Document and Entity Information
Document and Entity Information - shares shares in Millions | 3 Months Ended | |
Mar. 31, 2023 | May 05, 2023 | |
Document Information [Line Items] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2023 | |
Document Fiscal Year Focus | 2023 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | MPW | |
Entity Registrant Name | MEDICAL PROPERTIES TRUST, INC. | |
Entity Central Index Key | 0001287865 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Common Stock, Shares Outstanding | 598.3 | |
Title of 12(b) Security | Common stock, par value $0.001 per share, of Medical Properties Trust, Inc. | |
Security Exchange Name | NYSE | |
Entity Shell Company | false | |
Entity File Number | 001-32559 | |
Entity Tax Identification Number | 20-0191742 | |
Entity Address, Address Line One | 1000 URBAN CENTER DRIVE | |
Entity Address, Address Line Two | SUITE 501 | |
Entity Address, City or Town | BIRMINGHAM | |
Entity Address, State or Province | AL | |
Entity Address, Postal Zip Code | 35242 | |
City Area Code | 205 | |
Local Phone Number | 969-3755 | |
Entity Incorporation, State or Country Code | MD | |
Document Quarterly Report | true | |
Document Transition Report | false | |
MPT Operating Partnership, L.P. [Member] | ||
Document Information [Line Items] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2023 | |
Document Fiscal Year Focus | 2023 | |
Document Fiscal Period Focus | Q1 | |
Entity Registrant Name | MPT OPERATING PARTNERSHIP, L.P. | |
Entity Central Index Key | 0001524607 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Non-accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity File Number | 333-177186 | |
Entity Tax Identification Number | 20-0242069 | |
Entity Address, Address Line One | 1000 URBAN CENTER DRIVE | |
Entity Address, Address Line Two | SUITE 501 | |
Entity Address, City or Town | BIRMINGHAM | |
Entity Address, State or Province | AL | |
Entity Address, Postal Zip Code | 35242 | |
City Area Code | 205 | |
Local Phone Number | 969-3755 | |
Entity Incorporation, State or Country Code | DE |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Real estate assets | ||
Land, buildings and improvements, intangible lease assets, and other | $ 13,092,510 | $ 13,862,415 |
Investment in financing leases | 1,582,416 | 1,691,323 |
Real estate held for sale | 881,587 | |
Mortgage loans | 346,446 | 364,101 |
Gross investment in real estate assets | 15,902,959 | 15,917,839 |
Accumulated depreciation and amortization | (1,207,699) | (1,193,312) |
Net investment in real estate assets | 14,695,260 | 14,724,527 |
Cash and cash equivalents | 302,321 | 235,668 |
Interest and rent receivables, net | 169,511 | 167,035 |
Straight-line rent receivables | 810,911 | 787,166 |
Investments in unconsolidated real estate joint ventures | 1,506,474 | 1,497,903 |
Investments in unconsolidated operating entities | 1,310,460 | 1,444,872 |
Other loans | 276,367 | 227,839 |
Other assets | 578,853 | 572,990 |
Total Assets | 19,650,157 | 19,658,000 |
Liabilities | ||
Debt, net | 10,438,151 | 10,268,412 |
Accounts payable and accrued expenses | 595,269 | 621,324 |
Deferred revenue | 29,391 | 27,727 |
Obligations to tenants and other lease liabilities | 144,092 | 146,130 |
Total Liabilities | 11,206,903 | 11,063,593 |
Equity / Capital | ||
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding | ||
Common stock, $0.001 par value. Authorized 750,000 shares; issued and outstanding - 598,302 shares at March 31, 2023 and 597,476 shares at December 31, 2022 | 598 | 597 |
Additional paid-in capital | 8,541,414 | 8,535,140 |
Retained (deficit) earnings | (25,413) | 116,285 |
Accumulated other comprehensive loss | (74,919) | (59,184) |
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital) | 8,441,680 | 8,592,838 |
Non-controlling interests | 1,574 | 1,569 |
Total Equity / Capital | 8,443,254 | 8,594,407 |
Total Liabilities and Equity / Capital | 19,650,157 | 19,658,000 |
MPT Operating Partnership, L.P. [Member] | ||
Real estate assets | ||
Land, buildings and improvements, intangible lease assets, and other | 13,092,510 | 13,862,415 |
Investment in financing leases | 1,582,416 | 1,691,323 |
Real estate held for sale | 881,587 | |
Mortgage loans | 346,446 | 364,101 |
Gross investment in real estate assets | 15,902,959 | 15,917,839 |
Accumulated depreciation and amortization | (1,207,699) | (1,193,312) |
Net investment in real estate assets | 14,695,260 | 14,724,527 |
Cash and cash equivalents | 302,321 | 235,668 |
Interest and rent receivables, net | 169,511 | 167,035 |
Straight-line rent receivables | 810,911 | 787,166 |
Investments in unconsolidated real estate joint ventures | 1,506,474 | 1,497,903 |
Investments in unconsolidated operating entities | 1,310,460 | 1,444,872 |
Other loans | 276,367 | 227,839 |
Other assets | 578,853 | 572,990 |
Total Assets | 19,650,157 | 19,658,000 |
Liabilities | ||
Debt, net | 10,438,151 | 10,268,412 |
Accounts payable and accrued expenses | 420,387 | 444,354 |
Deferred revenue | 29,391 | 27,727 |
Obligations to tenants and other lease liabilities | 144,092 | 146,130 |
Payable due to Medical Properties Trust, Inc. | 174,492 | 176,580 |
Total Liabilities | 11,206,513 | 11,063,203 |
Equity / Capital | ||
General Partner - issued and outstanding - [ ] units at March 31, 2023 and 5,976 units at December 31, 2022 | 85,244 | 86,599 |
Limited Partners - issued and outstanding - xxx,xxx units at March 31, 2023 and 591,500 units at December 31, 2022 | 8,431,745 | 8,565,813 |
Accumulated other comprehensive loss | (74,919) | (59,184) |
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital) | 8,442,070 | 8,593,228 |
Non-controlling interests | 1,574 | 1,569 |
Total Equity / Capital | 8,443,644 | 8,594,797 |
Total Liabilities and Equity / Capital | $ 19,650,157 | $ 19,658,000 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | Mar. 31, 2023 | Dec. 31, 2022 |
Preferred stock, par value | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized | 10,000,000 | 10,000,000 |
Preferred stock, shares outstanding | 0 | 0 |
Common stock, par value | $ 0.001 | $ 0.001 |
Common stock, shares authorized | 750,000,000 | 750,000,000 |
Common stock, shares issued | 598,302,000 | 597,476,000 |
Common stock, shares outstanding | 598,302,000 | 597,476,000 |
General Partner [Member] | MPT Operating Partnership, L.P. [Member] | ||
General partner, units issued | 5,984,000 | 5,976,000 |
General partner, units outstanding | 5,984,000 | 5,976,000 |
Common Units | MPT Operating Partnership, L.P. [Member] | ||
Limited Partners, units issued | 592,318,000 | 591,500,000 |
Limited Partners, units outstanding | 592,318,000 | 591,500,000 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Revenues | ||
Rent billed | $ 248,157 | $ 263,402 |
Straight-line rent | 56,693 | 61,044 |
Income from financing leases | 13,195 | 51,776 |
Interest and other income | 32,166 | 33,578 |
Total revenues | 350,211 | 409,800 |
Expenses | ||
Interest | 97,654 | 91,183 |
Real estate depreciation and amortization | 83,860 | 85,316 |
Property-related | 7,110 | 8,598 |
General and administrative | 41,724 | 41,424 |
Total expenses | 230,348 | 226,521 |
Other (expense) income | ||
Gain on sale of real estate | 62 | 451,638 |
Real estate and other impairment charges | (89,538) | (4,875) |
Earnings from equity interests | 11,352 | 7,338 |
Debt refinancing and unutilized financing costs | (8,816) | |
Other (including fair value adjustments on securities) | (5,166) | 14,762 |
Total other (expense) income | (83,290) | 460,047 |
Income before income tax | 36,573 | 643,326 |
Income tax expense | (3,543) | (11,379) |
Net income | 33,030 | 631,947 |
Net income attributable to non-controlling interests | (236) | (266) |
Net income attributable to MPT common stockholders (Operating Partnership partners) | $ 32,794 | $ 631,681 |
Earnings per common share (units) basic | ||
Net income attributable to MPT common stockholders (Operating Partnership partners), basic | $ 0.05 | $ 1.05 |
Earnings per common share (units) diluted | ||
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted | $ 0.05 | $ 1.05 |
Weighted average shares (units) outstanding basic | 598,302 | 598,676 |
Weighted average shares (units) outstanding diluted | 598,310 | 598,932 |
Dividends declared per common share (unit) | $ 0.29 | $ 0.29 |
MPT Operating Partnership, L.P. [Member] | ||
Revenues | ||
Rent billed | $ 248,157 | $ 263,402 |
Straight-line rent | 56,693 | 61,044 |
Income from financing leases | 13,195 | 51,776 |
Interest and other income | 32,166 | 33,578 |
Total revenues | 350,211 | 409,800 |
Expenses | ||
Interest | 97,654 | 91,183 |
Real estate depreciation and amortization | 83,860 | 85,316 |
Property-related | 7,110 | 8,598 |
General and administrative | 41,724 | 41,424 |
Total expenses | 230,348 | 226,521 |
Other (expense) income | ||
Gain on sale of real estate | 62 | 451,638 |
Real estate and other impairment charges | (89,538) | (4,875) |
Earnings from equity interests | 11,352 | 7,338 |
Debt refinancing and unutilized financing costs | (8,816) | |
Other (including fair value adjustments on securities) | (5,166) | 14,762 |
Total other (expense) income | (83,290) | 460,047 |
Income before income tax | 36,573 | 643,326 |
Income tax expense | (3,543) | (11,379) |
Net income | 33,030 | 631,947 |
Net income attributable to non-controlling interests | (236) | (266) |
Net income attributable to MPT common stockholders (Operating Partnership partners) | $ 32,794 | $ 631,681 |
Earnings per common share (units) basic | ||
Net income attributable to MPT common stockholders (Operating Partnership partners), basic | $ 0.05 | $ 1.05 |
Earnings per common share (units) diluted | ||
Net income attributable to MPT common stockholders (Operating Partnership partners), diluted | $ 0.05 | $ 1.05 |
Weighted average shares (units) outstanding basic | 598,302 | 598,676 |
Weighted average shares (units) outstanding diluted | 598,310 | 598,932 |
Dividends declared per common share (unit) | $ 0.29 | $ 0.29 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Net income | $ 33,030 | $ 631,947 |
Other comprehensive income: | ||
Unrealized (loss) gain on interest rate swaps, net of tax | (15,325) | 44,932 |
Foreign currency translation gain (loss) | 28,143 | (13,215) |
Reclassification of interest rate swap gain from AOCI, net of tax | (28,553) | |
Total comprehensive income | 17,295 | 663,664 |
Comprehensive income attributable to non-controlling interests | (236) | (266) |
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners) | 17,059 | 663,398 |
MPT Operating Partnership, L.P. [Member] | ||
Net income | 33,030 | 631,947 |
Other comprehensive income: | ||
Unrealized (loss) gain on interest rate swaps, net of tax | (15,325) | 44,932 |
Foreign currency translation gain (loss) | 28,143 | (13,215) |
Reclassification of interest rate swap gain from AOCI, net of tax | (28,553) | |
Total comprehensive income | 17,295 | 663,664 |
Comprehensive income attributable to non-controlling interests | (236) | (266) |
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners) | $ 17,059 | $ 663,398 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Equity / Capital - USD ($) shares in Thousands, $ in Thousands | Total | MPT Operating Partnership, L.P. [Member] | MPT Operating Partnership, L.P. [Member] General Partner [Member] | MPT Operating Partnership, L.P. [Member] Limited Partner [Member] | Common Par Value [Member] | Common Par Value [Member] MPT Operating Partnership, L.P. [Member] Limited Partner [Member] | Additional Paid-in Capital [Member] | Retained Earnings (Deficit) [Member] | Accumulated Other Comprehensive Loss [Member] | Accumulated Other Comprehensive Loss [Member] MPT Operating Partnership, L.P. [Member] | Non-Controlling Interests [Member] | Non-Controlling Interests [Member] MPT Operating Partnership, L.P. [Member] |
Beginning balance at Dec. 31, 2021 | $ 8,445,671 | $ 8,446,061 | $ 84,847 | $ 597 | $ 8,392,458 | $ 8,564,009 | $ (87,691) | $ (36,727) | $ (36,727) | $ 5,483 | $ 5,483 | |
Beginning balance (in shares) at Dec. 31, 2021 | 5,968 | 596,748 | 590,780 | |||||||||
Net income | 631,947 | 631,947 | $ 6,317 | $ 625,364 | 631,681 | 266 | 266 | |||||
Unrealized gain (loss) on interest rate swap, net of tax | 44,932 | 44,932 | 44,932 | 44,932 | ||||||||
Foreign currency translation (loss) gain | (13,215) | (13,215) | (13,215) | (13,215) | ||||||||
Stock (Unit) vesting and amortization of stock (unit)-based compensation | 11,804 | 11,804 | $ 118 | $ 3 | $ 11,686 | 11,801 | ||||||
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares) | 31 | 3,107 | 3,076 | |||||||||
Issuance of non-controlling interests | 929 | 929 | 929 | 929 | ||||||||
Stock vesting - satisfaction of tax withholding | (27,919) | (27,919) | $ (279) | $ 1 | $ (27,640) | (27,918) | ||||||
Stock vesting - satisfaction of tax withholding (Shares) | (12) | (1,179) | (1,167) | |||||||||
Distributions to non-controlling interests | (772) | (772) | (772) | (772) | ||||||||
Dividends (Distributions) declared | (174,018) | (174,018) | $ (1,740) | $ (172,278) | (174,018) | |||||||
Ending balance at Mar. 31, 2022 | 8,919,359 | 8,919,749 | $ 89,263 | $ 599 | $ 8,829,590 | 8,547,892 | 369,972 | (5,010) | (5,010) | 5,906 | 5,906 | |
Ending balance (in shares) at Mar. 31, 2022 | 5,987 | 598,676 | 592,689 | |||||||||
Beginning balance at Dec. 31, 2022 | 8,594,407 | 8,594,797 | $ 86,599 | $ 597 | $ 8,565,813 | 8,535,140 | 116,285 | (59,184) | (59,184) | 1,569 | 1,569 | |
Beginning balance (in shares) at Dec. 31, 2022 | 5,976 | 597,476 | 591,500 | |||||||||
Net income | 33,030 | 33,030 | $ 328 | $ 32,466 | 32,794 | 236 | 236 | |||||
Unrealized gain (loss) on interest rate swap, net of tax | (15,325) | (15,325) | (15,325) | (15,325) | ||||||||
Foreign currency translation (loss) gain | 28,143 | 28,143 | 28,143 | 28,143 | ||||||||
Reclassification of interest rate swap gain to earnings, net of tax | (28,553) | (28,553) | (28,553) | (28,553) | ||||||||
Stock (Unit) vesting and amortization of stock (unit)-based compensation | 11,829 | 11,829 | $ 118 | $ 11,711 | $ 1 | 11,828 | ||||||
Stock (Unit) vesting and amortization of stock (unit)-based compensation (shares) | 13 | 1,312 | 1,325 | |||||||||
Stock vesting - satisfaction of tax withholding | 5,554 | (5,554) | $ (56) | $ (5,498) | 5,554 | |||||||
Stock vesting - satisfaction of tax withholding (Shares) | (5) | (494) | (499) | |||||||||
Distributions to non-controlling interests | (231) | (231) | (231) | 231 | ||||||||
Dividends (Distributions) declared | (174,492) | (174,492) | $ (1,745) | $ (172,747) | (174,492) | |||||||
Ending balance at Mar. 31, 2023 | $ 8,443,254 | $ 8,443,644 | $ 85,244 | $ 598 | $ 8,431,745 | $ 8,541,414 | $ (25,413) | $ (74,919) | $ (74,919) | $ 1,574 | $ 1,574 | |
Ending balance (in shares) at Mar. 31, 2023 | 5,984 | 598,302 | 592,318 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Equity / Capital (Parenthetical) - $ / shares | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Dividends (Distributions) declared per common share / unit | $ 0.29 | $ 0.29 |
MPT Operating Partnership, L.P. [Member] | ||
Dividends (Distributions) declared per common share / unit | 0.29 | 0.29 |
