24,332	37,962
Obligations to tenants and other lease liabilities	136,635	156,603
Payable due to Medical Properties Trust, Inc.	48,172	92,808
Total Liabilities	9,794,667	10,670,589
Equity / Capital
General Partner - issued and outstanding - 6,004 units at September 30, 2024 and 5,991 units at December 31, 2023	53,893	75,969
Limited Partners - issued and outstanding - 594,225 units at September 30, 2024 and 593,000 units at December 31, 2023	5,327,947	7,513,520
Accumulated other comprehensive income	57,114	42,501
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	5,438,954	7,631,990
Non-controlling interests	2,535	2,265
Total Equity / Capital	5,441,489	7,634,255
Total Liabilities and Equity / Capital	$ 15,236,156	$ 18,304,844

Real Estate and Other Activities - Schedule of Real Estate and Other Impairment Charges, Net (Detail) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
Business Combinations [Abstract]
Working capital and other loans	$ 425	$ 787
Real estate, primarily Space Coast facilities	180	277
Investment in Massachusetts partnership		445
9.9% equity investment in Steward		36
Property taxes, insurance and other, net	(2)	18
Total real estate and other impairment charges, net	$ 603	$ 1,563

Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2024 Lease
Lessor Lease Description [Line Items]
Lease renewal term	5 years
Annual rent escalations	99.00%
Minimum [Member]
Lessor Lease Description [Line Items]
Term of lease	15 years
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

Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands, shares in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock/Unit-based compensation expense	$ 30,581	$ 29,719
Value of common stock granted with cash settlement feature	$ 9,300
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	28.9
Common stock remaining for future stock awards transferred to the equity incentive plan	8.8

- Definition

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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 1D
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480483/718-10-35-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
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+ Details

Real Estate and Other Activities - Other Activity - Additional Information (Detail) - USD ($) $ in Millions		3 Months Ended	9 Months Ended
	Oct. 01, 2024	Sep. 30, 2024	Sep. 30, 2024
Business Acquisition [Line Items]
Received rent			$ 38
Subsequent Event [Member] \| Space Coast Properties [Member]
Business Acquisition [Line Items]
Proceeds from sale of facilities	$ 440
Steward [Member]
Business Acquisition [Line Items]
Rent and interest revenue		$ 10	40
Steward [Member] \| Subsequent Event [Member]
Business Acquisition [Line Items]
Bankruptcy claims amount settled	$ 395
Massachusetts-Based Steward [Member]
Business Acquisition [Line Items]
Received rent			$ 76

Real Estate and Other Activities

9 Months Ended

Sep. 30, 2024

Real Estate [Abstract]

Real Estate and Other Activities

3. Real Estate and Other Activities

New Investments

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


	For the Nine Months Ended September 30,
	2024			2023

Land and land improvements	$	—		$	28,916
Buildings		—			114,966
Intangible lease assets — subject to amortization (weighted-average useful life of 24.8 years for 2023)		—			16,305
Investments in unconsolidated real estate joint ventures		107,908			—
Investments in unconsolidated operating entities		—			50,000
Other loans		—			25,000
Liabilities assumed		(2,290	)		—
	$	105,618		$	235,187
Loans repaid(1)		—			(22,900	)
Total net assets acquired	$	105,618		$	212,287

(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.

2024 Activity

Utah Transaction

On April 12, 2024, we sold our interests in five Utah hospitals for an aggregate agreed valuation of approximately $1.2 billion to a newly formed joint venture (the "Utah partnership") with an institutional asset manager (the "Fund"), which we call the Utah Transaction, and we recognized a gain on real estate of approximately $380 million, partially offset by a $20 million write-off of unbilled straight-line rent receivables. We retained an approximately 25% interest in the Utah partnership valued initially at approximately $108 million, which is being accounted for on the equity method on a quarterly lag basis and included in the "Investments in unconsolidated real estate joint ventures" line of the condensed consolidated balance sheets. The Fund purchased an approximate 75% interest for $886 million. In conjunction with this transaction closing, the Utah partnership placed new non-recourse secured financing, providing $190 million of additional cash to us. In total, the Utah Transaction generated $1.1 billion of cash to us.

The Utah lessee (an affiliate of CommonSpirit Health ("CommonSpirit")) may acquire the leased real estate at a price equal to the greater of fair market value and the approximate $1.2 billion lease base at the fifth or tenth anniversary of the 2023 master lease commencement. We granted the Fund certain limited and conditional preferences based on the possible execution of the purchase option, which we accounted for as a derivative liability with an initial value of approximately $2.3 million.

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 global pandemic commencing in early 2020, but Prospect remained 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 that would have recapitalized Prospect and provided for payment of unpaid rent and interest, 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 then $1.7 billion investment in Prospect including: a) maintaining the master lease covering six California hospitals without any changes in rental rates or escalator provisions, but with cash payments starting in September 2023 for a substantial portion of the contractual monthly rent due on these California properties, b) transitioning the Pennsylvania properties back to Prospect in return for a $150 million first lien mortgage on the facilities, c) providing 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 in full during 2023, d) continuing to pursue the sale of the three Connecticut properties to Yale New Haven ("Yale"), as more fully described in Note 9 to the condensed consolidated financial statements, and e) obtaining a non-controlling ownership interest in PHP Holdings of approximately $654 million 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 $82 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.

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 is leased, along with other behavioral health hospitals, to Lifepoint Behavioral, under a master lease agreement. In connection with the Lifepoint Transaction, Lifepoint extended its lease on eight existing general acute care hospitals by five years to 2041.

In the first quarter of 2024, we sold our minority equity investment in Lifepoint Behavioral for approximately $12 million.

Other Transactions

In the second quarter of 2023, we acquired three inpatient rehabilitation facilities for a total of approximately €70 million (approximately $77 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 U.K. for approximately £44 million (approximately $58 million). These hospitals are leased to Priory Group ("Priory") pursuant to five separate lease agreements 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 September 30, 2024		Estimated Rent Commencement Date
IMED Hospitales ("IMED") (Spain)	$	38,974	$	31,445	3Q 2025
IMED (Spain)		53,427		21,594	3Q 2026
	$	92,401	$	53,039

We have two other development projects ongoing in Texas (Texarkana development) and Massachusetts (Norwood redevelopment). These are not highlighted above; however, on a combined basis, we have spent approximately $400 million through September 30, 2024.

Separately, on the Norwood redevelopment, we recovered cash in November 2024 that was in excess of our recovery receivable (included in "Other assets" in the condensed consolidated balance sheets), resulting in a $24 million additional recovery in the 2024 third quarter.

2024 Activity

During the first quarter of 2024, we completed construction and began recording rental income on a $35.4 million behavioral health facility located in McKinney, Texas, that is leased to Lifepoint Behavioral. We also completed construction and began recording rental income on a €46 million (approximately $49.0 million) general acute care facility located in Spain that is leased to IMED.

2023 Activity

During the first nine months of 2023, we completed construction and began recording rental income on one inpatient rehabilitation facility located in Lexington, South Carolina, which commenced rent on July 1, 2023, and another inpatient rehabilitation facility located in Stockton, California, which commenced rent on May 1, 2023. Both of these facilities are leased to Ernest Health, Inc. ("Ernest") pursuant to an existing long-term master lease.

Disposals

2024 Activity

During the first nine months of 2024, we had the following disposal activities:

•

See Utah Transaction above for a discussion of the five Utah hospitals sold on April 12, 2024.

•

On April 9, 2024, we sold five properties to Prime Healthcare Services, Inc. ("Prime") for total proceeds of approximately $250 million along with a $100 million interest-bearing mortgage loan (which was fully repaid on August 29, 2024). This transaction resulted in a gain on real estate of approximately $53 million, partially offset by a non-cash straight-line rent write-off of approximately $30 million. As part of this sale transaction, we extended the lease maturity of four other facilities with Prime to 2044. This amended lease has inflation-based escalators, collared between 2% and 4%, and a purchase option on or prior to August 26, 2028 for a value of $238 million, which is greater than our net book value for these properties at September 30, 2024. After August 26, 2028, this option price reverts to $260 million (subject to annual escalations).

