Universal Health Realty Income Trust (UHT) 10-Q 8 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	Apr. 30, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	UHT
Entity Registrant Name	UNIVERSAL HEALTH REALTY INCOME TRUST
Entity Central Index Key	0000798783
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		13,747,585

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2019	Mar. 31, 2018
Revenues:
Revenues, Total		$ 19,112	$ 18,539
Expenses:
Depreciation and amortization		6,708	6,287
Other operating expenses		5,210	5,208
Costs and Expenses, Total		12,888	12,399
Income before equity in income of unconsolidated limited liability companies ("LLCs"), hurricane insurance recovery proceeds, gain and interest expense		6,224	6,140
Equity in income of unconsolidated LLCs		430	429
Hurricane insurance recovery proceeds in excess of damaged property write-downs			4,535
Hurricane business interruption insurance recovery proceeds			968
Gain on sale of land		250
Interest expense, net		(2,692)	(2,468)
Net income		$ 4,212	$ 9,604
Basic and diluted earnings per share		$ 0.31	$ 0.70
Weighted average number of shares outstanding - Basic		13,728	13,718
Weighted average number of shares outstanding - Diluted		13,747	13,718
Non-Related Parties
Revenues:
Lease revenue		$ 12,731	$ 12,507
Other
Revenues:
Other revenue		375	235
Management Service
Expenses:
Advisory fees to UHS		970	904
UHS Facilities
Revenues:
Lease revenue	[1]	5,793	5,735
UHS Facilities | Other
Revenues:
Other revenue		$ 213	$ 62
[1]	Includes bonus rental on UHS hospital facilities of $1,394 and $1,326 for the three-month periods ended March 31, 2019 and 2018, respectively.

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Income (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
UHS Hospital Facilities
Bonus rental	$ 1,394	$ 1,326

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 4,212	$ 9,604
Other comprehensive (loss)/income:
Unrealized derivative (loss)/gain on interest rate caps	(132)	148
Total other comprehensive (loss)/income:	(132)	148
Total comprehensive income	$ 4,080	$ 9,752

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019		Dec. 31, 2018
Real Estate Investments:
Buildings and improvements and construction in progress	$ 558,414		$ 557,650
Accumulated depreciation	(178,481)		(173,316)
Real Estate Investment Property, Net, Total	379,933		384,334
Land	53,396		53,396
Net Real Estate Investments	433,329		437,730
Investments in limited liability companies ("LLCs")	4,944		5,019
Other Assets:
Cash and cash equivalents	6,032		5,036
Lease and other receivables from UHS	4,145		2,739
Lease receivable - other	7,031		7,469
Intangible assets (net of accumulated amortization of $25.4 million and $27.6 million, respectively)	16,565		17,407
Right-of-use land assets	8,848
Deferred charges and other assets, net	8,156		8,356
Total Assets	489,050		483,756
Liabilities:
Line of credit borrowings	200,300		196,400
Mortgage notes payable, non-recourse to us, net	64,456	[1]	64,881
Accrued interest	488		450
Accrued expenses and other liabilities	10,164		11,765
Ground lease liabilities	8,848
Tenant reserves, deposits and deferred and prepaid rents	11,167		11,650
Total Liabilities	295,423		285,146
Equity:
Preferred shares of beneficial interest, $.01 par value; 5,000,000 shares authorized; none issued and outstanding
Common shares, $.01 par value; 95,000,000 shares authorized; issued and outstanding: 2019 - 13,747,567; 2018 - 13,746,803	137		137
Capital in excess of par value	266,247		266,031
Cumulative net income	646,528		642,316
Cumulative dividends	(719,285)		(710,006)
Accumulated other comprehensive income			132
Total Equity	193,627		198,610
Total Liabilities and Equity	$ 489,050		$ 483,756
[1]	All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Mar. 31, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
Intangible assets, accumulated amortization	$ 25.4	$ 27.6
Preferred shares of beneficial interest, par value	$ 0.01	$ 0.01
Preferred shares of beneficial interest, shares authorized	5,000,000	5,000,000
Preferred shares of beneficial interest, issued	0	0
Preferred shares of beneficial interest, outstanding	0	0
Common shares, par value	$ 0.01	$ 0.01
Common shares, shares authorized	95,000,000	95,000,000
Common shares, issued	13,747,567	13,746,803
Common shares, outstanding	13,747,567	13,746,803

