Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically ~~and posted on its corporate Web site, if any,~~ every Interactive Data File required to be submitted ~~and posted~~ pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit ~~and post~~ such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

Indicate the number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date.

As of May ~~4, 2018,~~3, 2019, Medical Properties Trust, Inc. had ~~364,736,886~~394,424,343 shares of common stock, par value $0.001, outstanding.

This report combines the Quarterly Reports on Form 10-Q for the three months ended March 31, ~~2018~~2019 of Medical Properties Trust, Inc., a Maryland corporation, and MPT Operating Partnership, L.P., a Delaware limited partnership, through which Medical Properties Trust, Inc. conducts substantially all of its operations. Unless otherwise indicated or unless the context requires otherwise, all references in this report to “we,” “us,” “our,” “our company,” “Medical Properties,” “MPT,” or “the company” refer to Medical Properties Trust, Inc. together with its consolidated subsidiaries, including MPT Operating Partnership, L.P. Unless otherwise indicated or unless the context requires otherwise, all references to “our operating partnership” or “the operating partnership” refer to MPT Operating Partnership, L.P. together with its consolidated subsidiaries.

	March 31, 2018			December 31, 2017			March 31, 2019			December 31, 2018
(In thousands, except per share amounts)	(Unaudited)			(Note 2)			(Unaudited)			(Note 2)
Assets
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$	5,867,286		$	5,797,605		$	5,394,092		$	5,268,459
Real estate held for sale		—			146,615
Mortgage loans		1,927,393			1,778,316			1,214,780			1,213,322
Net investment in direct financing leases		686,024			698,727			684,547			684,053
Gross investment in real estate assets		8,480,703			8,421,263			7,293,419			7,165,834
Accumulated depreciation and amortization		(493,782	)		(455,712	)		(498,915	)		(464,984	)
Net investment in real estate assets		7,986,921			7,965,551			6,794,504			6,700,850
Cash and cash equivalents		138,314			171,472			995,548			820,868
Interest and rent receivables		81,965			78,970			24,788			25,855
Straight-line rent receivables		202,317			185,592			243,556			220,848
Equity investments								506,123			520,058
Other loans		148,842			150,209			365,402			373,198
Other assets		473,481			468,494			301,532			181,966
Total Assets	$	9,031,840		$	9,020,288		$	9,231,453		$	8,843,643
Liabilities and Equity
Liabilities
Debt, net	$	4,898,364		$	4,898,667		$	4,023,568		$	4,037,389
Accounts payable and accrued expenses		206,891			211,188			188,956			204,325
Deferred revenue		15,549			18,178			9,979			13,467
Lease deposits and other obligations to tenants		57,847			57,050
Total liabilities		5,178,651			5,185,083
Obligations to tenants and other lease liabilities								118,474			27,524
Total Liabilities								4,340,977			4,282,705
Equity
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding		—			—			—			—
Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding — 364,695 shares at March 31, 2018 and 364,424 shares at December 31, 2017		365			364
Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding — 391,839 shares at March 31, 2019 and 370,637 shares at December 31, 2018								392			371
Additional paid-in capital		4,333,972			4,333,027			4,803,672			4,442,948
Distributions in excess of net income		(484,804	)		(485,932	)
Retained earnings								141,427			162,768
Accumulated other comprehensive loss		(9,961	)		(26,049	)		(67,892	)		(58,202	)
Treasury shares, at cost		(777	)		(777	)		(777	)		(777	)
Total Medical Properties Trust, Inc. Stockholders’ Equity		3,838,795			3,820,633			4,876,822			4,547,108
Non-controlling interests		14,394			14,572			13,654			13,830
Total Equity		3,853,189			3,835,205			4,890,476			4,560,938
Total Liabilities and Equity	$	9,031,840		$	9,020,288		$	9,231,453		$	8,843,643

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
(In thousands, except per share amounts)	2018			2017			2019			2018
Revenues
Rent billed	$	128,011		$	96,763		$	108,598		$	128,011
Straight-line rent		15,791			12,779			20,651			15,791
Income from direct financing leases		17,681			17,880			17,280			17,681
Interest and fee income		43,563			28,975
Interest and other income								33,925			43,563
Total revenues		205,046			156,397			180,454			205,046
Expenses
Interest		57,023			38,029			50,551			57,023
Real estate depreciation and amortization		35,802			27,586			33,352			35,802
Property-related		2,184			1,328			3,066			2,184
General and administrative		17,818			13,197			23,451			17,818
Acquisition costs		—			2,756
Total expenses		112,827			82,896			110,420			112,827
Other income (expense)
Gain on sale of real estate, net		1,467			7,413			—			1,467
Debt refinancing costs		—			(13,629	)
Earnings from equity interests								3,720			3,271
Other		(1,468	)		1,767			204			(4,739	)
Total other income (expense)		(1	)		(4,449	)		3,924			(1	)

Income before income tax		92,218			69,052			73,958			92,218
Income tax expense		(1,175	)		(867	)
Income tax benefit (expense)								2,333			(1,175	)

Net income		91,043			68,185			76,291			91,043
Net income attributable to non-controlling interests		(442	)		(215	)		(469	)		(442	)
Net income attributable to MPT common stockholders	$	90,601		$	67,970		$	75,822		$	90,601

Earnings per common share — basic and diluted
Net income attributable to MPT common stockholders	$	0.25		$	0.21		$	0.20		$	0.25

Weighted average shares outstanding — basic		364,882			321,057			380,551			364,882
Weighted average shares outstanding — diluted		365,343			321,423			381,675			365,343

Dividends declared per common share	$	0.25		$	0.24		$	0.25		$	0.25

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
(In thousands)	2018			2017			2019			2018
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Other comprehensive income:
Foreign currency translation gain		16,088			6,292
Unrealized loss on interest rate swap								(3,772	)		—
Foreign currency translation (loss) gain								(5,918	)		16,088
Total comprehensive income		107,131			74,477			66,601			107,131
Comprehensive income attributable to non-controlling interests		(442	)		(215	)		(469	)		(442	)
Comprehensive income attributable to MPT common stockholders	$	106,689		$	74,262		$	66,132		$	106,689

	Preferred				Common
	Shares		Par Value		Shares		Par Value		Additional Paid-in Capital			Retained Earnings (Deficit)			Accumulated Other Comprehensive Loss			Treasury Stock			Non- Controlling Interests			Total Equity
Balance at December 31, 2017		—	$	—		364,424	$	364	$	4,333,027		$	(485,932	)	$	(26,049	)	$	(777	)	$	14,572		$	3,835,205
Net income		—		—		—		—		—			90,601			—			—			442			91,043
Cumulative effect of change in accounting principles		—		—		—		—		—			1,938			—			—			—			1,938
Foreign currency translation gain		—		—		—		—		—			—			16,088			—			—			16,088
Stock vesting and amortization of stock-based compensation		—		—		271		1		1,855			—			—			—			—			1,856
Redemption of MOP units		—		—		—		—		(816	)		—			—			—			—			(816	)
Distributions to non-controlling interests		—		—		—		—		—			—			—			—			(620	)		(620	)
Proceeds from offering (net of offering costs)		—		—		—		—		(94	)		—			—			—			—			(94	)
Dividends declared ($0.25 per common share)		—		—		—		—		—			(91,411	)		—			—			—			(91,411	)
Balance at March 31, 2018		—	$	—		364,695	$	365	$	4,333,972		$	(484,804	)	$	(9,961	)	$	(777	)	$	14,394		$	3,853,189

	Preferred				Common
	Shares		Par Value		Shares		Par Value		Additional Paid-in Capital		Retained Earnings (Deficit)			Accumulated Other Comprehensive Loss			Treasury Stock			Non- Controlling Interests			Total Equity
Balance at December 31, 2018		—	$	—		370,637	$	371	$	4,442,948	$	162,768		$	(58,202	)	$	(777	)	$	13,830		$	4,560,938
Net income		—		—		—		—		—		75,822			—			—			469			76,291
Unrealized loss on interest rate swap		—		—		—		—		—		—			(3,772	)		—			—			(3,772	)
Foreign currency translation loss		—		—		—		—		—		—			(5,918	)		—			—			(5,918	)
Stock vesting and amortization of stock-based compensation		—		—		1,055		1		6,714		—			—			—			—			6,715
Distributions to non-controlling interests		—		—		—		—		—		—			—			—			(645	)		(645	)
Proceeds from offering (net of offering costs)		—		—		20,147		20		354,010		—			—			—			—			354,030
Dividends declared ($0.25 per common share)		—		—		—		—		—		(97,163	)		—			—			—			(97,163	)
Balance at March 31, 2019		—	$	—		391,839	$	392	$	4,803,672	$	141,427		$	(67,892	)	$	(777	)	$	13,654		$	4,890,476

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
	2018			2017			2019			2018
	(In thousands)						(In thousands)
Operating activities
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization		37,858			28,954			34,675			37,858
Amortization of deferred financing costs and debt discount		1,789			1,617			1,827			1,789
Direct financing lease interest accretion		(2,340	)		(2,286	)		(2,337	)		(2,340	)
Straight-line rent revenue		(20,377	)		(13,896	)		(23,959	)		(20,377	)
Share-based compensation		1,856			1,971			6,715			1,856
Gain from sale of real estate, net		(1,467	)		(7,413	)		—			(1,467	)
Straight-line rent and other write-off		6,059			1,117
Debt refinancing costs		—			13,629
Straight-line rent and other write-off, net of tax benefit								2,596			6,059
Other adjustments		(3,217	)		(2,959	)		2,249			(3,217	)
Changes in:
Interest and rent receivables		(3,678	)		(4,208	)		(1,193	)		(3,678	)
Accounts payable and accrued expenses		(12,729	)		(20,428	)		(9,940	)		(12,729	)
Net cash provided by operating activities		94,797			64,283			86,924			94,797
Investing activities
Cash paid for acquisitions and other related investments		—			(9,004	)		(6,492	)		—
Net proceeds from sale of real estate		148,809			64,335			—			148,809
Principal received on loans receivable		1,734			3,233			420			1,734
Investment in loans receivable		(149,080	)		(1,410	)		(1,185	)		(149,080	)
Construction in progress and other		(8,399	)		(26,898	)		(160,736	)		(8,399	)
Net cash (used for) provided by investing activities		(6,936	)		30,256
Net cash used for investing activities								(167,993	)		(6,936	)
Financing activities
Proceeds from term debt		—			955,280
Payments of term debt		—			(675,201	)
Revolving credit facilities, net		(33,590	)		90,000			9,097			(33,590	)
Distributions paid		(89,403	)		(74,521	)		(95,419	)		(89,403	)
Lease deposits and other obligations to tenants		1,299			3,307			3,677			1,299
Proceeds from sale of common shares, net of offering costs								354,030			(94	)
Debt issuance costs paid and other financing activities		(1,643	)		(15,882	)		(677	)		(1,549	)
Net cash (used for) provided by financing activities		(123,337	)		282,983
(Decrease) increase in cash, cash equivalents and restricted cash for period		(35,476	)		377,522
Net cash provided by (used for) financing activities								270,708			(123,337	)
Increase (decrease) in cash, cash equivalents and restricted cash for period								189,639			(35,476	)
Effect of exchange rate changes		2,774			(10,083	)		(11,450	)		2,774
Cash, cash equivalents and restricted cash at beginning of period		172,247			84,882			822,425			172,247
Cash, cash equivalents and restricted cash at end of period	$	139,545		$	452,321		$	1,000,614		$	139,545
Interest paid	$	57,025		$	51,601		$	51,296		$	57,025
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	$	91,410		$	77,172		$	97,163		$	91,411
Cash, cash equivalents and restricted cash are comprised of the following:
Beginning of period:
Cash and cash equivalents	$	171,472		$	83,240		$	820,868		$	171,472
Restricted cash, included in Other assets	775				1,642			1,557		775
	$	172,247		$	84,882		$	822,425		$	172,247
End of period:
Cash and cash equivalents	$	138,314		$	446,948		$	995,548		$	138,314
Restricted cash, included in Other assets		1,231			5,373			5,066			1,231
	$	139,545		$	452,321		$	1,000,614		$	139,545

