MPT Operating Partnership 10-Q 10 May 18 2018 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2018	May 04, 2018
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q1
Trading Symbol	MPW
Entity Registrant Name	MEDICAL PROPERTIES TRUST INC
Entity Central Index Key	1,287,865
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		364,736,886
MPT Operating Partnership, L.P. [Member]
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q1
Entity Registrant Name	MPT OPERATING PARTNERSHIP, L.P.
Entity Central Index Key	1,524,607
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	$ 5,867,286	$ 5,797,605
Real estate held for sale		146,615
Mortgage loans	1,927,393	1,778,316
Net investment in direct financing leases	686,024	698,727
Gross investment in real estate assets	8,480,703	8,421,263
Accumulated depreciation and amortization	(493,782)	(455,712)
Net investment in real estate assets	7,986,921	7,965,551
Cash and cash equivalents	138,314	171,472
Interest and rent receivables	81,965	78,970
Straight-line rent receivables	202,317	185,592
Other loans	148,842	150,209
Other assets	473,481	468,494
Total Assets	9,031,840	9,020,288
Liabilities
Debt, net	4,898,364	4,898,667
Accounts payable and accrued expenses	206,891	211,188
Deferred revenue	15,549	18,178
Lease deposits and other obligations to tenants	57,847	57,050
Total liabilities	5,178,651	5,185,083
Equity / Capital
Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding
Common stock, $0.001 par value. Authorized 500,000 shares; issued and outstanding — 364,695 shares at March 31, 2018 and 364,424 shares at December 31, 2017	365	364
Limited Partners:
Additional paid-in capital	4,333,972	4,333,027
Distributions in excess of net income	(484,804)	(485,932)
Accumulated other comprehensive loss	(9,961)	(26,049)
Treasury shares, at cost	(777)	(777)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	3,838,795	3,820,633
Non-controlling interests	14,394	14,572
Total Equity / Capital	3,853,189	3,835,205
Total Liabilities and Equity / Capital	9,031,840	9,020,288
MPT Operating Partnership, L.P. [Member]
Real estate assets
Land, buildings and improvements, intangible lease assets, and other	5,867,286	5,797,605
Real estate held for sale		146,615
Mortgage loans	1,927,393	1,778,316
Net investment in direct financing leases	686,024	698,727
Gross investment in real estate assets	8,480,703	8,421,263
Accumulated depreciation and amortization	(493,782)	(455,712)
Net investment in real estate assets	7,986,921	7,965,551
Cash and cash equivalents	138,314	171,472
Interest and rent receivables	81,965	78,970
Straight-line rent receivables	202,317	185,592
Other loans	148,842	150,209
Other assets	473,481	468,494
Total Assets	9,031,840	9,020,288
Liabilities
Debt, net	4,898,364	4,898,667
Accounts payable and accrued expenses	115,149	121,465
Deferred revenue	15,549	18,178
Lease deposits and other obligations to tenants	57,847	57,050
Payable due to Medical Properties Trust, Inc.	91,352	89,333
Total liabilities	5,178,261	5,184,693
Limited Partners:
Accumulated other comprehensive loss	(9,961)	(26,049)
Total Medical Properties Trust, Inc. Stockholders' Equity (MPT Operating Partnership, L.P. capital)	3,839,185	3,821,023
Non-controlling interests	14,394	14,572
Total Equity / Capital	3,853,579	3,835,595
Total Liabilities and Equity / Capital	9,031,840	9,020,288
MPT Operating Partnership, L.P. [Member] | General Partner [Member]
Equity / Capital
General Partner — issued and outstanding — 3,647 units at March 31, 2018 and 3,644 units at December 31, 2017	38,518	38,489
MPT Operating Partnership, L.P. [Member] | Common Units [Member]
Limited Partners:
Limited Partners Capital	$ 3,810,628	$ 3,808,583

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Mar. 31, 2018	Dec. 31, 2017
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	500,000,000	500,000,000
Common stock, shares issued	364,695,000	364,424,000
Common stock, shares outstanding	364,695,000	364,424,000
MPT Operating Partnership, L.P. [Member] | Common Units [Member]
Limited Partners, units issued	361,048,000	360,780,000
Limited Partners, units outstanding	361,048,000	360,780,000
General Partner [Member] | MPT Operating Partnership, L.P. [Member]
General partner, units issued	3,647,000	3,644,000
General partner, units outstanding	3,647,000	3,644,000
LTIP Units [Member] | MPT Operating Partnership, L.P. [Member]
LTIP Units, shares issued	232,000	292,000
LTIP Units, shares outstanding	232,000	292,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Net Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Revenues
Rent billed	$ 128,011	$ 96,763
Straight-line rent	15,791	12,779
Income from direct financing leases	17,681	17,880
Interest and fee income	43,563	28,975
Total revenues	205,046	156,397
Expenses
Interest	57,023	38,029
Real estate depreciation and amortization	35,802	27,586
Property-related	2,184	1,328
General and administrative	17,818	13,197
Acquisition costs		2,756
Total expenses	112,827	82,896
Other income (expense)
Gain on sale of real estate, net	1,467	7,413
Debt refinancing costs		(13,629)
Other	(1,468)	1,767
Total other income (expense)	(1)	(4,449)
Income before income tax	92,218	69,052
Income tax expense	(1,175)	(867)
Net income	91,043	68,185
Net income attributable to non-controlling interests	(442)	(215)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 90,601	$ 67,970
Earnings per common share — basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.25	$ 0.21
Weighted average shares outstanding - basic	364,882	321,057
Weighted average shares outstanding - diluted	365,343	321,423
Dividends declared per common share	$ 0.25	$ 0.24
MPT Operating Partnership, L.P. [Member]
Revenues
Rent billed	$ 128,011	$ 96,763
Straight-line rent	15,791	12,779
Income from direct financing leases	17,681	17,880
Interest and fee income	43,563	28,975
Total revenues	205,046	156,397
Expenses
Interest	57,023	38,029
Real estate depreciation and amortization	35,802	27,586
Property-related	2,184	1,328
General and administrative	17,818	13,197
Acquisition costs		2,756
Total expenses	112,827	82,896
Other income (expense)
Gain on sale of real estate, net	1,467	7,413
Debt refinancing costs		(13,629)
Other	(1,468)	1,767
Total other income (expense)	(1)	(4,449)
Income before income tax	92,218	69,052
Income tax expense	(1,175)	(867)
Net income	91,043	68,185
Net income attributable to non-controlling interests	(442)	(215)
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 90,601	$ 67,970
Earnings per common share — basic and diluted
Net income attributable to MPT common stockholders (Operating Partnership partners)	$ 0.25	$ 0.21
Weighted average shares outstanding - basic	364,882	321,057
Weighted average shares outstanding - diluted	365,343	321,423
Dividends declared per common share	$ 0.25	$ 0.24

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Net income	$ 91,043	$ 68,185
Other comprehensive income:
Foreign currency translation gain	16,088	6,292
Total comprehensive income	107,131	74,477
Comprehensive income attributable to non-controlling interests	(442)	(215)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	106,689	74,262
MPT Operating Partnership, L.P. [Member]
Net income	91,043	68,185
Other comprehensive income:
Foreign currency translation gain	16,088	6,292
Total comprehensive income	107,131	74,477
Comprehensive income attributable to non-controlling interests	(442)	(215)
Comprehensive income attributable to MPT common stockholders (Operating Partnership Partners)	$ 106,689	$ 74,262