•

On July 23, 2024, we sold the 50-bed Arizona General Hospital in Mesa, Arizona and seven freestanding emergency departments to Dignity Health ("Dignity") for $160 million. This sale resulted in a gain on real estate of approximately $85 million, partially offset by a non-cash straight-line rent write-off of approximately $20 million.

•

On August 14, 2024, we sold 11 freestanding emergency departments to UCHealth for $86 million. This sale resulted in a gain on real estate of approximately $40 million, partially offset by a non-cash straight-line rent write-off of approximately $16 million.

•

As a result of the Company’s global settlement with Steward Health Care System ("Steward") approved by the bankruptcy court on September 18, 2024 (as discussed further under "Leasing Operations (Lessor)" under this same Note 3), we agreed to sell three facilities located in Florida ("Space Coast" properties) to Orlando Health. As such, we designated these properties as held for sale at September 30, 2024 and adjusted the value of our investment, after considering the provisions of the settlement agreement, to $45 million, equal to fair value less cost to sell.

•

In the third quarter of 2024, Pajaro Valley Healthcare District Corporation notified us of their intent to exercise their purchase option on the Watsonville facility. As such, we designated this property as held for sale at September 30, 2024 under a sales-type lease. This transaction, which closed on October 31, 2024, resulted in an approximate $4 million gain in the third quarter of 2024.

•

During the first nine months of 2024, we also completed the sale of four other facilities and two ancillary facilities for approximately $9 million, resulting in a loss on real estate of approximately $2 million.

Summary of Operations for Disposed (or to be Disposed) Assets in 2024


	For the Three Months Ended September 30,						For the Nine Months Ended September 30,
	2024			2023			2024			2023
Revenues(1)	$	5,305		$	64,318		$	67,672		$	106,435
Real estate depreciation and amortization(2)		(10,429	)		(12,101	)		(24,213	)		(324,720	)
Property-related expenses		134			(600	)		(4,017	)		(6,252	)
Real estate impairment charges(3)		(129,159	)		—			(129,159	)		—
Other income (expense)(4)		91,728			(29	)		476,999			(77	)
(Expense) income from real estate dispositions, net	$	(42,421	)	$	51,588		$	387,282		$	(224,614	)

(1)

(2)

(3)

Includes the charge associated with the three Space Coast facilities in the third quarter of 2024 due to the global settlement reached with Steward and its lenders.

(4)

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 approximately $79 million of net impairment charges at that time, which included $37.4 million of straight-line rent receivable write-offs and approximately $8 million in fees to sell the hospitals, partially offset by approximately $16 million of gains from our interest rate swap and foreign currency translation amounts in accumulated other comprehensive income that were reclassified to earnings in 2023 as part of the transaction. This transaction closed in two phases. The first phase closed on May 18, 2023, in which we sold seven of the 11 facilities for A$730 million, and the final phase closed on October 10, 2023, in which we sold the remaining four facilities for approximately A$470 million.

On March 8, 2023, we received notice that 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 impairment charge in the first quarter of 2023 related to non-cash rent receivables on the three facilities that were sold on July 11, 2023.

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 September 30, 2024, 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 September 30, 2024			As of December 31, 2023
Minimum lease payments receivable	$	596,274		$	611,669
Estimated unguaranteed residual values		203,818			203,818
Less: Unearned income and allowance for credit loss		(553,772	)		(571,059	)
Net investment in direct financing leases		246,320			244,428
Other financing leases (net of allowance for credit loss)		938,672			987,202
Total investment in financing leases	$	1,184,992		$	1,231,630

Other Leasing Activities

At September 30, 2024, our vacant properties represent less than 1% of total assets. We are in various stages of either re-leasing or selling these vacant properties.

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, extreme or severe weather and climate-related events, 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 Pipeline Health System), or in the form of temporary loans (like as described previously in the Prospect Transaction). See below for an update on some of our tenants:

Steward Health Care System

As discussed in previous filings, Steward has experienced significant operational and liquidity challenges and filed for Chapter 11 bankruptcy on May 6, 2024 with the United States Bankruptcy Court for the Southern District of Texas. On September 11, 2024, the bankruptcy court entered an interim order approving a global settlement between Steward, its lenders, the unsecured creditors committee, and the Company. The interim order was made final by the bankruptcy court on September 18, 2024. The order provided for the following: a) termination of our master lease with Steward; b) the release of claims against 23 of our properties, allowing us to begin the process of re-tenanting or selling these properties; and c) a full release of claims against us from all parties. In return, we agreed to provide $395 million to the Steward estate from the proceeds of the sale of the Space Coast properties along with a full release of our claims in Steward including claims to past due rent and interest, outstanding loans, and our equity investment.

With this global settlement, our relationship with Steward effectively ends with no remaining Steward exposure on our condensed consolidated balance sheets at September 30, 2024, other than from the re-tenanting or selling of formerly leased Steward properties that are currently not under lease.

In regard to our real estate partnership with Macquarie Asset Management (“Macquarie”), the bankruptcy court approved the termination of the partnership’s master lease with Steward during the 2024 third quarter. In addition, we and Macquarie entered into an agreement with the mortgage lender of the partnership to transition the eight Massachusetts properties to them along with cash proceeds of approximately $40 million (representing our share), in return for full payment of the underlying mortgage debt and a release of claims against each party.

Impairment Charges

Due to the events discussed above, we recorded real estate and other impairment charges, net of approximately $600 million and $1.6 billion for the three and nine months ended September 30, 2024, which included the following (in millions):


Description	For the Three Months Ended September 30, 2024			For the Nine Months Ended September 30, 2024
Working capital and other loans	$	425		$	787
Real estate, primarily Space Coast facilities		180			277
Investment in Massachusetts partnership(1)		—			445
9.9% equity investment in Steward		—			36
Property taxes, insurance and other, net		(2	)		18
Total real estate and other impairment charges, net	$	603		$	1,563

(1)

$410 million of this charge was recorded in the "Earnings (loss) from equity interests" line of our condensed consolidated statements of net income.

In addition with the lease termination discussed above, we accelerated the amortization on the related in-place lease intangibles resulting in $115 million and $149 million of amortization expense in the three and nine months ended September 30, 2024 as reflected in the real estate depreciation and amortization line of our condensed consolidated statements of net income.

Re-tenanting Activity

Subsequent to the release of claims on the 23 properties as part of the global settlement, we reached definitive agreements with five operators (Healthcare Systems of America, Honor Health, Insight Health, Quorum Health, and College Health) to lease 17 of these facilities during and shortly after the quarter ending September 30, 2024. Excluding the two developments, the remaining four properties (with a net book value of less than 1% of our total assets) are in various stages of being re-tenanted or sold.

Other Activity

During 2024, we received and recorded rent and interest revenue from Steward of $10 million and $40 million for the three and nine months ended September 30, 2024, respectively. In addition, we were benefited from rent paid by Steward to the Massachusetts partnership of $76 million ($38 million representing our share) for the nine months ended September 30, 2024.

Subsequent to September 30, 2024, the sale of the Space Coast properties to Orlando Health was completed, and the Steward bankruptcy estate retained $395 million of the approximately $440 million total proceeds as discussed above.

Prospect

We lease real estate assets to Prospect in California and Connecticut and have a mortgage loan secured by four properties in Pennsylvania. Our total real estate investment is approximately $1 billion at September 30, 2024. Starting January 1, 2023, we began accounting for our leases and loans to Prospect on a cash basis versus our normal accrual method. In the first nine months of 2024, we recognized approximately $25 million of revenue representing cash received for rents on our California properties. In addition, we received and recorded approximately $3.8 million of interest on the asset-backed loan in 2024. However, Prospect did not make any scheduled rent or interest payments in the 2024 third quarter, resulting in no revenue recorded in the period. Although we believe our remaining real estate and asset-backed loan investments are recoverable at September 30, 2024, no assurances can be given that a future impairment will not be needed, particularly if Prospect's east coast operations do not improve or are not sold timely and they continue to miss scheduled rent and interest payments.