MPT Operating Partnership, L.P. [Member] | General Partner [Member] | ||
Dividends (Distributions) declared per common share / unit | $ 0.29 | $ 0.29 |
Condensed Consolidated Statem_5
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Operating activities | ||
Net income | $ 33,030 | $ 631,947 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 87,586 | 88,760 |
Amortization of deferred financing costs and debt discount | 4,014 | 5,285 |
Straight-line rent revenue and other | (58,566) | (75,385) |
Stock / (Unit)-based compensation expense | 11,829 | 11,804 |
Gain on sale of real estate | (62) | (451,638) |
Real estate and other impairment charges | 89,538 | 4,875 |
Straight-line rent and other write-off (recovery) | 2,192 | (2,271) |
Debt refinancing and unutilized financing costs | 8,816 | |
Tax rate changes | (7,305) | |
Other adjustments | (8,505) | (1,040) |
Changes in: | ||
Interest and rent receivables | (514) | (12,431) |
Other assets | (2,493) | (41) |
Accounts payable and accrued expenses | (15,696) | (21,648) |
Deferred revenue | 600 | (7,646) |
Net cash provided by operating activities | 135,648 | 179,387 |
Investing activities | ||
Cash paid for acquisitions and other related investments | (72,900) | (724,795) |
Net proceeds from sale of real estate | 100 | 1,711,608 |
Principal received on loans receivable | 221,876 | 6,355 |
Investment in loans receivable | (50,000) | (10,414) |
Construction in progress and other | (13,292) | (36,115) |
Capital additions and other investments, net | (68,606) | (67,605) |
Net cash provided by investing activities | 17,178 | 879,034 |
Financing activities | ||
Payments of term debt | (869,606) | |
Revolving credit facilities, net | 95,919 | (198,599) |
Dividends paid | (176,580) | (176,494) |
Lease deposits and other obligations to tenants | (2,691) | 15,168 |
Stock vesting - satisfaction of tax withholdings | (5,554) | (27,919) |
Payment of debt refinancing, deferred financing costs, and other financing activities | (219) | (6,366) |
Net cash used for financing activities | (89,125) | (1,263,816) |
Increase (decrease) in cash, cash equivalents, and restricted cash for period | 63,701 | (205,395) |
Effect of exchange rate changes | 2,927 | (4,721) |
Cash, cash equivalents, and restricted cash at beginning of period | 241,538 | 461,882 |
Cash, cash equivalents, and restricted cash at end of period | 308,166 | 251,766 |
Interest paid | 116,436 | 111,012 |
Supplemental schedule of non-cash financing activities: | ||
Dividends declared, unpaid | 174,492 | 174,018 |
Cash, cash equivalents, and restricted cash are comprised of the following: | ||
Cash and cash equivalents at beginning of period | 235,668 | 459,227 |
Restricted cash, included in Other assets at beginning of period | $ 5,870 | $ 2,655 |
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List] | Other Assets | Other Assets |
Cash, cash equivalents, and restricted cash at beginning of period | $ 241,538 | $ 461,882 |
Cash and cash equivalents at end of period | 302,321 | 248,846 |
Restricted cash, included in Other assets at end of period | $ 5,845 | $ 2,920 |
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List] | Other Assets | Other Assets |
Cash, cash equivalents, and restricted cash at end of period | $ 308,166 | $ 251,766 |
MPT Operating Partnership, L.P. [Member] | ||
Operating activities | ||
Net income | 33,030 | 631,947 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Depreciation and amortization | 87,586 | 88,760 |
Amortization of deferred financing costs and debt discount | 4,014 | 5,285 |
Straight-line rent revenue and other | (58,566) | (75,385) |
Stock / (Unit)-based compensation expense | 11,829 | 11,804 |
Gain on sale of real estate | (62) | (451,638) |
Real estate and other impairment charges | 89,538 | 4,875 |
Straight-line rent and other write-off (recovery) | 2,192 | (2,271) |
Debt refinancing and unutilized financing costs | 8,816 | |
Tax rate changes | (7,305) | |
Other adjustments | (8,505) | (1,040) |
Changes in: | ||
Interest and rent receivables | (514) | (12,431) |
Other assets | (2,493) | (41) |
Accounts payable and accrued expenses | (15,696) | (21,648) |
Deferred revenue | 600 | (7,646) |
Net cash provided by operating activities | 135,648 | 179,387 |
Investing activities | ||
Cash paid for acquisitions and other related investments | (72,900) | (724,795) |
Net proceeds from sale of real estate | 100 | 1,711,608 |
Principal received on loans receivable | 221,876 | 6,355 |
Investment in loans receivable | (50,000) | (10,414) |
Construction in progress and other | (13,292) | (36,115) |
Capital additions and other investments, net | (68,606) | (67,605) |
Net cash provided by investing activities | 17,178 | 879,034 |
Financing activities | ||
Payments of term debt | (869,606) | |
Revolving credit facilities, net | 95,919 | (198,599) |
Dividends paid | (176,580) | (176,494) |
Lease deposits and other obligations to tenants | (2,691) | 15,168 |
Stock vesting - satisfaction of tax withholdings | (5,554) | (27,919) |
Payment of debt refinancing, deferred financing costs, and other financing activities | (219) | (6,366) |
Net cash used for financing activities | (89,125) | (1,263,816) |
Increase (decrease) in cash, cash equivalents, and restricted cash for period | 63,701 | (205,395) |
Effect of exchange rate changes | 2,927 | (4,721) |
Cash, cash equivalents, and restricted cash at beginning of period | 241,538 | 461,882 |
Cash, cash equivalents, and restricted cash at end of period | 308,166 | 251,766 |
Interest paid | 116,436 | 111,012 |
Supplemental schedule of non-cash financing activities: | ||
Dividends declared, unpaid | 174,492 | 174,018 |
Cash, cash equivalents, and restricted cash are comprised of the following: | ||
Cash and cash equivalents at beginning of period | 235,668 | 459,227 |
Restricted cash, included in Other assets at beginning of period | $ 5,870 | $ 2,655 |
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List] | Other Assets | Other Assets |
Cash, cash equivalents, and restricted cash at beginning of period | $ 241,538 | $ 461,882 |
Cash and cash equivalents at end of period | 302,321 | 248,846 |
Restricted cash, included in Other assets at end of period | $ 5,845 | $ 2,920 |
Restricted Cash and Cash Equivalents, Asset, Statement of Financial Position [Extensible List] | Other Assets | Other Assets |
Cash, cash equivalents, and restricted cash at end of period | $ 308,166 | $ 251,766 |
Organization
Organization | 3 Months Ended |
Mar. 31, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Organization | 1. Organ ization Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the Maryland General Corporation Law for the purpose of engaging in the business of investing in, owning, and leasing healthcare real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P. (the “Operating Partnership”), through which we conduct substantially all of our operations, was formed in September 2003. At present, we own all of the partnership interests in the Operating Partnership and have elected to report our required disclosures and that of the Operating Partnership on a combined basis, except where material differences exist. We operate as a real estate investment trust (“REIT”). Accordingly, we are generally not subject to United States (“U.S.”) federal income tax on our REIT taxable income, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed such taxable income. Certain non-real estate activities we undertake are conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRS”). Our TRS entities are subject to both U.S. federal and state income taxes. For our properties located outside the U.S., we are subject to the local taxes of the jurisdictions where our properties reside and/or legal entities are domiciled; however, we do not expect to incur additional taxes, of a significant nature, in the U.S. from foreign-based income as the majority of such income flows through our REIT. Our primary business strategy is to acquire and develop healthcare facilities and lease the facilities to healthcare operating companies under long-term net leases, which require the tenant to bear most of the costs associated with the property. The majority of our leased assets are owned 100 %; however, we do own some leased assets through joint ventures with other partners that share our view that healthcare facilities are part of the infrastructure of any community, which we refer to as investments in unconsolidated real estate joint ventures. We also may make mortgage loans to healthcare operators collateralized by their real estate. In addition, we may make noncontrolling investments in our tenants (which we refer to as investments in unconsolidated operating entities), from time-to-time, typically in conjunction with larger real estate transactions with the tenant, which may enhance our overall return and provide for certain minority rights and protections. Our business model facilitates acquisitions and recapitalizations, and allows operators of healthcare facilities to unlock the value of their real estate to fund facility improvements, technology upgrades, and other investments in operations. At March 31, 2023 , we have investments in 444 facilities in 31 states in the U.S., in seven countries in Europe, one country in South America, and across Australia. Our properties consist of general acute care hospitals, behavioral health facilities, inpatient physical rehabilitation facilities, long-term acute care hospitals, and freestanding ER/urgent care facilities. We manage our business as a single business segment. |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2023 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | 2. Summary o f Significant Accounting Policies Unaudited Interim Condensed Consolidated Financial Statements : The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement have been included. Operating results for the three months ended March 31, 2023, are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The condensed consolidated balance sheet at December 31, 2022 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. The preparation of our condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2023 (particularly as it relates to our assessments of the recoverability of our real estate and the adequacy of our credit loss reserves on loans and financing receivables). Actual results could differ from these estimates for various reasons as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2022. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2022. There have been no material changes to these significant accounting policies. Reclassifications Certain amounts in the condensed consolidated financial statements for prior periods have been reclassified to conform to the current period presentation. Variable Interest Entities At March 31, 2023 , we had loans and/or equity investments in certain variable interest entities approximating $ 425 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities. |
Real Estate and Other Activitie
Real Estate and Other Activities | 3 Months Ended |
Mar. 31, 2023 | |
Real Estate [Abstract] | |
Real Estate and Other Activities | 3. Real Estate a nd Other Activities New Investments We acquired or invested in the following net assets (in thousands): For the Three Months 2023 2022 Land and land improvements $ 9,313 $ 9,671 Buildings 11,652 204,829 Intangible lease assets — subject to amortization (weighted-average useful 28.8 years for 2023 and 13.2 years for 2022) 1,935 5,461 Investments in unconsolidated real estate joint ventures — 399,456 Investments in unconsolidated operating entities 50,000 131,105 Liabilities assumed — ( 25,727 ) $ 72,900 $ 724,795 Loans repaid(1) ( 22,900 ) — Total net assets acquired $ 50,000 $ 724,795 (1) The 2023 column includes a $ 23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below. 2023 Activity Lifepoint Transaction On February 7, 2023, a subsidiary of Lifepoint Health, Inc. ("Lifepoint") acquired a majority interest in Springstone (the "Lifepoint Transaction") based on an enterprise value of $ 250 million. As part of the transaction, we received approximately $ 205 million in full satisfaction of our initial acquisition loan to Springstone, including accrued interest, and we retained our minority equity investment in the operations of Springstone. Separately, and as part of our acquisition in 2021 of Springstone's real estate assets, we converted a mortgage loan into the fee simple ownership of a property in Washington, which will be leased, along with the other 17 behavioral health hospitals already leased to Springstone, under the master lease agreement. In connection with the Lifepoint Transaction, Lifepoint extended its current lease with us on eight existing general acute care hospitals by five years to 2041 . Other Transactions As part of an expected series of Prospect Medical Holdings, Inc. ("Prospect") capital restructuring transactions, we originated a $ 50 million convertible loan to PHP Holdings, the managed care business of Prospect, in the first quarter of 2023. The loan is convertible into equity of PHP Holdings. See subsection titled "Leasing Operations (Lessor)" in this same Note 3 for further information on Prospect. 