Condensed Consolidated Stateme6

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Operating activities
Net income	$ 91,043	$ 68,185
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	37,858	28,954
Amortization of deferred financing costs and debt discount	1,789	1,617
Direct financing lease interest accretion	(2,340)	(2,286)
Straight-line rent revenue	(20,377)	(13,896)
Share / (Unit)-based compensation expense	1,856	1,971
Gain from sale of real estate, net	(1,467)	(7,413)
Straight-line rent and other write-off	6,059	1,117
Debt refinancing costs		13,629
Other adjustments	(3,217)	(2,959)
Changes in:
Interest and rent receivables	(3,678)	(4,208)
Accounts payable and accrued expenses	(12,729)	(20,428)
Net cash provided by operating activities	94,797	64,283
Investing activities
Cash paid for acquisitions and other related investments		(9,004)
Net proceeds from sale of real estate	148,809	64,335
Principal received on loans receivable	1,734	3,233
Investment in loans receivable	(149,080)	(1,410)
Construction in progress and other	(8,399)	(26,898)
Net cash (used for) provided by investing activities	(6,936)	30,256
Financing activities
Proceeds from term debt		955,280
Payments of term debt		(675,201)
Revolving credit facilities, net	(33,590)	90,000
Distributions paid	(89,403)	(74,521)
Lease deposits and other obligations to tenants	1,299	3,307
Debt issuance costs paid and other financing activities	(1,643)	(15,882)
Net cash (used for) provided by financing activities	(123,337)	282,983
(Decrease) increase in cash, cash equivalents and restricted cash for period	(35,476)	377,522
Effect of exchange rate changes	2,774	(10,083)
Cash, cash equivalents and restricted cash at beginning of period	172,247	84,882
Cash, cash equivalents and restricted cash at end of period	139,545	452,321
Interest paid	57,025	51,601
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	91,410	77,172
Cash, cash equivalents and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	171,472	83,240
Restricted cash, included in Other assets at beginning of period	775	1,642
Cash, cash equivalents and restricted cash at beginning of period	172,247	84,882
Cash and cash equivalents at end of period	138,314	446,948
Restricted cash, included in Other assets at end of period	1,231	5,373
Cash, cash equivalents and restricted cash at end of period	139,545	452,321
MPT Operating Partnership, L.P. [Member]
Operating activities
Net income	91,043	68,185
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	37,858	28,954
Amortization of deferred financing costs and debt discount	1,789	1,617
Direct financing lease interest accretion	(2,340)	(2,286)
Straight-line rent revenue	(20,377)	(13,896)
Share / (Unit)-based compensation expense	1,856	1,971
Gain from sale of real estate, net	(1,467)	(7,413)
Straight-line rent and other write-off	6,059	1,117
Debt refinancing costs		13,629
Other adjustments	(3,217)	(2,959)
Changes in:
Interest and rent receivables	(3,678)	(4,208)
Accounts payable and accrued expenses	(12,729)	(20,428)
Net cash provided by operating activities	94,797	64,283
Investing activities
Cash paid for acquisitions and other related investments		(9,004)
Net proceeds from sale of real estate	148,809	64,335
Principal received on loans receivable	1,734	3,233
Investment in loans receivable	(149,080)	(1,410)
Construction in progress and other	(8,399)	(26,898)
Net cash (used for) provided by investing activities	(6,936)	30,256
Financing activities
Proceeds from term debt		955,280
Payments of term debt		(675,201)
Revolving credit facilities, net	(33,590)	90,000
Distributions paid	(89,403)	(74,521)
Lease deposits and other obligations to tenants	1,299	3,307
Debt issuance costs paid and other financing activities	(1,643)	(15,882)
Net cash (used for) provided by financing activities	(123,337)	282,983
(Decrease) increase in cash, cash equivalents and restricted cash for period	(35,476)	377,522
Effect of exchange rate changes	2,774	(10,083)
Cash, cash equivalents and restricted cash at beginning of period	172,247	84,882
Cash, cash equivalents and restricted cash at end of period	139,545	452,321
Interest paid	57,025	51,601
Supplemental schedule of non-cash financing activities:
Distributions declared, unpaid	91,410	77,172
Cash, cash equivalents and restricted cash are comprised of the following:
Cash and cash equivalents at beginning of period	171,472	83,240
Restricted cash, included in Other assets at beginning of period	775	1,642
Cash, cash equivalents and restricted cash at beginning of period	172,247	84,882
Cash and cash equivalents at end of period	138,314	446,948
Restricted cash, included in Other assets at end of period	1,231	5,373
Cash, cash equivalents and restricted cash at end of period	$ 139,545	$ 452,321

Organization

Organization	3 Months Ended
	Mar. 31, 2018
Accounting Policies [Abstract]
Organization	1. Organization Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003, under the Maryland General Corporation Law for the purpose of engaging in the business of investing in, owning, and leasing commercial real estate. Our operating partnership subsidiary, MPT Operating Partnership, L.P., (the “Operating Partnership”) through which we conduct all of our operations, was formed in September 2003. Through another wholly-owned subsidiary, Medical Properties Trust, LLC, we are the sole general partner of the Operating Partnership. At present, we directly own substantially all of the limited partnership interests in the Operating Partnership and have elected to report our required disclosures and that of the Operating Partnership on a combined basis except where material differences exist. We have operated as a real estate investment trust (“REIT”) since April 6, 2004 and elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will generally not be subject to federal income tax in the United States (“U.S.”), provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income. Certain non-real estate activities we undertake are conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRS”). Our TRS entities are subject to both U.S. federal and state income taxes. For our properties located outside the U.S., we are subject to local taxes; however, we do not expect to incur additional taxes in the U.S. as such income flows through our REIT. Our primary business strategy is to acquire and develop real estate and improvements, primarily for long-term lease to providers of healthcare services such as operators of general acute care hospitals, inpatient physical rehabilitation hospitals, long-term acute care hospitals, surgery centers, centers for treatment of specific conditions such as cardiac, pulmonary, cancer, and neurological hospitals, and other healthcare-oriented facilities. We also make mortgage and other loans to operators of similar facilities. In addition, we may obtain profits or equity interests in our tenants, from time to time, in order to enhance our overall return. We manage our business as a single business segment. Our properties are located in the U.S. and Europe.

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2018
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Unaudited Interim Condensed Consolidated Financial Statements : The accompanying unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the U.S. for interim financial information, including rules and regulations of the Securities and Exchange Commission (“SEC”). Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation have been included. Operating results for the three months ended March 31, 2018, are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. The condensed consolidated balance sheet at December 31, 2017 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2017. There have been no material changes to these significant accounting policies other than the following: On January 1, 2018, we adopted Accounting Standards Update (“ASU”) No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”). ASU 2017-01 provides an initial screen to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, in which case, the transaction would be accounted for as an asset acquisition rather than as a business combination. In addition, ASU 2017-01 clarifies the requirements for a set of activities to be considered a business and narrows the definition of an output. With this accounting change, we expect to recognize a majority of our future real estate acquisitions as asset transactions rather than business combinations, which will result in the capitalization of third party transaction costs that are directly related to an acquisition and significantly decrease acquisition expenses. Indirect and internal transaction costs will continue to be expensed, but we do not expect to treat these costs as acquisition expenses for purposes of deriving normalized funds from operations in the future. Accordingly, this change in accounting increased our general and administrative expenses by $1.6 million for the three months ended March 31, 2018 compared to prior year. On January 1, 2018, we adopted ASU No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. This standard should not have a significant impact on our financial results, as a substantial portion of our revenue consists of rental income from leasing arrangements and interest income from loans, which are specifically excluded from ASU No. 2014-09. However, we also adopted a related standard ASU No. 2017-05 “Other Income - Gains and Losses from the Derecognition of Nonfinancial Assets” on January 1, 2018, which we expect will allow for more transactions to qualify as sales of real estate with gains on sales being recognized earlier than under previous accounting guidance, as the new guidance is based on transfer of control versus whether or not the seller has continuing involvement. Upon adoption of this new standard, we recorded a $1.9 million adjustment to retained earnings to fully recognize gains on real estate sold in prior years that was required to be deferred under previous accounting guidance. In August and November 2016, the Financial Accounting Standards Board (“FASB”) issued guidance on the classification of certain receipts and payments in the statements of cash flows and to require companies to separately disclose the changes in total cash, cash equivalents, and amounts generally described as restricted cash on statements of cash flows (ASU 2016-18). Restricted cash recorded in other assets on the condensed consolidated balance sheets includes certain operating deposits, tenant capital reserve deposits and deposits related to real estate acquisitions. This guidance was adopted on January 1, 2018 by applying a retrospective transition method resulting in the restatement of all periods presented. This change did not have a material impact on the statements of cash flows for the three months ended March 31, 2018 and March 31, 2017, respectively. Recent Accounting Developments: Leases In February 2016, FASB issued ASU 2016-02, “Leases”, which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either financing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. We will adopt this new standard on January 1, 2019. We are continuing to evaluate this standard and the impact to us from both a lessor and lessee perspective. We do have leases in which we are the lessee, including ground leases, on which certain of our facilities reside, along with corporate office and equipment leases, that will be required to be recorded on our balance sheet upon adoption of this standard. From a lessor perspective, we do expect certain non-lease components (including certain operating expenses that the tenants of our facilities are required to pay pursuant to our “triple-net” leases) to be recorded gross versus net of the respective expenses upon adoption of this standard in 2019 in accordance with ASU No. 2014-09. Reclassifications and Revisions Certain amounts in the consolidated financial statements for prior periods have been reclassified to conform to the current period presentation. Variable Interest Entities At March 31, 2018, we had loans to and/or equity investments in certain variable interest entities (“VIEs”), which are also tenants of our facilities. We have determined that we are not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at March 31, 2018 (in thousands): VIE Type Maximum Loss Exposure(1) Asset Type Classification Carrying Amount(2) Loans, net $ 334,906 Mortgage and other loans $ 233,470 Equity investments $ 14,553 Other assets $ — (1) Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investment in VIEs represents the current carrying values of such investment plus any other related assets (such as rent receivables), less any liabilities. (2) Carrying amount reflects the net book value of our loan or equity interest only in the VIE. For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance. As of March 31, 2018, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which they could be exposed to further losses (e.g., cash short falls). Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower. See Note 3 and Note 5 for additional description of the nature, purpose and activities of our more significant VIEs (such as Ernest Health Inc. (“Ernest”)) and interests therein.