In regard to PHP Holdings, we account for our investment (both the equity investment and convertible loan) using the fair value option method. Prospect and its investment bankers continued to work through the sale process during and subsequent to the end of the period, resulting in a binding agreement with Astrana Health on November 8, 2024, as further described in Note 10 to the condensed consolidated financial statements. Based on our consideration of information in the purchase agreement, along with consultations with our third party appraisers, we recorded an additional approximate $134 million unfavorable fair value adjustment in the third quarter of 2024 (total unfavorable fair value adjustment in 2024 of $498 million), resulting in a total investment in PHP Holdings of approximately $200 million at September 30, 2024. Each quarter, we mark such investment to fair value as more fully described in Note 7 to the condensed consolidated financial statements.

Pipeline Health System

On October 2, 2022, Pipeline Health System ("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 lease of our California assets remained 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. As part of the settlement, we deferred approximately $6 million, or approximately 30%, of rent in 2023 to be paid in 2024 with interest. As of September 30, 2024, Pipeline is current on their monthly base rent obligations per the terms of the lease, and we hold a rent deposit that more than covers the remaining $5 million of unpaid deferred rent.

International Joint Venture

As discussed in our Annual Report on Form 10-K for the year ending December 31, 2023, we placed our loan to the international joint venture on the cash basis of accounting, as we determined that it was no longer probable that the borrower would pay its future interest in full. This loan, accounted for under the fair value option method, was collateralized by the equity of Steward held by an investor in both Steward and the international joint venture. Consistent with the discussion above on non-real estate investments in Steward, we recorded a $225 million unfavorable fair value adjustment in the 2024 first quarter to fully reserve for the loan and related equity investment. These investments, which are included in “Investments in unconsolidated operating entities” on our condensed consolidated balance sheets, were adjusted for after comparing our carrying value to an updated fair value analysis of the underlying collateral, with assistance from a third-party, independent valuation firm.

CommonSpirit

On May 1, 2023, Catholic Health Initiatives Colorado ("CHIC"), a wholly owned subsidiary of CommonSpirit, acquired the Utah hospital operations of five general acute care facilities previously operated by Steward. 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, at the time, for these Utah assets had an initial fixed term of 15 years with annual escalation provisions. As part of this transaction, we severed these facilities from the master lease with Steward, and accordingly accelerated the amortization of the associated in-place lease intangibles (approximately $286 million) and wrote-off approximately $95 million of straight-line rent receivables. As described earlier, these five properties make up the Utah Transaction.

Other Tenant Matters

In the 2023 third quarter, we moved to the cash basis of accounting for a tenant that comprised approximately 1% of our total assets due to declines in operating results. As a result, we recorded a $49 million charge to reserve billed and straight-line rent receivables. During the 2024 third quarter, we terminated the lease with this tenant, resulting in the acceleration of lease intangible amortization of $22 million. The former tenant is currently working on raising external capital, independent of us. In addition, we are currently working with the former tenant on an agreement that could result in either the sale and/or re-leasing of these real estate assets in early 2025. At September 2024, we believe the net book value of the related assets are recoverable. However, no assurances can be given that a future 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 investments. 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 through unconsolidated real estate joint ventures. The underlying real estate and leases in these

unconsolidated real estate joint ventures are generally 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 September 30, 2024		As of December 31, 2023
Swiss Medical Network	70%	$	515,878	$	472,434
MEDIAN	50%		472,179		471,336
CommonSpirit (Utah partnership)	25%		119,708		—
Policlinico di Monza	50%		81,785		80,562
HM Hospitales	45%		53,222		56,071
Steward (Macquarie partnership)	50%		—		394,052
Total		$	1,242,772	$	1,474,455

The decrease in our total investment in unconsolidated real estate joint ventures since December 31, 2023, is primarily due to the impairment recorded to our Massachusetts-based partnership with Macquarie in the second quarter of 2024 as more fully described above in this same Note 3. In the third quarter of 2024, we and the other equity owners funded capital contributions (our share being approximately $40 million) to the Swiss Medical Network investment, proceeds of which were used to pay off debt inside the joint venture.

As discussed previously, we hold a 25% interest in the Utah partnership accounted for under the equity method. The Utah partnership elected to apply specialized accounting and reporting for investment companies under Topic 946, which measures the underlying investments at fair value. For the quarter ending September 30, 2024, our share of the Utah partnership's favorable fair value adjustment was approximately $13.5 million, primarily related to the underlying real estate.

Investments in Unconsolidated Operating Entities

Our investments in unconsolidated operating entities are noncontrolling investments that are typically made in conjunction with larger real estate transactions in which the operators are vetted as part of our overall underwriting process. In many cases, we would not be able to acquire the larger real estate portfolio without such investments in operators. These investments also offer the opportunity to enhance our overall return and provide for certain minority rights and protections.

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


Operator	As of September 30, 2024		As of December 31, 2023
PHP Holdings	$	201,526	$	699,535
Swiss Medical Network		185,185		186,113
Aevis Victoria SA ("Aevis")		63,758		77,345
Priory		41,670		163,837
Aspris Children's Services ("Aspris")		15,958		15,986
Caremax		130		1,148
Steward (loan investment)		—		361,591
International joint venture		—		225,960
Steward (equity investment)		—		35,696
Lifepoint Behavioral		—		11,429
Total	$	508,227	$	1,778,640

See "Leasing Operations (Lessor)" under this same Note 3 for details on the change in the first nine months of 2024 related to Steward.

For our investments marked to fair value (including our investments in PHP Holdings, Aevis, Caremax, and the international joint venture), we recorded approximately $739 million in unfavorable non-cash fair value adjustments during the first nine months of 2024; whereas, this was a $48.7 million favorable non-cash fair value adjustment for the same period of 2023. The amount recorded in 2024 includes an approximate $498 million unfavorable fair market value adjustment to our investment in PHP Holdings, as further described in the "Prospect" subheading of this Note 3 (included in the "Other (including fair value adjustments on securities)" line of the condensed consolidated statements of net income) and $225 million unfavorable fair value adjustment in the 2024 first quarter

related to our international joint venture investments as described in Note 3 and included in the "Real estate and other impairment charges, net" line of the condensed consolidated statements of net income.

In the first quarter of 2024, we sold our interest in the Priory syndicated term loan for £90 million (approximately $115 million), resulting in an approximate £6 million ($7.8 million) economic loss. In addition, we sold our remaining minority equity investment in Lifepoint Behavioral in the 2024 first quarter.

Other Investment Activities

In the third quarter of 2023, we invested approximately $105 million for a participation in Steward's syndicated asset-backed credit facility, and we loaned an additional $40 million. On August 17, 2023, we sold the $105 million interest to a global asset manager for approximately $100 million, and Steward paid approximately $2 million on November 3, 2023. The remainder was written off as part of the $425 million loan impairment charge in the 2024 third quarter as discussed in the "Leasing Operations (Lessor)" section of this same Note 3.

In the second quarter 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 September 30,
	2024				2023
Balance at beginning of the period	$	538,534			$	87,105
Provision for credit loss, net		438,154		(1)		165
Expected credit loss reserve written off or related to financial instruments sold, repaid, or satisfied		(825,548	)	(3)		(63	)
Balance at end of the period	$	151,140			$	87,207


	For the Nine Months Ended September 30,
	2024				2023
Balance at beginning of the year	$	96,001			$	121,146
Provision for credit loss, net		880,687		(1)(2)		1,513
Expected credit loss reserve written off or related to financial instruments sold, repaid, or satisfied		(825,548	)	(3)		(35,452	)
Balance at end of the period	$	151,140			$	87,207

(1)

Includes charges and reserves related to our investments in cash basis tenants.

(2)

Includes the charge related to the $362 million loan to Steward, as further described under "Steward Health Care System" subheading of this Note 3.

(3)

Includes write-offs in the third quarter of 2024 of previously reserved loans to Steward as further described under "Steward Health Care System" subheading of this Note 3.