	March 31, 2018			December 31, 2017			March 31, 2019			December 31, 2018
(In thousands)	(Unaudited)			(Note 2)			(Unaudited)			(Note 2)
Assets
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$	5,867,286		$	5,797,605		$	5,394,092		$	5,268,459
Real estate held for sale		—			146,615
Mortgage loans		1,927,393			1,778,316			1,214,780			1,213,322
Net investment in direct financing leases		686,024			698,727			684,547			684,053
Gross investment in real estate assets		8,480,703			8,421,263			7,293,419			7,165,834
Accumulated depreciation and amortization		(493,782	)		(455,712	)		(498,915	)		(464,984	)
Net investment in real estate assets		7,986,921			7,965,551			6,794,504			6,700,850
Cash and cash equivalents		138,314			171,472			995,548			820,868
Interest and rent receivables		81,965			78,970			24,788			25,855
Straight-line rent receivables		202,317			185,592			243,556			220,848
Equity investments								506,123			520,058
Other loans		148,842			150,209			365,402			373,198
Other assets		473,481			468,494			301,532			181,966
Total Assets	$	9,031,840		$	9,020,288		$	9,231,453		$	8,843,643
Liabilities and Capital
Liabilities
Debt, net	$	4,898,364		$	4,898,667		$	4,023,568		$	4,037,389
Accounts payable and accrued expenses		115,149			121,465			91,461			108,574
Deferred revenue		15,549			18,178			9,979			13,467
Lease deposits and other obligations to tenants		57,847			57,050
Obligations to tenants and other lease liabilities								118,474			27,524
Payable due to Medical Properties Trust, Inc.		91,352			89,333			97,105			95,361
Total liabilities		5,178,261			5,184,693
Total Liabilities								4,340,587			4,282,315
Capital
General Partner — issued and outstanding — 3,647 units at March 31, 2018 and 3,644 units at December 31, 2017		38,518			38,489
General Partner — issued and outstanding — 3,918 units at March 31, 2019 and 3,706 units at December 31, 2018								49,478			46,084
Limited Partners:
Common units — issued and outstanding — 361,048 units at March 31, 2018 and 360,780 units at December 31, 2017		3,810,628			3,808,583
LTIP units — issued and outstanding — 232 units at March 31, 2018 and 292 units at December 31, 2017		—			—
Common units — issued and outstanding — 387,921 units at March 31, 2019 and 366,931 units at December 31, 2018								4,895,626			4,559,616
LTIP units — issued and outstanding — 232 units at March 31, 2019 and 232 units at December 31, 2018								—			—
Accumulated other comprehensive loss		(9,961	)		(26,049	)		(67,892	)		(58,202	)
Total MPT Operating Partnership, L.P. Capital		3,839,185			3,821,023
Total MPT Operating Partnership, L.P. capital								4,877,212			4,547,498
Non-controlling interests		14,394			14,572			13,654			13,830
Total capital		3,853,579			3,835,595
Total Capital								4,890,866			4,561,328
Total Liabilities and Capital	$	9,031,840		$	9,020,288		$	9,231,453		$	8,843,643

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
(In thousands, except per unit amounts)	2018			2017			2019			2018
Revenues
Rent billed	$	128,011		$	96,763		$	108,598		$	128,011
Straight-line rent		15,791			12,779			20,651			15,791
Income from direct financing leases		17,681			17,880			17,280			17,681
Interest and fee income		43,563			28,975
Interest and other income								33,925			43,563
Total revenues		205,046			156,397			180,454			205,046
Expenses
Interest		57,023			38,029			50,551			57,023
Real estate depreciation and amortization		35,802			27,586			33,352			35,802
Property-related		2,184			1,328			3,066			2,184
General and administrative		17,818			13,197			23,451			17,818
Acquisition costs		—			2,756
Total expenses		112,827			82,896			110,420			112,827
Other income (expense)
Gain on sale of real estate, net		1,467			7,413			—			1,467
Debt refinancing costs		—			(13,629	)
Earnings from equity interests								3,720			3,271
Other		(1,468	)		1,767			204			(4,739	)
Total other income (expense)		(1	)		(4,449	)		3,924			(1	)

Income before income tax		92,218			69,052			73,958			92,218
Income tax expense		(1,175	)		(867	)
Income tax benefit (expense)								2,333			(1,175	)

Net income		91,043			68,185			76,291			91,043
Net income attributable to non-controlling interests		(442	)		(215	)		(469	)		(442	)
Net income attributable to MPT Operating Partnership partners	$	90,601		$	67,970		$	75,822		$	90,601

Earnings per units — basic and diluted
Net income attributable to MPT Operating Partnership partners	$	0.25		$	0.21		$	0.20		$	0.25

Weighted average units outstanding — basic		364,882			321,057			380,551			364,882
Weighted average units outstanding — diluted		365,343			321,423			381,675			365,343

Dividends declared per unit	$	0.25		$	0.24		$	0.25		$	0.25

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
(In thousands)	2018			2017			2019			2018
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Other comprehensive income:
Foreign currency translation gain		16,088			6,292
Unrealized loss on interest rate swap								(3,772	)		—
Foreign currency translation (loss) gain								(5,918	)		16,088
Total comprehensive income		107,131			74,477			66,601			107,131
Comprehensive income attributable to non-controlling interests		(442	)		(215	)		(469	)		(442	)
Comprehensive income attributable to MPT Operating Partnership partners	$	106,689		$	74,262		$	66,132		$	106,689

	General					Limited Partners											Accumulated
	Partner					Common						LTIPs					Other			Non-
	Units		Unit Value			Units			Unit Value			Units			Unit Value		Comprehensive Loss			Controlling Interests			Total Capital
Balance at December 31, 2017		3,644	$	38,489			360,780		$	3,808,583			292		$	—	$	(26,049	)	$	14,572		$	3,835,595
Net income		—		906			—			89,695			—			—		—			442			91,043
Cumulative effect of change in accounting principles		—		19			—			1,919			—			—		—			—			1,938
Foreign currency translation gain		—		—			—			—			—			—		16,088			—			16,088
Unit vesting and amortization of unit-based compensation		3		19			268			1,837			—			—		—			—			1,856
Conversion of LTIP units to common units		—		—			60			—			(60	)		—		—			—			—
Redemption of common units		—		—			(60	)		(816	)		—			—		—			—			(816	)
Distributions to non-controlling interests		—		—			—			—			—			—		—			(620	)		(620	)
Proceeds from offering (net of offering costs)		—		(1	)		—			(93	)		—			—		—			—			(94	)
Distributions declared ($0.25 per unit)		—		(914	)		—			(90,497	)		—			—		—			—			(91,411	)
Balance at March 31, 2018		3,647	$	38,518			361,048		$	3,810,628			232		$	—	$	(9,961	)	$	14,394		$	3,853,579

	General					Limited Partners									Accumulated
	Partner					Common					LTIPs				Other			Non-
	Units		Unit Value			Units		Unit Value			Units		Unit Value		Comprehensive Loss			Controlling Interests			Total Capital
Balance at December 31, 2018		3,706	$	46,084			366,931	$	4,559,616			232	$	—	$	(58,202	)	$	13,830		$	4,561,328
Net income		—		758			—		75,064			—		—		—			469			76,291
Unrealized loss on interest rate swap		—		—			—		—			—		—		(3,772	)		—			(3,772	)
Foreign currency translation loss		—		—			—		—			—		—		(5,918	)		—			(5,918	)
Unit vesting and amortization of unit-based compensation		11		68			1,044		6,647			—		—		—			—			6,715
Distributions to non-controlling interests		—		—			—		—			—		—		—			(645	)		(645	)
Proceeds from offering (net of offering costs)		201		3,540			19,946		350,490			—		—		—			—			354,030
Distributions declared ($0.25 per unit)		—		(972	)		—		(96,191	)		—		—		—			—			(97,163	)
Balance at March 31, 2019		3,918	$	49,478			387,921	$	4,895,626			232	$	—	$	(67,892	)	$	13,654		$	4,890,866

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
	2018			2017			2019			2018
	(In thousands)						(In thousands)
Operating activities
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization		37,858			28,954			34,675			37,858
Amortization of deferred financing costs and debt discount		1,789			1,617			1,827			1,789
Direct financing lease interest accretion		(2,340	)		(2,286	)		(2,337	)		(2,340	)
Straight-line rent revenue		(20,377	)		(13,896	)		(23,959	)		(20,377	)
Unit-based compensation		1,856			1,971			6,715			1,856
Gain from sale of real estate, net		(1,467	)		(7,413	)		—			(1,467	)
Straight-line rent and other write-off		6,059			1,117
Debt refinancing costs		—			13,629
Straight-line rent and other write-off, net of tax benefit								2,596			6,059
Other adjustments		(3,217	)		(2,959	)		2,249			(3,217	)
Changes in:
Interest and rent receivables		(3,678	)		(4,208	)		(1,193	)		(3,678	)
Accounts payable and accrued expenses		(12,729	)		(20,428	)		(9,940	)		(12,729	)
Net cash provided by operating activities		94,797			64,283			86,924			94,797
Investing activities
Cash paid for acquisitions and other related investments		—			(9,004	)		(6,492	)		—
Net proceeds from sale of real estate		148,809			64,335			—			148,809
Principal received on loans receivable		1,734			3,233			420			1,734
Investment in loans receivable		(149,080	)		(1,410	)		(1,185	)		(149,080	)
Construction in progress and other		(8,399	)		(26,898	)		(160,736	)		(8,399	)
Net cash (used for) provided by investing activities		(6,936	)		30,256
Net cash used for investing activities								(167,993	)		(6,936	)
Financing activities
Proceeds from term debt		—			955,280
Payments of term debt		—			(675,201	)
Revolving credit facilities, net		(33,590	)		90,000			9,097			(33,590	)
Distributions paid		(89,403	)		(74,521	)		(95,419	)		(89,403	)
Lease deposits and other obligations to tenants		1,299			3,307			3,677			1,299
Proceeds from sale of units, net of offering costs								354,030			(94	)
Debt issuance costs paid and other financing activities		(1,643	)		(15,882	)		(677	)		(1,549	)
Net cash (used for) provided by financing activities		(123,337	)		282,983
(Decrease) increase in cash, cash equivalents and restricted cash for period		(35,476	)		377,522
Net cash provided by (used for) financing activities								270,708			(123,337	)
Increase (decrease) in cash, cash equivalents and restricted cash for period								189,639			(35,476	)
Effect of exchange rate changes		2,774			(10,083	)		(11,450	)		2,774
Cash, cash equivalents and restricted cash at beginning of period		172,247			84,882			822,425			172,247
Cash, cash equivalents and restricted cash at end of period	$	139,545		$	452,321		$	1,000,614		$	139,545
Interest paid	$	57,025		$	51,601		$	51,296		$	57,025
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	$	91,410		$	77,172		$	97,163		$	91,411
Cash, cash equivalents, and restricted cash are comprised of the following:
Beginning of period:
Cash and cash equivalents	$	171,472		$	83,240		$	820,868		$	171,472
Restricted cash, included in Other assets		775			1,642			1,557			775
	$	172,247		$	84,882		$	822,425		$	172,247
End of period:
Cash and cash equivalents	$	138,314		$	446,948		$	995,548		$	138,314
Restricted cash, included in Other assets		1,231			5,373			5,066			1,231
	$	139,545		$	452,321		$	1,000,614		$	139,545

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 ~~commercial~~healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., (the “Operating Partnership”) through which we conduct all of our operations, was formed in September 2003. Through another wholly-owned subsidiary, Medical Properties Trust, LLC, we are the sole general partner of the Operating Partnership. At present, we directly own substantially all of the limited 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 have operated as a real estate investment trust (“REIT”) since April 6, 2004 and elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will generally not be subject to federal income tax in the United States (“U.S.”), provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income. Certain non-real estate activities we undertake are conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRS”). Our TRS entities are subject to both U.S. federal and state income taxes. For our properties located outside the U.S., we are subject to the local ~~taxes;~~taxes of the jurisdictions where our properties reside and/or legal entities are domiciled; however, we do not expect to incur additional taxes in the U.S. as such income flows through our REIT.