Real Estate and Lending Activit

Real Estate and Lending Activities	3 Months Ended
	Mar. 31, 2018
Text Block [Abstract]
Real Estate and Lending Activities	3. Real Estate and Lending Activities Acquisitions We acquired the following assets (in thousands): Three Months Ended March 31, 2018 2017 Assets Acquired Land $ — $ 1,230 Building — 6,901 Intangible lease assets — subject to amortization — 873 Total assets acquired $ — $ 9,004 On January 30, 2017, we acquired an inpatient rehabilitation hospital in Germany for €8.4 million. This acquisition was the final property to close as part of the six hospital portfolio that we agreed to buy in September 2016 for an aggregate amount of €44.1 million. This property is leased to affiliates of Median Kliniken S.à r.l. (“MEDIAN”) pursuant to the existing long-term master lease agreement reached with MEDIAN in 2015. Development Activities During the 2018 first quarter, we completed construction on Ernest Flagstaff. This $24 million inpatient rehabilitation facility located in Flagstaff, Arizona opened on March 1, 2018 and is being leased to Ernest pursuant to a stand-alone lease, with terms generally similar to the original master lease. See table below for a status update on our current development projects (in thousands): Property Commitment Costs Incurred as of March 31, 2018 Estimated Completion Date Circle Health (Birmingham, England) $ 45,211 $ 18,369 1Q 2019 Surgery Partners (Idaho Falls, Idaho) 113,468 16,753 1Q 2020 $ 158,679 $ 35,122 Disposals On March 1, 2018, we sold the real estate of St. Joseph Medical Center in Houston, Texas, for approximately $148 million to Steward Health Care System LLC (“Steward”). In return, we received a mortgage loan equal to the purchase price, with such loan secured by the underlying real estate. The mortgage loan has terms consistent with the other mortgage loans in the Steward portfolio. This transaction resulted in a gain of $1.5 million, offset by a $1.7 million non-cash charge to revenue to write-off related straight-line rent receivables on this property. On March 31, 2017, we sold the EASTAR Health System real estate located in Muskogee, Oklahoma, which was leased to RCCH Healthcare Partners (“RCCH”). Total proceeds from this transaction were approximately $64 million resulting in a gain of $7.4 million, partially offset by a $0.6 million non-cash charge to revenue to write-off related straight-line rent receivables on this property. Leasing Operations At March 31, 2018, leases on 14 Ernest facilities, ten Prime Healthcare Services, Inc. (“Prime”) facilities, and two Alecto Healthcare Services LLC (“Alecto”) facilities are accounted for as direct financing leases (“DFLs”). The components of our net investment in DFLs consisted of the following (in thousands): As of March 31, 2018 As of December 31, 2017 Minimum lease payments receivable $ 2,223,869 $ 2,294,081 Estimated residual values 434,769 448,339 Less: Unearned income (1,972,614 ) (2,043,693 ) Net investment in direct financing leases $ 686,024 $ 698,727 On March 15, 2018, we entered into a new lease agreement of our long-term acute care facility in Boise, Idaho with a joint venture formed by Vibra Healthcare, LLC (“Vibra”) and Ernest. The new lease has an initial 15-year fixed term (ending March 2033) with three extension options of five years each. With this transaction, we incurred a non-cash charge of $1.5 million to write-off DFL unbilled interest associated with the previous lease to Ernest on this property. Adeptus Health As noted in previous filings, we have 16 properties that we plan to re-lease to a new operator or sell. These properties are being transitioned away from Adeptus Health in stages over a two year period as part of Adeptus Health’s confirmed plan of reorganization under Chapter 11 of the Bankruptcy Code. Rent is being paid by Adeptus Health during this transition period. On January 1, 2018 and April 1, 2018, Adeptus Health vacated and stopped making rent payments on five and three properties, respectively. As a result of the shortening of our lease term on these and eight other properties, we recorded $1.8 million to accelerate straight-line rent receivable amortization in the 2018 first quarter. At March 31, 2018, Adeptus Health is current on its rent obligations to us. Although no assurances can be made that we will not recognize a loss in the future, we believe at March 31, 2018 that the sale or re-leasing of the assets related to these 16 transition facilities will not result in any material loss or impairment. Gilbert and Florence Facilities In the first quarter of 2018, we terminated the lease at our Gilbert and Florence, Arizona facilities due to the tenant not meeting its rent obligations pursuant to the lease. As a result of the lease terminating, we recorded a charge of $1.1 million to reserve against the straight-line rent receivables. This former tenant has continued to occupy the facility, but on April 25, 2018, this former tenant filed for involuntary bankruptcy. At March 31, 2018, all outstanding receivables were completely reserved. Although no assurances can be made that we will not have any impairment charges in the future, we believe our investment in Gilbert and Florence of $38.1 million at March 31, 2018, is fully recoverable. Loans The following is a summary of our loans (in thousands): As of March 31, 2018 As of December 31, 2017 Mortgage loans $ 1,927,393 $ 1,778,316 Acquisition loans 117,627 118,448 Working capital and other loans 31,215 31,761 $ 2,076,235 $ 1,928,525 The increase in mortgage loans relates to the St. Joseph property that was sold on March 1, 2018 – see “Disposals” section of this Note 3 for further information. Concentrations of Credit Risk Our revenue concentration for the three months ended March 31, 2018 as compared to the prior year is as follows (dollars in thousands): Revenue by Operator For the Three Months Ended March 31, 2018 2017 Operators Total Revenue Percentage of Total Revenue Total Revenue Percentage of Total Revenue Steward (1) $ 73,227 35.7 % $ 33,704 21.6 % Prime 31,778 15.5 % 31,511 20.1 % MEDIAN 29,088 14.2 % 23,450 15.0 % Ernest 16,416 8.0 % 17,520 11.2 % RCCH 9,537 4.7 % 9,306 6.0 % Other operators 45,000 21.9 % 40,906 26.1 % Total $ 205,046 100.0 % $ 156,397 100.0 % (1) Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017. Revenue by U.S. State and Country For the Three Months Ended March 31, 2018 2017 U.S. States and Other Countries Total Revenue Percentage of Total Revenue Total Revenue Percentage of Total Revenue Texas $ 30,355 14.8 % $ 24,737 15.8 % Massachusetts 26,940 13.1 % 26,584 17.0 % Utah 20,871 10.2 % 2,534 1.6 % California 16,666 8.1 % 16,565 10.6 % Arizona 11,386 5.6 % 7,332 4.7 % All other states 60,037 29.3 % 51,465 32.9 % Total U.S. $ 166,255 81.1 % $ 129,217 82.6 % Germany $ 37,665 18.4 % $ 26,190 16.7 % United Kingdom, Italy, and Spain 1,126 0.5 % 990 0.7 % Total International $ 38,791 18.9 % $ 27,180 17.4 % Grand Total $ 205,046 100.0 % $ 156,397 100.0 % On a gross asset basis (as defined in the “Reconciliation of Non-GAAP Financial Measures” section of Item 2 of this Form 10-Q), our concentration as of March 31, 2018 as compared to December 31, 2017 is as follows (dollars in thousands): Gross Assets by Operator As of March 31, 2018 As of December 31, 2017 Operators Total Gross Assets Percentage of Total Gross Assets Total Gross Assets Percentage of Total Gross Assets Steward (1) $ 3,459,275 36.2 % $ 3,457,384 36.5 % MEDIAN 1,261,991 13.2 % 1,229,325 13.0 % Prime 1,120,737 11.7 % 1,119,484 11.8 % Ernest 612,112 6.4 % 629,161 6.6 % RCCH 506,265 5.3 % 506,265 5.3 % Other operators 2,118,132 22.3 % 2,089,934 22.1 % Other assets 466,095 4.9 % 444,659 4.7 % Total $ 9,544,607 100.0 % $ 9,476,212 100.0 % (1) Includes approximately $1.8 billion of triple net leased gross assets. Gross Assets by U.S. State and Country As of March 31, 2018 As of December 31, 2017 U.S. States and Other Countries Total Gross Assets Percentage of Total Gross Assets Total Gross Assets Percentage of Total Gross Assets Massachusetts $ 1,298,226 13.6 % $ 1,297,226 13.7 % Texas 1,260,795 13.2 % 1,257,390 13.3 % Utah 1,035,748 10.9 % 1,035,501 10.9 % California 542,873 5.7 % 542,876 5.7 % Arizona 489,185 5.1 % 491,284 5.2 % All other states 2,616,686 27.4 % 2,618,536 27.6 % Other domestic assets 402,841 4.2 % 387,050 4.1 % Total U.S. $ 7,646,354 80.1 % $ 7,629,863 80.5 % Germany $ 1,623,755 17.0 % $ 1,581,726 16.7 % United Kingdom, Italy, and Spain 211,244 2.2 % 207,014 2.2 % Other international assets 63,254 0.7 % 57,609 0.6 % Total International $ 1,898,253 19.9 % $ 1,846,349 19.5 % Grand Total $ 9,544,607 100.0 % $ 9,476,212 100.0 % On an individual property basis, we had no investment of any single property greater than 3.7% of our total gross assets as of March 31, 2018.