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 ability 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 September 30, 2024						As of December 31, 2023
Operators	Total Assets (1)			Percentage of Total Assets			Total Assets (1)		Percentage of Total Assets
Circle Health Ltd ("Circle")	$	2,179,805			14.3	%	$	2,119,392		11.6	%
Priory		1,325,408			8.7	%		1,391,005		7.6	%
Healthcare Systems of America		1,176,533			7.7	%		—		0.0	%
Prospect		1,042,343			6.8	%		1,092,974		6.0	%
Lifepoint Behavioral		815,439			5.4	%		813,527		4.4	%
Steward		—			0.0	%		3,518,537		19.2	%
Other operators		7,059,205			46.3	%		7,352,012		40.2	%
Other assets		1,637,423	(2)		10.8	%		2,017,397		11.0	%
Total	$	15,236,156			100.0	%	$	18,304,844		100.0	%

(1)

(2)

Includes our investment in PHP Holdings of approximately $200 million as part of the Prospect Transaction and tenant update described previously in this same Note 3.

Total Assets by U.S. State and Country (1)


	As of September 30, 2024					As of December 31, 2023
U.S. States and Other Countries	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
Texas	$	1,367,932		9.0	%	$	1,891,482		10.3	%
California		1,051,443		6.9	%		1,252,674		6.8	%
Florida		890,879		5.8	%		1,348,210		7.4	%
Pennsylvania		455,757		3.0	%		470,562		2.6	%
Arizona		380,756		2.5	%		547,789		3.0	%
All other states		2,890,763		19.0	%		4,264,392		23.3	%
Other domestic assets		858,750		5.7	%		1,397,170		7.6	%
Total U.S.	$	7,896,280		51.9	%	$	11,172,279		61.0	%
United Kingdom	$	4,283,890		28.1	%	$	4,261,944		23.3	%
Switzerland		764,821		5.0	%		735,891		4.0	%
Germany		732,489		4.8	%		734,630		4.0	%
Spain		265,574		1.7	%		252,529		1.4	%
All other countries		514,429		3.4	%		527,344		2.9	%
Other international assets		778,673		5.1	%		620,227		3.4	%
Total international	$	7,339,876		48.1	%	$	7,132,565		39.0	%
Grand total	$	15,236,156		100.0	%	$	18,304,844		100.0	%

Total Assets by Facility Type (1)


	As of September 30, 2024					As of December 31, 2023
Facility Types	Total Assets		Percentage of Total Assets			Total Assets		Percentage of Total Assets
General acute care hospitals	$	9,308,236		61.1	%	$	11,764,151		64.3	%
Behavioral health facilities		2,487,861		16.3	%		2,576,983		14.1	%
Post acute care facilities		1,676,426		11.0	%		1,716,248		9.4	%
Freestanding ER/urgent care facilities		126,210		0.8	%		230,065		1.2	%
Other assets		1,637,423		10.8	%		2,017,397		11.0	%
Total	$	15,236,156		100.0	%	$	18,304,844		100.0	%

(1)

On an individual property basis, our largest investment in any single property was less than 2% of our total assets as of September 30, 2024.

From a revenue concentration perspective, Circle and Priory individually represented more than 10% of our total revenues for the three and nine months ended September 30, 2024. Steward and Circle each represented more than 10% of our total revenues for the three and nine months ended September 30, 2023.

Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Schedule of Equity Method Investments [Line Items]
Investments in unconsolidated real estate joint ventures	$ 1,242,772	$ 1,474,455
Swiss Medical Network [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	70.00%
Investments in unconsolidated real estate joint ventures	$ 515,878	472,434
MEDIAN [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 472,179	471,336
Common Spirit [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	25.00%
Investments in unconsolidated real estate joint ventures	$ 119,708	0
Policlinico di Monza [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 81,785	80,562
HM Hospital [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	45.00%
Investments in unconsolidated real estate joint ventures	$ 53,222	56,071
Steward (Macquarie partnership) [Member]
Schedule of Equity Method Investments [Line Items]
Ownership interest	50.00%
Investments in unconsolidated real estate joint ventures	$ 0	$ 394,052

Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Business Acquisition [Line Items]
Total Assets	$ 15,236,156		$ 15,236,156		$ 18,304,844
Total Revenues	$ 225,827	$ 306,576	$ 763,703	$ 994,182
Minimum [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Maximum percentage of entity's assets invested on single property	2.00%		2.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member]
Business Acquisition [Line Items]
Total Assets	$ 15,236,156		$ 15,236,156		$ 18,304,844
Percentage of concentration risk			100.00%		100.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Assets [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			10.80%		11.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Total Assets	2,179,805		$ 2,179,805		$ 2,119,392
Percentage of concentration risk			14.30%		11.60%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Priory [Member]
Business Acquisition [Line Items]
Total Assets	1,325,408		$ 1,325,408		$ 1,391,005
Percentage of concentration risk			8.70%		7.60%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Healthcare Systems of America [Member]
Business Acquisition [Line Items]
Total Assets	1,176,533		$ 1,176,533		$ 0
Percentage of concentration risk			7.70%		0.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Prospect [Member]
Business Acquisition [Line Items]
Total Assets	1,042,343		$ 1,042,343		$ 1,092,974
Percentage of concentration risk			6.80%		6.00%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Lifepoint Behavioral [Member]
Business Acquisition [Line Items]
Total Assets	815,439		$ 815,439		$ 813,527
Percentage of concentration risk			5.40%		4.40%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Steward [Member]
Business Acquisition [Line Items]
Total Assets	0		$ 0		$ 3,518,537
Percentage of concentration risk			0.00%		19.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Operators [Member]
Business Acquisition [Line Items]
Total Assets	7,059,205		$ 7,059,205		$ 7,352,012
Percentage of concentration risk			46.30%		40.20%
Total Gross Assets [Member] \| Operator Concentration Risk [Member] \| Other Assets by Operator [Member]
Business Acquisition [Line Items]
Total Assets	1,637,423		$ 1,637,423		$ 2,017,397
Total Gross Assets [Member] \| Geographic Concentration [Member]
Business Acquisition [Line Items]
Total Assets	15,236,156		$ 15,236,156		$ 18,304,844
Percentage of concentration risk			100.00%		100.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Texas [Member]
Business Acquisition [Line Items]
Total Assets	1,367,932		$ 1,367,932		$ 1,891,482
Percentage of concentration risk			9.00%		10.30%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| California [Member]
Business Acquisition [Line Items]
Total Assets	1,051,443		$ 1,051,443		$ 1,252,674
Percentage of concentration risk			6.90%		6.80%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Florida [Member]
Business Acquisition [Line Items]
Total Assets	890,879		$ 890,879		$ 1,348,210
Percentage of concentration risk			5.80%		7.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Pennsylvania [Member]
Business Acquisition [Line Items]
Total Assets	455,757		$ 455,757		$ 470,562
Percentage of concentration risk			3.00%		2.60%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Arizona [Member]
Business Acquisition [Line Items]
Total Assets	380,756		$ 380,756		$ 547,789
Percentage of concentration risk			2.50%		3.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other States [Member]
Business Acquisition [Line Items]
Total Assets	2,890,763		$ 2,890,763		$ 4,264,392
Percentage of concentration risk			19.00%		23.30%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total U.S. [Member]
Business Acquisition [Line Items]
Total Assets	7,896,280		$ 7,896,280		$ 11,172,279
Percentage of concentration risk			51.90%		61.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| United Kingdom [Member]
Business Acquisition [Line Items]
Total Assets	4,283,890		$ 4,283,890		$ 4,261,944
Percentage of concentration risk			28.10%		23.30%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Switzerland [Member]
Business Acquisition [Line Items]
Total Assets	764,821		$ 764,821		$ 735,891
Percentage of concentration risk			5.00%		4.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Germany [Member]
Business Acquisition [Line Items]
Total Assets	732,489		$ 732,489		$ 734,630
Percentage of concentration risk			4.80%		4.00%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Spain [Member]
Business Acquisition [Line Items]
Total Assets	265,574		$ 265,574		$ 252,529
Percentage of concentration risk			1.70%		1.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| All Other Countries [Member]
Business Acquisition [Line Items]
Total Assets	514,429		$ 514,429		$ 527,344
Percentage of concentration risk			3.40%		2.90%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other Domestic Assets [Member]
Business Acquisition [Line Items]
Total Assets	858,750		$ 858,750		$ 1,397,170
Percentage of concentration risk			5.70%		7.60%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Other International Assets [Member]
Business Acquisition [Line Items]
Total Assets	778,673		$ 778,673		$ 620,227
Percentage of concentration risk			5.10%		3.40%
Total Gross Assets [Member] \| Geographic Concentration [Member] \| Total International [Member]
Business Acquisition [Line Items]
Total Assets	7,339,876		$ 7,339,876		$ 7,132,565
Percentage of concentration risk			48.10%		39.00%
Total Gross Assets [Member] \| Customer Concentration Risk [Member]
Business Acquisition [Line Items]
Total Assets	15,236,156		$ 15,236,156		$ 18,304,844
Percentage of concentration risk			100.00%		100.00%
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| General Acute Care Hospitals [Member]
Business Acquisition [Line Items]
Total Assets	9,308,236		$ 9,308,236		$ 11,764,151
Percentage of concentration risk			61.10%		64.30%
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Behavioral Health Facilities [Member]
Business Acquisition [Line Items]
Total Assets	2,487,861		$ 2,487,861		$ 2,576,983
Percentage of concentration risk			16.30%		14.10%
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Post Acute Care Facilities [Member]
Business Acquisition [Line Items]
Total Assets	1,676,426		$ 1,676,426		$ 1,716,248
Percentage of concentration risk			11.00%		9.40%
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Freestanding ER/Urgent Care Facilities [Member]
Business Acquisition [Line Items]
Total Assets	126,210		$ 126,210		$ 230,065
Percentage of concentration risk			0.80%		1.20%
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Other Assets By Facility [Member]
Business Acquisition [Line Items]
Total Assets	$ 1,637,423		$ 1,637,423		$ 2,017,397
Total Gross Assets [Member] \| Customer Concentration Risk [Member] \| Other Assets [Member]
Business Acquisition [Line Items]
Percentage of concentration risk			10.80%		11.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Circle [Member]
Business Acquisition [Line Items]
Percentage of concentration risk	10.00%		10.00%
Revenue [Member] \| Customer Concentration Risk [Member] \| Steward and Circle [Member]
Business Acquisition [Line Items]
Percentage of concentration risk		10.00%		10.00%