Our primary business strategy is to acquire and develop real estate and improvements, primarily for long-term lease to providers of healthcare services, such as operators of general acute care hospitals, inpatient physical rehabilitation hospitals, and long-term acute care ~~hospitals, surgery centers, centers for treatment of specific conditions such as cardiac, pulmonary, cancer, and neurological hospitals, and other healthcare-oriented facilities.~~hospitals. We also make mortgage and other loans to operators of similar facilities. In addition, we may obtain profits or equity interests in our tenants, from time to time, in order to enhance our overall return. We manage our business as a single business segment. ~~Our~~All of our properties are currently located in the U.S. and Europe.

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 presentation have been included. Operating results for the three months ended March 31, ~~2018,~~2019, are not necessarily indicative of the results that may be expected for the year ending December 31, ~~2018.~~2019. The condensed consolidated balance sheet at December 31, ~~2017~~2018 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.

For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, ~~2017.~~2018. There have been no material changes to these significant accounting policies other than the following:

On January 1, ~~2018,~~2019, we adopted Accounting Standards Update (“ASU”) ~~No. 2017-01, “Clarifying the Definition of a Business”~~2016-02, “Leases”, (“ASU ~~2017-01”~~2016-02”). ASU 2017-01 provides an initial screen to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, in which case, the transaction would be accounted for as an asset acquisition rather than as a business combination. In addition, ASU 2017-01 clarifies the requirements for a set of activities to be considered a business and narrows the definition of an output. With this accounting change, we expect to recognize a majority of our future real estate acquisitions as asset transactions rather than business combinations, which will result in the capitalization of third party transaction costs that are directly related to an acquisition and significantly decrease acquisition expenses. Indirect and internal transaction costs will continue to be expensed, but we do not expect to treat these costs as acquisition expenses for purposes of deriving normalized funds from operations in the future. Accordingly, this change in accounting increased our general and administrative expenses by $1.6 million for the three months ended March 31, 2018 compared to prior year.

On January 1, 2018, we adopted ASU No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. This standard should not have a significant impact on our financial results, as a substantial portion of our revenue consists of rental income from leasing arrangements and interest income from loans, which are specifically excluded from ASU No. 2014-09. However, we also adopted a related standard ASU No. 2017-05 “Other Income - Gains and Losses from the

Derecognition of Nonfinancial Assets” on January 1, 2018, which we expect will allow for more transactions to qualify as sales of real estate with gains on sales being recognized earlier than under previous accounting guidance, as the new guidance is based on transfer of control versus whether or not the seller has continuing involvement. Upon adoption of this new standard, we recorded a $1.9 million adjustment to retained earnings to fully recognize gains on real estate sold in prior years that was required to be deferred under previous accounting guidance.

In August and November 2016, the Financial Accounting Standards Board (“FASB”) issued guidance on the classification of certain receipts and payments in the statements of cash flows and to require companies to separately disclose the changes in total cash, cash equivalents, and amounts generally described as restricted cash on statements of cash flows (ASU 2016-18). Restricted cash recorded in other assets on the condensed consolidated balance sheets includes certain operating deposits, tenant capital reserve deposits and deposits related to real estate acquisitions. This guidance was adopted on January 1, 2018 by applying a retrospective transition method resulting in the restatement of all periods presented. This change did not have a material impact on the statements of cash flows for the three months ended March 31, 2018 and March 31, 2017, respectively.

~~In February 2016, FASB issued ASU~~ 2016-02 ~~“Leases”, which~~ sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). We adopted this standard using the modified retrospective approach and have elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, permits the following: no reassessment of whether existing contracts are or contain a lease; no reassessment of lease classification for existing leases; and no reassessment of initial direct costs for existing leases. Additionally, we made certain elections permitted in accordance with ASU 2018-11, “Leases (Topic 842): – Targeted Improvements.” which (1) permits entities to apply the transition provisions of the new standard at its adoption date instead of at the earliest comparative period presented in its financial statements and (2) permits lessors to account for lease and non-lease components as a single lease component in a contract if certain criteria are met.

The ~~new~~ standard requires lessees to apply a dual approach, classifying leases as either financing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method (for finance leases) or on a straight-line basis (for operating leases) over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Leases with a term of 12 months or less will ~~be accounted for~~remain off balance sheet with lease expense recognized on a straight-line basis over the lease term, similar to ~~existing~~previous guidance for operating ~~leases today.~~leases. The ~~new~~ standard requires lessors to account for leases using an approach that is substantially equivalent to ~~existing~~previous guidance for sales-type leases, direct financing leases and operating leases.

~~We will adopt this new standard on January 1, 2019. We are continuing to evaluate this standard and the impact to us from both a lessor and lessee perspective. We do have~~For our leases in which we are the lessee, including ground leases on which certain of our facilities reside, along with corporate office and equipment leases, ~~that will be required to be~~we recorded ~~on our balance sheet~~a right-of-use asset and offsetting lease liability of approximately $84 million upon adoption of this ~~standard.~~standard – resulting in no material cumulative effect adjustment. From a lessor perspective, we ~~do expect certain non-lease components (including~~did not change the classification or accounting of our existing leases except, we are now grossing up our income statement for certain operating expenses, such as property taxes and insurance, that the tenants of our facilities are required to ~~pay~~reimburse us for pursuant to our “triple-net” ~~leases)~~leases. See Note 10 for additional detail.

In June 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-13, “Measurement of Credit Losses on Financial Instruments" ("ASU 2016-13"). This standard requires a new forward-looking “expected loss” model to be ~~recorded gross versus net~~used for our financing receivables, including direct financing leases and loan receivables, which the FASB believes will result in more timely recognition of such losses. ASU 2016-13 is effective for us beginning January 1, 2020. We are currently evaluating the ~~respective expenses upon adoption of this~~impact that the standard ~~in 2019 in accordance with ASU No. 2014-09.~~will have on our consolidated financial statements.

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

At March 31, 2018, we had loans to and/or equity investments in certain variable interest entities (“VIEs”), which are also tenants of our facilities. We have determined that we are 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 are presented below at March 31, 2018 (in thousands):

For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance.

As of March 31, 2018, 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).

Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower.

~~See Note 3 and Note 5 for additional description of the nature, purpose and activities of our more significant VIEs (such as Ernest Health Inc. (“Ernest”)) and interests therein.~~

	Three Months Ended March 31,				Three Months Ended March 31,
	2018		2017		2019		2018
Assets Acquired
Land	$	—	$	1,230	$	169	$	—
Building		—		6,901		5,327		—
Intangible lease assets — subject to amortization		—		873		996		—
Total assets acquired	$	—	$	9,004	$	6,492	$	—

On ~~January 30, 2017,~~February 8, 2019, we acquired an inpatient rehabilitation hospital in Germany for ~~€8.4 million.~~€5.7 million (including real estate transfer taxes). This acquisition was the final property to close as part of ~~the six hospital~~a four-hospital portfolio that we agreed to ~~buy in September 2016~~purchase for an aggregate amount of ~~€44.1 million. This~~€23 million (including real estate transfer taxes). The property is leased to affiliates of Median Kliniken S.à ~~r.l.~~.r.l. (“MEDIAN”), pursuant to ~~the existing long-term~~a new 27-year master lease ~~agreement reached~~ with ~~MEDIAN~~annual escalators at the greater of 1% or 70% of the change in ~~2015.~~German consumer price index (“CPI”).

During the 2018 first quarter, we completed construction on ~~Ernest Flagstaff. This $24~~a $25.5 million inpatient rehabilitation facility located in Flagstaff, ~~Arizona~~Arizona. This facility opened on March 1, 2018 and is being leased to Ernest Health, Inc. (“Ernest”) pursuant to a stand-alone lease, with terms generally similar to the original master lease.

See table below for a status update on our current development projects (in thousands):

Property	Commitment		Costs Incurred as of March 31, 2018		Estimated Completion Date	Commitment		Costs Incurred as of March 31, 2019		Estimated Rent Commencement Date
Circle Health (Birmingham, England)	$	45,211	$	18,369	1Q 2019	$	44,241	$	34,705	3Q 2019
Circle Health Rehabilitation (Birmingham, England)							21,979		11,677	3Q 2019
Surgery Partners (Idaho Falls, Idaho)		113,468		16,753	1Q 2020		113,468		55,857	1Q 2020
	$	158,679	$	35,122		$	179,688	$	102,239

On March 1, 2018, we sold the real estate of St. Joseph Medical Center in Houston, Texas, for approximately $148 million to Steward Health Care System LLC (“Steward”). In return, we received a mortgage loan equal to the purchase price, with such loan secured by the underlying real estate. The mortgage loan ~~has~~had terms consistent with the other mortgage loans in the Steward portfolio. This transaction resulted in a gain of $1.5 million, offset by a $1.7 million non-cash charge to revenue to write-off related straight-line rent receivables on this property.

As noted earlier, we acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases (typical initial fixed terms ranging from 10 to 15 years) and most include renewal options at the election of our tenants, generally in five year increments. More than 95% of our leases provide annual rent escalations based on increases in the consumer price index (or similar index outside the U.S.) and/or fixed minimum annual escalations ranging from 0.5% to 3.0%. Many of our domestic leases contain purchase options with pricing set at various terms but in no case less than our total investment. For five properties with a carrying value of $210 million, our leases require a residual value guarantee from the tenant. Our leases typically require the tenant to handle and bear most of the costs associated with our properties including repair/maintenance, property taxes, and insurance. We routinely inspect our properties to ensure the residual value of each of our assets is being maintained. Except for leases noted below as direct finance leases (“DFLs”), all of our leases are classified as operating leases.

The following table summarizes future minimum lease payments to be received, excluding operating expense reimbursements, from tenants under noncancelable leases as of March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to RCCH Healthcare Partners (“RCCH”). Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million, partially offset by a $0.6 million non-cash charge to revenue to write-off related straight-line rent receivables on this property.