2022 Activity Macquarie Transaction On March 14, 2022, we completed a transaction with Macquarie Asset Management (“MAM”), an unrelated party, to form a partnership (the “Macquarie Transaction”), pursuant to which we contributed eight Massachusetts-based general acute care hospitals that are leased to Steward Health Care System LLC ("Steward"), and a fund managed by MAM acquired, for cash consideration, a 50 % interest in the partnership. The transaction valued the portfolio at approximately $ 1.7 billion, and we recognized a gain on sale of real estate of approximately $ 600 million from this transaction, partially offset by the write-off of unbilled straight-line rent receivables. The partnership raised nonrecourse secured debt of 55 % of asset value, and we received proceeds, including from the secured debt, of approximately $ 1.3 billion. We obtained a 50 % interest in the real estate partnership valued at approximately $ 400 million (included in the "Investments in unconsolidated real estate joint ventures" line of our condensed consolidated balance sheets), which is being accounted for under the equity method of accounting. In connection with this transaction, we separated the eight Massachusetts-based facilities into a new master lease with terms generally identical to the other master lease, and the initial fixed lease term of both master leases was extended to 2041 . Other Transactions On March 11, 2022, we acquired four general acute care hospitals in Finland for € 178 million ($ 194 million). These hospitals are leased to Pihlajalinna pursuant to a long-term lease with annual inflation-based escalators. We acquired these facilities by purchasing the shares of the real estate holding entities, which included deferred income tax and other liabilities of approximately $ 26 million. On February 16, 2022, we agreed to participate in an existing syndicated term loan with a term of six years originated on behalf of Priory Group ("Priory"), of which we funded £ 96.5 million towards a £ 100 million participation level in the variable rate loan. Development Activities See table below for a status summary of our current development projects (in thousands): Property Commitment Costs Estimated Rent Ernest Health, Inc. ("Ernest") (Stockton, California) $ 47,700 $ 46,372 2Q 2023 IMED Hospitales ("IMED") (Spain) 51,043 13,323 2Q 2023 Ernest (South Carolina) 22,400 14,469 3Q 2023 IMED (Spain) 45,976 37,568 3Q 2023 Springstone (Texas) 31,600 4,099 1Q 2024 IMED (Spain) 37,193 9,170 3Q 2024 Steward (Texas) 169,408 57,059 1Q 2026 $ 405,320 $ 182,060 During the 2022 first quarter, we completed construction and began recording rental income on an inpatient rehabilitation facility located in Bakersfield, California. This facility commenced rent on March 1, 2022 and is being leased to Ernest pursuant to an existing long-term master lease. We continue to fund the redevelopment of our Norwood facility in Massachusetts, and recovery receivables of approximately $ 150 million associated with the prior storm and flood damage to this facility are included in the "Other assets" line of our condensed consolidated balance sheets. Disposals 2023 Activity On March 30, 2023, we entered into a definitive agreement to sell our 11 general acute care facilities located in Australia and operated by Healthscope Ltd. ("Healthscope") (the "Australia Transaction") to affiliates of HMC Capital for cash proceeds of approximately A$ 1.2 billion. As a result, we designated the Australian portfolio as held for sale and recorded an approximate $ 79 million net impairment charge, which included $ 37.4 million of straight-line rent receivables, an estimated $ 8 million in fees to sell the hospitals, and $ 13 million of accumulated other comprehensive loss related to foreign currency translation. This impairment charge was partially offset by approximately $ 29 million of deferred gains from our interest rate swap in accumulated other comprehensive income that was reclassified to earnings as part of this expected transaction. This transaction is expected to close in two phases with the first (and larger) phase expected to close in the second quarter and the full transaction expected to be complete by the end of 2023. We currently plan to use proceeds from the sale to prepay in full the Australian term loan. On March 8, 2023, we received notice that Prime Healthcare Services, Inc. ("Prime") will exercise its right to repurchase from us during the third quarter of 2023 the real estate associated with one master lease for approximately $ 100 million. As such, we recorded an approximate $ 11 million non-cash impairment charge in the first quarter of 2023 related to unbilled rent on the three facilities expected to be sold. Although we currently expect the Australia Transaction and Prime repurchase will occur as planned, no assurances can be given that the transactions will close as described above. 2022 Activity On March 14, 2022, we completed the previously described partnership with MAM, in which we sold the real estate of eight Massachusetts-based general acute care hospitals, with a fair value of approximately $ 1.7 billion. See "New Investments" in this same Note 3 for further details on this transaction. During the first three months of 2022, we also completed the sale of two other facilities and an ancillary property for approximately $ 48 million, resulting in a gain on real estate of approximately $ 15 million. Summary of Operations for Disposed (or to be Disposed) Assets in 2023 and 2022 The properties expected to be sold during 2023 and sold during 2022 do not meet the definition of discontinued operations. However, the following represents the operating results from these properties for the periods presented (in thousands): For the Three Months 2023(1) 2022 Revenues(2) $ 18,877 $ 40,579 Real estate depreciation and amortization ( 4,991 ) ( 5,247 ) Property-related expenses ( 1,413 ) ( 3,015 ) Real estate and other impairment charges(3) ( 89,538 ) — Other (expense) income(4) ( 7,244 ) 444,268 Income from real estate dispositions, net $ ( 84,309 ) $ 476,585 (1) The 2023 column consists of assets designated as held for sale in the first quarter of 2023 as a result of the transactions described in the "2023 Activity" subsection above. (2) Includes $ 4.5 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three months ended March 31, 2022. (3) Includes an approximate $ 79 million net impairment charge (including $ 37.4 million of straight-line rent write-offs) associated with the Australia Transaction and an approximate $ 11 million non-cash impairment charge associated with the repurchase of three Prime facilities for the three months ended March 31, 2023. (4) Includes $ 451.6 million of gains (net of $ 125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three months ended March 31, 2022. Leasing Operations (Lessor) We acquire and develop healthcare facilities and lease the facilities to healthcare operating companies. The initial fixed lease terms of these infrastructure-type assets are typically at least 15 years, and most include renewal options at the election of our tenants, generally in five year increments. Over 99 % of our leases provide annual rent escalations based on increases in the Consumer Price Index ("CPI") (or similar indices outside the U.S.) and/or fixed minimum annual rent escalations. Many of our domestic leases contain purchase options with pricing set at various terms but in no case less than our total initial investment. Our leases typically require the tenant to handle and bear most of the costs associated with our properties including repair/maintenance, property taxes, and insurance. For all of our properties subject to lease, we are the legal owner of the property, and the tenant's right to use and possess such property is guided by the terms of a lease. At March 31, 2023 , we account for all of these leases as operating leases, except where GAAP requires alternative classification, including leases on 13 Ernest facilities that are accounted for as direct financing leases and leases on 13 of our Prospect facilities and five of our Ernest facilities that are accounted for as a financing. The components of our total investment in financing leases consisted of the following (in thousands): As of March 31, As of December 31, Minimum lease payments receivable $ 626,721 $ 880,253 Estimated unguaranteed residual values 203,818 203,818 Less: Unearned income and allowance for credit loss ( 588,097 ) ( 731,915 ) Net investment in direct financing leases 242,442 352,156 Other financing leases (net of allowance for credit loss) 1,339,974 1,339,167 Total investment in financing leases $ 1,582,416 $ 1,691,323 The decrease in our net investment in direct financing leases since December 31, 2022, is the result of classifying three Prime facilities as held for sale at March 31, 2023. See subsection above titled "Disposals" for further information. Other Leasing Activities At March 31, 2023 , 99 % of our properties are occupied by tenants, leaving five properties as vacant, representing less than 0.3 % of total assets. We are in various stages of either releasing or selling these vacant properties, for one of which we received and recorded a significant termination fee in 2019. As more fully described in “Item 1A. Risk Factors” in our Annual Report on Form 10-K, our tenants’ financial performance and resulting ability to satisfy their lease and loan obligations to us are material to our financial results and our ability to service our debt and make distributions to our stockholders. Our tenants operate in the healthcare industry, which is highly regulated, and changes in regulation (or delays in enacting regulation) may temporarily impact our tenants’ operations until they are able to make the appropriate adjustments to their business. In addition, our tenants may experience operational challenges from time-to-time as a result of many factors, including those external to them, such as public health crises (like the coronavirus ("COVID-19") pandemic), economic issues resulting in high inflation and spikes in labor costs, and adverse market and political conditions. We monitor our tenants' operating results and the potential impact from these challenges. We may elect to provide support to our tenants from time-to-time in the form of short-term rent deferrals to be paid back in full (like as described below under COVID-19 Rent Deferrals and Pipeline Health System), or in the form of temporary loans (like as described below under Prospect Medical Holdings). COVID-19 Rent Deferrals Due to COVID-19 and its impact on our tenants' business, we agreed to defer collection of a certain amount of rent for certain tenants. Pursuant to our agreements with these tenants, we expect repayments of previously deferred rent to continue, with the remaining outstanding deferred rent balance of approximately $ 12.2 million as of March 31, 2023, to be paid over specified periods in the future with interest. Pipeline Health System On October 2, 2022, Pipeline filed for reorganization relief under Chapter 11 protection of the United States Bankruptcy Code in the Southern District of Texas, while keeping its hospitals open to continue providing care to the communities served. On February 6, 2023, Pipeline emerged from bankruptcy. Per the bankruptcy settlement, Pipeline's current lease of our California assets remains in place, and we were repaid on February 7, 2023 for all rent that was outstanding at December 31, 2022, along with what was due for the first quarter of 2023. We have agreed to defer $ 5.6 million, or approximately 30 %, of rent in 2023 to be paid in 2024 with interest. Prospect Medical Holdings In August 2019, we invested in a portfolio of 14 acute care hospitals in three states (California, Pennsylvania, and Connecticut) operated by and master leased to or mortgaged by Prospect for a combined investment of approximately $ 1.5 billion. In addition, we originated a $ 112.9 million term loan cross-defaulted to the master lease and mortgage loan agreements and further secured by a parent guaranty. In the 2022 second quarter, we funded an additional $ 100 million towards the existing mortgage loan that is secured by a first lien on a California hospital. Prospect's operations were negatively impacted by the COVID-19 global pandemic commencing in early 2020, but Prospect continued to remain current with respect to contractual rent and interest payments until the fourth quarter of 2022. Accordingly, and due further to termination of certain refinancing negotiations between Prospect and certain third parties, we recorded an approximate $ 280 million impairment charge in the 2022 fourth quarter. As part of this charge, we reduced the carrying value of the underperforming Pennsylvania properties by approximately $ 170 million (to approximately $ 250 million) and reserved all unbilled rent accruals for a total of $ 112 million. In the first quarter of 2023, we began accounting for Prospect revenue on a cash basis and did not recognize any rent or interest revenue in the quarter. In late March 2023, Prospect received a binding commitment from several lenders that is expected to provide them with liquidity to pay down certain debt instruments. Along with these commitments from third-party lenders, we agreed to pursue certain transactions with Prospect that would result in the following: a) maintain the master lease covering six California hospitals with no changes in rental rates or escalator provisions, and with the expectation that Prospect will begin making cash payments for approximately 50 % of the contractual monthly rent due on these California properties starting in September 2023, b) transition the Pennsylvania properties back to Prospect in return for a well-collateralized mortgage on the facilities, c) provide up to $ 75 million in a loan secured by a first lien on Prospect's accounts receivable and certain other assets, d) obtain a non-controlling ownership interest in Prospect's managed care business (PHP Holdings) equal in value to unpaid rent and interest, our $ 112.9 million term loan, and other obligations at the time of such investment, and e) complete the previously disclosed sale of the Connecticut properties to Yale New Haven ("Yale"), as more fully described in Note 9 to the condensed consolidated financial statements. As part of these capital restructuring steps (as discussed under "New Investments" in this same Note 3 ), we originated a $ 50 million loan to PHP Holdings in March 2023 that is convertible into equity of PHP Holdings. At March 31, 2023, we believe our remaining investment in the Prospect real estate and other assets are fully recoverable from the collateral available, but no assurances can be given that the transactions described above will occur or that we will not have any further impairments in future periods. Investments in Unconsolidated Entities Investments in Unconsolidated Real Estate Joint Ventures Our primary business strategy is to acquire real estate and lease to providers of healthcare services. Typically, we directly own 100 % of such investment. However, from time-to-time, we will co-invest with other investors that share a similar view that hospital real estate is a necessary infrastructure-type asset in communities. In these types of investments, we will own undivided interests of less than 100 % of the real estate and share control over the assets through unconsolidated real estate joint ventures. The underlying real estate and leases in these unconsolidated real estate joint ventures are structured similarly and carry a similar risk profile to the rest of our real estate portfolio. The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands): Operator Ownership Percentage As of March 31, As of December 31, Median Kliniken S.