Earnings Per Share/Unit (Tables)

9 Months Ended

Sep. 30, 2024

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 September 30,
	2024			2023
Numerator:
Net (loss) income	$	(800,929	)	$	116,895
Non-controlling interests’ share in net income		(234	)		(185	)
Participating securities’ share in earnings		(153	)		(311	)
Net (loss) income, less participating securities’ share in earnings	$	(801,316	)	$	116,399
Denominator:
Basic weighted-average common shares		600,229			598,444
Dilutive potential common shares(1)		—			109
Diluted weighted-average common shares		600,229			598,553


	For the Nine Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(1,995,965	)	$	107,492
Non-controlling interests’ share in net income		(1,458	)		(25	)
Participating securities’ share in earnings		(807	)		(1,295	)
Net (loss) income, less participating securities’ share in earnings	$	(1,998,230	)	$	106,172
Denominator:
Basic weighted-average common shares		600,197			598,363
Dilutive potential common shares(1)		—			43
Diluted weighted-average common shares		600,197			598,406

MPT Operating Partnership, L.P.

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


	For the Three Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(800,929	)	$	116,895
Non-controlling interests’ share in net income		(234	)		(185	)
Participating securities’ share in earnings		(153	)		(311	)
Net (loss) income, less participating securities’ share in earnings	$	(801,316	)	$	116,399
Denominator:
Basic weighted-average units		600,229			598,444
Dilutive potential units(1)		—			109
Diluted weighted-average units		600,229			598,553


	For the Nine Months Ended September 30,
	2024			2023
Numerator:
Net (loss) income	$	(1,995,965	)	$	107,492
Non-controlling interests’ share in net income		(1,458	)		(25	)
Participating securities’ share in earnings		(807	)		(1,295	)
Net (loss) income, less participating securities’ share in earnings	$	(1,998,230	)	$	106,172
Denominator:
Basic weighted-average units		600,197			598,363
Dilutive potential units(1)		—			43
Diluted weighted-average units		600,197			598,406

(1)

The above computation of diluted earnings per share/units does not include 37,967 and 18,422 potential common shares/units for the three and nine months ended September 30, 2024, respectively.

Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Direct Financing Lease Net Investment In Leases [Abstract]
Minimum lease payments receivable	$ 596,274	$ 611,669
Estimated unguaranteed residual values	203,818	203,818
Less: Unearned income and allowance for credit loss	(553,772)	(571,059)
Net investment in direct financing leases	246,320	244,428
Other financing leases (net of allowance for credit loss)	938,672	987,202
Total investment in financing leases	$ 1,184,992	$ 1,231,630

Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details)	Sep. 30, 2024
Business Combinations [Abstract]
Percentage of vacant on leased property	1.00%