At March 31, ~~2018,~~2019, leases on 14 Ernest facilities, ten Prime Healthcare Services, Inc. (“Prime”) facilities, and two Alecto Healthcare Services LLC (“Alecto”) facilities are accounted for as ~~direct financing leases (“DFLs”).~~DFLs. The components of our net investment in DFLs consisted of the following (in thousands):

	As of March 31, 2018			As of December 31, 2017			As of March 31, 2019			As of December 31, 2018
Minimum lease payments receivable	$	2,223,869		$	2,294,081		$	2,078,099		$	2,091,504
Estimated residual values		434,769			448,339			421,893			424,719
Less: Unearned income		(1,972,614	)		(2,043,693	)		(1,815,445	)		(1,832,170	)
Net investment in direct financing leases	$	686,024		$	698,727		$	684,547		$	684,053

On March 15, 2018, we entered into a new lease agreement of our long-term acute care facility in Boise, Idaho with a joint venture formed by Vibra Healthcare, LLC (“Vibra”) and Ernest. The new lease ~~has~~had an initial 15-year fixed term (ending March 2033) with three extension options of five years each. With this transaction, we incurred a non-cash charge of $1.5 million to write-off DFL unbilled interest associated with the previous lease to Ernest on this property.

As noted in previous filings, effective October 2, 2017, we ~~have~~had 16 properties ~~that we plan to re-lease to a new operator or sell. These properties are being transitioned~~transitioning away from Adeptus Health, Inc. (“Adeptus”) in stages over a two year period as part of ~~Adeptus Health’s~~Adeptus’ confirmed plan of reorganization under Chapter 11 of the Bankruptcy Code. Rent is being paid by Adeptus Health during this transition period. On January 1, 2018 and April 1, 2018, Adeptus Health vacated and stopped making rent payments on five and three properties, respectively. As a result of the shortening of our lease term on these and eight other properties, we recorded $1.8 million to accelerate straight-line rent receivable amortization in the 2018 first quarter. At March 31, ~~2018,~~2019, nine of these properties have been re-leased at rates consistent with that of the previous Adeptus ~~Health~~lease, and one property in the Dallas market was sold in April 2019. Of the six remaining facilities (representing less than 0.6% of our total assets at March 31, 2019), five remain vacant and the final property will be transitioned away from Adeptus on October 1, 2019.

At March 31, 2019, Adeptus is current on its rent obligations to us. Although no assurances can be made that we will not recognize a loss in the future, we believe, at March 31, ~~2018~~2019, that the sale or re-leasing of the ~~assets related to these 16~~remaining six transition facilities will not result in any material loss or additional impairment.

In the first quarter of 2018, we terminated the lease at our Gilbert and Florence, Arizona facilities due to the tenant not meeting its rent obligations pursuant to the lease. As a result of the lease terminating, we recorded a charge of $1.1 million to reserve against the straight-line rent receivables. ~~This former tenant has continued to occupy the facility, but on April 25, 2018, this former tenant filed for involuntary bankruptcy.~~ At March 31, ~~2018,~~2019, all outstanding receivables due from the former tenant of Florence and Gilbert were completely reserved. On December 14, 2018, the Florence facility was re-leased to Steward pursuant to our original master lease with them with a term to begin in the second quarter of 2019. At March 31, 2019, our Gilbert facility is vacant. Although no assurances can be made that we will not have any impairment charges in the future, we believe our investment in the Gilbert ~~and Florence~~facility (less than 0.2% of ~~$38.1 million~~total assets at March 31, ~~2018,~~2019), is fully recoverable.

At March 31, 2019, we own four acute care facilities that are leased to Alecto and have a mortgage loan on a fifth property. With the decline in the operating results of the facility tenant, we recorded a charge to reserve against the straight-line rent and other receivables outstanding during the three months ended March 31, 2019. At March 31, 2019, our total overall investment in these properties is approximately 1% of our total assets.

~~The increase in mortgage loans relates to the St. Joseph property that was sold on March 1, 2018 – see “Disposals” section of this Note 3 for further information. Our non-mortgage~~Other loans typically consist of loans to our tenants for acquisitions and working capital ~~purposes. At March 31, 2018, acquisition loans includes $113.9 million~~purposes, and include our shareholder loan made to the joint venture with Primotop Holdings S.à.r.l. (“Primotop”) in ~~loans to Ernest.~~the amount of €290 million.

~~Our revenue~~We monitor concentration ~~for the three months ended March 31, 2018 as compared~~risk in several ways due to the ~~prior year is as follows (dollars~~nature of our real estate assets that are vital to the communities in ~~thousands):~~

~~Revenue by Operator~~which they are located and given our history of being able to replace inefficient operators of our facilities if needed, with more effective operators:

~~(1) Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017.~~

For the Three Months Ended March 31,

2018

2017

U.S. States and Other Countries

Total
Revenue

Percentage of
Total Revenue

Total
Revenue

Percentage of
Total Revenue

Texas

$
30,355

14.8
%

$
24,737

15.8
%
Massachusetts

26,940

13.1
%

26,584

17.0
%
Utah

20,871

10.2
%

2,534

1.6
%
California

16,666

8.1
%

16,565

10.6
%
Arizona

11,386

5.6
%

7,332

4.7
%
All other states

60,037

29.3
%

51,465

32.9
%
Total U.S.

$
166,255

81.1
%

$
129,217

82.6
%
Germany

$
37,665

18.4
%

$
26,190

16.7
%
United Kingdom, Italy, and Spain

1,126

0.5
%

990

0.7
%
Total International

$
38,791

18.9
%

$
27,180

17.4
%
Grand Total

$
205,046

100.0
%

$
156,397

100.0
%

Operator concentration – For the three months ended March 31, 2019, revenue from Steward and Prime of $86.6 million and $32.0 million, respectively, exceeded 10% of our total revenues. In comparison, Steward ($73.2 million), Prime ($31.8 million) and MEDIAN ($29.1 million), respectively, exceeded 10% of our total revenues for the first three months of 2018.

On a gross asset basis (as defined in the “Reconciliation of Non-GAAP Financial Measures” section of Item 2 of this Form 10-Q), our concentration as of March 31, 2018 as compared to December 31, 2017 is as follows (dollars in thousands):

As of March 31, 2018

As of December 31, 2017

Operators

Total
Gross Assets

Percentage of
Total Gross Assets

Total
Gross Assets

Percentage of
Total Gross Assets

Steward (1)

$
3,459,275

36.2
%

$
3,457,384

36.5
%
MEDIAN

1,261,991

13.2
%

1,229,325

13.0
%
Prime

1,120,737

11.7
%

1,119,484

11.8
%
Ernest

612,112

6.4
%

629,161

6.6
%
RCCH

506,265

5.3
%

506,265

5.3
%
Other operators

2,118,132

22.3
%

2,089,934

22.1
%
Other assets

466,095

4.9
%

444,659

4.7
%
Total

$
9,544,607

100.0
%

$
9,476,212

100.0
%

Geographic concentration – At March 31, 2019, investments in the U.S. and Europe represented approximately 80% and 20%, respectively, of our total assets, which is consistent with December 31, 2018.

As of March 31, 2018

As of December 31, 2017

U.S. States and Other Countries

Total
Gross Assets

Percentage of
Total Gross Assets

Total
Gross Assets

Percentage of
Total Gross Assets

Massachusetts

$
1,298,226

13.6
%

$
1,297,226

13.7
%
Texas

1,260,795

13.2
%

1,257,390

13.3
%
Utah

1,035,748

10.9
%

1,035,501

10.9
%
California

542,873

5.7
%

542,876

5.7
%
Arizona

489,185

5.1
%

491,284

5.2
%
All other states

2,616,686

27.4
%

2,618,536

27.6
%
Other domestic assets

402,841

4.2
%

387,050

4.1
%
Total U.S.

$
7,646,354

80.1
%

$
7,629,863

80.5
%
Germany

$
1,623,755

17.0
%

$
1,581,726

16.7
%
United Kingdom, Italy, and Spain

211,244

2.2
%

207,014

2.2
%
Other international assets

63,254

0.7
%

57,609

0.6
%
Total International

$
1,898,253

19.9
%

$
1,846,349

19.5
%
Grand Total

$
9,544,607

100.0
%

$
9,476,212

100.0
%

~~On an individual property basis, we had no investment of any single property greater than 3.7% of our total gross assets as of March 31, 2018.~~

	As of March 31, 2018			As of December 31, 2017			As of March 31, 2019			As of December 31, 2018
Revolving credit facility(A)	$	807,614		$	840,810		$	37,802		$	28,059
Term loans		200,000			200,000
Term loan								200,000			200,000
4.000% Senior Unsecured Notes due 2022(B)		616,200			600,250			560,900			573,350
5.500% Senior Unsecured Notes due 2024		300,000			300,000			300,000			300,000
6.375% Senior Unsecured Notes due 2024		500,000			500,000			500,000			500,000
3.325% Senior Unsecured Notes due 2025(B)		616,200			600,250			560,900			573,350
5.250% Senior Unsecured Notes due 2026		500,000			500,000			500,000			500,000
5.000% Senior Unsecured Notes due 2027		1,400,000			1,400,000			1,400,000			1,400,000
	$	4,940,014		$	4,941,310		$	4,059,602		$	4,074,759
Debt issue costs, net		(41,650	)		(42,643	)		(36,034	)		(37,370	)
	$	4,898,364		$	4,898,667		$	4,023,568		$	4,037,389

As of March 31, ~~2018,~~2019, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2018	$	—
2019		—	$	—
2020		—		—
2021		807,614		37,802
2022		816,200		760,900
2023				—
Thereafter		3,316,200		3,260,900
Total	$	4,940,014	$	4,059,602

On February 1, 2017, we replaced our previous unsecured credit facility (which we had entered into in 2014 and amended in 2015) with a new revolving credit and term loan agreement (“Credit Facility”). The new agreement included a $1.3 billion unsecured

revolving loan facility (same amount as the previous revolving loan facility), a $200 million unsecured term loan facility ($50 million lower than the previous term loan), and a new €200 million unsecured term loan facility.

~~On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020.~~

On March 24, 2017, we completed a €500 million senior unsecured notes offering (“3.325% Senior Unsecured Notes due 2025”). A portion of the proceeds from this offering were used to prepay and extinguish the €200 million term loan facility portion of our Credit Facility on March 30, 2017.

With the replacement of our old credit facility, the redemption of the 5.750% Senior Unsecured Notes due 2020, and the payoff of our €200 million euro term loan, we incurred a debt refinancing charge of approximately $14 million in the 2017 first quarter.

Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our revolving credit and term loan agreement (“Credit ~~Facility~~Facility”) limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations, as defined in the agreements, on a rolling four quarter basis. At March 31, ~~2018,~~2019, the dividend restriction was 95% of normalized adjusted funds from operations (“NAFFO”). The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness.

In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. ~~This~~The Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At March 31, ~~2018,~~2019, we were in compliance with all such financial and operating covenants.

In the 2019 first quarter, we sold 20.1 million shares of common stock under our at-the-market equity offering program, resulting in net proceeds of approximately $354 million.

We sold an additional 2.5 million shares of common stock under our at-the-market equity offering program subsequent to March 31, 2019, resulting in net proceeds of approximately $45 million.

At March 31, 2019, the Company has a 99.9% ownership interest in the Operating Partnership, with the remainder owned by two other partners, who are employees.

During the three months ended March 31, 2019, the Operating Partnership issued approximately 20.1 million units in direct response to the common stock at-the-market offerings by Medical Properties Trust, Inc. during the same period.

We adopted the 2013 Equity Incentive Plan (the “Equity Incentive Plan”) during the second quarter of 2013, 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. The Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 8,196,770 shares of common stock for awards under the Equity Incentive Plan. No shares remain available for future stock awards as of March 31, 2019. Share-based compensation expense totaled $6.7 million and $1.9 million for the three months ended March 31, 2019 and 2018, respectively.