Debt

Debt	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Debt	4. Debt The following is a summary of debt (dollar amounts in thousands): As of March 31, 2018 As of December 31, 2017 Revolving credit facility(A) $ 807,614 $ 840,810 Term loans 200,000 200,000 4.000% Senior Unsecured Notes due 2022(B) 616,200 600,250 5.500% Senior Unsecured Notes due 2024 300,000 300,000 6.375% Senior Unsecured Notes due 2024 500,000 500,000 3.325% Senior Unsecured Notes due 2025(B) 616,200 600,250 5.250% Senior Unsecured Notes due 2026 500,000 500,000 5.000% Senior Unsecured Notes due 2027 1,400,000 1,400,000 $ 4,940,014 $ 4,941,310 Debt issue costs, net (41,650 ) (42,643 ) $ 4,898,364 $ 4,898,667 (A) Includes £9 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively. (B) These notes are Euro-denominated and reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively. As of March 31, 2018, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands): 2018 $ — 2019 — 2020 — 2021 807,614 2022 816,200 Thereafter 3,316,200 Total $ 4,940,014 On February 1, 2017, we replaced our previous unsecured credit facility (which we had entered into in 2014 and amended in 2015) with a new revolving credit and term loan agreement (“Credit Facility”). The new agreement included a $1.3 billion unsecured revolving loan facility (same amount as the previous revolving loan facility), a $200 million unsecured term loan facility ($50 million lower than the previous term loan), and a new €200 million unsecured term loan facility. On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020. On March 24, 2017, we completed a €500 million senior unsecured notes offering (“3.325% Senior Unsecured Notes due 2025”). A portion of the proceeds from this offering were used to prepay and extinguish the €200 million term loan facility portion of our Credit Facility on March 30, 2017. With the replacement of our old credit facility, the redemption of the 5.750% Senior Unsecured Notes due 2020, and the payoff of our €200 million euro term loan, we incurred a debt refinancing charge of approximately $14 million in the 2017 first quarter. 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, as defined in the agreements, on a rolling four quarter basis. At March 31, 2018, the dividend restriction was 95% of normalized adjusted funds from operations (“NAFFO”). The indentures governing our senior unsecured notes also limit the amount of dividends we can pay based on the sum of 95% of NAFFO, proceeds of equity issuances and certain other net cash proceeds. Finally, our senior unsecured notes require us to maintain total unencumbered assets (as defined in the related indenture) of not less than 150% of our unsecured indebtedness. In addition to these restrictions, the Credit Facility contains customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, secured leverage ratio, consolidated adjusted net worth, unsecured leverage ratio, and unsecured interest coverage ratio. This Credit Facility also contains customary events of default, including among others, nonpayment of principal or interest, material inaccuracy of representations and failure to comply with our covenants. If an event of default occurs and is continuing under the Credit Facility, the entire outstanding balance may become immediately due and payable. At March 31, 2018, we were in compliance with all such financial and operating covenants.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
	Mar. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	5. 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 working capital loans are estimated by using Level 2 inputs such as discounting the estimated future cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and for the same remaining maturities. We determine the fair value of our senior unsecured notes using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our revolving credit facility and term loan using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt. Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands): As of As of March 31, 2018 December 31, 2017 Asset (Liability) Book Value Fair Value Book Value Fair Value Interest and rent receivables $ 81,965 $ 81,009 $ 78,970 $ 78,028 Loans (1) 1,846,525 1,871,705 1,698,471 1,722,101 Debt, net (4,898,364 ) (4,968,232 ) (4,898,667 ) (5,073,707 ) (1) Excludes loans related to Ernest since they are recorded at fair value and discussed below. Items Measured at Fair Value on a Recurring Basis Our equity interest in Ernest along with their related loans are measured at fair value on a recurring basis as we elected to account for these investments using the fair value option method. We have elected to account for these investments at fair value due to the size of the investments and because we believe this method is more reflective of current values. We have not made a similar election for other currently existing equity interests or loans. At March 31, 2018, these amounts were as follows (in thousands): Asset Type Fair Value Original Cost Asset Type Classification Mortgage loans $ 115,000 $ 115,000 Mortgage loans Equity investments and other loans 112,256 118,010 Other loans/other assets $ 227,256 $ 233,010 Our mortgage and other loans with Ernest are recorded at fair value based on Level 2 inputs by discounting the estimated cash flows using the market rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our equity investment in Ernest is recorded at fair value based on Level 3 inputs, by using a discounted cash flow model, which requires significant estimates of our investee such as projected revenue and expenses and appropriate consideration of the underlying risk profile of the forecast assumptions associated with the investee. We classify the equity investment as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuation requires management judgment due to the absence of quoted market prices. For the cash flow model, our observable inputs include use of a capitalization rate, discount rate (which is based on a weighted average cost of capital), and market interest rates, and our unobservable input includes an adjustment for a marketability discount (“DLOM”) on our equity investment of 40% at March 31, 2018. In regards to the underlying projection of revenues and expenses used in the discounted cash flow model, such projections are provided by Ernest. However, we will modify such projections (including underlying assumptions used) as needed based on our review and analysis of Ernest’s historical results, meetings with key members of management, and our understanding of trends and developments within the healthcare industry. In arriving at the DLOM, we started with a DLOM range based on the results of studies supporting valuation discounts for other transactions or structures without a public market. To select the appropriate DLOM within the range, we then considered many qualitative factors including the percent of control, the nature of the underlying investee’s business along with our rights as an investor pursuant to the operating agreement, the size of investment, expected holding period, number of shareholders, access to capital marketplace, etc. To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands): Basis Point Change in Marketability Discount Estimated Increase (Decrease) In Fair Value +100 basis points $ (9 ) - 100 basis points 9 Because the fair value of the Ernest investments noted above is below our original cost, we recognized an unrealized loss during the first quarter of 2018. No unrealized gain/loss on the Ernest investments was recorded in the first quarter of 2017.

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2018
Earnings Per Share [Abstract]
Earnings Per Share	6. Earnings Per Share Medical Properties Trust, Inc. Our earnings per share were calculated based on the following (amounts in thousands): For the Three Months Ended March 31, 2018 2017 Numerator: Net income $ 91,043 $ 68,185 Non-controlling interests’ share in net income (442 ) (215 ) Participating securities’ share in earnings (195 ) (125 ) Net income, less participating securities’ share in earnings $ 90,406 $ 67,845 Denominator: Basic weighted-average common shares 364,882 321,057 Dilutive potential common shares 461 366 Dilutive weighted-average common shares 365,343 321,423 MPT Operating Partnership, L.P. Our earnings per common unit were calculated based on the following (amounts in thousands): For the Three Months Ended March 31, 2018 2017 Numerator: Net income $ 91,043 $ 68,185 Non-controlling interests’ share in net income (442 ) (215 ) Participating securities’ share in earnings (195 ) (125 ) Net income, less participating securities’ share in earnings $ 90,406 $ 67,845 Denominator: Basic weighted-average units 364,882 321,057 Dilutive potential units 461 366 Diluted weighted-average units 365,343 321,423

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2018
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies Commitments On September 28, 2016, we entered into definitive agreements to acquire an acute care hospital in Washington for a purchase price of $17.5 million. Upon closing, the facility will be leased to RCCH, pursuant to the current master lease. Closing of this transaction, which is expected to be completed in 2018 is subject to customary real estate, regulatory and other closing conditions. Contingencies We are a party to various legal proceedings incidental to our business. In the opinion of management, after consultation with legal counsel, the ultimate liability, if any, with respect to those proceedings is not presently expected to materially affect our financial position, results of operations or cash flows.