á.r.l ("MEDIAN") 50 % $ 483,706 $ 482,735 Swiss Medical Network 70 % 461,952 454,083 Steward (Macquarie Transaction) 50 % 416,068 417,701 Policlinico di Monza 50 % 88,658 86,245 HM Hospitales 45 % 56,090 57,139 Total $ 1,506,474 $ 1,497,903 Investments in Unconsolidated Operating Entities Our investments in unconsolidated operating entities are noncontrolling investments that are typically made in conjunction with larger real estate transactions in which the operators are vetted as part of our overall underwriting process. In many cases, we would not be able to acquire the larger real estate portfolio without such investments in operators. These investments also offer the opportunity to enhance our overall return and provide for certain minority rights and protections. The following is a summary of our investments in unconsolidated operating entities (amounts in thousands): Operator As of March 31, As of December 31, Steward (loan investment) $ 362,586 $ 362,831 International joint venture 230,153 231,402 Priory 159,668 156,575 Swiss Medical Network 158,687 157,145 Steward (equity investment) 125,862 125,862 Prospect 112,701 112,777 Aevis Victoria SA ("Aevis") 77,618 72,904 PHP Holdings 49,895 — Aspris Children's Services ("Aspris") 16,014 16,023 Springstone 10,933 200,827 Caremax 6,343 8,526 Total $ 1,310,460 $ 1,444,872 The change since December 31, 2022 primarily relates to the payoff of the Springstone loan in February 2023, partially offset by the loan made to PHP Holdings. See "2023 Activity" under subsection titled "New Investments" in this same Note 3 for further details. Pursuant to our approximate 5 % stake in Aevis and other investments marked to fair value, we recorded approximately $ 4 million in favorable non-cash fair value adjustments during the first quarter of 2023 as shown in the "Other (including fair value adjustments on securities)" line of the condensed consolidated statements of net income; whereas, this was an $ 8.0 million favorable non-cash fair value adjustment for the same period of 2022. Other Investment Activities In conjunction with the redevelopment of Steward's Norwood hospital, we advanced $ 50 million, in the 2023 first quarter, that is secured by, among other things, proceeds from insurance claims in excess of the advance. Credit Loss Reserves We apply a forward-looking "expected loss" model to all of our financing receivables, including financing leases and loans, based on historical credit losses of similar instruments. The following table summarizes the activity in our credit loss reserves (in thousands): For the Three Months 2023 2022 Balance at beginning of the year $ 121,146 $ 48,527 Provision for credit loss, net 986 5,412 Expected credit loss reserve related to financial instruments ( 160 ) ( 6 ) Balance at end of the period $ 121,972 $ 53,933 Concentrations of Credit Risk We monitor concentration risk in several ways due to the nature of our real estate assets that are vital to the communities in which they are located and given our history of being able to replace inefficient operators of our facilities, if needed, with more effective operators. See below for our concentration details (dollars in thousands): Total Assets by Operator As of March 31, 2023 As of December 31, 2022 Operators Total Assets Percentage of Total Assets Percentage of Steward $ 4,800,594 24.4 % $ 4,762,673 24.2 % Circle Health Ltd ("Circle") 2,092,822 10.7 % 2,062,474 10.5 % Prospect 1,533,412 7.8 % 1,483,599 7.5 % Priory 1,310,968 6.7 % 1,290,213 6.6 % Springstone 796,248 4.0 % 985,959 5.0 % Other operators 7,406,721 37.7 % 7,461,923 38.0 % Other assets 1,709,392 8.7 % 1,611,159 8.2 % Total $ 19,650,157 100.0 % $ 19,658,000 100.0 % Total Assets by U.S. State and Country As of March 31, 2023 As of December 31, 2022 U.S. States and Other Countries Total Assets Percentage of Total Assets Percentage of Texas $ 2,008,146 10.2 % $ 1,967,948 10.0 % California 1,502,060 7.7 % 1,450,112 7.4 % Florida 1,319,878 6.7 % 1,324,555 6.8 % Utah 1,218,883 6.2 % 1,224,484 6.2 % Massachusetts 763,555 3.9 % 761,694 3.9 % All other states 4,035,762 20.5 % 4,245,306 21.6 % Other domestic assets 1,087,136 5.5 % 1,028,946 5.2 % Total U.S. $ 11,935,420 60.7 % $ 12,003,045 61.1 % United Kingdom $ 4,145,170 21.1 % $ 4,083,244 20.8 % Australia 781,585 4.0 % 854,582 4.3 % Switzerland 763,711 3.9 % 748,947 3.8 % Germany 666,930 3.4 % 664,900 3.4 % Spain 226,800 1.1 % 222,316 1.1 % All other countries 508,285 2.6 % 498,753 2.5 % Other international assets 622,256 3.2 % 582,213 3.0 % Total international $ 7,714,737 39.3 % $ 7,654,955 38.9 % Grand total $ 19,650,157 100.0 % $ 19,658,000 100.0 % On an individual property basis, we had no investment in any single property greater than 3 % of our total assets as of March 31, 2023. Total Revenues by Operator For the Three Months Ended March 31, 2023 2022 Operators Total Revenues Percentage of Total Revenues Percentage of Steward $ 103,494 29.6 % $ 121,244 29.6 % Circle 47,415 13.5 % 51,212 12.5 % Prospect — 0.0 % 38,684 9.4 % Priory 24,740 7.1 % 19,070 4.7 % Springstone 20,167 5.8 % 21,664 5.3 % Other operators 154,395 44.0 % 157,926 38.5 % Total $ 350,211 100.0 % $ 409,800 100.0 % Total Revenues by U.S. State and Country For the Three Months Ended March 31, 2023 2022 U.S. States and Other Countries Total Revenues Percentage of Total Revenues Percentage of Texas $ 44,116 12.6 % $ 34,844 8.5 % Utah 35,641 10.2 % 33,768 8.2 % Florida 26,182 7.5 % 25,305 6.2 % California 19,495 5.6 % 41,291 10.1 % Massachusetts 6,816 1.8 % 32,631 8.0 % All other states 99,137 28.4 % 125,907 30.7 % Total U.S. $ 231,387 66.1 % $ 293,746 71.7 % United Kingdom $ 84,206 24.0 % $ 83,906 20.5 % Australia 15,237 4.4 % 17,031 4.1 % All other countries 19,381 5.5 % 15,117 3.7 % Total international $ 118,824 33.9 % $ 116,054 28.3 % Grand total $ 350,211 100.0 % $ 409,800 100.0 % Total Revenues by Facility Type For the Three Months Ended March 31, 2023 2022 Facility Types Total Revenues Percentage of Total Revenues Percentage of General acute care hospitals $ 253,036 72.3 % $ 316,019 77.0 % Behavioral health facilities 53,658 15.3 % 50,897 12.4 % Inpatient rehabilitation facilities 29,046 8.3 % 28,906 7.1 % Long-term acute care hospitals 8,251 2.4 % 8,302 2.1 % Freestanding ER/urgent care facilities 6,220 1.7 % 5,676 1.4 % Total $ 350,211 100.0 % $ 409,800 100.0 % For geographic and facility type concentration metrics above, we allocate our investments in operating entities pro rata based on the gross book value of the real estate. Such pro rata allocations are subject to change from period to period . |
Debt
Debt | 3 Months Ended |
Mar. 31, 2023 | |
Debt Disclosure [Abstract] | |
Debt | 4. D ebt The following is a summary of debt (dollar amounts in thousands): As of March 31, As of December 31, Revolving credit facility(A) $ 1,031,037 $ 929,584 Term loan 200,000 200,000 British pound sterling term loan due 2024(B) 129,353 126,690 British pound sterling term loan due 2025(B) 863,590 845,810 Australian term loan facility(B) 802,200 817,560 2.550 % Senior Unsecured Notes due 2023(B) 493,480 483,320 3.325 % Senior Unsecured Notes due 2025(B) 541,950 535,250 0.993 % Senior Unsecured Notes due 2026(B) 541,950 535,250 2.500 % Senior Unsecured Notes due 2026(B) 616,850 604,150 5.250 % Senior Unsecured Notes due 2026 500,000 500,000 5.000 % Senior Unsecured Notes due 2027 1,400,000 1,400,000 3.692 % Senior Unsecured Notes due 2028(B) 740,220 724,980 4.625 % Senior Unsecured Notes due 2029 900,000 900,000 3.375 % Senior Unsecured Notes due 2030(B) 431,795 422,905 3.500 % Senior Unsecured Notes due 2031 1,300,000 1,300,000 $ 10,492,425 $ 10,325,499 Debt issue costs and discount, net ( 54,274 ) ( 57,087 ) $ 10,438,151 $ 10,268,412 (A) Includes £ 119 million of GBP-denominated borrowings and € 253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023 . (B) Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022 . As of March 31, 2023, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (amounts in thousands): 2023 $ 493,480 2024 931,553 2025 1,405,540 2026 2,689,837 2027 1,600,000 Thereafter 3,372,015 Total $ 10,492,425 On March 15, 2022 , we paid off and terminated our $ 1 billion interim credit facility that was entered into on July 27, 2021 with proceeds from the Macquarie Transaction as more fully described in Note 3 to the condensed consolidated financial statements. As part of this transaction, we incurred approximately $ 8.8 million of debt refinancing costs. Covenants Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem, or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our Credit Facility limit the amount of dividends we can pay as a percentage of normalized adjusted funds from operations (“NAFFO”), as defined in the agreements, on a rolling four quarter basis. At March 31, 2023 , the dividend restriction was 95 % of NAFFO. The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95 % of NAFFO, proceeds of equity issuances, and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150 % of our unsecured indebtedness. In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. The Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations, and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At March 31, 2023 , we were in compliance with all such financial and operating covenants. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 5. Income Taxes As a result of the Australia Transaction described in Note 3 to the condensed consolidated financial statements, we recorded a $ 5 million tax benefit in the first quarter of 2023. |
Stock Awards
Stock Awards | 3 Months Ended |
Mar. 31, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Stock Awards | 6 . Stock Awards During the second quarter of 2022, we amended the 2019 Equity Incentive Plan (the “Equity Incentive Plan”), which authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units, and awards of interests in our Operating Partnership. Our Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors, and we have reserved 28.9 million shares of common stock for awards, of which 16.7 million shares remain available for future stock awards as of March 31, 2023 . Share-based compensation expense totaled $ 11.8 million for each of the three months ended March 31, 2023 and 2022 . |
Fair Value of Financial Instrum
Fair Value of Financial Instruments | 3 Months Ended |
Mar. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Fair Value of Financial Instruments | 7 . Fair Value of Financial Instruments We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents and accounts payable and accrued expenses approximate their fair values. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as discounting the estimated future cash flows using the current rates at which similar receivables would be made to others with similar credit ratings and for the same remaining maturities. The fair value of our mortgage loans and other loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our revolving credit facility and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt. Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands): As of March 31, 2023 As of December 31, 2022 Asset (Liability) Book Fair Book Fair Interest and rent receivables, net $ 169,511 $ 160,947 $ 167,035 $ 163,101 Loans(1) 1,511,182 (2) 1,456,753 1,405,615 (2) 1,360,113 Debt, net ( 10,438,151 ) ( 8,594,584 ) ( 10,268,412 ) ( 8,697,042 ) (1) Excludes the acquisition loan made in May 2020 related to our investment in the international joint venture, along with the related subsequent investment in the real estate of three hospitals in Colombia, as these assets are accounted for under the fair value option method, as noted below. In addition for December 31, 2022 only, this excludes the acquisition and mortgage loans made to Springstone, which were satisfied in full in February 2023 as further described in Note 3 to the condensed consolidated financial statements. (2) Includes $ 224.4 million and $ 223.8 million of mortgage loans, a $ 319.9 million and $ 315.9 million shareholder loan included in investments in unconsolidated real estate joint ventures, $ 693.0 million and $ 640.4 million of loans that are part of our investments in unconsolidated operating entities, and $ 273.9 million and $ 225.5 million of other loans at March 31, 2023 and December 31, 2022, respectively. Items Measured at Fair Value on a Recurring Basis Our equity investment and related loan to the international joint venture, our loan investment in the real estate of three hospitals operated by subsidiaries of the international joint venture in Colombia, and our equity investment in Springstone are measured at fair value on a recurring basis as we elected to account for these investments using the fair value option at the point of initial investment. For December 31, 2022, our acquisition and mortgage loans to Springstone (which were satisfied in full in February 2023 as described in Note 3 to the condensed consolidated financial statements) were also accounted for under the fair value option method. We elected to account for these investments at fair value due to the size of the investments and because we believe this method was more reflective of current values. At March 31, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands): As of March 31, 2023 As of December 31, 2022 Asset (Liability) Fair Value Original Fair Value Original Asset Type Classification Mortgage loans $ 122,073 $ 122,073 $ 140,260 $ 140,260 Mortgage loans Equity investment and other loans 243,561 247,125 434,609 441,943 Investments in unconsolidated operating entities/Other loans Our loans to the international joint venture and its subsidiaries (as well as the Springstone loans at December 31, 2022) are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates at which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities, while also considering the value of the underlying collateral of the loans. Our equity investment in Springstone is recorded at fair value based on Level 2 inputs by discounting the estimated cash flows expected to be realized as part of the Lifepoint Transaction described in Note 3 to the condensed consolidated financial statements. Our equity investment in the international joint venture is recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecasted assumptions associated with the investee. We classify our valuations of equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuations require management judgment due to absence of quoted market prices. For the cash flow models, our observable inputs include use of a capitalization rate and discount rate (which is based on a weighted-average cost of capital). In regard to the underlying projections used in the discounted cash flow model, such projections are provided by the investees. However, we will modify such projections as needed based on our review and analysis of historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry. In the first quarter of 2023, we had a net favorable adjustment to the investments accounted for under the fair value option method, compared to an unfavorable adjustment in the first quarter of 2022. Items Measured at Fair Value on a Nonrecurring Basis In addition to items that are measured at fair value on a recurring basis, we have assets and liabilities that are measured, from time-to-time, at fair value on a nonrecurring basis, such as for long-lived asset impairment purposes. In these cases, fair value may be based on estimated cash flows discounted at a risk-adjusted rate of interest by using Level 2 inputs. For our real estate, including for the impairment analysis on our Prospect Pennsylvania real estate, we may use a market approach using Level 2 inputs, whereby we will divide the expected net operating income (i.e. rent revenue less expenses, if any) of the facility by a market capitalization rate. |
Earnings Per Share_Unit
Earnings Per Share/Unit | 3 Months Ended |
Mar. 31, 2023 | |
Earnings Per Share [Abstract] | |