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 ~~working capital~~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 loan 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 possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):

	As of						As of						As of						As of
	March 31, 2018						December 31, 2017						March 31, 2019						December 31, 2018
Asset (Liability)	Book Value			Fair Value			Book Value			Fair Value			Book Value			Fair Value			Book Value			Fair Value
Interest and rent receivables	$	81,965		$	81,009		$	78,970		$	78,028		$	24,788		$	23,925		$	25,855		$	24,942
Loans (1)		1,846,525			1,871,705			1,698,471			1,722,101
Loans(1)														1,465,182			1,552,687			1,471,520			1,490,758
Debt, net		(4,898,364	)		(4,968,232	)		(4,898,667	)		(5,073,707	)		(4,023,568	)		(4,170,310	)		(4,037,389	)		(3,947,795	)

Our ~~equity interest in~~ Ernest ~~along with their related~~mortgage loans are measured at fair value on a recurring basis as we elected to account for these investments using the fair value option ~~method.~~method in 2012 when we acquired an equity interest in and made an acquisition loan to Ernest. Such equity interest was sold and the acquisition loan was paid off in October 2018. We ~~have~~ elected to account for these investments at fair value due to

the size of the investments and because we believe this method iswas more reflective of current values. We have not made a similar election for other ~~currently~~investments existing ~~equity interests or loans.~~at March 31, 2019.

At March 31, ~~2018, these~~2019, the amounts recorded under the fair value option method were as follows (in thousands):

Asset Type	Fair Value		Original Cost		Asset Type Classification	Fair Value		Original Cost		Asset Type Classification
Mortgage loans	$	115,000	$	115,000	Mortgage loans	$	115,000	$	115,000	Mortgage loans
Equity investments and other loans		112,256		118,010	Other loans/other assets
	$	227,256	$	233,010

Our mortgage ~~and other~~ loans with Ernest are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investment in Ernest is recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecast assumptions associated with the investee. We classify the equity investment as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuation requires management judgment due to the absence of quoted market prices. For the cash flow model, our observable inputs include use of a capitalization rate, discount rate (which is based on a weighted average cost of capital), and market interest rates, and our unobservable input includes an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at March 31, 2018.

In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections are provided by Ernest. However, we will modify such projections (including underlying assumptions used) as needed based on our review and analysis of Ernest’s historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry.

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

~~Because~~During the ~~fair value~~first quarter of ~~the Ernest investments noted above is below our original cost,~~2018, we recognized an unrealized loss on our investment in Ernest. There was no gain or loss recorded during the first ~~quarter~~three months of ~~2018. No unrealized gain/loss on the Ernest investments was recorded in the first quarter of 2017.~~2019.

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

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
	2018			2017			2019			2018
Numerator:
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Non-controlling interests’ share in net income		(442	)		(215	)		(469	)		(442	)
Participating securities’ share in earnings		(195	)		(125	)		(476	)		(195	)
Net income, less participating securities’ share in earnings	$	90,406		$	67,845		$	75,346		$	90,406
Denominator:
Basic weighted-average common shares		364,882			321,057			380,551			364,882
Dilutive potential common shares		461			366			1,124			461
Dilutive weighted-average common shares		365,343			321,423			381,675			365,343

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

	For the Three Months Ended March 31,						For the Three Months Ended March 31,
	2018			2017			2019			2018
Numerator:
Net income	$	91,043		$	68,185		$	76,291		$	91,043
Non-controlling interests’ share in net income		(442	)		(215	)		(469	)		(442	)
Participating securities’ share in earnings		(195	)		(125	)		(476	)		(195	)
Net income, less participating securities’ share in earnings	$	90,406		$	67,845		$	75,346		$	90,406
Denominator:
Basic weighted-average units		364,882			321,057			380,551			364,882
Dilutive potential units		461			366			1,124			461
Diluted weighted-average units		365,343			321,423			381,675			365,343

On ~~September 28, 2016,~~January 31, 2019, we entered into definitive agreements to acquire a portfolio of eleven Australian hospitals currently operated by Healthscope Ltd. (“Healthscope”) for an ~~acute care hospital in Washington for a~~aggregate purchase price of ~~$17.5 million.~~approximately $859 million, of which approximately $36.4 million was paid into escrow on February 4, 2019. Upon closing, ~~the facility~~these facilities will be leased to ~~RCCH,~~Healthscope pursuant to ~~the current~~ master ~~lease.~~lease agreements that have an average initial term of 20 years with annual fixed escalations and multiple extension options. In a related transaction, Brookfield Business Partners L.P. together with its institutional partners (“Brookfield”) has agreed to acquire up to 100% of Healthscope’s outstanding shares. Closing of ~~this transaction,~~our acquisition, which is expected to be completed in ~~2018~~the second quarter of 2019, is subject to Healthscope shareholder approval, customary real estate and regulatory approvals, the successful completion of the Brookfield transactions, and other closing conditions. In April 2019, we entered into an Australian term loan commitment in the amount of $1.2 billion Australian dollars for which closing and funding is contingent on the successful completion of the Healthscope transaction.

We are a party to various legal proceedings incidental to our business. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to those proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

We have leased land on which certain of our facilities reside, along with corporate office and equipment. Our leases have remaining lease terms of 5.3 years to 42.5 years, some of which may include options to extend the leases up to, or just beyond, the depreciable life of the properties that occupy the leased land. Renewal options that we are reasonably certain to exercise are recognized in our right-of-use assets and lease liabilities. As most of our leases do not provide an implicit rate, we use our incremental borrowing rate based on the information available at lease commencement date in determining the present value of future payments.

Properties subject to ground leases are subleased to our tenants, except for three Adeptus transition properties.

Fixed minimum payments due over the remaining lease term under non-cancelable leases of more than one year and amounts to be received in the future from non-cancelable subleases over their remaining lease term at March 31, 2019 are as follows (amounts in thousands):

	Operating leases			Finance leases			Amounts to be received from subleases			Net payments
2019 (1)	$	4,598		$	93		$	(2,542	)	$	2,149
2020		6,437			125			(3,456	)		3,106
2021		6,606			126			(3,561	)		3,171
2022		6,750			128			(3,715	)		3,163
2023		6,815			129			(3,719	)		3,225
Thereafter		196,788			5,045			(95,320	)		106,513	(2)
Total undiscounted minimum lease payments	$	227,994		$	5,646		$	(112,313	)	$	121,327
Less: interest		(146,478	)		(3,717	)
Present value of lease liabilities	$	81,516		$	1,929

Supplemental balance sheet information is as follows (in thousands, except lease terms and discount rate):

On April 3, 2019, we closed on the acquisition of one acute care hospital in Poole, England for a purchase price of approximately £34.5 million. Upon closing, this facility was leased to BMI Healthcare, pursuant to an in-place lease with 14 years remaining on its term and fixed 2.5% annual escalators.

On April 11, 2019, we re-leased our Twelve Oaks facility to a new tenant, Advanced Diagnostics Health System, LLC, pursuant to a new 10-year lease, subject to four additional five-year extension options.

On April 12, 2019, we closed on the acquisition of one acute care hospital in Big Spring, Texas for a purchase price of $26 million. Upon closing, this facility was leased to Steward pursuant to the existing master lease agreement.

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.

The following discussion and analysis of the consolidated financial condition and consolidated results of operations are presented on a combined basis for Medical Properties Trust and MPT Operating Partnership, L.P. as there are no material differences between these two entities.

The following discussion and analysis of the consolidated financial condition and consolidated results of operations should be read together with the condensed consolidated financial statements and notes thereto contained in this Form 10-Q and the consolidated financial statements and notes thereto contained in our Annual Report on Form 10-K for the year ended December 31, ~~2017.~~2018.

This ~~report~~Quarterly Report on Form 10-Q contains certain “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Such forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause our actual results or future performance, achievements or transactions or events to be materially different from those expressed or implied by such forward-looking statements, including, but not limited to, the risks described in our Annual Report on Form 10-K and as updated in our ~~quarterly reports~~Quarterly Reports on Form 10-Q for future periods, and ~~current reports~~Current Reports on Form 8-K as we file them with the SEC under the Securities Exchange Act of 1934, as amended. Such factors include, among others, the following:

Our revenue is derived from rents we earn pursuant to the lease agreements with our tenants, from interest income from loans to our tenants and other facility owners and from profits or equity interests in real estate joint ventures and other investments including interest held in certain of our tenants’ operations. Our tenants operate in the healthcare industry, generally providing medical, surgical and rehabilitative care to patients. The capacity of our tenants to pay our rents and interest is dependent upon their ability to conduct their operations at profitable levels. We believe that the business environment of the industry segments in which our tenants operate is generally positive for efficient operators. However, our tenants’ operations are subject to economic, regulatory and market conditions that may affect their profitability, which could impact our results. Accordingly, we monitor certain key factors, changes to which we believe may provide early indications of conditions that may affect the level of risk in our portfolio.

Key factors that we consider in underwriting prospective tenants and borrowers and in monitoring the performance of existing tenants and borrowers include the following:

Certain business factors, in addition to those described above that directly affect our tenants and borrowers, will likely materially influence our future results of operations. These factors include:

Refer to our ~~2017~~2018 Annual Report on Form 10-K for a discussion of our critical accounting policies, which include revenue recognition, investments in real estate, purchase price allocation, loans, losses from rent and interest receivables, stock-based compensation, our fair value option election, and our accounting policy on consolidation. During the three months ended March 31, ~~2018,~~2019, there were no material changes to these ~~policies.~~policies except for those described in Note 2 to Item 1 of this Form 10-Q.

We are a self-advised ~~real estate investment trust (“REIT”)~~REIT focused on investing in and owning net-leased healthcare facilities across the U.S. and selectively in foreign jurisdictions. We have operated as a REIT since April 6, 2004, and accordingly, elected REIT status upon the filing of our calendar year 2004 federal income tax return. Medical Properties Trust, Inc. was incorporated under Maryland law on August 27, 2003, and MPT Operating Partnership, L.P. was formed under Delaware law on September 10, 2003. We conduct substantially all of our business through MPT Operating Partnership, L.P. We 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. We also make mortgage loans to healthcare operators collateralized by their real estate assets. In addition, we selectively make loans to certain of our operators through our taxable REIT subsidiaries, the proceeds of which are typically used for acquisitions and working capital. Finally, from time to time, we acquire a profits or other equity interest in our tenants that gives us a right to share in such tenant’s profits and losses.

At March 31, ~~2018,~~2019, our portfolio consisted of ~~274~~276 properties leased or loaned to 3129 operators, of which ~~two~~three are under development and 1510 are in the form of mortgage loans.