Summary of Significant Accoun14

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2018
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 presentation have been included. Operating results for the three months ended March 31, 2018, are not necessarily indicative of the results that may be expected for the year ending December 31, 2018. The condensed consolidated balance sheet at December 31, 2017 has been derived from the audited financial statements at that date but does not include all of the information and footnotes required by accounting principles generally accepted in the U.S. for complete financial statements. For information about significant accounting policies, refer to the consolidated financial statements and footnotes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2017. There have been no material changes to these significant accounting policies other than the following: On January 1, 2018, we adopted Accounting Standards Update (“ASU”) No. 2017-01, “Clarifying the Definition of a Business” (“ASU 2017-01”). ASU 2017-01 provides an initial screen to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, in which case, the transaction would be accounted for as an asset acquisition rather than as a business combination. In addition, ASU 2017-01 clarifies the requirements for a set of activities to be considered a business and narrows the definition of an output. With this accounting change, we expect to recognize a majority of our future real estate acquisitions as asset transactions rather than business combinations, which will result in the capitalization of third party transaction costs that are directly related to an acquisition and significantly decrease acquisition expenses. Indirect and internal transaction costs will continue to be expensed, but we do not expect to treat these costs as acquisition expenses for purposes of deriving normalized funds from operations in the future. Accordingly, this change in accounting increased our general and administrative expenses by $1.6 million for the three months ended March 31, 2018 compared to prior year. On January 1, 2018, we adopted ASU No. 2014-09, “Revenue from Contracts with Customers.” Under the new standard, revenue is recognized at the time a good or service is transferred to a customer for the amount of consideration received for that specific good or service. This standard should not have a significant impact on our financial results, as a substantial portion of our revenue consists of rental income from leasing arrangements and interest income from loans, which are specifically excluded from ASU No. 2014-09. However, we also adopted a related standard ASU No. 2017-05 “Other Income - Gains and Losses from the Derecognition of Nonfinancial Assets” on January 1, 2018, which we expect will allow for more transactions to qualify as sales of real estate with gains on sales being recognized earlier than under previous accounting guidance, as the new guidance is based on transfer of control versus whether or not the seller has continuing involvement. Upon adoption of this new standard, we recorded a $1.9 million adjustment to retained earnings to fully recognize gains on real estate sold in prior years that was required to be deferred under previous accounting guidance. In August and November 2016, the Financial Accounting Standards Board (“FASB”) issued guidance on the classification of certain receipts and payments in the statements of cash flows and to require companies to separately disclose the changes in total cash, cash equivalents, and amounts generally described as restricted cash on statements of cash flows (ASU 2016-18). Restricted cash recorded in other assets on the condensed consolidated balance sheets includes certain operating deposits, tenant capital reserve deposits and deposits related to real estate acquisitions. This guidance was adopted on January 1, 2018 by applying a retrospective transition method resulting in the restatement of all periods presented. This change did not have a material impact on the statements of cash flows for the three months ended March 31, 2018 and March 31, 2017, respectively.
Recent Accounting Developments	Recent Accounting Developments: Leases In February 2016, FASB issued ASU 2016-02, “Leases”, which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e. lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either financing or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. We will adopt this new standard on January 1, 2019. We are continuing to evaluate this standard and the impact to us from both a lessor and lessee perspective. We do have leases in which we are the lessee, including ground leases, on which certain of our facilities reside, along with corporate office and equipment leases, that will be required to be recorded on our balance sheet upon adoption of this standard. From a lessor perspective, we do expect certain non-lease components (including certain operating expenses that the tenants of our facilities are required to pay pursuant to our “triple-net” leases) to be recorded gross versus net of the respective expenses upon adoption of this standard in 2019 in accordance with ASU No. 2014-09.
Reclassifications and Revisions	Reclassifications and Revisions Certain amounts in the 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, 2018, we had loans to and/or equity investments in certain variable interest entities (“VIEs”), which are also tenants of our facilities. We have determined that we are not the primary beneficiary of these VIEs. The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at March 31, 2018 (in thousands): VIE Type Maximum Loss Exposure(1) Asset Type Classification Carrying Amount(2) Loans, net $ 334,906 Mortgage and other loans $ 233,470 Equity investments $ 14,553 Other assets $ — (1) Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investment in VIEs represents the current carrying values of such investment plus any other related assets (such as rent receivables), less any liabilities. (2) Carrying amount reflects the net book value of our loan or equity interest only in the VIE. For the VIE types above, we do not consolidate the VIE because we do not have the ability to control the activities (such as the day-to-day healthcare operations of our borrowers or investees) that most significantly impact the VIE’s economic performance. As of March 31, 2018, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which they could be exposed to further losses (e.g., cash short falls). Typically, our loans are collateralized by assets of the borrower (some assets of which are on the premises of facilities owned by us) and further supported by limited guarantees made by certain principals of the borrower. See Note 3 and Note 5 for additional description of the nature, purpose and activities of our more significant VIEs (such as Ernest Health Inc. (“Ernest”)) and interests therein.

Summary of Significant Accoun15

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2018
Accounting Policies [Abstract]
Carrying Value and Classification of Related Assets and Maximum Exposure to Loss	The carrying value and classification of the related assets and maximum exposure to loss as a result of our involvement with these VIEs are presented below at March 31, 2018 (in thousands): VIE Type Maximum Loss Exposure(1) Asset Type Classification Carrying Amount(2) Loans, net $ 334,906 Mortgage and other loans $ 233,470 Equity investments $ 14,553 Other assets $ — (1) Our maximum loss exposure related to loans with VIEs represents our current aggregate gross carrying value of the loan plus accrued interest and any other related assets (such as rent receivables), less any liabilities. Our maximum loss exposure related to our equity investment in VIEs represents the current carrying values of such investment plus any other related assets (such as rent receivables), less any liabilities. (2) Carrying amount reflects the net book value of our loan or equity interest only in the VIE.

Real Estate and Lending Activ16

Real Estate and Lending Activities (Tables)	3 Months Ended
	Mar. 31, 2018
Text Block [Abstract]
Assets Acquired	We acquired the following assets (in thousands): Three Months Ended March 31, 2018 2017 Assets Acquired Land $ — $ 1,230 Building — 6,901 Intangible lease assets — subject to amortization — 873 Total assets acquired $ — $ 9,004
Summary of Status Update on Current Development Projects	See table below for a status update on our current development projects (in thousands): Property Commitment Costs Incurred as of March 31, 2018 Estimated Completion Date Circle Health (Birmingham, England) $ 45,211 $ 18,369 1Q 2019 Surgery Partners (Idaho Falls, Idaho) 113,468 16,753 1Q 2020 $ 158,679 $ 35,122
Components of Net Investment in Direct Financing Leases	The components of our net investment in DFLs consisted of the following (in thousands): As of March 31, 2018 As of December 31, 2017 Minimum lease payments receivable $ 2,223,869 $ 2,294,081 Estimated residual values 434,769 448,339 Less: Unearned income (1,972,614 ) (2,043,693 ) Net investment in direct financing leases $ 686,024 $ 698,727
Summary of Loans	The following is a summary of our loans (in thousands): As of March 31, 2018 As of December 31, 2017 Mortgage loans $ 1,927,393 $ 1,778,316 Acquisition loans 117,627 118,448 Working capital and other loans 31,215 31,761 $ 2,076,235 $ 1,928,525
Schedule of Revenue by Operator	Revenue by Operator For the Three Months Ended March 31, 2018 2017 Operators Total Revenue Percentage of Total Revenue Total Revenue Percentage of Total Revenue Steward (1) $ 73,227 35.7 % $ 33,704 21.6 % Prime 31,778 15.5 % 31,511 20.1 % MEDIAN 29,088 14.2 % 23,450 15.0 % Ernest 16,416 8.0 % 17,520 11.2 % RCCH 9,537 4.7 % 9,306 6.0 % Other operators 45,000 21.9 % 40,906 26.1 % Total $ 205,046 100.0 % $ 156,397 100.0 % (1) Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017.
Schedule of Revenue from External Customers by Geographic Areas	Revenue by U.S. State and Country For the Three Months Ended March 31, 2018 2017 U.S. States and Other Countries Total Revenue Percentage of Total Revenue Total Revenue Percentage of Total Revenue Texas $ 30,355 14.8 % $ 24,737 15.8 % Massachusetts 26,940 13.1 % 26,584 17.0 % Utah 20,871 10.2 % 2,534 1.6 % California 16,666 8.1 % 16,565 10.6 % Arizona 11,386 5.6 % 7,332 4.7 % All other states 60,037 29.3 % 51,465 32.9 % Total U.S. $ 166,255 81.1 % $ 129,217 82.6 % Germany $ 37,665 18.4 % $ 26,190 16.7 % United Kingdom, Italy, and Spain 1,126 0.5 % 990 0.7 % Total International $ 38,791 18.9 % $ 27,180 17.4 % Grand Total $ 205,046 100.0 % $ 156,397 100.0 %
Schedule of Gross Assets by Operator	Gross Assets by Operator As of March 31, 2018 As of December 31, 2017 Operators Total Gross Assets Percentage of Total Gross Assets Total Gross Assets Percentage of Total Gross Assets Steward (1) $ 3,459,275 36.2 % $ 3,457,384 36.5 % MEDIAN 1,261,991 13.2 % 1,229,325 13.0 % Prime 1,120,737 11.7 % 1,119,484 11.8 % Ernest 612,112 6.4 % 629,161 6.6 % RCCH 506,265 5.3 % 506,265 5.3 % Other operators 2,118,132 22.3 % 2,089,934 22.1 % Other assets 466,095 4.9 % 444,659 4.7 % Total $ 9,544,607 100.0 % $ 9,476,212 100.0 % (1) Includes approximately $1.8 billion of triple net leased gross assets.
Schedule of Gross Assets by Geographic Areas	Gross Assets by U.S. State and Country As of March 31, 2018 As of December 31, 2017 U.S. States and Other Countries Total Gross Assets Percentage of Total Gross Assets Total Gross Assets Percentage of Total Gross Assets Massachusetts $ 1,298,226 13.6 % $ 1,297,226 13.7 % Texas 1,260,795 13.2 % 1,257,390 13.3 % Utah 1,035,748 10.9 % 1,035,501 10.9 % California 542,873 5.7 % 542,876 5.7 % Arizona 489,185 5.1 % 491,284 5.2 % All other states 2,616,686 27.4 % 2,618,536 27.6 % Other domestic assets 402,841 4.2 % 387,050 4.1 % Total U.S. $ 7,646,354 80.1 % $ 7,629,863 80.5 % Germany $ 1,623,755 17.0 % $ 1,581,726 16.7 % United Kingdom, Italy, and Spain 211,244 2.2 % 207,014 2.2 % Other international assets 63,254 0.7 % 57,609 0.6 % Total International $ 1,898,253 19.9 % $ 1,846,349 19.5 % Grand Total $ 9,544,607 100.0 % $ 9,476,212 100.0 %