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating activities
Net (loss) income	$ (1,995,965)	$ 107,492
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	387,545	536,200
Amortization of deferred financing costs and debt discount	12,266	11,978
Straight-line rent revenue and other	(127,326)	(174,202)
Stock/Unit-based compensation expense	30,581	29,719
Gain on sale of real estate	(475,196)	(209)
Real estate and other impairment charges, net	1,438,429	93,288
Equity interest real estate impairment	410,790	0
Straight-line rent and other write-off	2,846	150,576
Debt refinancing and unutilized financing costs (benefit)	3,677	(46)
Tax rate changes and other	4,596	(164,535)
Non-cash fair value adjustments	511,472	(42,562)
Non-cash revenue from debt and equity securities received	0	(81,706)
Other adjustments	12,406	15,062
Changes in:
Interest and rent receivables	4,147	(100,384)
Other assets	(18,884)	(6,701)
Accounts payable and accrued expenses	(20,869)	(6,279)
Deferred revenue	(11,719)	2,677
Net cash provided by operating activities	168,796	370,368
Investing activities
Acquisitions and other related investments	(105,618)	(235,187)
Net proceeds from sale of real estate	1,761,661	589,420
Proceeds received from sale and repayment of loans receivable	214,416	499,549
Investment in loans receivable	(392,241)	(220,223)
Construction in progress and other	(63,535)	(80,708)
Proceeds from sale and return of equity investments	11,656	12,430
Capital additions and other investments, net	(199,735)	(217,940)
Net cash provided by investing activities	1,226,604	347,341
Financing activities
Proceeds from term debt	804,188	0
Payments of term debt	(662,968)	(533,864)
Revolving credit facility, net	(1,119,312)	426,515
Dividends/Distributions paid	(272,909)	(524,155)
Lease deposits and other obligations to tenants	(726)	7,752
Stock vesting/Unit vesting - satisfaction of tax withholdings	(3,252)	(6,090)
Other financing activities, payment of debt refinancing, and deferred financing costs	(124,595)	12,243
Net cash used for financing activities	(1,379,574)	(617,599)
Increase in cash, cash equivalents, and restricted cash for period	15,826	100,110
Effect of exchange rate changes	7,969	4,238
Cash, cash equivalents, and restricted cash at beginning of period	255,952	241,538
Cash, cash equivalents, and restricted cash at end of period	279,747	345,886
Interest paid	349,608	322,006
Supplemental schedule of non-cash investing activities:
Debt and equity securities received for certain obligations, real estate, and revenue	0	804,520
Certain obligations and receivable satisfied and real estate sold	0	722,814
Supplemental schedule of non-cash financing activities:
Dividends/Distributions declared, unpaid	48,172	90,467
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	250,016	235,668
Restricted cash, included in Other assets at beginning of period	$ 5,936	$ 5,870
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	$ 255,952	$ 241,538
Cash and cash equivalents at end of period	275,616	340,058
Restricted cash, included in Other assets at end of period	$ 4,131	$ 5,828
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	$ 279,747	$ 345,886
MPT Operating Partnership, L.P. [Member]
Operating activities
Net (loss) income	(1,995,965)	107,492
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Depreciation and amortization	387,545	536,200
Amortization of deferred financing costs and debt discount	12,266	11,978
Straight-line rent revenue and other	(127,326)	(174,202)
Stock/Unit-based compensation expense	30,581	29,719
Gain on sale of real estate	(475,196)	(209)
Real estate and other impairment charges, net	1,438,429	93,288
Equity interest real estate impairment	410,790	0
Straight-line rent and other write-off	2,846	150,576
Debt refinancing and unutilized financing costs (benefit)	3,677	(46)
Tax rate changes and other	4,596	(164,535)
Non-cash fair value adjustments	511,472	(42,562)
Non-cash revenue from debt and equity securities received	0	(81,706)
Other adjustments	12,406	15,062
Changes in:
Interest and rent receivables	4,147	(100,384)
Other assets	(18,884)	(6,701)
Accounts payable and accrued expenses	(20,869)	(6,279)
Deferred revenue	(11,719)	2,677
Net cash provided by operating activities	168,796	370,368
Investing activities
Acquisitions and other related investments	(105,618)	(235,187)
Net proceeds from sale of real estate	1,761,661	589,420
Proceeds received from sale and repayment of loans receivable	214,416	499,549
Investment in loans receivable	(392,241)	(220,223)
Construction in progress and other	(63,535)	(80,708)
Proceeds from sale and return of equity investments	11,656	12,430
Capital additions and other investments, net	(199,735)	(217,940)
Net cash provided by investing activities	1,226,604	347,341
Financing activities
Proceeds from term debt	804,188	0
Payments of term debt	(662,968)	(533,864)
Revolving credit facility, net	(1,119,312)	426,515
Dividends/Distributions paid	(272,909)	(524,155)
Lease deposits and other obligations to tenants	(726)	7,752
Stock vesting/Unit vesting - satisfaction of tax withholdings	(3,252)	(6,090)
Other financing activities, payment of debt refinancing, and deferred financing costs	(124,595)	12,243
Net cash used for financing activities	(1,379,574)	(617,599)
Increase in cash, cash equivalents, and restricted cash for period	15,826	100,110
Effect of exchange rate changes	7,969	4,238
Cash, cash equivalents, and restricted cash at beginning of period	255,952	241,538
Cash, cash equivalents, and restricted cash at end of period	279,747	345,886
Interest paid	349,608	322,006
Supplemental schedule of non-cash investing activities:
Debt and equity securities received for certain obligations, real estate, and revenue	0	804,520
Certain obligations and receivable satisfied and real estate sold	0	722,814
Supplemental schedule of non-cash financing activities:
Dividends/Distributions declared, unpaid	48,172	90,467
Cash, cash equivalents, and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	250,016	235,668
Restricted cash, included in Other assets at beginning of period	$ 5,936	$ 5,870
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	$ 255,952	$ 241,538
Cash and cash equivalents at end of period	275,616	340,058
Restricted cash, included in Other assets at end of period	$ 4,131	$ 5,828
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	$ 279,747	$ 345,886

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	9 Months Ended
	Sep. 30, 2024 USD ($)
+ 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ (2,315)
- 100 Basis Points [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Estimated Increase (Decrease) in Fair Value	$ 2,315

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
2024	$ 0
2025	1,256,262
2026	2,122,891
2027	1,600,000
2028	802,500
Thereafter	3,512,595
Total	$ 9,294,248	$ 10,109,133

Commitments and Contingencies - Additional Information (Detail) $ in Thousands		3 Months Ended
	Oct. 05, 2022 USD ($) Facility	Mar. 31, 2023 Facility	Sep. 30, 2024 USD ($)	Dec. 31, 2023 USD ($)
Commitment And Contingencies [Line Items]
Number of facilities sold \| Facility		3
Percentage of net book value of assets			2.00%
Obligations to tenants and other lease liabilities			$ 136,635	$ 156,603
Prospect [Member] \| Connecticut [Member]
Commitment And Contingencies [Line Items]
Number of facilities sold \| Facility	3
Expected cash proceeds on transaction close	$ 457,000
Excepted proceeds in cash	$ 355,000
Steward [Member]
Commitment And Contingencies [Line Items]
Bridge financing to affiliate forfeited			60,000
Obligations to tenants and other lease liabilities			$ 35,000

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($) Health_Center	Dec. 31, 2023 USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	$ 298,221	$ 309,315
Investments in unconsolidated real estate joint ventures	1,242,772	1,474,455
Investments in unconsolidated operating entities	508,227	1,778,640
Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Investments in unconsolidated operating entities	42,600	526,900
Other loans	150,600	289,600
Shareholder Loan [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Mortgage loans	162,000	162,400
Investments in unconsolidated real estate joint ventures	$ 339,600	$ 323,800
Fair Value, Recurring [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired \| Health_Center	3
Fair Value, Recurring [Member] \| Acquisition Loans [Member] \| Colombia [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Number of facilities acquired \| Health_Center	3

Fair Value of Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

Summary of Fair Value Information of Financial Instruments

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


	As of September 30, 2024							As of December 31, 2023
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables	$	35,142			$	35,130		$	45,059			$	45,476
Loans(1)		694,809		(2)		675,683			1,302,727		(2)		1,202,383
Debt, net		(9,215,751	)			(8,035,236	)		(10,064,236	)			(8,256,465	)

(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.

(2)

Includes $162.0 million and $162.4 million of mortgage loans, a $339.6 million and $323.8 million shareholder loan included in investments in unconsolidated real estate joint ventures, $42.6 million and $526.9 million of loans that are part of our investments in unconsolidated operating entities, and $150.6 million and $289.6 million of other loans at September 30, 2024 and December 31, 2023, respectively.

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

At September 30, 2024 and December 31, 2023, the amounts recorded under the fair value option method were as follows (in thousands):


	As of September 30, 2024				As of December 31, 2023
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	136,192	$	136,192	$	146,892	$	146,892	Mortgage loans
Equity investment and other loans		206,798		909,726		939,903		912,999	Investments in unconsolidated operating entities/Other loans

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


Basis Point Change in Marketability Discount	Estimated Increase (Decrease) In Fair Value
+100 basis points	$	(2,315	)
- 100 basis points		2,315

Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net (loss) income	$ (800,929)	$ (319,659)	$ (875,377)	$ 116,895	$ (42,433)	$ 33,030	$ (1,995,965)	$ 107,492
Non-controlling interests' share in net income	(234)			(185)			(1,458)	(25)
Participating securities’ share in earnings	(153)			(311)			(807)	(1,295)
Net (loss) income, less participating securities' share in earnings	$ (801,316)			$ 116,399			$ (1,998,230)	$ 106,172
Basic weighted-average common shares	600,229			598,444			600,197	598,363
Dilutive potential common shares	0			109			0	43
Diluted weighted-average common shares	600,229			598,553			600,197	598,406
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net (loss) income	$ (800,929)	$ (319,659)	$ (875,377)	$ 116,895	$ (42,433)	$ 33,030	$ (1,995,965)	$ 107,492
Non-controlling interests' share in net income	(234)			(185)			(1,458)	(25)
Participating securities’ share in earnings	(153)			(311)			(807)	(1,295)
Net (loss) income, less participating securities' share in earnings	$ (801,316)			$ 116,399			$ (1,998,230)	$ 106,172
Basic weighted-average common shares	600,229			598,444			600,197	598,363
Dilutive potential common shares	0			109			0	43
Diluted weighted-average common shares	600,229			598,553			600,197	598,406

- Definition

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

+ References

+ Details

- Definition

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

+ References

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+ Details

Commitments and Contingencies

9 Months Ended

Sep. 30, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

9. 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 are still contractually owed $355 million in cash and have previously received the remainder in additional investments in PHP Holdings - part of the Prospect Transaction discussed in Note 3. This transaction was approved by the state of Connecticut's Office of Health Strategy on March 27, 2024 and is now subject to the completion of Yale's acquisition of the hospital operations from Prospect. However, given the length of time since the definitive agreements were signed, no assurances can be given that this transaction will be consummated as described or at all. Our net book value for these three facilities is slightly less than 2% of our total assets at September 30, 2024.