Our investments in healthcare real estate, including mortgage and other loans, as well as any equity investments in our tenants are considered a single reportable segment. ~~All~~At March 31, 2019, all of our investments are ~~currently~~ located in the U.S. and Europe. Our total assets are made up of the following (dollars in thousands):

	As of March 31, 2018		% of Total			As of December 31, 2017		% of Total			As of March 31, 2019		% of Total			As of December 31, 2018		% of Total
Real estate owned (gross)	$	6,518,188		72.2	%	$	6,595,252		73.1	%	$	5,976,400		64.7	%	$	5,868,340		66.4	%
Mortgage loans		1,927,393		21.3	%		1,778,316		19.7	%		1,214,780		13.2	%		1,213,322		13.7	%
Other loans		148,842		1.6	%		150,209		1.7	%		365,402		4.0	%		373,198		4.2	%
Construction in progress		35,122		0.4	%		47,695		0.5	%		102,239		1.1	%		84,172		1.0	%
Other assets		402,295		4.5	%		448,816		5.0	%		1,572,632		17.0	%		1,304,611		14.7	%
Total assets ~~(1)~~	$	9,031,840		100.0	%	$	9,020,288		100.0	%	$	9,231,453		100.0	%	$	8,843,643		100.0	%

~~The following~~ is ~~our revenue by operating type (dollar amounts~~as follows (dollars in thousands):

For the Three
Months Ended
March 31, 2018

% of
Total

For the Three
Months Ended
March 31, 2017

% of
Total

General Acute Care Hospitals (1)

$
145,797

71.1
%

$
107,126

68.5
%
Rehabilitation Hospitals

50,159

24.5
%

38,279

24.5
%
Long-term Acute Care Hospitals

9,090

4.4
%

10,992

7.0
%
Total revenues

$
205,046

100.0
%

$
156,397

100.0
%

	As of March 31, 2019					As of December 31, 2018
Operators	Total Pro Forma Gross Assets		Percentage of Total Pro Forma Gross Assets			Total Pro Forma Gross Assets		Percentage of Total Pro Forma Gross Assets
Steward	$	3,879,006		37.9	%	$	3,823,625		38.0	%
Prime		1,145,909		11.2	%		1,124,711		11.2	%
MEDIAN		1,041,121		10.2	%		1,075,504		10.7	%
Healthscope		858,569		8.4	%		858,569		8.5	%
Ernest		504,546		4.9	%		500,397		5.0	%
LifePoint		502,072		4.9	%		502,072		5.0	%
Other operators		1,745,797		16.9	%		1,644,900		16.3	%
Other assets		569,876		5.6	%		528,669		5.3	%
Total	$	10,246,896		100.0	%	$	10,058,447		100.0	%

	As of March 31, 2019					As of December 31, 2018
U.S. States and Other Countries	Total Pro Forma Gross Assets		Percentage of Total Pro Forma Gross Assets			Total Pro Forma Gross Assets		Percentage of Total Pro Forma Gross Assets
Massachusetts	$	1,476,887		14.4	%	$	1,469,423		14.6	%
Texas		1,195,752		11.7	%		1,126,217		11.2	%
Utah		1,057,519		10.3	%		1,054,539		10.5	%
California		522,750		5.1	%		522,753		5.2	%
Arizona		488,198		4.8	%		483,778		4.8	%
All other states		2,666,821		25.9	%		2,630,231		26.1	%
Other domestic assets		552,005		5.4	%		482,992		4.8	%
Total U.S.	$	7,959,932		77.6	%	$	7,769,933		77.2	%
Germany	$	1,132,936		11.1	%	$	1,164,973		11.6	%
Australia		858,569		8.4	%		858,569		8.5	%
United Kingdom, Italy, and Spain		277,588		2.7	%		219,295		2.2	%
Other international assets		17,871		0.2	%		45,677		0.5	%
Total international	$	2,286,964		22.4	%	$	2,288,514		22.8	%
Grand total	$	10,246,896		100.0	%	$	10,058,447		100.0	%

On an individual property basis, we had no investment in any single property greater than 3.6% of our total pro forma gross assets as of ~~May 4, 2018. We believe that any foreseeable increase~~March 31, 2019.

On an adjusted revenue basis (as defined in the ~~number~~“Reconciliation of ~~our employees will have only immaterial effects~~Non-GAAP Financial Measures” section of Item 2 of this Quarterly Report on ~~our operations~~Form 10-Q), concentration for the three months ended March 31, 2019 as compared to the prior year is as follows (dollars in thousands):

AdjustedRevenue by U.S. State and ~~general and administrative expenses. We believe that our relations with our employees are good. None of our employees are members of any labor union.~~Country

	For the Three Months Ended March 31,
	2019					2018
U.S. States and Other Countries	Total Adjusted Revenue		Percentage of Total Adjusted Revenue			Total Adjusted Revenue		Percentage of Total Adjusted Revenue
Massachusetts	$	34,036		17.1	%	$	26,940		13.1	%
Texas		27,231		13.7	%		30,355		14.8	%
Utah		21,591		10.9	%		20,871		10.2	%
California		15,822		8.0	%		16,666		8.1	%
Arizona		12,583		6.3	%		11,386		5.6	%
All other states		59,757		29.9	%		60,037		29.3	%
Total U.S.	$	171,020		85.9	%	$	166,255		81.1	%
Germany	$	24,175		12.2	%	$	37,665		18.4	%
United Kingdom, Italy, and Spain		3,808		1.9	%		1,126		0.5	%
Total international	$	27,983		14.1	%	$	38,791		18.9	%
Grand total	$	199,003		100.0	%	$	205,046		100.0	%

Net income for the three months ended March 31, ~~2018,~~2019, was ~~$90.6~~$75.8 million, compared to ~~$68.0~~$90.6 million for the three months ended March 31, ~~2017.~~2018. This ~~increase~~decrease is primarily due to ~~additional revenue from~~expected lower revenues as a result of property sales post the ~~Steward and MEDIAN investments that were made in 2017 and no debt refinancing charges in~~ 2018 ~~compared~~first quarter including 71 properties sold to ~~$13.6 million~~form the Primotop joint venture in the ~~2017 first~~2018 third quarter. This ~~increase~~decrease is partially offset by ~~increased interest expense~~additional revenue from ~~higher average outstanding debt balances to fund~~ new investments ~~in 2017, higher general and administrative costs~~post the 2018 first quarter along with additional straight-line rent revenue recorded from the ~~growth~~conversion of ~~our company, higher depreciation expenses from investments made subsequent~~Steward mortgage loans to ~~March 31, 2017, and a larger gain on disposition made during the first quarter of 2017.~~fee simple real estate throughout 2018. Funds from operations (“FFO”), after adjusting for certain items (as more fully described in Reconciliation of Non-GAAP Financial Measures), was ~~$131.5~~$117.8 million ~~or $0.36 per diluted share~~ for the ~~2018~~2019 first quarter as compared to ~~$105.9~~$131.5 million ~~or $0.33 per diluted share~~ for the ~~2017~~2018 first quarter. ~~This 24.2% increase~~Similar to net income, this decrease in FFO is primarily due to ~~the increase in~~lower revenue from ~~acquisitions and completed development projects made since~~the property sales post March ~~2017 (primarily our Steward investments).~~
31, 2018.

A comparison of revenues for the three month periods ended March 31, ~~2018~~2019 and ~~2017~~2018 is as follows (dollar amounts in thousands):

	2018		% of Total			2017		% of Total			Year over Year Change			2019		% of Total			2018		% of Total			Year over Year Change
Rent billed	$	128,011		62.4	%	$	96,763		61.9	%		32.3	%	$	108,598		60.2	%	$	128,011		62.4	%		-15.2	%
Straight-line rent		15,791		7.7	%		12,779		8.2	%		23.6	%		20,651		11.4	%		15,791		7.7	%		30.8	%
Income from direct financing leases		17,681		8.6	%		17,880		11.4	%		(1.1	)%		17,280		9.6	%		17,681		8.6	%		-2.3	%
Interest and fee income from loans		43,563		21.3	%		28,975		18.5	%		50.3	%
Interest and other income															33,925		18.8	%		43,563		21.3	%		-22.1	%
Total revenues	$	205,046		100.0	%	$	156,397		100.0	%		31.1	%	$	180,454		100.0	%	$	205,046		100.0	%		-12.0	%

Our total revenue for the ~~2018~~2019 first quarter is ~~up $48.6~~down $24.6 million, or ~~31.1%~~12%, over the prior year. This ~~increase~~decrease is made up of the following:

Interest expense for the quarters ended March 31, 2019 and 2018, ~~and 2017,~~ totaled ~~$57.0~~$50.6 million and ~~$38.0~~$57.0 million, respectively. This ~~increase~~decrease is primarily related to the ~~higher~~lower average revolving debt balance during the ~~2018~~2019 first quarter compared to the prior year first quarter in order to fund our 2017 acquisition activity and approximately $2 million relates to foreign currency fluctuation. The impact on interest expense is partially offset by slightly lower weighted average interest rates period over period due to certain refinancing activities in our debt during 2017. Our weighted-average interest rate was 4.4% for the three months ended March 31, 2018, as compared to 4.6% in the same period in 2017. See Note 4 to Item 1 of this Form 10-Q for a description of our refinancing activities in 2017 that lead to a $13.6 million refinancing charge in the 2017 first quarter.

~~General and administrative expenses totaled $17.8 million for the~~ 2018 first quarter ~~which is a $4.6 million increase~~as we paid down our revolver with proceeds from the prior year first quarter. As noted in Note 2 to Item 1 of this Form 10-Q, general and administrative expenses were higher in the 2018 first quarter by $1.6 million due to our adoption of ASU 2017-01. Excluding the $1.6 million of higher expense due to the accounting change, general and administrative expenses represented 7.9% of revenue in the 2018 first quarter, which was lower than 8.4% in 2017. On a dollar basis (exclusive of the accounting change impact), general and administrative expenses were up $3 million from the prior year first quarter due to travel and compensation expense, which are up as a result of the growth and expansion of our company.property sales post March 31, 2018.

Real estate depreciation and amortization during the first quarter of ~~2018 increased~~2019 decreased to $33.4 million from $35.8 million ~~from $27.6 million~~ in ~~2017,~~2018, due to the ~~incremental depreciation from the facilities acquired (particularly the Steward facilities acquired~~property sales in ~~the 2017 third quarter)~~2018, partially offset by new investments made and the ~~development properties completed in 2017~~conversion of the four Steward mortgage loans to fee simple assets.

Property-related expenses totaled $3.1 million and $2.2 million for the quarters ended March 31, 2019 and 2018, respectively. As noted above under the caption “Other income,” this increase was primarily due to the grossing up of certain expenses (such as ground lease, property taxes and insurance) as part of our implementation of the lease accounting standard on January 1, 2019.

General and administrative expenses totaled $23.5 million for the 2019 first quarter, ~~of 2018.~~

~~Acquisition costs decreased $2.8~~which is a $5.6 million increase from the prior ~~year.~~year first quarter. The ~~acquisition costs~~majority of the increase relates to stock compensation expense from our performance-based awards. Given our strong performance in ~~2017 primarily related to the MEDIAN transaction~~2018 with a total shareholder return of 25% along with ~~deals completed subsequent~~our current acquisition pipeline and expectations to ~~March 2017. Furthermore,~~close a substantial amount of acquisitions in ~~the 2018 first quarter, all third party transaction costs directly related to acquisitions were capitalized due to the adoption of ASU 2017-01 as noted previously.~~2019, we believe it is more likely that such performance awards will be earned and have adjusted our stock compensation expense accordingly.

During the three months ended March 31, 2018, we sold our St. Joseph’s property at a gain of $1.5 million. ~~Similarly,~~We have no dispositions in the ~~2017~~ first quarter ~~we sold one RCCH property resulting in a $7.4 million gain.~~of 2019. See Note 3 to Item 1 of this Form 10-Q for further details.

In the first quarter of 2018, we incurred other expense of $4.7 million, which included non-cash and unrealized fair value adjustments on our Ernest investments that were sold or repaid in October 2018. No similar fair value adjustments were recorded in the 2019 first quarter.