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Summary of Debt	The following is a summary of debt (dollar amounts in thousands): As of March 31, 2018 As of December 31, 2017 Revolving credit facility(A) $ 807,614 $ 840,810 Term loans 200,000 200,000 4.000% Senior Unsecured Notes due 2022(B) 616,200 600,250 5.500% Senior Unsecured Notes due 2024 300,000 300,000 6.375% Senior Unsecured Notes due 2024 500,000 500,000 3.325% Senior Unsecured Notes due 2025(B) 616,200 600,250 5.250% Senior Unsecured Notes due 2026 500,000 500,000 5.000% Senior Unsecured Notes due 2027 1,400,000 1,400,000 $ 4,940,014 $ 4,941,310 Debt issue costs, net (41,650 ) (42,643 ) $ 4,898,364 $ 4,898,667 (A) Includes £9 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively. (B) These notes are Euro-denominated and reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively.
Principal Payments Due on Debt	As of March 31, 2018, principal payments due on our debt (which exclude the effects of any discounts, premiums, or debt issue costs recorded) are as follows (in thousands): 2018 $ — 2019 — 2020 — 2021 807,614 2022 816,200 Thereafter 3,316,200 Total $ 4,940,014

Fair Value of Financial Instr18

Fair Value of Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2018
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 As of March 31, 2018 December 31, 2017 Asset (Liability) Book Value Fair Value Book Value Fair Value Interest and rent receivables $ 81,965 $ 81,009 $ 78,970 $ 78,028 Loans (1) 1,846,525 1,871,705 1,698,471 1,722,101 Debt, net (4,898,364 ) (4,968,232 ) (4,898,667 ) (5,073,707 ) (1) Excludes loans related to Ernest since they are recorded at fair value and discussed below.
Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis	At March 31, 2018, these amounts were as follows (in thousands): Asset Type Fair Value Original Cost Asset Type Classification Mortgage loans $ 115,000 $ 115,000 Mortgage loans Equity investments and other loans 112,256 118,010 Other loans/other assets $ 227,256 $ 233,010
Summary Showing Sensitivity Analysis by Using Basis Point Variations	To illustrate the effect of movements in the DLOM, we performed a sensitivity analysis below by using basis point variations (dollars in thousands): Basis Point Change in Marketability Discount Estimated Increase (Decrease) In Fair Value +100 basis points $ (9 ) - 100 basis points 9

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2018
Earnings Per Share [Abstract]
Calculation of Earnings Per Share	Medical Properties Trust, Inc. Our earnings per share were calculated based on the following (amounts in thousands): For the Three Months Ended March 31, 2018 2017 Numerator: Net income $ 91,043 $ 68,185 Non-controlling interests’ share in net income (442 ) (215 ) Participating securities’ share in earnings (195 ) (125 ) Net income, less participating securities’ share in earnings $ 90,406 $ 67,845 Denominator: Basic weighted-average common shares 364,882 321,057 Dilutive potential common shares 461 366 Dilutive weighted-average common shares 365,343 321,423 MPT Operating Partnership, L.P. Our earnings per common unit were calculated based on the following (amounts in thousands): For the Three Months Ended March 31, 2018 2017 Numerator: Net income $ 91,043 $ 68,185 Non-controlling interests’ share in net income (442 ) (215 ) Participating securities’ share in earnings (195 ) (125 ) Net income, less participating securities’ share in earnings $ 90,406 $ 67,845 Denominator: Basic weighted-average units 364,882 321,057 Dilutive potential units 461 366 Diluted weighted-average units 365,343 321,423

Summary of Significant Accoun20

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Millions	Jan. 01, 2018	Mar. 31, 2018
Accounting Standards Update No. 2017-01 [Member] | General and Administrative Expenses [Member]
Summary Of Significant Accounting Policies [Line Items]
Increase in general and administrative expenses		$ 1.6
Accounting Standards Update 2014-09 [Member]
Summary Of Significant Accounting Policies [Line Items]
Adjustment to retained earnings	$ 1.9

Summary of Significant Accoun21

Summary of Significant Accounting Policies - Carrying Value and Classification of Related Assets and Maximum Exposure to Loss (Detail)	Mar. 31, 2018USD ($)
Mortgage and other loans [Member]
Variable Interest Entity [Line Items]
Carrying Amount	$ 233,470,000
Loans, net [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	334,906,000
Equity investments [Member]
Variable Interest Entity [Line Items]
Maximum Loss Exposure	$ 14,553,000

Real Estate and Lending Activ22

Real Estate and Lending Activities - Assets Acquired (Detail) $ in Thousands	Mar. 31, 2017USD ($)
Business Acquisition [Line Items]
Total assets acquired	$ 9,004
Land [Member]
Business Acquisition [Line Items]
Total assets acquired	1,230
Building [Member]
Business Acquisition [Line Items]
Total assets acquired	6,901
Intangible Lease Assets - Subject to Amortization [Member]
Business Acquisition [Line Items]
Total assets acquired	$ 873

Real Estate and Lending Activ23

Real Estate and Lending Activities - Acquisitions - Additional Information (Detail) - Germany [Member] - Rehabilitation Hospital with Covenant Health System [Member] € in Millions	Jan. 30, 2017EUR (€)	Jan. 30, 2017EUR (€)Hospital
Business Acquisition [Line Items]
Purchase price of acquisition | €	€ 8.4	€ 44.1
Number of facilities acquired | Hospital		6

Real Estate and Lending Activ24

Real Estate and Lending Activities - Development Activities - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2018USD ($)
Ernest [Member] | Development Activities [Member]
Business Acquisition [Line Items]
Estimated total development cost	$ 24

Real Estate and Lending Activ25

Real Estate and Lending Activities - Summary of Status Update on Current Development Projects (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2018USD ($)
Business Acquisition [Line Items]
Commitment	$ 158,679
Costs Incurred as of March 31, 2018	35,122
Circle Health [Member] | Birmingham, England [Member]
Business Acquisition [Line Items]
Commitment	45,211
Costs Incurred as of March 31, 2018	$ 18,369
Estimated Completion Date	1Q 2019
Surgery Partners [Member] | Idaho Falls, ID [Member]
Business Acquisition [Line Items]
Commitment	$ 113,468
Costs Incurred as of March 31, 2018	$ 16,753
Estimated Completion Date	1Q 2020

Real Estate and Lending Activ26

Real Estate and Lending Activities - Disposals - Additional Information (Detail) - USD ($) $ in Thousands	Mar. 01, 2018	Mar. 31, 2017	Mar. 31, 2018	Mar. 31, 2017
Debt Instrument [Line Items]
Net proceeds from sale of real estate			$ 148,809	$ 64,335
Gain on real estate dispositions		$ 7,400
Gain offset by non-cash charges		600
Proceeds from sale of facilities		$ 64,000
Steward Health Care System LLC [Member] | Houston, Texas [Member] | St. Joseph Medical Center [Member]
Debt Instrument [Line Items]
Net proceeds from sale of real estate	$ 148,000
Gain on real estate dispositions	1,500
Gain offset by non-cash charges	$ 1,700