Contingencies

As part of the global settlement with Steward discussed in Note 3, upon completion of the transfers to the new operators and satisfaction of certain other conditions, in addition to approval by relevant state and local regulators, each of the Company and Steward have agreed, subject to specified exceptions, to the mutual release of claims against each other, including payment by Steward of any accrued or future rent under its master leases with the Company and accrued or future payments of principal and interest on outstanding loans from the Company. Steward’s asset backed lenders also forfeited their right to cause the Company to purchase up to $60 million of bridge loans made to Steward during the first quarter of 2024. In connection with the global settlement with Steward and reciprocal release of claims, the Company has an approximate $35 million liability at September 30, 2024, for property taxes, other property related expenses, and other obligations due to third parties.

We are party to various lawsuits as described below:

Securities and Derivative Litigation

On April 13, 2023, we and certain of our executives were named as defendants in a putative federal securities class action lawsuit alleging false and/or misleading statements and/or omissions resulted in artificially inflated prices for our common stock, filed by a purported stockholder in the United States District Court for the Northern District of Alabama (Case No. 2:23-cv-00486). The complaint seeks class certification on behalf of purchasers of our common stock between July 15, 2019 and February 22, 2023 and unspecified damages including interest and an award of reasonable costs and expenses. This class action complaint was amended on September 22, 2023 and alleges that we made material misstatements or omissions relating to the financial health of certain of our tenants. On September 26, 2024, the Court dismissed the amended complaint with prejudice. On October 24, 2024, the plaintiff moved to alter the Court’s judgment and for leave to further amend the complaint. On November 11, 2024, the Company filed an opposition to plaintiff's motion.

Members of our Board of Directors were also named as defendants in two related shareholder derivative lawsuits filed by purported stockholders in the United States District Court for the Northern District of Alabama on October 19, 2023 (Case No. 2:23- cv-01415) and December 7, 2023 (Case No. 2:23-cv-01667). The Company was named as a nominal defendant in both complaints. These shareholder derivative complaints both make allegations similar to those made in the Alabama securities lawsuit described above relating to purported material misstatements or omissions relating to the financial health of certain of our tenants. Members of our Board of Directors were also named as defendants in three related shareholder derivative lawsuits filed by purported stockholders in the United States District Court for the District of Maryland on February 16, 2024 (Case No. 1:24-cv-00471), June 28, 2024 (Case No. 1:24-cv-01899), and July 26, 2024 (Case No. 1 24-cv-02173). The Company was named as a nominal defendant. These shareholder derivative complaints make allegations similar to those made in the Alabama securities and derivative lawsuits described above relating to purported material misstatements or omissions relating to the financial health of certain of our tenants.

On September 29, 2023, we and certain of our executives were named as defendants in a putative federal securities class action lawsuit filed by a purported stockholder in the United States District Court for the Southern District of New York (Case No. 1:23-cv- 08597). The complaint seeks class certification on behalf of purchasers of our common stock between May 23, 2023 and August 17, 2023 and alleges false and/or misleading statements and/or omissions in connection with certain transactions involving Prospect. This class action complaint was amended on October 30, 2024 and alleges that we made material misstatements or omissions in connection with certain transactions involving Prospect.

Members of our Board of Directors were also named as defendants in two related shareholder derivative lawsuits filed by purported stockholders in the United States District Court for the Southern District of New York on December 18, 2023 (Case No. 1:23-cv- 10934) and March 1, 2024 (Case No. 1:24-cv-01589). The Company was named as a nominal defendant in both complaints. These shareholder derivative complaints both make allegations similar to those made in the New York securities lawsuit described above relating to purported false and/or misleading statements and/or omissions in connection with certain transactions involving Prospect. On February 21, 2024, members of our Board of Directors were named as defendants in a shareholder derivative lawsuit filed by a purported stockholder in the United States District Court for the District of Maryland (Case No. 1:24-cv-00527). The Company was named as a nominal defendant. This shareholder derivative complaint makes allegations similar to those made in the New York securities and derivative lawsuits described above relating to purported false and/or misleading statements and/or omissions in connection with certain transactions involving Prospect.

We believe these claims are without merit and intend to defend the cases vigorously. We have not recorded a liability related to the lawsuits above because, at this time, we are unable to determine whether an unfavorable outcome is probable or to estimate reasonably possible losses.

Defamation Litigation

On March 30, 2023, we commenced an action in the United States District Court for the Northern District of Alabama (Case No. 2:23-cv-00408), against short-seller Viceroy Research LLC (“Viceroy”) and its members. We are seeking injunctive relief and damages for defamation, civil conspiracy, tortious interference, private nuisance, and unjust enrichment based on defamatory statements expressed against us. On June 29, 2023, we won a preliminary ruling in this lawsuit after Viceroy's motion to dismiss the case was denied by a judge in the United States District Court for the Northern District of Alabama.

From time-to-time, we are a party to other legal proceedings, claims, or regulatory inquiries and investigations arising out of, or incidental to, our business. While we are unable to predict with certainty the outcome of any particular matter, 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.

Summary of Significant Accounting Policies - Additional Information (Detail)	Sep. 30, 2024
Accounting Policies [Abstract]
Minimum percentage of reconciling items quantitative threshold of the statutory tax	5.00%

Condensed Consolidated Statements of Comprehensive (Loss) Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Net (loss) income	$ (800,929)	$ 116,895	$ (1,995,965)	$ 107,492
Other comprehensive (loss) income:
Unrealized loss on interest rate hedge, net of tax	(9,823)	(12,440)	(16,099)	(9,845)
Reclassification of interest rate hedge gain from AOCI to earnings, net of tax	(13,349)		(17,354)	(28,553)
Foreign currency translation gain (loss)	114,196	(54,018)	48,066	34,570
Reclassification of foreign currency translation loss from AOCI to earnings				3,234
Total comprehensive (loss) income	(709,905)	50,437	(1,981,352)	106,898
Comprehensive income attributable to non-controlling interests	(234)	(185)	(1,458)	(25)
Comprehensive (loss) income attributable to MPT Operating Partnership partners	(710,139)	50,252	(1,982,810)	106,873
MPT Operating Partnership, L.P. [Member]
Net (loss) income	(800,929)	116,895	(1,995,965)	107,492
Other comprehensive (loss) income:
Unrealized loss on interest rate hedge, net of tax	(9,823)	(12,440)	(16,099)	(9,845)
Reclassification of interest rate hedge gain from AOCI to earnings, net of tax	(13,349)		(17,354)	(28,553)
Foreign currency translation gain (loss)	114,196	(54,018)	48,066	34,570
Reclassification of foreign currency translation loss from AOCI to earnings				3,234
Total comprehensive (loss) income	(709,905)	50,437	(1,981,352)	106,898
Comprehensive income attributable to non-controlling interests	(234)	(185)	(1,458)	(25)
Comprehensive (loss) income attributable to MPT Operating Partnership partners	$ (710,139)	$ 50,252	$ (1,982,810)	$ 106,873

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2024
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
Rule 10b51 Arr Mofified Flag	false
Non Rule 10b51 Arr Modified Flag	false

Fair Value of Financial Instruments

9 Months Ended

Sep. 30, 2024

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 September 30, 2024							As of December 31, 2023
Asset (Liability)	Book Value				Fair Value			Book Value				Fair Value
Interest and rent receivables	$	35,142			$	35,130		$	45,059			$	45,476
Loans(1)		694,809		(2)		675,683			1,302,727		(2)		1,202,383
Debt, net		(9,215,751	)			(8,035,236	)		(10,064,236	)			(8,256,465	)

(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 (which was sold in March 2024), and our 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. We elected to account for these investments at fair value due to the size of the investments and because we believed this method was more reflective of current values.