Income tax expense typically includes U.S. federal and state income taxes on our TRS entities, as well as non-U.S. income based or withholding taxes on certain investments located in jurisdictions outside the U.S. The $2.3 million income tax ~~expense~~benefit for the three months ended March 31, ~~2018, reflects an increase~~2019, represents the benefit from ~~prior year due to an increase~~straight-line rent and other write-offs on our TRS in the quarter. The benefit is partially offset by financial taxable income from our international investments. We utilize the asset and liability method of accounting for income taxes. Deferred tax assets are recorded to the extent we believe these assets will more likely than not be realized. In making such determination, all available positive and negative evidence is considered, including scheduled reversals of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. Based upon our review of all positive and negative evidence, including our three-year cumulative pre-tax book loss position in certain entities, we concluded that a full valuation allowance of $3 million should continue to be recorded against ~~the majority of our U.S. and~~ certain of our international net deferred tax assets at March 31, ~~2018.~~2019. In the future, if we determine that it is more likely than not that we will realize our net deferred tax assets, we will reverse the applicable portion of the valuation allowance, recognize an income tax benefit in the period in which such determination is made, and incur higher income taxes in future ~~periods.~~periods as income earned.

Investors and analysts following the real estate industry utilize funds from operations, or FFO, as a supplemental performance measure. FFO, reflecting the assumption that real estate asset values rise or fall with market conditions, principally adjusts for the effects of GAAP depreciation and amortization of real estate assets, which assumes that the value of real estate diminishes predictably over time. We compute FFO in accordance with the definition provided by the National Association of Real Estate Investment Trusts, or ~~NAREIT,~~Nareit, which represents net income (loss) (computed in accordance with GAAP), excluding gains (losses) on sales of real estate and impairment charges on real estate assets, plus real estate depreciation and amortization and after adjustments for unconsolidated partnerships and joint ventures.

In addition to presenting FFO in accordance with the ~~NAREIT~~Nareit definition, we also disclose normalized FFO, which adjusts FFO for items that relate to unanticipated or non-core events or activities or accounting changes that, if not noted, would make comparison to prior period results and market expectations less meaningful to investors and analysts.

We believe that the use of FFO, combined with the required GAAP presentations, improves the understanding of our operating results among investors and the use of normalized FFO makes comparisons of our operating results with prior periods and other companies more meaningful. While FFO and normalized FFO are relevant and widely used supplemental measures of operating and financial performance of REITs, they should not be viewed as a substitute measure of our operating performance since the measures do not reflect either depreciation and amortization costs or the level of capital expenditures and leasing costs necessary to maintain the operating performance of our properties, which can be significant economic costs that could materially impact our results of operations. FFO and normalized FFO should not be considered an alternative to net income (loss) (computed in accordance with GAAP) as indicators of our financial performance or to cash flow from operating activities (computed in accordance with GAAP) as an indicator of our liquidity.

The following table presents a reconciliation of net income attributable to MPT common stockholders to FFO for the three months ended March 31, ~~2018~~2019 and ~~2017~~2018 (in thousands, except per share data):

	For the Three Months Ended						For the Three Months Ended
	March 31, 2018			March 31, 2017			March 31, 2019			March 31, 2018
FFO information:
Net income attributable to MPT common stockholders	$	90,601		$	67,970		$	75,822		$	90,601
Participating securities’ share in earnings		(195	)		(125	)		(476	)		(195	)
Net income, less participating securities’ share in earnings	$	90,406		$	67,845		$	75,346		$	90,406
Depreciation and amortization		36,517			28,099			39,854			36,517
Gain on sale of real estate, net		(1,467	)		(7,413	)		-			(1,467	)
Funds from operations	$	125,456		$	88,531		$	115,200		$	125,456
Write-off of straight-line rent and other		6,059			1,117
Debt refinancing costs		—			13,629
Acquisition costs, net of tax benefit		—			2,645
Write-off of straight-line rent and other, net of tax benefit								2,596			6,059
Normalized funds from operations	$	131,515		$	105,922		$	117,796		$	131,515
Per diluted share data:
Net income, less participating securities’ share in earnings	$	0.25		$	0.21		$	0.20		$	0.25
Depreciation and amortization		0.09			0.09			0.10			0.09
Gain on sale of real estate, net		—			(0.02	)		—			—
Funds from operations	$	0.34		$	0.28		$	0.30		$	0.34
Write-off of straight-line rent and other		0.02			—
Debt refinancing costs		—			0.04
Acquisition costs, net of tax benefit		—			0.01
Write-off of straight-line rent and other, net of tax benefit								0.01			0.02
Normalized funds from operations	$	0.36		$	0.33		$	0.31		$	0.36

~~Gross~~Pro forma gross assets is total assets before accumulated depreciation/amortization (adjusted for our unconsolidated joint ventures) and assumes all real estate binding commitments on new investments and unfunded amounts on development deals and commenced capital improvement projects as of the applicable reporting periods are fully funded, ~~(see Note 7 of Item 1 on this Form 10-Q),~~ and assumes cash on hand is ~~fully~~ used in these transactions. We believe ~~total~~pro forma gross assets is useful to investors as it provides a more current view of our portfolio and allows for a better understanding of our concentration levels as our binding commitments close and our other commitments are fully funded. The following table presents a reconciliation of total assets to ~~total~~pro forma gross assets (in thousands):

	As of			As of			As of			As of
	March 31, 2018			December 31, 2017			March 31, 2019			December 31, 2018
Total Assets	$	9,031,840		$	9,020,288
Total assets							$	9,231,453		$	8,843,643
Add:
Binding real estate commitments on new investments(1)		17,500			17,500			929,964			865,165
Unfunded amounts on development deals and commenced capital improvement projects(2)		139,799			154,184			214,722			229,979
Accumulated depreciation and amortization		493,782			455,712			498,915			464,984
Incremental gross assets of our joint ventures(3)								367,390			375,544
Less:
Cash and cash equivalents		(138,314	)		(171,472	)		(995,548	)		(720,868	)
Total Gross Assets	$	9,544,607		$	9,476,212
Total pro forma gross assets							$	10,246,896		$	10,058,447

Adjusted revenue is total revenues adjusted for our pro rata portion of similar revenues in our joint venture arrangements. We believe adjusted revenue is useful to investors as it provides a more complete view of revenue across all of our investments and allows for better understanding of our revenue concentration. The following table presents a reconciliation of total revenues to total adjusted revenue (in thousands):

During the 2019 first quarter, we generated $86.9 million of cash flows from operating activities, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cash on-hand to fund our dividends of $95.4 million and certain investing activities including an initial deposit on the Healthscope acquisition discussed in Note 9, development costs on our construction projects and improvements to certain of our corporate assets.

In anticipation of future acquisitions in 2019, we sold 20.1 million shares of common stock under our at-the-market equity program in the first quarter generating net proceeds of approximately $354 million. Furthermore, in April 2019, we entered into a $1.2 billion Australian dollar term loan commitment that will close and fund once shareholder approval of the Healthscope acquisition is received.

During the 2018 first quarter, we generated $94.8 million of cash flows from operating activities, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cash on-hand to fund our dividends of $89.4 million and certain investing and financing activities (including a $33.6 million reduction in our revolving credit facility).

During the 2017 first quarter, we generated $64.3 million of cash flows from operating activities, primarily consisting of rent and interest from mortgage and other loans. We used these operating cash flows along with cash on-hand to fund our dividends of $74.5 million and certain investing activities.

As of March 31, ~~2018,~~2019, we have no debt principal payments due in the next twelve months — see debt maturity schedule below. At May ~~4, 2018,~~3, 2019, our availability under our revolving credit facility plus cash on-hand approximated ~~$0.6~~$2 billion. We believe this liquidity along with our current monthly cash receipts from rent and loan interest, ~~and~~quarterly distributions from our joint venture arrangements, availability under our at-the-market equity program, and expected proceeds from the Australian term loan commitment is sufficient to fund our operations, debt and interest obligations, our firm commitments (including expected funding requirements on our development projects), our $2.5 billion acquisition goal (including our commitment to acquire 11 properties in Australia for approximately $860 million), and dividends in order to comply with REIT requirements for the next twelve months.

We expect to lower our outstanding borrowings on our revolving credit facility, improve our leverage metrics, and reduce our tenant concentration in Steward during 2018. We expect to accomplish this by entering into joint venture arrangements, and/or completing strategic property sales, among other alternatives. However, no assurance can be made that such transactions will be available to us or that our plans will be successful.

As of March 31, ~~2018,~~2019, we have no debt principal payments due between now and January 2021 when our revolving credit facility comes due (which can be extended by one year). With our liquidity at May ~~4, 2018~~3, 2019 of approximately ~~$0.6~~$2 billion, along with our current monthly cash receipts from rent and loan interest, ~~and the~~quarterly distributions from our joint venture arrangements, availability under our at-the-market equity program and expected proceeds from the Australian term loan commitment, we believe we have the liquidity available to us to fund our operations, debt and interest obligations, dividends in order to comply with REIT requirements, ~~and~~ firm commitments (including expected funding requirements on our development projects) ~~for~~and our 2019 acquisition goal of $2.5 billion (including our commitment to acquire the ~~foreseeable future.~~Australian portfolio).

However, our acquisition pipeline is robust, so in order to fund acquisitions above our ~~investment strategies~~$2.5 billion goal for 2019 and beyond and to fund debt maturities coming due in later years, we will need additional capital, and we believe the following sources ~~of capital~~ are generally available in the market and we may access one or a combination of them:

However, there is no assurance that conditions will be favorable for such possible transactions or that our plans will be successful.

As of March 31, ~~2018,~~2019, principal payments due on our debt (which excludes the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands):

2018	$	—
2019		—	$	—
2020		—		—
2021		807,614		37,802
2022		816,200		760,900
2023				—
Thereafter		3,316,200		3,260,900
Total	$	4,940,014	$	4,059,602

We presented our contractual obligations in our Annual Report on Form 10-K for the fiscal year ended December 31, ~~2017.~~2018. Except for changes to our ~~operating lease commitments,~~purchase obligations, there have been no other significant changes ~~in those obligations~~ during the three months ended March 31, ~~2018.~~2019.

The following table updates our contractual obligations schedule for updates to our ~~operating lease commitments~~purchase obligations (in thousands):

Contractual Obligations

Less Than

1 Year

1-3 Years

3-5 Years

After

5 Years

Total

Less Than

1 Year

1-3 Years

3-5 Years

After

5 Years

Total

Operating lease commitments (1)

6,612

14,337

14,848

120,396

156,193

Purchase obligations(1)

1,161,935

44,353

—

1,206,288

The table below is a summary of our distributions declared during the two year period ended March 31, ~~2018:~~2019:

Declaration Date

Record Date

Date of Distribution

Distribution per Share

Record Date

Date of Distribution

Distribution per Share

February 14, 2019

March 14, 2019

April 11, 2019

0.25

November 15, 2018

December 13, 2018

January 10, 2019

0.25

August 16, 2018

September 13, 2018

October 11, 2018

0.25

May 24, 2018

June 14, 2018

July 12, 2018

0.25

February 15, 2018

March 15, 2018

April 12, 2018

0.25

March 15, 2018

April 12, 2018

0.25

November 9, 2017

December 7, 2017

January 11, 2018

0.24

December 7, 2017

January 11, 2018

0.24

August 17, 2017

September 14, 2017

October 12, 2017

0.24

September 14, 2017

October 12, 2017

0.24

May 25, 2017

June 15, 2017

July 14, 2017

0.24

June 15, 2017

July 14, 2017

0.24

February 16, 2017

March 16, 2017

April 13, 2017

0.24

November 10, 2016

December 8, 2016

January 12, 2017

0.23

August 18, 2016

September 15, 2016

October 13, 2016

0.23

May 19, 2016

June 16, 2016

July 14, 2016

0.23

We intend to pay to our stockholders, within the time periods prescribed by the Internal Revenue Code (“Code”), all or substantially all of our annual taxable income, including taxable gains from the sale of real estate and recognized gains on the sale of securities. It is our policy to make sufficient cash distributions to stockholders in order for us to maintain our status as a REIT under the Code and to avoid corporate income and excise taxes on undistributed income. However, our Credit Facility limits the amount of dividends we can pay - see Note 4 in Item 1 to this Form 10-Q for further information.