Real Estate and Lending Activ27

Real Estate and Lending Activities - Leasing Operations - Additional Information (Detail) $ in Millions	Mar. 15, 2018USD ($)RenewalOption	Mar. 31, 2018Lease
Ernest [Member]
Business Acquisition [Line Items]
Number of direct financing leases		14
Prime Facilities [Member]
Business Acquisition [Line Items]
Number of direct financing leases		10
Alecto Healthcare Services [Member]
Business Acquisition [Line Items]
Number of direct financing leases		2
Vibra Healthcare, LLC [Member] | Acute Care Hospital [Member]
Business Acquisition [Line Items]
Term of lease, years	15 years
Number of lease extension options | RenewalOption	3
Term of lease extension, years	5 years
Write off of unbilled direct finance lease rent | $	$ 1.5

Real Estate and Lending Activ28

Real Estate and Lending Activities - Components of Net Investment in Direct Financing Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Business Combinations [Abstract]
Minimum lease payments receivable	$ 2,223,869	$ 2,294,081
Estimated residual values	434,769	448,339
Less: Unearned income	(1,972,614)	(2,043,693)
Net investment in direct financing leases	$ 686,024	$ 698,727

Real Estate and Lending Activ29

Real Estate and Lending Activities - Adeptus Health - Additional Information (Detail) - Adeptus Health [Member] $ in Millions	Apr. 01, 2018Property	Jan. 01, 2018Property	Mar. 31, 2018USD ($)PropertyFacility
Business Acquisition [Line Items]
Number of properties closed		5
Number of properties			8
Amortization of straight line rent receivable | $			$ 1.8
Number of facilities expected to sell or re-lease | Facility			16
Subsequent Event [Member]
Business Acquisition [Line Items]
Number of properties closed	3

Real Estate and Lending Activ30

Real Estate and Lending Activities - Gilbert and Florence Facilities - Additional Information (Detail) - USD ($) $ in Millions	Mar. 31, 2017	Mar. 31, 2018
Business Acquisition [Line Items]
Gain offset by non-cash charges	$ 0.6
Gilbert and Florence Facilities [Member]
Business Acquisition [Line Items]
Gain offset by non-cash charges		$ 1.1
Total budgeted investment		$ 38.1

Real Estate and Lending Activ31

Real Estate and Lending Activities - Summary of Loans (Detail) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Loans [Line Items]
Loans, Balance	$ 2,076,235	$ 1,928,525
Mortgage Loans [Member]
Loans [Line Items]
Loans, Balance	1,927,393	1,778,316
Acquisition Loans [Member]
Loans [Line Items]
Loans, Balance	117,627	118,448
Working Capital and Other Loans [Member]
Loans [Line Items]
Loans, Balance	$ 31,215	$ 31,761

Real Estate and Lending Activ32

Real Estate and Lending Activities - Loans - Additional Information (Detail) $ in Millions	Mar. 31, 2018USD ($)
Ernest Transaction and Other Acquisitions [Member]
Business Acquisition [Line Items]
Existing mortgage loans	$ 113.9

Real Estate and Lending Activ33

Real Estate and Lending Activities - Schedule of Revenue by Operator (Detail) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2018	Mar. 31, 2017
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 205,046	$ 156,397
Revenue [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 205,046	$ 156,397
Percentage of Total Revenue		100.00%	100.00%
Revenue [Member] | Prime [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 31,778	$ 31,511
Percentage of Total Revenue		15.50%	20.10%
Revenue [Member] | Steward [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue	[1]	$ 73,227	$ 33,704
Percentage of Total Revenue	[1]	35.70%	21.60%
Revenue [Member] | MEDIAN [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 29,088	$ 23,450
Percentage of Total Revenue		14.20%	15.00%
Revenue [Member] | Ernest [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 16,416	$ 17,520
Percentage of Total Revenue		8.00%	11.20%
Revenue [Member] | RCCH [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 9,537	$ 9,306
Percentage of Total Revenue		4.70%	6.00%
Revenue [Member] | Other Operators [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Revenue		$ 45,000	$ 40,906
Percentage of Total Revenue		21.90%	26.10%
[1]	Includes revenue from IASIS prior to being acquired by Steward on September 29, 2017.

Real Estate and Lending Activ34

Real Estate and Lending Activities - Schedule of Revenue from External Customers by Geographic Areas (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 205,046	$ 156,397
Revenue [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 205,046	$ 156,397
Percentage of Total Revenue	100.00%	100.00%
Revenue [Member] | Massachusetts [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 26,940	$ 26,584
Percentage of Total Revenue	13.10%	17.00%
Revenue [Member] | Texas [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 30,355	$ 24,737
Percentage of Total Revenue	14.80%	15.80%
Revenue [Member] | Utah [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 20,871	$ 2,534
Percentage of Total Revenue	10.20%	1.60%
Revenue [Member] | California [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 16,666	$ 16,565
Percentage of Total Revenue	8.10%	10.60%
Revenue [Member] | Arizona [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 11,386	$ 7,332
Percentage of Total Revenue	5.60%	4.70%
Revenue [Member] | All Other States [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 60,037	$ 51,465
Percentage of Total Revenue	29.30%	32.90%
Revenue [Member] | United States [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 166,255	$ 129,217
Percentage of Total Revenue	81.10%	82.60%
Revenue [Member] | Germany [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 37,665	$ 26,190
Percentage of Total Revenue	18.40%	16.70%
Revenue [Member] | United Kingdom, Italy, and Spain [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 1,126	$ 990
Percentage of Total Revenue	0.50%	0.70%
Revenue [Member] | International [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Revenue	$ 38,791	$ 27,180
Percentage of Total Revenue	18.90%	17.40%

Real Estate and Lending Activ35

Real Estate and Lending Activities - Schedule of Gross Assets by Operator (Detail) - USD ($) $ in Thousands		3 Months Ended	12 Months Ended
		Mar. 31, 2018	Dec. 31, 2017
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 9,031,840	$ 9,020,288
Total Gross Assets [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 9,544,607	$ 9,476,212
Percentage of Total Gross Assets		100.00%	100.00%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Steward [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets	[1]	$ 3,459,275	$ 3,457,384
Percentage of Total Gross Assets	[1]	36.20%	36.50%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Prime [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 1,120,737	$ 1,119,484
Percentage of Total Gross Assets		11.70%	11.80%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | MEDIAN [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 1,261,991	$ 1,229,325
Percentage of Total Gross Assets		13.20%	13.00%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Ernest [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 612,112	$ 629,161
Percentage of Total Gross Assets		6.40%	6.60%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | RCCH [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 506,265	$ 506,265
Percentage of Total Gross Assets		5.30%	5.30%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Other Operators [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 2,118,132	$ 2,089,934
Percentage of Total Gross Assets		22.30%	22.10%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Other Assets Operators
Investment And Revenue From External Customers [Line Items]
Total Gross Assets		$ 466,095	$ 444,659
Percentage of Total Gross Assets		4.90%	4.70%
[1]	Includes approximately $1.8 billion of triple net leased gross assets.

Real Estate and Lending Activ36

Real Estate and Lending Activities - Schedule of Gross Assets by Operator (Parenthetical) (Detail) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Investment And Revenue From External Customers [Line Items]
Total Gross Assets	$ 9,031,840	$ 9,020,288
Mortgage Loans [Member] | Credit Concentration Risk [Member] | Steward [Member]
Investment And Revenue From External Customers [Line Items]
Total Gross Assets	$ 1,800,000

Real Estate and Lending Activ37

Real Estate and Lending Activities - Schedule of Gross Assets by Geographic Areas (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 9,031,840	$ 9,020,288
Total Gross Assets [Member] | Credit Concentration Risk [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 9,544,607	$ 9,476,212
Percentage of Total Gross Assets	100.00%	100.00%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Massachusetts [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 1,298,226	$ 1,297,226
Percentage of Total Gross Assets	13.60%	13.70%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Texas [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 1,260,795	$ 1,257,390
Percentage of Total Gross Assets	13.20%	13.30%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Utah [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 1,035,748	$ 1,035,501
Percentage of Total Gross Assets	10.90%	10.90%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | California [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 542,873	$ 542,876
Percentage of Total Gross Assets	5.70%	5.70%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Arizona [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 489,185	$ 491,284
Percentage of Total Gross Assets	5.10%	5.20%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | All Other States [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 2,616,686	$ 2,618,536
Percentage of Total Gross Assets	27.40%	27.60%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Other Domestic Assets [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 402,841	$ 387,050
Percentage of Total Gross Assets	4.20%	4.10%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | United States [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 7,646,354	$ 7,629,863
Percentage of Total Gross Assets	80.10%	80.50%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Germany [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 1,623,755	$ 1,581,726
Percentage of Total Gross Assets	17.00%	16.70%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | United Kingdom, Italy, and Spain [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 211,244	$ 207,014
Percentage of Total Gross Assets	2.20%	2.20%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | Other International States
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 63,254	$ 57,609
Percentage of Total Gross Assets	0.70%	0.60%
Total Gross Assets [Member] | Credit Concentration Risk [Member] | International [Member]
Investment And Revenue From External Customers By Geographic Area [Line Items]
Total Gross Assets	$ 1,898,253	$ 1,846,349
Percentage of Total Gross Assets	19.90%	19.50%