Earnings Per Share/Unit | 8 . Earnings Per Share/Unit Medical Properties Trust, Inc. Our earnings per share were calculated based on the following (amounts in thousands): For the Three Months 2023 2022 Numerator: Net income $ 33,030 $ 631,947 Non-controlling interests’ share in earnings ( 236 ) ( 266 ) Participating securities’ share in earnings ( 515 ) ( 402 ) Net income, less participating securities’ share in earnings $ 32,279 $ 631,279 Denominator: Basic weighted-average common shares 598,302 598,676 Dilutive potential common shares 8 256 Diluted weighted-average common shares 598,310 598,932 MPT Operating Partnership, L.P. Our earnings per unit were calculated based on the following (amounts in thousands): For the Three Months 2023 2022 Numerator: Net income $ 33,030 $ 631,947 Non-controlling interests’ share in earnings ( 236 ) ( 266 ) Participating securities’ share in earnings ( 515 ) ( 402 ) Net income, less participating securities’ share in earnings $ 32,279 $ 631,279 Denominator: Basic weighted-average units 598,302 598,676 Dilutive potential units 8 256 Diluted weighted-average units 598,310 598,932 |
Commitments and Contingencies
Commitments and Contingencies | 3 Months Ended |
Mar. 31, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | . Commitments and Contingencies Commitments On October 5, 2022, we entered into definitive agreements to sell three Prospect facilities located in Connecticut to Yale for approximately $ 457 million, of which we expect to receive the majority in cash and the remainder in equity securities of PHP Holdings. This transaction is expected to close in 2023 subject to certain regulatory approvals and the completion of Yale's acquisition of the hospital operations from Prospect. No assurances can be given that this transaction will be consummated as described or at all. Contingencies During and subsequent to the first quarter of 2023, the Company became party to various lawsuits as further described in Item 1 of Part II of this Quarterly Report on Form 10-Q. We have not recorded a liability related to these lawsuits because, at this time, we are unable to determine whether an unfavorable outcome is probable or to estimate reasonably possible losses. We are a party to various other legal proceedings incidental to our business from time-to-time. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to those proceedings is not presently expected to materially affect our financial position, results of operations, or cash flows. |
Subsequent Events
Subsequent Events | 3 Months Ended |
Mar. 31, 2023 | |
Subsequent Events [Abstract] | |
Subsequent Events | 10. Subsequent Events On April 14, 2023, we acquired five behavioral health hospitals located in the United Kingdom for approximately £ 44 million. These hospitals are leased to Priory pursuant to five separate lease agreements with annual inflation-based escalators. On April 19, 2023, we acquired two behavioral health hospitals and have a signed definitive agreement to acquire an additional facility, located in Germany, for a total of approximately € 70 million. These hospitals will be leased to MEDIAN pursuant to a long-term master lease with annual inflation-based escalators. On May 1, 2023, Catholic Health Initiatives Colorado ("CHIC"), a wholly owned subsidiary of CommonSpirit Health ("CommonSpirit"), acquired the Utah hospital operations of five general acute care facilities previously operated by Steward. As a result of this transaction, we expect to receive $ 150 million of proceeds from Steward to pay down outstanding loans, $ 100 million of which we received on May 1, 2023. The new lease with CHIC for these Utah assets will have an initial fixed term of 15 years with annual escalation provisions. As part of this transaction, we severed these facilities from the master lease with Steward, and accordingly will accelerate the amortization of the associated in-place lease intangibles (approximately $ 288 million at March 31, 2023) and write-off approximately $ 94 million of straight-line rent receivables. With this transaction, we expect to lower our overall asset concentration with Steward by approximately 4 % and our revenue concentration by approximately 8 %. |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2023 | |
Accounting Policies [Abstract] | |
Unaudited Interim Condensed Consolidated Financial Statements | Unaudited Interim Condensed Consolidated Financial Statements : The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair statement have been included. Operating results for the three months ended March 31, 2023, are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The condensed consolidated balance sheet at December 31, 2022 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. The preparation of our condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We believe the estimates and assumptions underlying our condensed consolidated financial statements are reasonable and supportable based on the information available as of March 31, 2023 (particularly as it relates to our assessments of the recoverability of our real estate and the adequacy of our credit loss reserves on loans and financing receivables). Actual results could differ from these estimates for various reasons as outlined in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2022. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2022. There have been no material changes to these significant accounting policies. |
Reclassifications | Reclassifications Certain amounts in the condensed consolidated financial statements for prior periods have been reclassified to conform to the current period presentation. |
Variable Interest Entities | Variable Interest Entities At March 31, 2023 , we had loans and/or equity investments in certain variable interest entities approximating $ 425 million, which represents our maximum exposure to loss as a result of our involvement in such entities. We have determined that we were not the primary beneficiary of any variable interest entity in which we hold a variable interest because we do not control the activities (such as the day-to-day operations) that most significantly impact the economic performance of these entities. |
Real Estate and Other Activit_2
Real Estate and Other Activities (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Real Estate [Abstract] | |
Net Assets Acquired | We acquired or invested in the following net assets (in thousands): For the Three Months 2023 2022 Land and land improvements $ 9,313 $ 9,671 Buildings 11,652 204,829 Intangible lease assets — subject to amortization (weighted-average useful 28.8 years for 2023 and 13.2 years for 2022) 1,935 5,461 Investments in unconsolidated real estate joint ventures — 399,456 Investments in unconsolidated operating entities 50,000 131,105 Liabilities assumed — ( 25,727 ) $ 72,900 $ 724,795 Loans repaid(1) ( 22,900 ) — Total net assets acquired $ 50,000 $ 724,795 (1) The 2023 column includes a $ 23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below. |
Summary of Status on Current Development Projects | See table below for a status summary of our current development projects (in thousands): Property Commitment Costs Estimated Rent Ernest Health, Inc. ("Ernest") (Stockton, California) $ 47,700 $ 46,372 2Q 2023 IMED Hospitales ("IMED") (Spain) 51,043 13,323 2Q 2023 Ernest (South Carolina) 22,400 14,469 3Q 2023 IMED (Spain) 45,976 37,568 3Q 2023 Springstone (Texas) 31,600 4,099 1Q 2024 IMED (Spain) 37,193 9,170 3Q 2024 Steward (Texas) 169,408 57,059 1Q 2026 $ 405,320 $ 182,060 |
Summary of Operating Results from Properties | The properties expected to be sold during 2023 and sold during 2022 do not meet the definition of discontinued operations. However, the following represents the operating results from these properties for the periods presented (in thousands): For the Three Months 2023(1) 2022 Revenues(2) $ 18,877 $ 40,579 Real estate depreciation and amortization ( 4,991 ) ( 5,247 ) Property-related expenses ( 1,413 ) ( 3,015 ) Real estate and other impairment charges(3) ( 89,538 ) — Other (expense) income(4) ( 7,244 ) 444,268 Income from real estate dispositions, net $ ( 84,309 ) $ 476,585 (1) The 2023 column consists of assets designated as held for sale in the first quarter of 2023 as a result of the transactions described in the "2023 Activity" subsection above. (2) Includes $ 4.5 million of straight-line rent write-offs associated with the non-Macquarie disposal transactions for the three months ended March 31, 2022. (3) Includes an approximate $ 79 million net impairment charge (including $ 37.4 million of straight-line rent write-offs) associated with the Australia Transaction and an approximate $ 11 million non-cash impairment charge associated with the repurchase of three Prime facilities for the three months ended March 31, 2023. (4) Includes $ 451.6 million of gains (net of $ 125 million write-off of straight-line rent receivables related to the Macquarie Transaction) for the three months ended March 31, 2022. |
Components of Total Investment in Financing Leases | The components of our total investment in financing leases consisted of the following (in thousands): As of March 31, As of December 31, Minimum lease payments receivable $ 626,721 $ 880,253 Estimated unguaranteed residual values 203,818 203,818 Less: Unearned income and allowance for credit loss ( 588,097 ) ( 731,915 ) Net investment in direct financing leases 242,442 352,156 Other financing leases (net of allowance for credit loss) 1,339,974 1,339,167 Total investment in financing leases $ 1,582,416 $ 1,691,323 |
Summary of Investments in Unconsolidated Operating Entities | The following is a summary of our investments in unconsolidated real estate joint ventures by operator (amounts in thousands): Operator Ownership Percentage As of March 31, As of December 31, Median Kliniken S.á.r.l ("MEDIAN") 50 % $ 483,706 $ 482,735 Swiss Medical Network 70 % 461,952 454,083 Steward (Macquarie Transaction) 50 % 416,068 417,701 Policlinico di Monza 50 % 88,658 86,245 HM Hospitales 45 % 56,090 57,139 Total $ 1,506,474 $ 1,497,903 The following is a summary of our investments in unconsolidated operating entities (amounts in thousands): Operator As of March 31, As of December 31, Steward (loan investment) $ 362,586 $ 362,831 International joint venture 230,153 231,402 Priory 159,668 156,575 Swiss Medical Network 158,687 157,145 Steward (equity investment) 125,862 125,862 Prospect 112,701 112,777 Aevis Victoria SA ("Aevis") 77,618 72,904 PHP Holdings 49,895 — Aspris Children's Services ("Aspris") 16,014 16,023 Springstone 10,933 200,827 Caremax 6,343 8,526 Total $ 1,310,460 $ 1,444,872 |
Summary of Activity in Credit Loss reserves | The following table summarizes the activity in our credit loss reserves (in thousands): For the Three Months 2023 2022 Balance at beginning of the year $ 121,146 $ 48,527 Provision for credit loss, net 986 5,412 Expected credit loss reserve related to financial instruments ( 160 ) ( 6 ) Balance at end of the period $ 121,972 $ 53,933 |
Schedule of Concentrations of Credit Risk | See below for our concentration details (dollars in thousands): Total Assets by Operator As of March 31, 2023 As of December 31, 2022 Operators Total Assets Percentage of Total Assets Percentage of Steward $ 4,800,594 24.4 % $ 4,762,673 24.2 % Circle Health Ltd ("Circle") 2,092,822 10.7 % 2,062,474 10.5 % Prospect 1,533,412 7.8 % 1,483,599 7.5 % Priory 1,310,968 6.7 % 1,290,213 6.6 % Springstone 796,248 4.0 % 985,959 5.0 % Other operators 7,406,721 37.7 % 7,461,923 38.0 % Other assets 1,709,392 8.7 % 1,611,159 8.2 % Total $ 19,650,157 100.0 % $ 19,658,000 100.0 % Total Assets by U.S. State and Country As of March 31, 2023 As of December 31, 2022 U.S. States and Other Countries Total Assets Percentage of Total Assets Percentage of Texas $ 2,008,146 10.2 % $ 1,967,948 10.0 % California 1,502,060 7.7 % 1,450,112 7.4 % Florida 1,319,878 6.7 % 1,324,555 6.8 % Utah 1,218,883 6.2 % 1,224,484 6.2 % Massachusetts 763,555 3.9 % 761,694 3.9 % All other states 4,035,762 20.5 % 4,245,306 21.6 % Other domestic assets 1,087,136 5.5 % 1,028,946 5.2 % Total U.S. $ 11,935,420 60.7 % $ 12,003,045 61.1 % United Kingdom $ 4,145,170 21.1 % $ 4,083,244 20.8 % Australia 781,585 4.0 % 854,582 4.3 % Switzerland 763,711 3.9 % 748,947 3.8 % Germany 666,930 3.4 % 664,900 3.4 % Spain 226,800 1.1 % 222,316 1.1 % All other countries 508,285 2.6 % 498,753 2.5 % Other international assets 622,256 3.2 % 582,213 3.0 % Total international $ 7,714,737 39.3 % $ 7,654,955 38.9 % Grand total $ 19,650,157 100.0 % $ 19,658,000 100.0 % Total Revenues by Operator For the Three Months Ended March 31, 2023 2022 Operators Total Revenues Percentage of Total Revenues Percentage of Steward $ 103,494 29.6 % $ 121,244 29.6 % Circle 47,415 13.5 % 51,212 12.5 % Prospect — 0.0 % 38,684 9.4 % Priory 24,740 7.1 % 19,070 4.7 % Springstone 20,167 5.8 % 21,664 5.3 % Other operators 154,395 44.0 % 157,926 38.5 % Total $ 350,211 100.0 % $ 409,800 100.0 % Total Revenues by U.S. State and Country For the Three Months Ended March 31, 2023 2022 U.S. States and Other Countries Total Revenues Percentage of Total Revenues Percentage of Texas $ 44,116 12.6 % $ 34,844 8.5 % Utah 35,641 10.2 % 33,768 8.2 % Florida 26,182 7.5 % 25,305 6.2 % California 19,495 5.6 % 41,291 10.1 % Massachusetts 6,816 1.8 % 32,631 8.0 % All other states 99,137 28.4 % 125,907 30.7 % Total U.S. $ 231,387 66.1 % $ 293,746 71.7 % United Kingdom $ 84,206 24.0 % $ 83,906 20.5 % Australia 15,237 4.4 % 17,031 4.1 % All other countries 19,381 5.5 % 15,117 3.7 % Total international $ 118,824 33.9 % $ 116,054 28.3 % Grand total $ 350,211 100.0 % $ 409,800 100.0 % Total Revenues by Facility Type For the Three Months Ended March 31, 2023 2022 Facility Types Total Revenues Percentage of Total Revenues Percentage of General acute care hospitals $ 253,036 72.3 % $ 316,019 77.0 % Behavioral health facilities 53,658 15.3 % 50,897 12.4 % Inpatient rehabilitation facilities 29,046 8.3 % 28,906 7.1 % Long-term acute care hospitals 8,251 2.4 % 8,302 2.1 % Freestanding ER/urgent care facilities 6,220 1.7 % 5,676 1.4 % Total $ 350,211 100.0 % $ 409,800 100.0 % |
Debt (Tables)
Debt (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Debt Disclosure [Abstract] | |
Summary of Debt | The following is a summary of debt (dollar amounts in thousands): As of March 31, As of December 31, Revolving credit facility(A) $ 1,031,037 $ 929,584 Term loan 200,000 200,000 British pound sterling term loan due 2024(B) 129,353 126,690 British pound sterling term loan due 2025(B) 863,590 845,810 Australian term loan facility(B) 802,200 817,560 2.550 % Senior Unsecured Notes due 2023(B) 493,480 483,320 3.325 % Senior Unsecured Notes due 2025(B) 541,950 535,250 0.993 % Senior Unsecured Notes due 2026(B) 541,950 535,250 2.500 % Senior Unsecured Notes due 2026(B) 616,850 604,150 5.250 % Senior Unsecured Notes due 2026 500,000 500,000 5.000 % Senior Unsecured Notes due 2027 1,400,000 1,400,000 3.692 % Senior Unsecured Notes due 2028(B) 740,220 724,980 4.625 % Senior Unsecured Notes due 2029 900,000 900,000 3.375 % Senior Unsecured Notes due 2030(B) 431,795 422,905 3.500 % Senior Unsecured Notes due 2031 1,300,000 1,300,000 $ 10,492,425 $ 10,325,499 Debt issue costs and discount, net ( 54,274 ) ( 57,087 ) $ 10,438,151 $ 10,268,412 (A) Includes £ 119 million of GBP-denominated borrowings and € 253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023 . (B) Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022 . |
Principal Payments Due on Debt | As of March 31, 2023, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (amounts in thousands): 2023 $ 493,480 2024 931,553 2025 1,405,540 2026 2,689,837 2027 1,600,000 Thereafter 3,372,015 Total $ 10,492,425 |