Market risk includes risks that arise from changes in interest rates, foreign currency exchange rates, commodity prices, equity prices and other market changes that affect market sensitive instruments. We seek to mitigate the effects of fluctuations in interest rates by matching the terms of new investments with new long-term fixed rate borrowings to the extent possible. We may or may not elect to use financial derivative instruments to hedge interest rate or foreign currency exposure. For interest rate hedging, these decisions are principally based on our policy to match ~~our variable rate~~ investments with comparable borrowings, but are also based on the general trend in interest rates at the applicable dates and our perception of the future volatility of interest rates. For foreign currency hedging, these decisions are principally based on how our investments are financed, the long-term nature of our investments, the need to repatriate earnings back to the U.S. and the general trend in foreign currency exchange rates.

In addition, the value of our facilities will be subject to fluctuations based on changes in local and regional economic conditions and changes in the ability of our tenants to generate profits, all of which may affect our ability to refinance our debt, if necessary. The changes in the value of our facilities would be impacted also by changes in “cap” rates, which is measured by the current base rent divided by the current market value of a facility.

Our primary exposure to market risks relates to fluctuations in interest rates and foreign currency. The following analyses present the sensitivity of the market value, earnings and cash flows of our significant financial instruments to hypothetical changes in interest rates and exchange rates as if these changes had occurred. The hypothetical changes chosen for these analyses reflect our view of changes that are reasonably possible over a one-year period. These forward looking disclosures are selective in nature and only address the potential impact from these hypothetical changes. They do not include other potential effects which could impact our business as a result of changes in market conditions. In addition, they do not include measures we may take to minimize our exposure such as entering into future interest rate swaps to hedge against interest rate increases on our variable rate debt.

For fixed rate debt, interest rate changes affect the fair market value but do not impact net income to common stockholders or cash flows. Conversely, for floating rate debt, interest rate changes generally do not affect the fair market value but do impact net income to common stockholders and cash flows, assuming other factors are held constant. At March 31, ~~2018,~~2019, our outstanding debt totaled ~~$4.9~~$4.0 billion, which consisted of fixed-rate debt of approximately ~~$3.9~~$3.8 billion and variable rate debt of ~~$1.0~~$0.2 billion. If market

interest rates increase by 1%, the fair value of our debt at March 31, ~~2018~~2019 would decrease by ~~$10.5~~$6.5 million. Changes in the fair value of our fixed rate debt will not have any impact on us unless we decided to repurchase the debt in the open market.

If market rates of interest on our variable rate debt increase by 1%, the increase in annual interest expense on our variable rate debt would decrease future earnings and cash flows by ~~$0.3~~$0.1 million per year. If market rates of interest on our variable rate debt decrease by 1%, the decrease in interest expense on our variable rate debt would increase future earnings and cash flows by ~~$0.3~~$0.1 million per year. This assumes that the average amount outstanding under our variable rate debt for a year is ~~$1.0~~$0.2 billion, the balance of such variable rate debt at March 31, ~~2018.~~2019.

With our investments in Germany, the United Kingdom, Spain, and Italy, we are subject to fluctuations in the euro and British pound to U.S. dollar currency exchange rates. Increases or decreases in the value of the euro to U.S. dollar and the British pound to U.S. dollar exchange rates may impact our financial condition and/or our results of operations. Based solely on operating results to-date in ~~2018~~2019 and on an annualized basis, if the euro exchange rate were to change by 5%, our net income and FFO would change by approximately ~~$5.2 million.~~$0.2 million and $1.4 million, respectively. Based solely on operating results to-date in ~~2018~~2019 and on an annualized basis, if the British pound exchange rate were to change by 5%, our net income and FFO would change by ~~less than~~approximately $0.1 million and $0.2 ~~million.~~million, respectively.

We have adopted and maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our reports under the Securities Exchange Act of 1934, as amended, is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow for timely decisions regarding required disclosure. In designing and evaluating the disclosure controls and procedures, management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, and management is required to apply its judgment in evaluating the cost-benefit relationship of possible controls and procedures.

As required by Rule 13a-15(b), under the Securities Exchange Act of 1934, as amended, we have carried out an evaluation, under the supervision and with the participation of management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as of the end of the quarter covered by this report. Based on the foregoing, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective in providing reasonable assurance that information required to be disclosed by us in the reports that we file under the Securities Exchange Act of 1934 is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms.

There has been no change in our internal control over financial reporting during our most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

The information contained in Note ~~7 “Contingencies”~~9 “Commitments and Contingencies” of Part I, Item 1 of this Quarterly Report on Form 10-Q is incorporated by reference into this Item 1.

There have been no material changes to the Risk Factors as presented in our Annual Report on Form 10-K for the year ended December 31, ~~2017.~~2018.

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.


Large accelerated filer	☒ (Medical Properties Trust, Inc. only)	Accelerated filer	☐
Non-accelerated filer	☒ (MPT Operating Partnership, L.P. only)	Smaller reporting company	☐
	~~(Do not check if a smaller reporting company)~~	Emerging growth company	☐

Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Common stock, par value $0.001	MPW	The New York Stock Exchange

	Page
PART I — FINANCIAL INFORMATION	3
Item 1 Financial Statements	3
Medical Properties Trust, Inc. and Subsidiaries
Condensed Consolidated Balance Sheets at March 31, ~~2018~~2019 and December 31, ~~2017~~2018	3
Condensed Consolidated Statements of Net Income for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	4
Condensed Consolidated Statements of Comprehensive Income for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	5
Condensed Consolidated Statements of Equity for the Three Months Ended March 31, 2019 and 2018	6
Condensed Consolidated Statements of Cash Flows for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	67
MPT Operating Partnership, L.P. and Subsidiaries
Condensed Consolidated Balance Sheets at March 31, ~~2018~~2019 and December 31, ~~2017~~2018	78
Condensed Consolidated Statements of Net Income for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	89
Condensed Consolidated Statements of Comprehensive Income for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	910
Condensed Consolidated Statements of Capital for the Three Months Ended March 31, 2019 and 2018	11
Condensed Consolidated Statements of Cash Flows for the ~~three months ended~~Three Months Ended March 31, ~~2018~~2019 and ~~2017~~2018	1012
Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.
Notes to Condensed Consolidated Financial Statements	1113
Item 2 Management’s Discussion and Analysis of Financial Condition and Results of Operations	2022
Item 3 Quantitative and Qualitative Disclosures about Market Risk	2731
Item 4 Controls and Procedures	2832
PART II — OTHER INFORMATION	2933
Item 1 Legal Proceedings	2933
Item 1A Risk Factors	2933
Item 2 Unregistered Sales of Equity Securities and Use of Proceeds	2933
Item 3 Defaults Upon Senior Securities	2933
Item 4 Mine Safety Disclosures	2933
Item 5 Other Information	2933
Item 6 Exhibits	3034
SIGNATURE	31
	35

	Total Under Operating Leases		Total Under DFLs		Total
2019 (nine months only)	$	329,487	$	48,491	$	377,978
2020		438,596		66,008		504,604
2021		447,232		67,388		514,620
2022		452,173		68,796		520,969
2023		459,222		70,232		529,454
Thereafter		9,636,734		1,550,857		11,187,591
	$	11,763,444	$	1,871,772	$	13,635,216

	As of March 31, 2018		As of December 31, 2017
Mortgage loans	$	1,927,393	$	1,778,316
Acquisition loans		117,627		118,448
Working capital and other loans		31,215		31,761
	$	2,076,235	$	1,928,525

	As of March 31, 2018					As of December 31, 2017
Operators	Total Gross Assets		Percentage of Total Gross Assets			Total Gross Assets		Percentage of Total Gross Assets
Steward (1)	$	3,459,275		36.2	%	$	3,457,384		36.5	%
MEDIAN		1,261,991		13.2	%		1,229,325		13.0	%
Prime		1,120,737		11.7	%		1,119,484		11.8	%
Ernest		612,112		6.4	%		629,161		6.6	%
RCCH		506,265		5.3	%		506,265		5.3	%
Other operators		2,118,132		22.3	%		2,089,934		22.1	%
Other assets		466,095		4.9	%		444,659		4.7	%
Total	$	9,544,607		100.0	%	$	9,476,212		100.0	%

	Classification	Three Months Ended March 31, 2019
Operating lease cost (1)	(2)	$	2,096
Finance lease cost:
Amortization of right-of-use assets	Real estate depreciation and amortization		13
Interest on lease liabilities	Interest expense		21
Sublease income	Interest and other income		(900	)
Total lease cost		$	1,230

	Classification	March 31, 2019
Right of use assets:
Operating leases - real estate	Land, buildings and improvements, intangible lease assets, and other	$	64,995
Finance leases - real estate	Land, buildings and improvements, intangible lease assets, and other		1,939
Real estate right of use assets, net			66,934
Operating leases - corporate	Other assets		11,419
Total right of use assets, net		$	78,353

Lease liabilities:
Operating leases	Obligations to tenants and other lease liabilities	$	81,516
Financing leases	Obligations to tenants and other lease liabilities		1,929
Total lease liabilities		$	83,445

Weighted average remaining lease term:
Operating leases			32.2
Finance leases			37.7
Weighted average discount rate:
Operating leases			6.3	%
Finance leases			6.6	%

	Three Months Ended March 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	1,459
Operating cash flows from finance leases		10
Financing cash flows from finance leases		21
Right-of-use assets obtained in exchange for lease obligations:
Operating leases		1,042
Finance leases		—

	For the Three Months Ended March 31, 2019		For the Three Months Ended March 31, 2018
Total revenues	$	180,454	$	205,046
Revenue from properties owned through joint venture arrangements		18,549		—
Total adjusted revenue	$	199,003	$	205,046

Exhibit Number		Description

31.1*		Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)

31.2*		Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)

31.3*		Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)

31.4*		Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)

32.1**		Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (Medical Properties Trust, Inc.)

32.2**		Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (MPT Operating Partnership, L.P.)

Exhibit 101.INS		XBRL Instance Document

Exhibit 101.SCH		XBRL Taxonomy Extension Schema Document

Exhibit 101.CAL		XBRL Taxonomy Extension Calculation Linkbase Document

Exhibit 101.DEF		XBRL Taxonomy Extension Definition Linkbase Document

Exhibit 101.LAB		XBRL Taxonomy Extension Label Linkbase Document

Exhibit 101.PRE		XBRL Taxonomy Extension Presentation Linkbase Document

MEDICAL PROPERTIES TRUST, INC.

By:		/s/ J. Kevin Hanna
		J. Kevin Hanna
		Vice President, Controller, Assistant Treasurer, and Chief Accounting Officer (Principal Accounting Officer)

MPT OPERATING PARTNERSHIP, L.P.

By:		/s/ J. Kevin Hanna
		J. Kevin Hanna
		Vice President, Controller, Assistant Treasurer, and Chief Accounting Officer of the sole member of the general partner of MPT Operating Partnership, L.P. (Principal Accounting Officer)