Real Estate and Lending Activ38

Real Estate and Lending Activities - Concentrations of Credit Risk - Additional Information (Detail) - Pro Forma [Member] - Total Gross Assets [Member] - Customer Concentration Risk [Member]	Mar. 31, 2018Investment
Business Acquisition [Line Items]
Number of investment in property	0
Maximum percentage of entity's gross assets invested on single property	3.70%

Debt - Summary of Debt (Detail)

Debt - Summary of Debt (Detail) - USD ($) $ in Thousands		Mar. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Debt		$ 4,940,014	$ 4,941,310
Debt issue costs, net		(41,650)	(42,643)
Debt, net		4,898,364	4,898,667
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt	[1]	807,614	840,810
Term Loans [Member]
Debt Instrument [Line Items]
Debt		200,000	200,000
4.000% Senior Unsecured Notes due 2022 [Member]
Debt Instrument [Line Items]
Debt	[2]	616,200	600,250
5.500% Senior Unsecured Notes Due 2024 [Member]
Debt Instrument [Line Items]
Debt		300,000	300,000
3.325% Senior Unsecured Notes Due 2025 [Member]
Debt Instrument [Line Items]
Debt	[2]	616,200	600,250
6.375% Senior Unsecured Notes due 2024 [Member]
Debt Instrument [Line Items]
Debt		500,000	500,000
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
[1]	Includes £9 million and £8 million of GBP-denominated borrowings that reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively.
[2]	These notes are Euro-denominated and reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively.

Debt - Summary of Debt (Parenth

Debt - Summary of Debt (Parenthetical) (Detail) $ in Thousands, £ in Millions		Mar. 31, 2018USD ($)		Mar. 31, 2018GBP (£)		Dec. 31, 2017USD ($)	Dec. 31, 2017GBP (£)	Mar. 24, 2017
Debt Instrument [Line Items]
Debt		$ 4,940,014				$ 4,941,310
GBP-denominated Borrowings [Member]
Debt Instrument [Line Items]
Debt | £				£ 9			£ 8
4.000% Senior Unsecured Notes due 2022 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate	[1]	4.00%		4.00%
Debt	[1]	$ 616,200				600,250
5.500% Senior Unsecured Notes Due 2024 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		5.50%		5.50%
Debt		$ 300,000				300,000
6.375% Senior Unsecured Notes due 2024 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		6.375%		6.375%
Debt		$ 500,000				500,000
3.325% Senior Unsecured Notes Due 2025 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		3.325%	[1]	3.325%	[1]			3.325%
Debt	[1]	$ 616,200				600,250
5.000% Senior Unsecured Notes Due 2027 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate		5.00%		5.00%
Debt		$ 1,400,000				1,400,000
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
[1]	These notes are Euro-denominated and reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively.

Debt - Principal Payments Due f

Debt - Principal Payments Due for Debt (Detail) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Debt Disclosure [Abstract]
2,021	$ 807,614
2,022	816,200
Thereafter	3,316,200
Total	$ 4,940,014	$ 4,941,310

Debt - Additional Information (

Debt - Additional Information (Detail) $ in Thousands	Mar. 30, 2017EUR (€)	Mar. 04, 2017EUR (€)	Feb. 01, 2017USD ($)	Mar. 31, 2018		Mar. 31, 2017USD ($)	Mar. 24, 2017EUR (€)	Feb. 01, 2017EUR (€)
Debt Instrument [Line Items]
Debt refinancing charge						$ 13,629
5.750% Senior Unsecured Notes Due 2020 [Member]
Debt Instrument [Line Items]
Senior notes, redemption date		Mar. 4, 2017
Amount of senior unsecured debt redeemed | €		€ 200,000,000
Senior unsecured notes, interest rate		5.75%
Senior unsecured notes, redemption description				On March 4, 2017, we redeemed the €200 million aggregate principal amount of our 5.750% Senior Unsecured Notes due 2020
Debt refinancing charge						$ 14,000
3.325% Senior Unsecured Notes Due 2025 [Member]
Debt Instrument [Line Items]
Senior unsecured notes, interest rate				3.325%	[1]		3.325%
Senior unsecured notes face amount | €							€ 500,000,000
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt			$ 1,300,000
Term Loans [Member]
Debt Instrument [Line Items]
Amount of senior unsecured debt			200,000					€ 200,000,000
Decrease in unsecured debt from previous facility			$ 50,000
Prepaid and extinguished term loans | €	€ 200,000,000
[1]	These notes are Euro-denominated and reflect the exchange rate at March 31, 2018 and December 31, 2017, respectively.

Debt - Covenants - Additional I

Debt - Covenants - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Percentage of dividends which could be paid from adjusted operating funds	95.00%
Percentage of dividends which could be paid from operation funds	95.00%
Maximum percentage of total unencumbered assets	150.00%

Fair Value of Financial Instr44

Fair Value of Financial Instruments - Summary of Fair Value Information of Financial Instruments (Detail) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Fair Value Disclosures [Abstract]
Interest and rent receivables, Book value	$ 81,965	$ 78,970
Loans, Book value	1,846,525	1,698,471
Debt, net Book value	(4,898,364)	(4,898,667)
Interest and rent receivables, Fair value	81,009	78,028
Loans, Fair value	1,871,705	1,722,101
Debt, net Fair value	$ (4,968,232)	$ (5,073,707)

Fair Value of Financial Instr45

Fair Value of Financial Instruments - Equity Interest in Related Party and Related Loans Measured at Fair Value on Recurring Basis (Detail) $ in Thousands	Mar. 31, 2018USD ($)
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	$ 227,256
Original Cost	233,010
Fair Value Measurements, Recurring [Member] | Equity Method Investments and Other Loans [Member] | Other Loans and Other Assets [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	112,256
Original Cost	118,010
Fair Value Measurements, Recurring [Member] | Mortgage Loans [Member] | Mortgage Loans [Member]
Financial Instruments Measured At Fair Value On Recurring Basis [Line Items]
Fair Value	115,000
Original Cost	$ 115,000

Fair Value of Financial Instr46

Fair Value of Financial Instruments - Additional information (Detail) - USD ($)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Adjustment for DLOM on our equity investment	40.00%
Ernest [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Unrealized gain/loss on investments		$ 0

Fair Value of Financial Instr47

Fair Value of Financial Instruments - Summary Showing Sensitivity Analysis by Using Basis Point Variations (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2018USD ($)
Fair Value Disclosures [Abstract]
Estimated Increase (Decrease) In Fair Value of Financial Instruments plus 100 basis points	$ (9)
Estimated Increase (Decrease) In Fair Value of Financial Instruments minus 100 basis points	$ 9

Earnings Per Share - Calculatio

Earnings Per Share - Calculation of Earnings Per Share (Detail) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 91,043	$ 68,185
Non-controlling interests’ share in net income	(442)	(215)
Participating securities’ share in earnings	(195)	(125)
Net income, less participating securities’ share in earnings	$ 90,406	$ 67,845
Basic weighted-average common shares	364,882	321,057
Dilutive potential common shares	461	366
Dilutive weighted-average common shares	365,343	321,423
MPT Operating Partnership, L.P. [Member]
Earnings Per Share, Basic, by Common Class, Including Two Class Method [Line Items]
Net income	$ 91,043	$ 68,185
Non-controlling interests’ share in net income	(442)	(215)
Participating securities’ share in earnings	(195)	(125)
Net income, less participating securities’ share in earnings	$ 90,406	$ 67,845
Basic weighted-average common shares	364,882	321,057
Dilutive potential common shares	461	366
Dilutive weighted-average common shares	365,343	321,423

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) $ in Millions	Sep. 28, 2016USD ($)
Washington and Idaho [Member] | Acute Care Hospital [Member]
Commitment And Contingencies [Line Items]
Purchase price of acquisition	$ 17.5