Fair Value of Financial Instr_2
Fair Value of Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Summary of Fair Value Information of Financial Instruments | The following table summarizes fair value estimates for our financial instruments (in thousands): As of March 31, 2023 As of December 31, 2022 Asset (Liability) Book Fair Book Fair Interest and rent receivables, net $ 169,511 $ 160,947 $ 167,035 $ 163,101 Loans(1) 1,511,182 (2) 1,456,753 1,405,615 (2) 1,360,113 Debt, net ( 10,438,151 ) ( 8,594,584 ) ( 10,268,412 ) ( 8,697,042 ) (1) Excludes the acquisition loan made in May 2020 related to our investment in the international joint venture, along with the related subsequent investment in the real estate of three hospitals in Colombia, as these assets are accounted for under the fair value option method, as noted below. In addition for December 31, 2022 only, this excludes the acquisition and mortgage loans made to Springstone, which were satisfied in full in February 2023 as further described in Note 3 to the condensed consolidated financial statements. (2) Includes $ 224.4 million and $ 223.8 million of mortgage loans, a $ 319.9 million and $ 315.9 million shareholder loan included in investments in unconsolidated real estate joint ventures, $ 693.0 million and $ 640.4 million of loans that are part of our investments in unconsolidated operating entities, and $ 273.9 million and $ 225.5 million of other loans at March 31, 2023 and December 31, 2022, respectively. |
Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis | At March 31, 2023 and December 31, 2022, the amounts recorded under the fair value option method were as follows (in thousands): As of March 31, 2023 As of December 31, 2022 Asset (Liability) Fair Value Original Fair Value Original Asset Type Classification Mortgage loans $ 122,073 $ 122,073 $ 140,260 $ 140,260 Mortgage loans Equity investment and other loans 243,561 247,125 434,609 441,943 Investments in unconsolidated operating entities/Other loans |
Earnings Per Share_Unit (Tables
Earnings Per Share/Unit (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Earnings Per Share [Abstract] | |
Calculation of Earnings Per Share | Our earnings per share were calculated based on the following (amounts in thousands): For the Three Months 2023 2022 Numerator: Net income $ 33,030 $ 631,947 Non-controlling interests’ share in earnings ( 236 ) ( 266 ) Participating securities’ share in earnings ( 515 ) ( 402 ) Net income, less participating securities’ share in earnings $ 32,279 $ 631,279 Denominator: Basic weighted-average common shares 598,302 598,676 Dilutive potential common shares 8 256 Diluted weighted-average common shares 598,310 598,932 MPT Operating Partnership, L.P. Our earnings per unit were calculated based on the following (amounts in thousands): For the Three Months 2023 2022 Numerator: Net income $ 33,030 $ 631,947 Non-controlling interests’ share in earnings ( 236 ) ( 266 ) Participating securities’ share in earnings ( 515 ) ( 402 ) Net income, less participating securities’ share in earnings $ 32,279 $ 631,279 Denominator: Basic weighted-average units 598,302 598,676 Dilutive potential units 8 256 Diluted weighted-average units 598,310 598,932 |
Organization - Additional Infor
Organization - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2023 State Facility Country | |
Business Acquisition [Line Items] | |
Percentage of leased assets owned | 100% |
Number of facilities | Facility | 444 |
Number of states | State | 31 |
Europe [Member] | |
Business Acquisition [Line Items] | |
Number of countries | 7 |
South America [Member] | |
Business Acquisition [Line Items] | |
Number of countries | 1 |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies - Additional Information (Detail) $ in Millions | Mar. 31, 2023 USD ($) |
Accounting Policies [Abstract] | |
Loans and/or equity investments in variable interest entities | $ 425 |
Real Estate and Other Activit_3
Real Estate and Other Activities - Net Assets Acquired (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Mar. 31, 2022 | |
Business Acquisition [Line Items] | |||
Total assets acquired | $ 72,900 | $ 724,795 | |
Liabilities assumed | (25,727) | ||
Loans repaid | [1] | (22,900) | |
Total net assets acquired | 50,000 | 724,795 | |
Land and Land Improvements [Member] | |||
Business Acquisition [Line Items] | |||
Total assets acquired | 9,313 | 9,671 | |
Building [Member] | |||
Business Acquisition [Line Items] | |||
Total assets acquired | 11,652 | 204,829 | |
Intangible Lease Assets [Member] | |||
Business Acquisition [Line Items] | |||
Total assets acquired | 1,935 | 5,461 | |
Investments in Unconsolidated Real Estate Joint Ventures [Member] | |||
Business Acquisition [Line Items] | |||
Total assets acquired | 399,456 | ||
Investments In Unconsolidated Operating Entities [Member] | |||
Business Acquisition [Line Items] | |||
Total assets acquired | $ 50,000 | $ 131,105 | |
[1] The 2023 column includes a $ 23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below. |
Real Estate and Other Activit_4
Real Estate and Other Activities - Net Assets Acquired (Parenthetical) (Detail) - USD ($) $ in Thousands | 3 Months Ended | |||
Mar. 31, 2023 | Mar. 31, 2022 | Dec. 31, 2021 | ||
Business Acquisition [Line Items] | ||||
Advanced to the mortgage loan | [1] | $ 22,900 | ||
Mortgage Loans [Member] | Springstone Health Opco, LLC [Member] | ||||
Business Acquisition [Line Items] | ||||
Advanced to the mortgage loan | $ 23,000 | |||
Intangible Lease Assets [Member] | ||||
Business Acquisition [Line Items] | ||||
Weighted-average useful life of acquired intangible lease assets (in years) | 28 years 9 months 18 days | 13 years 2 months 12 days | ||
[1] The 2023 column includes a $ 23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below. |
Real Estate and Other Activit_5
Real Estate and Other Activities - 2023 Activity - Additional Information (Detail) $ in Thousands | 1 Months Ended | |||
Feb. 07, 2023 USD ($) Facility | Aug. 31, 2019 USD ($) | Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | |
Business Acquisition [Line Items] | ||||
Acquisition loan | $ 72,900 | $ 724,795 | ||
Prospect [Member] | ||||
Business Acquisition [Line Items] | ||||
Purchase price of acquisition | $ 1,500,000 | |||
Prospect [Member] | PHP Holdings [Member] | ||||
Business Acquisition [Line Items] | ||||
Convertible loan | $ 50,000 | |||
General Acute Care Hospitals [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of facilities acquired | Facility | 8 | |||
Lease extension expiration term | 5 years | |||
Lease extension expiration year | 2041 | |||
Springstone Health Opco, LLC [Member] | ||||
Business Acquisition [Line Items] | ||||
Purchase price of acquisition | $ 250,000 | |||
Acquisition loan | $ 205,000 | |||
Springstone Health Opco, LLC [Member] | Behavioral Health Hospitals [Member] | ||||
Business Acquisition [Line Items] | ||||
Number of facilities acquired | Facility | 17 |
Real Estate and Other Activit_6
Real Estate and Other Activities - 2022 Activity - Additional Information (Detail) $ in Thousands, € in Millions, £ in Millions | 3 Months Ended | |||||||
Feb. 07, 2023 Facility | Mar. 14, 2022 USD ($) Facility | Mar. 11, 2022 USD ($) Facility | Mar. 11, 2022 EUR (€) Facility | Feb. 16, 2022 GBP (£) | Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | Dec. 31, 2022 USD ($) | |
Business Acquisition [Line Items] | ||||||||
Proceeds from sale of facilities | $ 48,000 | |||||||
Gain (loss) on real estate dispositions | 15,000 | |||||||
Investments in unconsolidated real estate joint ventures | $ 1,506,474 | $ 1,497,903 | ||||||
Acquisition loan | 72,900 | $ 724,795 | ||||||
Deferred income tax liabilities and other liabilities, incurred | $ 26,000 | |||||||
Syndicated Term Loan [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Purchase price of acquisition | £ | £ 96.5 | |||||||
Acquisition loan | £ | £ 100 | |||||||
Loan term | 6 years | |||||||
Corporate Joint Venture [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Investments in unconsolidated real estate joint ventures | $ 400,000 | |||||||
Massachusetts [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Redevelopment recovery receivables of prior storm and flood damage | 150,000 | |||||||
Real Estate Partnership [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Percentage of equity investment | 50% | |||||||
General Acute Care Hospitals [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Number of facilities acquired | Facility | 8 | |||||||
Lease extension expiration year | 2041 | |||||||
General Acute Care Hospitals [Member] | Finland [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Number of facilities acquired | Facility | 4 | 4 | ||||||
Purchase price of acquisition | $ 194,000 | € 178 | ||||||
Massachusetts-based General Acute Care Hospitals [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Number of facilities acquired | Facility | 8 | |||||||
Purchase price of acquisition | $ 1,700,000 | |||||||
Gain (loss) on real estate dispositions | $ 600,000 | |||||||
Nonrecourse secured debt percentage of asset value | 55% | |||||||
Proceeds from expected secured debt | $ 1,300,000 | |||||||
Lease extension expiration year | 2041 | |||||||
Massachusetts-based General Acute Care Hospitals [Member] | Macquarie Asset Management [Member] | ||||||||
Business Acquisition [Line Items] | ||||||||
Percentage of equity investment | 50% |
Real Estate and Other Activit_7
Real Estate and Other Activities - 2021 Activity - Additional Information (Detail) - General Acute Care Hospitals [Member] | Feb. 07, 2023 Facility |
Business Acquisition [Line Items] | |
Number of facilities acquired | 8 |
Lease extension expiration year | 2041 |
Real Estate and Other Activit_8
Real Estate and Other Activities - Development Activities - Summary of Status on Current Development Projects (Detail) $ in Thousands | 3 Months Ended |
Mar. 31, 2023 USD ($) | |
Business Acquisition [Line Items] | |
Commitment | $ 405,320 |
Costs Incurred as of March 31, 2023 | 182,060 |
Steward [Member] | Texas [Member] | |
Business Acquisition [Line Items] | |
Commitment | 169,408 |
Costs Incurred as of March 31, 2023 | $ 57,059 |
Estimated Rent Commencement Date | 1Q 2026 |
Ernest [Member] | Stockton, California [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 47,700 |
Costs Incurred as of March 31, 2023 | $ 46,372 |
Estimated Rent Commencement Date | 2Q 2023 |
Ernest [Member] | South Carolina [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 22,400 |
Costs Incurred as of March 31, 2023 | $ 14,469 |
Estimated Rent Commencement Date | 3Q 2023 |
IMED [Member] | Spain [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 51,043 |
Costs Incurred as of March 31, 2023 | $ 13,323 |
Estimated Rent Commencement Date | 2Q 2023 |
IMED [Member] | Spain [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 45,976 |
Costs Incurred as of March 31, 2023 | $ 37,568 |
Estimated Rent Commencement Date | 3Q 2023 |
Springstone [Member] | Texas [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 31,600 |
Costs Incurred as of March 31, 2023 | $ 4,099 |
Estimated Rent Commencement Date | 1Q 2024 |
IMED [Member] | Spain [Member] | |
Business Acquisition [Line Items] | |
Commitment | $ 37,193 |
Costs Incurred as of March 31, 2023 | $ 9,170 |
Estimated Rent Commencement Date | 3Q 2024 |
Real Estate and Other Activit_9
Real Estate and Other Activities - Disposals - 2023 Activity Additional Information (Detail) $ in Millions, $ in Billions | 3 Months Ended | ||
Mar. 29, 2023 AUD ($) Facility | Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | |
Debt Instrument [Line Items] | |||
Proceeds from sale of facilities | $ 48 | ||
Net impairment charge | $ 79 | ||
Straight-line rent receivables | 37.4 | ||
Estimated fees to sell the hospitals | 8 | ||
Accumulated other comprehensive income (loss), foreign currency translation adjustment, net of tax | 13 | ||
Deferred gains from our interest rate swap in AOCI | $ 29 | ||
Derivative Instrument, Gain (Loss) Reclassified from AOCI into Income, Effective Portion, Statement of Income or Comprehensive Income [Extensible Enumeration] | Other Comprehensive Income (Loss), Cash Flow Hedge, Gain (Loss), Reclassification, after Tax | ||
Australia Transaction [Member] | |||
Debt Instrument [Line Items] | |||
Proceeds from sale of facilities | $ 1.2 | ||
Australia [Member] | General Acute Care Facility [Member] | |||
Debt Instrument [Line Items] | |||
Number of facilities sold | Facility | 11 | ||
Prime [Member] | |||
Debt Instrument [Line Items] | |||
Proceeds from sale of facilities | $ 100 | ||
Non-cash impairment charge | $ 11 |
Real Estate and Other Activi_10
Real Estate and Other Activities - Disposals - Summary of Assets Designated as Held for Sale (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Real estate held for sale | $ 881,587 | |
Other assets,net | 578,853 | $ 572,990 |
Total Assets | $ 19,650,157 | $ 19,658,000 |
Real Estate and Other Activi_11
Real Estate and Other Activities - Disposals - 2022 Activity - Additional Information (Detail) $ in Millions | 3 Months Ended | ||
Mar. 14, 2022 USD ($) Facility | Mar. 31, 2023 USD ($) | Mar. 31, 2022 USD ($) | |
Debt Instrument [Line Items] | |||
Gain (loss) on real estate dispositions | $ 15 | ||
Proceeds from sale of facilities | 48 | ||
Massachusetts-based General Acute Care Hospitals [Member] | |||
Debt Instrument [Line Items] | |||
Number of facilities acquired | Facility | 8 | ||
Purchase price of acquisition | $ 1,700 | ||
Gain (loss) on real estate dispositions | $ 600 | ||
Straight-line rent write-offs | $ 125 | ||
Prime [Member] | |||
Debt Instrument [Line Items] | |||
Proceeds from sale of facilities | $ 100 |
Real Estate and Other Activi_12
Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Business Acquisition [Line Items] | ||
Revenues | $ 350,211 | $ 409,800 |
Real estate depreciation and amortization | (83,860) | (85,316) |
Real estate and other impairment charges | (89,538) | (4,875) |
Other (expense) income | (5,166) | 14,762 |
Disposal Group, Not Discontinued Operations [Member] | ||
Business Acquisition [Line Items] | ||
Revenues | 18,877 | 40,579 |
Real estate depreciation and amortization | (4,991) | (5,247) |
Property-related expenses | (1,413) | (3,015) |
Real estate and other impairment charges | (89,538) | |
Other (expense) income | (7,244) | 444,268 |
Income from real estate dispositions, net | $ (84,309) | $ 476,585 |
Real Estate and Other Activi_13
Real Estate and Other Activities - Summary of Operating Results from Properties Sold (Parenthetical) (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Business Acquisition [Line Items] | ||
Net impairment charge | $ 79 | |
Disposal Group, Not Discontinued Operations [Member] | ||
Business Acquisition [Line Items] | ||
Straight-line rent write-offs | $ 4.5 | |
Massachusetts-based General Acute Care Hospitals [Member] | ||
Business Acquisition [Line Items] | ||
Straight-line rent write-offs | 125 | |
Massachusetts-based General Acute Care Hospitals [Member] | Disposal Group, Not Discontinued Operations [Member] | ||
Business Acquisition [Line Items] | ||