At September 30, 2024 and December 31, 2023, the amounts recorded under the fair value option method were as follows (in thousands):


	As of September 30, 2024				As of December 31, 2023
Asset (Liability)	Fair Value		Original Cost		Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	136,192	$	136,192	$	146,892	$	146,892	Mortgage loans
Equity investment and other loans		206,798		909,726		939,903		912,999	Investments in unconsolidated operating entities/Other loans

Our loans to the international joint venture and its subsidiaries are recorded at fair value based on Level 2 and Level 3 inputs by discounting the estimated future contractual cash flows using a credit-adjusted rate of return, which is derived from market rates of return on similar loans with similar credit quality and remaining maturity. Our equity investment in Lifepoint Behavioral (which was sold in March 2024) was recorded at fair value as of December 31, 2023, 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 investment in PHP Holdings are recorded at fair value based on Level 3 inputs, by using a market approach (for our equity investment in the international joint venture) and a discounted cash flow model and guideline public company model, a form of market approach, (for our investment in PHP Holdings), 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 these 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 and market approach models used for our investment in PHP Holdings, our unobservable inputs include use of a discount rate (which is based on a weighted-average cost of capital), selected revenue and EBITDA multiples in reference to guideline public companies, and 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 may modify such projections as needed based on our review and analysis of historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

In the first nine months of 2024, we recorded a net unfavorable adjustment to the investments accounted for under the fair value option method of approximately $720 million, primarily related to the loan to the international joint venture and our investment in PHP Holdings as further discussed in Note 3 to the condensed consolidated financial statements. In the first nine months of 2023, we had a net favorable adjustment of approximately $25 million for our investments accounted for under the fair value option method.

The discount rate and DLOM on our investment in PHP Holdings was approximately 25% and 14%, respectively, at September 30, 2024, compared to 11% and 8% at December 31, 2023. The selected revenue multiples ranged from 0.60x to 0.70x at September

30, 2024 compared to 1.1x to 1.3x at December 31, 2023. The selected EBITDA multiples ranged from 5.5x to 6.5x at September 30, 2024, compared to 10x to 14x at December 31, 2023. The decrease in multiples used in the fair value analysis of our investment in PHP Holdings compared to December 31, 2023 aligned with the expected value from the Astrana Health deal more fully described in Note 10 to the condensed consolidated financial statements.

In arriving at the DLOM, we 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	$	(2,315	)
- 100 basis points		2,315

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 impairment purposes of our real estate, financial instruments, and for certain equity investments without a readily determinable fair value.

Impairment and Fair Value Adjustments of Non-Real Estate Investments

Prior to the global settlement in September 2024 (as described in Note 3 to the condensed consolidated financial statements) in which our claims were released, our non-real estate investments in Steward and related affiliates included our 9.9% equity investment, working capital and other secured loans, and a loan made to a Steward affiliate in 2021, proceeds of which were used to redeem a similarly sized convertible loan held by Steward’s former private equity sponsor. In addition, the loan to the international joint venture is collateralized by the equity of Steward held by an investor in both Steward and the international joint venture. To assess recovery of these investments, we performed a valuation of Steward’s business at March 31, 2024, with assistance from a third-party, independent valuation firm. The valuation approaches utilized included the cost, market, and income approaches. The fair value analysis was performed under a non-going concern, orderly liquidation premise of value and assuming normal exposure to market participants. We utilized this premise of value due to Steward’s ongoing financial distress and subsequent filing of bankruptcy. Accordingly, the valuation approaches used, including the Level 3 inputs, were based on the financial performance of the Steward assets. For profitable hospitals, Level 3 inputs included a weighted average EBITDA multiple of 6.48x from a selected range of 5x to 7x in reference to comparable transactions. We also used a weighted average discount rate of 15.03% from a selected range of 15% to 16%. For unprofitable hospitals, Level 3 inputs included a weighted average net revenue multiple range of 0.275x from a selected range of 0.25x to 0.30x in reference to comparable transactions. We also considered the reported book values inclusive of various adjustments for unprofitable hospitals. After reducing the derived fair value of Steward's business for Steward's secured debt (including our working capital and other secured loans) and their working capital deficit, we arrived at only a nominal remaining value that could not support the carrying value of the loan to a Steward affiliate from 2021 or our remaining 9.9% equity investment. In addition, the value of the investor's share of the remaining 90.1% of Steward's equity that collateralized the loan to the international joint venture was deemed insufficient to support recovery of this investment. As a result, we recorded impairment charges and negative fair value adjustments in the 2024 first quarter of more than $600 million, as discussed further in Note 3 to the condensed consolidated financial statements.

We updated our fair value analysis of Steward's business at June 30, 2024, using a similar approach as done in the 2024 first quarter resulting in no further impairments or fair value adjustments to non-real estate investments in the 2024 second quarter. In the third quarter of 2024, as a result of the Company’s global settlement with Steward (as discussed further in Note 3 to the condensed consolidated financial statements), the Company recorded impairment charges of approximately $425 million for the working capital loans and other secured loans previously advanced to Steward.

Impairment of Real Estate Investments

In the 2024 third quarter, we recognized a real estate impairment charge of approximately $180 million related to the Space Coast facilities and certain excess properties previously leased to Steward that were deemed held for sale at September 30, 2024. The charge was needed to adjust our net book value to align with fair value less cost to sell based on expected proceeds, including from a binding agreement for the Space Coast properties. In the 2024 second quarter, we recognized approximately $500 million of real

estate impairment charges, primarily involving the eight Massachusetts properties in the Macquarie partnership. In our assessment, we first made a comparison of the carrying value of our real estate to projected undiscounted cash flows. For those properties for which the carrying value was not deemed recoverable, we recorded an impairment charge to the extent our carrying value was greater than its estimated fair value. In estimating fair value for these properties, we, along with assistance from a third-party, independent valuation firm, used a combination of cost, market, and income approaches using Level 3 inputs. The cost approach used comparable sales to value the land and cost manuals to value the improvements. The value derived from the market approach was based on sale prices of similar properties. For the income approach, we divided the expected operating income (i.e. revenue less expenses, if any) from the property by a market capitalization rate (range from 7% to 10%). Our share of the real estate impairment charge in the Macquarie partnership exceeded the remaining equity amount in the joint venture, which resulted in a write down of our equity interest to zero and such charge is reflected in the "Earnings (loss) from equity interests" line on the condensed consolidated statements of net income.

- Definition

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

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+ Details

Organization

9 Months Ended

Sep. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization

1. Organization

Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the Maryland General Corporation Law for the purpose of engaging in the business of investing in, owning, and leasing healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P. (the “Operating Partnership”), through which we conduct substantially all of our operations, was formed in September 2003. At present, we own, directly and indirectly, 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, the majority of our real estate operations in the United Kingdom ("U.K.") operate as a REIT and generally are subject only to a withholding tax on earnings upon distribution out of the U.K. REIT. Certain non-real estate activities we undertake in the U.S. 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 U.K. REIT), we are subject to the local income taxes of the jurisdictions where our properties reside and/or legal entities are domiciled; however, we do not expect to incur additional taxes, of a significant nature, in the U.S. from foreign-based income as the majority of such income flows through our REIT.

Our primary business strategy is to acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases, which require the tenant to bear most of the costs associated with the property. The majority of our leased assets are owned 100%; however, we do own some leased assets through joint ventures with other partners that share our view that healthcare facilities are part of the infrastructure of any community, which we refer to as investments in unconsolidated real estate joint ventures. We also may make mortgage loans to healthcare operators collateralized by their real estate. In addition, we may make noncontrolling investments in our tenants (which we refer to as investments in unconsolidated operating entities), from time-to-time, typically in conjunction with larger real estate transactions with the tenant, which may enhance our overall return and provide for certain minority rights and protections.

Our business model facilitates acquisitions and recapitalizations, and allows operators of healthcare facilities to unlock the value of their real estate to fund facility improvements, technology upgrades, and other investments in operations. At September 30, 2024, we have investments in 402 facilities in 31 states in the U.S., in seven countries in Europe, and one country in South America. Our properties consist of general acute care hospitals, behavioral health facilities, post acute care facilities (including inpatient physical rehabilitation facilities and long-term acute care hospitals), and freestanding ER/urgent care facilities. We manage our business as a single business segment.