SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
01/25/2016
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3. Issuer Name and Ticker or Trading Symbol
MEDICAL PROPERTIES TRUST INC
[ mpw ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| VP, Controller, and CAO |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common stock, par value $.001 par value |
67,343 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
Alison G. Schmidt, by power of attorney |
02/04/2016 |
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** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
Exhibit 24 - Power of Attorney
LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING
OBLIGATIONS
I hereby constitute and appoint
Alison Schmidt, each an employee of
Medical Properties Trust, Inc. (the "Company") or certain
of its subsidiaries, as my true and lawful attorney-in-
fact to undertake the following activities, acting
individually and not collectively:
1. prepare, execute in my name and on my behalf, and
submit to the Securities and Exchange Commission (the
"SEC") a Form ID, including amendments thereto, and any
other documents necessary or appropriate to obtain codes
and passwords enabling me to make electronic filings with
the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934 or any rule or regulation
of the SEC;
2. execute, for and on my behalf, in my capacity as
an officer and/or director of the Company, Forms 3, 4 and
5 in accordance with Section 16(a) of the Securities
Exchange Act of 1934 and the related rules, and any other
forms or reports I may be required to file in connection
with my ownership, acquisition, or disposition of
securities of the Company;
3. perform any acts on my behalf which may be
necessary or desirable to complete and execute any such
Form 3, 4 or 5, or other form or report, and to file such
forms or reports with the SEC and any stock exchange or
similar authority; and
4. take any other action in connection with the
foregoing which, in the opinion of such attorney-in-fact,
may be of benefit to, in the best interest of, or legally
required by me, it being understood that the documents
executed by such attorney-in-fact on my behalf pursuant
to this power of attorney shall be in such form and
contain such terms and conditions as such attorney-in-
fact may approve in such attorney-in-fact's discretion.
I hereby grant such attorney-in-fact full
power and authority to perform any act necessary or
proper to be done in the exercise of any of the rights
and powers granted in this power of attorney, as fully as
I could do if personally present, with full power of
substitution or revocation, hereby ratifying and
confirming all that such attorney-in-fact, or their
substitutes, lawfully do or cause to be done by virtue of
this power of attorney and the rights and powers granted
in this power of attorney. I acknowledge that the
foregoing attorney-in-fact, in serving in such capacity
at my request, is not assuming, nor is the Company
assuming, any of my responsibilities to comply with
Section 16 of the Securities and Exchange Act of 1934.
This limited power of attorney shall be effective on
the date set forth below and shall remain in full force
and effect until I am no longer required to file Forms 3,
4 and 5 with respect to my holdings of and transactions
in the Company's securities, unless I revoke it earlier in
a signed writing filed with the SEC or delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, I have executed this power of
attorney this 1st day of February, 2016.
/s/ J. Kevin Hanna
_________________________________________________________
J. Kevin Hanna