Gains | $ 451.6 | |
Australia Transaction [Member] | ||
Business Acquisition [Line Items] | ||
Straight-line rent write-offs | 37.4 | |
Net impairment charge | 79 | |
Prime [Member] | ||
Business Acquisition [Line Items] | ||
Non-cash impairment charge | $ 11 |
Real Estate and Other Activi_14
Real Estate and Other Activities - Leasing Operations (Lessor) - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2023 Lease | |
Lessor Lease Description [Line Items] | |
Lease renewal term | 5 years |
Annual rent escalations | 99% |
Ernest [Member] | |
Lessor Lease Description [Line Items] | |
Number of direct financing leases | 13 |
Number of financing leases | 5 |
Prospect [Member] | |
Lessor Lease Description [Line Items] | |
Number of financing leases | 13 |
Minimum [Member] | |
Lessor Lease Description [Line Items] | |
Term of lease | 15 years |
Real Estate and Other Activi_15
Real Estate and Other Activities - Components of Total Investment in Financing Leases (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Direct Financing Lease Net Investment In Leases [Abstract] | ||
Minimum lease payments receivable | $ 626,721 | $ 880,253 |
Estimated unguaranteed residual values | 203,818 | 203,818 |
Less: Unearned income and allowance for credit loss | (588,097) | (731,915) |
Net investment in direct financing leases | 242,442 | 352,156 |
Other financing leases (net of allowance for credit loss) | 1,339,974 | 1,339,167 |
Total investment in financing leases | $ 1,582,416 | $ 1,691,323 |
Real Estate and Other Activi_16
Real Estate and Other Activities - Other Leasing Activities - Additional Information (Details) | 3 Months Ended |
Mar. 31, 2023 Property | |
Lessor, Lease, Description [Line Items] | |
Percentage of properties occupied by tenants | 99% |
Number of properties vacant | 5 |
Minimum [Member] | |
Lessor, Lease, Description [Line Items] | |
Percentage of vacant on leased property | 0.30% |
Real Estate and Other Activi_17
Real Estate and Other Activities - Coronavirus (COVID-19) Rent Deferrals - Additional Information (Detail) $ in Millions | Mar. 31, 2023 USD ($) |
Business Acquisition [Line Items] | |
Remaining outstanding deferred rent to be received | $ 12.2 |
Real Estate and Other Activi_18
Real Estate and Other Activities - Pipeline Health System - Additional Information (Detail) - Pipeline Health System [Member] $ in Millions | Feb. 07, 2023 USD ($) |
Business Acquisition [Line Items] | |
Cash rent | $ 5.6 |
Percentage of defered rent | 30% |
Real Estate and Other Activi_19
Real Estate and Other Activities - Watsonville Community Hospital - Additional Information (Details) $ in Thousands | Mar. 31, 2023 USD ($) | |
Business Acquisition [Line Items] | ||
Loans repaid | $ 22,900 | [1] |
[1] The 2023 column includes a $ 23 million mortgage loan to Springstone Health Opco, LLC ("Springstone") that was converted to fee simple ownership of one property as described below. |
Real Estate and Other Activi_20
Real Estate and Other Activities - Prospect Medical Holdings Additional Information (Detail) $ in Thousands | 1 Months Ended | 3 Months Ended | |||
Mar. 31, 2023 USD ($) | Aug. 31, 2019 USD ($) Hospital | Mar. 31, 2023 USD ($) | Dec. 31, 2022 USD ($) | Mar. 31, 2022 USD ($) | |
Business Acquisition [Line Items] | |||||
Additional mortgage loan | $ 72,900 | $ 72,900 | $ 724,795 | ||
Net impairment charge | 79,000 | ||||
Prospect [Member] | |||||
Business Acquisition [Line Items] | |||||
Purchase price of acquisition | $ 1,500,000 | ||||
Term loan | $ 112,900 | ||||
Net impairment charge | $ 280,000 | ||||
Percentage of cash payments | 50% | ||||
Prospect [Member] | Maximum [Member] | |||||
Business Acquisition [Line Items] | |||||
First lien secured loan | $ 75,000 | ||||
Prospect [Member] | Pennsylvania | |||||
Business Acquisition [Line Items] | |||||
Carrying value of lease requiring residual value guarantee | 170,000 | ||||
Unbilled rent accruals | $ 112,000 | ||||
Prospect [Member] | Pennsylvania | Maximum [Member] | |||||
Business Acquisition [Line Items] | |||||
Carrying value of lease requiring residual value guarantee | $ 250,000 | ||||
Prospect [Member] | Acute Care Campus [Member] | |||||
Business Acquisition [Line Items] | |||||
Number of facilities acquired | Hospital | 14 | ||||
PHP Holdings [Member] | Prospect [Member] | |||||
Business Acquisition [Line Items] | |||||
Convertible loan | 50,000 | 50,000 | |||
Unpaid rent and interest | 112,900 | ||||
Capital restructuring costs | 50,000 | ||||
Mortgage Loans [Member] | Prospect [Member] | |||||
Business Acquisition [Line Items] | |||||
Additional mortgage loan | $ 100,000 | $ 100,000 |
Real Estate and Other Activi_21
Real Estate and Other Activities - Investments in Unconsolidated Real Estate Joint Ventures - Additional Information (Details) - Investments in Unconsolidated Real Estate Joint Ventures [Member] | Mar. 31, 2023 |
Business Acquisition [Line Items] | |
Percentage of equity investment | 100% |
Maximum [Member] | |
Business Acquisition [Line Items] | |
Percentage of equity investment | 100% |
Real Estate and Other Activi_22
Real Estate and Other Activities - Summary of Investments in Unconsolidated Real Estate Joint Ventures by Operator (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated real estate joint ventures | $ 1,506,474 | $ 1,497,903 |
Median Kliniken S A R L [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Ownership interest | 50% | |
Investments in unconsolidated real estate joint ventures | $ 483,706 | 482,735 |
Swiss Medical Network [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Ownership interest | 70% | |
Investments in unconsolidated real estate joint ventures | $ 461,952 | 454,083 |
Steward (Macquarie Transaction) [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Ownership interest | 50% | |
Investments in unconsolidated real estate joint ventures | $ 416,068 | 417,701 |
Policlinico di Monza [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Ownership interest | 50% | |
Investments in unconsolidated real estate joint ventures | $ 88,658 | 86,245 |
HM Hospital [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Ownership interest | 45% | |
Investments in unconsolidated real estate joint ventures | $ 56,090 | $ 57,139 |
Real Estate and Other Activi_23
Real Estate and Other Activities - Summary of Investments in Unconsolidated Operating Entities (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | $ 1,310,460 | $ 1,444,872 |
Steward Loan Investment [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 362,586 | 362,831 |
International Joint Venture [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 230,153 | 231,402 |
Priory [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 159,668 | 156,575 |
Swiss Medical Network [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 158,687 | 157,145 |
Steward Equity Investment [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 125,862 | 125,862 |
Prospect [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 112,701 | 112,777 |
Aevis Victoria SA [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 77,618 | 72,904 |
PHP Holdings [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 49,895 | |
Aspris Children's Services [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 16,014 | 16,023 |
Springstone [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | 10,933 | 200,827 |
Caremax [Member] | ||
Schedule of Equity Method Investments [Line Items] | ||
Investments in unconsolidated operating entities | $ 6,343 | $ 8,526 |
Real Estate and Other Activi_24
Real Estate and Other Activities - Investments in Unconsolidated Operating Entities - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended |
Mar. 31, 2023 | Dec. 31, 2022 | |
Aevis Victoria SA [Member] | ||
Business Acquisition [Line Items] | ||
Ownership interest in joint venture under the cost method | 5% | |
COVID-19 Pandemic [Member] | Other [Member] | ||
Business Acquisition [Line Items] | ||
Favorable non-cash fair value adjustment on investment | $ 4 | $ 8 |
Real Estate and Other Activi_25
Real Estate and Other Activities - Other Investment Activities - Additional Information (Detail) $ in Millions | Mar. 31, 2023 USD ($) |
Steward Health Care System LLC [Member] | |
Business Acquisition [Line Items] | |
Real Estate Secured Advanced Loan | $ 50 |
Real Estate and Other Activi_26
Real Estate and Other Activities - Summary of Activity in Credit Loss Reserves (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Receivables [Abstract] | ||
Balance at beginning of the year | $ 121,146 | $ 48,527 |
Provision for credit loss, net | 986 | 5,412 |
Expected credit loss reserve related to financial instruments sold, repaid, or satisfied | (160) | (6) |
Balance at end of the period | $ 121,972 | $ 53,933 |
Real Estate and Other Activi_27
Real Estate and Other Activities - Schedule of Concentrations of Credit Risk (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | Dec. 31, 2022 | |
Business Acquisition [Line Items] | |||
Total Assets | $ 19,650,157 | $ 19,658,000 | |
Total Revenues | 350,211 | $ 409,800 | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 19,650,157 | $ 19,658,000 | |
Percentage of concentration risk | 100% | 100% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Other Assets [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,709,392 | $ 1,611,159 | |
Percentage of concentration risk | 8.70% | 8.20% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Steward [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 4,800,594 | $ 4,762,673 | |
Percentage of concentration risk | 24.40% | 24.20% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Circle [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 2,092,822 | $ 2,062,474 | |
Percentage of concentration risk | 10.70% | 10.50% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Prospect [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,533,412 | $ 1,483,599 | |
Percentage of concentration risk | 7.80% | 7.50% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Priory [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,310,968 | $ 1,290,213 | |
Percentage of concentration risk | 6.70% | 6.60% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Springstone [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 796,248 | $ 985,959 | |
Percentage of concentration risk | 4% | 5% | |
Total Gross Assets [Member] | Operator Concentration Risk [Member] | Other Operators [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 7,406,721 | $ 7,461,923 | |
Percentage of concentration risk | 37.70% | 38% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 19,650,157 | $ 19,658,000 | |
Percentage of concentration risk | 100% | 100% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Texas [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 2,008,146 | $ 1,967,948 | |
Percentage of concentration risk | 10.20% | 10% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | California [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,502,060 | $ 1,450,112 | |
Percentage of concentration risk | 7.70% | 7.40% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Florida [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,319,878 | $ 1,324,555 | |
Percentage of concentration risk | 6.70% | 6.80% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Utah [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,218,883 | $ 1,224,484 | |
Percentage of concentration risk | 6.20% | 6.20% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Massachusetts [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 763,555 | $ 761,694 | |
Percentage of concentration risk | 3.90% | 3.90% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | All Other States [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 4,035,762 | $ 4,245,306 | |
Percentage of concentration risk | 20.50% | 21.60% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Total U.S. [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 11,935,420 | $ 12,003,045 | |
Percentage of concentration risk | 60.70% | 61.10% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | United Kingdom [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 4,145,170 | $ 4,083,244 | |
Percentage of concentration risk | 21.10% | 20.80% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Australia [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 781,585 | $ 854,582 | |
Percentage of concentration risk | 4% | 4.30% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Switzerland [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 763,711 | $ 748,947 | |
Percentage of concentration risk | 3.90% | 3.80% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Germany [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 666,930 | $ 664,900 | |
Percentage of concentration risk | 3.40% | 3.40% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Spain [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 226,800 | $ 222,316 | |
Percentage of concentration risk | 1.10% | 1.10% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | All Other Countries [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 508,285 | $ 498,753 | |
Percentage of concentration risk | 2.60% | 2.50% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Total International [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 7,714,737 | $ 7,654,955 | |
Percentage of concentration risk | 39.30% | 38.90% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Other Domestic Assets [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 1,087,136 | $ 1,028,946 | |
Percentage of concentration risk | 5.50% | 5.20% | |
Total Gross Assets [Member] | Geographic Concentration [Member] | Other International Assets [Member] | |||
Business Acquisition [Line Items] | |||
Total Assets | $ 622,256 | $ 582,213 | |
Percentage of concentration risk | 3.20% | 3% | |
Revenue [Member] | Operator Concentration Risk [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 100% | 100% | |
Total Revenues | $ 350,211 | $ 409,800 | |
Revenue [Member] | Operator Concentration Risk [Member] | Steward [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 29.60% | 29.60% | |
Total Revenues | $ 103,494 | $ 121,244 | |
Revenue [Member] | Operator Concentration Risk [Member] | Circle [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 13.50% | 12.50% | |
Total Revenues | $ 47,415 | $ 51,212 | |
Revenue [Member] | Operator Concentration Risk [Member] | Prospect [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 0% | 9.40% | |
Total Revenues | $ 38,684 | ||
Revenue [Member] | Operator Concentration Risk [Member] | Priory [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 7.10% | 4.70% | |
Total Revenues | $ 24,740 | $ 19,070 | |
Revenue [Member] | Operator Concentration Risk [Member] | Springstone [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 5.80% | 5.30% | |
Total Revenues | $ 20,167 | $ 21,664 | |
Revenue [Member] | Operator Concentration Risk [Member] | Other Operators [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 44% | 38.50% | |
Total Revenues | $ 154,395 | $ 157,926 | |
Revenue [Member] | Geographic Concentration [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 100% | 100% | |
Total Revenues | $ 350,211 | $ 409,800 | |
Revenue [Member] | Geographic Concentration [Member] | Texas [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 12.60% | 8.50% | |
Total Revenues | $ 44,116 | $ 34,844 | |
Revenue [Member] | Geographic Concentration [Member] | California [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 5.60% | 10.10% | |
Total Revenues | $ 19,495 | $ 41,291 | |
Revenue [Member] | Geographic Concentration [Member] | Florida [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 7.50% | 6.20% | |
Total Revenues | $ 26,182 | $ 25,305 | |
Revenue [Member] | Geographic Concentration [Member] | Utah [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 10.20% | 8.20% | |
Total Revenues | $ 35,641 | $ 33,768 | |
Revenue [Member] | Geographic Concentration [Member] | Massachusetts [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 1.80% | 8% | |
Total Revenues | $ 6,816 | $ 32,631 | |
Revenue [Member] | Geographic Concentration [Member] | All Other States [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 28.40% | 30.70% | |
Total Revenues | $ 99,137 | $ 125,907 | |
Revenue [Member] | Geographic Concentration [Member] | Total U.S. [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 66.10% | 71.70% | |
Total Revenues | $ 231,387 | $ 293,746 | |
Revenue [Member] | Geographic Concentration [Member] | United Kingdom [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 24% | 20.50% | |
Total Revenues | $ 84,206 | $ 83,906 | |
Revenue [Member] | Geographic Concentration [Member] | Australia [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 4.40% | 4.10% | |
Total Revenues | $ 15,237 | $ 17,031 | |
Revenue [Member] | Geographic Concentration [Member] | All Other Countries [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 5.50% | 3.70% | |
Total Revenues | $ 19,381 | $ 15,117 | |
Revenue [Member] | Geographic Concentration [Member] | Total International [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 33.90% | 28.30% | |
Total Revenues | $ 118,824 | $ 116,054 | |
Revenue [Member] | Customer Concentration Risk [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 100% | 100% | |
Total Revenues | $ 350,211 | $ 409,800 | |
Revenue [Member] | Customer Concentration Risk [Member] | General Acute Care Hospitals [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 72.30% | 77% | |
Total Revenues | $ 253,036 | $ 316,019 | |
Revenue [Member] | Customer Concentration Risk [Member] | Behavioral Health Facilities [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 15.30% | 12.40% | |
Total Revenues | $ 53,658 | $ 50,897 | |
Revenue [Member] | Customer Concentration Risk [Member] | Inpatient Rehabilitation Facilities [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 8.30% | 7.10% | |
Total Revenues | $ 29,046 | $ 28,906 | |
Revenue [Member] | Customer Concentration Risk [Member] | Long Term Acute Care Hospital [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 2.40% | 2.10% | |
Total Revenues | $ 8,251 | $ 8,302 | |
Revenue [Member] | Customer Concentration Risk [Member] | Freestanding ER/Urgent Care Facilities [Member] | |||
Business Acquisition [Line Items] | |||
Percentage of concentration risk | 1.70% | 1.40% | |
Total Revenues | $ 6,220 | $ 5,676 | |
Pro Forma [Member] | Total Gross Assets [Member] | Customer Concentration Risk [Member] | |||
Business Acquisition [Line Items] | |||
Maximum percentage of entity's assets invested on single property | 3% |
Debt - Summary of Debt (Detail)
Debt - Summary of Debt (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 | |
Debt Instrument [Line Items] | |||
Debt | $ 10,492,425 | $ 10,325,499 | |
Debt issue costs and discount, net | (54,274) | (57,087) | |
Debt, net | 10,438,151 | 10,268,412 | |
Revolving Credit Facility [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [1] | 1,031,037 | 929,584 |
Term Loan [Member] | |||
Debt Instrument [Line Items] | |||
Debt | 200,000 | 200,000 | |
Term Loan [Member] | Australia [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 802,200 | 817,560 |
Term loan due 2024 | British Pound Sterling [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 129,353 | 126,690 |
Term loan due 2025 | British Pound Sterling [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 863,590 | 845,810 |
2.550% Senior Unsecured Notes due 2023 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 493,480 | 483,320 |
3.325% Senior Unsecured Notes due 2025 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 541,950 | 535,250 |
0.993% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 541,950 | 535,250 |
2.500% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 616,850 | 604,150 |
5.250% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | 500,000 | 500,000 | |
5.000% Senior Unsecured Notes due 2027 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | 1,400,000 | 1,400,000 | |
3.692% Senior Unsecured Notes due 2028 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 740,220 | 724,980 |
4.625% Senior Unsecured Notes due 2029 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | 900,000 | 900,000 | |
3.375% Senior Unsecured Notes due 2030 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | [2] | 431,795 | 422,905 |
3.500% Senior Unsecured Notes due 2031 [Member] | |||
Debt Instrument [Line Items] | |||
Debt | $ 1,300,000 | $ 1,300,000 | |
[1] Includes £ 119 million of GBP-denominated borrowings and € 253 million of Euro-denominated borrowings that reflect the applicable exchange rates at March 31, 2023 . Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022 . |
Debt - Summary of Debt (Parenth
Debt - Summary of Debt (Parenthetical) (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 | |
Debt Instrument [Line Items] | |||
Debt | $ 10,492,425 | $ 10,325,499 | |
GBP-denominated Borrowings [Member] | |||
Debt Instrument [Line Items] | |||
Debt | 119,000 | ||
EURO-denominated Borrowings [Member] | |||
Debt Instrument [Line Items] | |||
Debt | $ 253,000 | ||
2.550% Senior Unsecured Notes due 2023 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 2.55% | 2.55% | |
Debt | [1] | $ 493,480 | $ 483,320 |
3.325% Senior Unsecured Notes due 2025 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 3.325% | 3.325% | |
Debt | [1] | $ 541,950 | $ 535,250 |
0.993% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 0.993% | 0.993% | |
Debt | [1] | $ 541,950 | $ 535,250 |
2.500% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 2.50% | 2.50% | |
Debt | [1] | $ 616,850 | $ 604,150 |
5.250% Senior Unsecured Notes due 2026 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 5.25% | 5.25% | |
Debt | $ 500,000 | $ 500,000 | |
5.000% Senior Unsecured Notes due 2027 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 5% | 5% | |
Debt | $ 1,400,000 | $ 1,400,000 | |
3.692% Senior Unsecured Notes due 2028 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 3.692% | 3.692% | |
Debt | [1] | $ 740,220 | $ 724,980 |
4.625% Senior Unsecured Notes due 2029 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 4.625% | 4.625% | |
Debt | $ 900,000 | $ 900,000 | |
3.375% Senior Unsecured Notes due 2030 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 3.375% | 3.375% | |
Debt | [1] | $ 431,795 | $ 422,905 |
3.500% Senior Unsecured Notes due 2031 [Member] | |||
Debt Instrument [Line Items] | |||
Senior unsecured notes, interest rate | 3.50% | 3.50% | |
Debt | $ 1,300,000 | $ 1,300,000 | |
[1] Non-U.S. dollar denominated debt reflects the exchange rates at March 31, 2023 and December 31, 2022 . |
Debt - Principal Payments Due f
Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Debt Disclosure [Abstract] | ||
2023 | $ 493,480 | |
2024 | 931,553 | |
2025 | 1,405,540 | |
2026 | 2,689,837 | |
2027 | 1,600,000 | |
Thereafter | 3,372,015 | |
Total | $ 10,492,425 | $ 10,325,499 |
Debt - 2022 Activity - Addition
Debt - 2022 Activity - Additional Information (Detail) - USD ($) $ in Billions | 3 Months Ended | |
Mar. 31, 2023 | Mar. 15, 2022 | |
Debt Instrument [Line Items] | ||
Line of credit , entered date | Jul. 27, 2021 | |
Line of credit, terminated date | Mar. 15, 2022 | |
Line of credit facility, Borrowing capacity | $ 1 |
Debt - Additional Information (
Debt - Additional Information (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2023 USD ($) | |
Waterland Private Equity Fund VII C.V. [Member] | Interim Credit Facility [Member] | |
Debt Instrument [Line Items] | |
Debt refinancing costs | $ 8.8 |
Debt - Covenants - Additional I
Debt - Covenants - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2023 | |
Debt Disclosure [Abstract] | |
Percentage of dividends which could be paid from adjusted operating funds | 95% |
Percentage of dividends which could be paid from operation funds | 95% |
Maximum percentage of total unencumbered assets | 150% |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) $ in Millions | 3 Months Ended |
Mar. 31, 2023 USD ($) | |
Income Tax Disclosure [Abstract] | |
Income tax benefit related to the initial loan impairment | $ 5 |
Common Stock_Partners' Capital
Common Stock/Partners' Capital - Additional Information (Detail) - shares shares in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Class Of Stock [Line Items] | ||
Common stock, shares issued | 598,302 | 597,476 |
Stock Awards - Additional Infor
Stock Awards - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Stock / (Unit)-based compensation expense | $ 11,829 | $ 11,804 |
Equity Incentive Plan [Member] | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Reserved shares of new common stock for awards under the Equity Incentive Plan | 28,900,000 | |
Common stock remaining for future stock awards transferred to the equity incentive plan | 16,700,000 |
Fair Value of Financial Instr_3
Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Fair Value Disclosures [Abstract] | ||
Interest and rent receivables, Book value | $ 169,511 | $ 167,035 |
Loans, Book value | 1,511,182 | 1,405,615 |
Debt, net Book value | (10,438,151) | (10,268,412) |
Interest and rent receivables, Fair value | 160,947 | 163,101 |
Loans, Fair value | 1,456,753 | 1,360,113 |
Debt, net Fair value | $ (8,594,584) | $ (8,697,042) |
Fair Value of Financial Instr_4
Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Parenthetical) (Detail) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 USD ($) Health_Center | Dec. 31, 2022 USD ($) | |
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Mortgage loans | $ 346,446 | $ 364,101 |
Investments in unconsolidated real estate joint ventures | 1,506,474 | 1,497,903 |
Investments in unconsolidated operating entities | 1,310,460 | 1,444,872 |
Loans [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Investments in unconsolidated operating entities | 693,000 | 640,400 |
Other loans | 273,900 | 225,500 |
Shareholder Loan [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Mortgage loans | 224,400 | 223,800 |
Investments in unconsolidated real estate joint ventures | $ 319,900 | $ 315,900 |
Fair Value, Recurring [Member] | Colombia [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Number of facilities acquired | Health_Center | 3 | |
Fair Value, Recurring [Member] | Acquisition Loans [Member] | Colombia [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Number of facilities acquired | Health_Center | 3 |
Fair Value of Financial Instr_5
Fair Value of Financial Instruments - Additional Information (Detail) | 3 Months Ended |
Mar. 31, 2023 Health_Center | |
Fair Value, Recurring [Member] | Colombia [Member] | |
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | |
Number of facilities acquired | 3 |
Fair Value of Financial Instr_6
Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Recurring [Member] - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Mortgage Loans [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Fair Value | $ 122,073 | $ 140,260 |
Original Cost | 122,073 | 140,260 |
Equity Method Investment and Other Loans [Member] | ||
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items] | ||
Fair Value | 243,561 | 434,609 |
Original Cost | $ 247,125 | $ 441,943 |
Earnings Per Share_Unit - Calcu
Earnings Per Share/Unit - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items] | ||
Net income | $ 33,030 | $ 631,947 |
Non-controlling interests' share in earnings | (236) | (266) |
Participating securities’ share in earnings | (515) | (402) |
Net income, less participating securities’ share in earnings | $ 32,279 | $ 631,279 |
Basic weighted-average common shares | 598,302 | 598,676 |
Dilutive potential common shares | 8 | 256 |
Diluted weighted-average common shares | 598,310 | 598,932 |
MPT Operating Partnership, L.P. [Member] | ||
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items] | ||
Net income | $ 33,030 | $ 631,947 |
Non-controlling interests' share in earnings | (236) | (266) |
Participating securities’ share in earnings | (515) | (402) |
Net income, less participating securities’ share in earnings | $ 32,279 | $ 631,279 |
Basic weighted-average common shares | 598,302 | 598,676 |
Dilutive potential common shares | 8 | 256 |
Diluted weighted-average common shares | 598,310 | 598,932 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) $ in Millions | 3 Months Ended | |
Oct. 05, 2022 USD ($) Facility | Mar. 31, 2022 USD ($) | |
Commitment And Contingencies [Line Items] | ||
Expected cash proceeds on transaction close | $ 48 | |
Prospect [Member] | Connecticut [Member] | ||
Commitment And Contingencies [Line Items] | ||
Number of facilities sold | Facility | 3 | |
Expected cash proceeds on transaction close | $ 457 |
Subsequent Events - Additional
Subsequent Events - Additional Information (Detail) € in Millions, £ in Millions, $ in Millions | 3 Months Ended | |||||
May 01, 2023 USD ($) | Apr. 19, 2023 EUR (€) Facility | Apr. 14, 2023 GBP (£) Facility | Feb. 07, 2023 Facility | Mar. 31, 2023 USD ($) | Mar. 31, 2022 | |
In-place lease intangibles [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Amortization of intangibles | $ 288 | |||||
General Acute Care Hospitals [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Number of facilities acquired | Facility | 8 | |||||
Customer Concentration Risk [Member] | Revenue [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Percentage of concentration risk | 100% | 100% | ||||
Subsequent Event [Member] | Steward [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Proceeds to paydown outstanding loan | $ 150 | |||||
Proceeds received to paydown outstanding loan | 100 | |||||
Straight-line rent write-offs | $ 94 | |||||
Overall concentration percentage | 4% | |||||
Subsequent Event [Member] | Behavioral Health Hospitals [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Number of leased facilities | Facility | 5 | |||||
Payment for acquisition | € 70 | £ 44 | ||||
Number of facilities acquired | Facility | 2 | 5 | ||||
Subsequent Event [Member] | Utah [Member] | Catholic Health Initiatives Colorado [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Initial lease term | 15 years | |||||
Subsequent Event [Member] | Customer Concentration Risk [Member] | Revenue [Member] | Steward [Member] | ||||||
Subsequent Event [Line Items] | ||||||
Percentage of concentration risk | 8% |