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Changes in Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common stock	Capital in excess of par value	Cumulative net income	Cumulative dividends	Accumulated other comprehensive income/(loss)
Balance at Dec. 31, 2017	$ 210,561	$ 137	$ 265,335	$ 618,120	$ (673,175)	$ 144
Balance, Shares at Dec. 31, 2017		13,735
Shares of Beneficial Interest:
Issued	29		29
Issued (in shares)		1
Restricted stock-based compensation expense	147		147
Dividends ($.675/share) in 2019 and ($.665/share) in 2018	(9,134)				(9,134)
Comprehensive income:
Net income	9,604			9,604
Unrealized loss on interest rate cap	149					149
Subtotal - comprehensive income	9,753			9,604		149
Balance at Mar. 31, 2018	211,356	$ 137	265,511	627,724	(682,309)	293
Balance, Shares at Mar. 31, 2018		13,736
Balance at Dec. 31, 2018	198,610	$ 137	266,031	642,316	(710,006)	132
Balance, Shares at Dec. 31, 2018		13,747
Shares of Beneficial Interest:
Issued	57		57
Issued (in shares)		1
Restricted stock-based compensation expense	159		159
Dividends ($.675/share) in 2019 and ($.665/share) in 2018	(9,279)				(9,279)
Comprehensive income:
Net income	4,212			4,212
Unrealized loss on interest rate cap	(132)					(132)
Subtotal - comprehensive income	4,080			4,212		$ (132)
Balance at Mar. 31, 2019	$ 193,627	$ 137	$ 266,247	$ 646,528	$ (719,285)
Balance, Shares at Mar. 31, 2019		13,748

Condensed Consolidated Statem_5

Condensed Consolidated Statements of Changes in Equity (Parenthetical) - $ / shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement Of Stockholders Equity [Abstract]
Dividend, per share	$ 0.675	$ 0.665

Condensed Consolidated Statem_6

Condensed Consolidated Statement of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows from operating activities:
Net income	$ 4,212	$ 9,604
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	6,654	6,231
Amortization of debt premium	(13)	(10)
Stock-based compensation expense	159	119
Hurricane insurance recovery proceeds in excess of damaged property write-downs		(4,535)
Gain on sale of land	(250)
Changes in assets and liabilities:
Lease receivable	(968)	(405)
Accrued expenses and other liabilities	(734)	(367)
Tenant reserves, deposits and deferred and prepaid rents	(537)	296
Accrued interest	38	(182)
Leasing costs paid	(299)	(209)
Other, net	371	217
Net cash provided by operating activities	8,633	10,759
Cash flows from investing activities:
Investments in LLCs	(541)	(369)
Cash distributions in excess of income from LLCs	292	193
Additions to real estate investments, net	(1,834)	(1,987)
Cash proceeds received from divestiture of property, net	245
Hurricane insurance recovery proceeds in excess of damaged property write-downs		4,535
Hurricane remediation payments		(192)
Net cash (used in)/provided by investing activities	(1,838)	2,180
Cash flows from financing activities:
Net borrowings/(repayments) on line of credit	3,900	(6,050)
Repayments of mortgage notes payable	(442)	(4,596)
Financing costs paid	(35)	(1,527)
Dividends paid	(9,279)	(9,100)
Issuance of shares of beneficial interest, net	57	56
Net cash used in financing activities	(5,799)	(12,117)
Increase in cash and cash equivalents	996	822
Cash and cash equivalents, beginning of period	5,036	3,387
Cash and cash equivalents, end of period	6,032	4,209
Supplemental disclosures of cash flow information:
Interest paid	2,501	2,525
Invoices accrued for construction and improvements	382	$ 1,390
Right-of-use assets obtained in exchange for lease obligations	$ 8,855

General

General	3 Months Ended
	Mar. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
General	(1) General This Quarterly Report on Form 10-Q is for the quarter ended March 31, 2019. In this Quarterly Report, “we,” “us,” “our” and the “Trust” refer to Universal Health Realty Income Trust and its subsidiaries. In this Quarterly Report on Form 10-Q, the term “revenues” does not include the revenues of the unconsolidated LLCs in which we have various non-controlling equity interests ranging from 33% to 95%. As of March 31, 2019, we had investments in four jointly-owned LLCs/LPs which own medical office buildings, all of which are accounted for by the equity method (see Note 5). These LLCs are included in our consolidated financial statements for all periods presented on an unconsolidated basis since they are not variable interest entities for which we are the primary beneficiary, nor do we hold a controlling voting interest. The condensed consolidated financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the SEC and reflect all normal and recurring adjustments which, in our opinion, are necessary to fairly present results for the interim periods. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. It is suggested that these condensed consolidated financial statements be read in conjunction with the condensed consolidated financial statements, the notes thereto and accounting policies included in our Annual Report on Form 10-K for the year ended December 31, 2018. The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires us to make estimates and assumptions that affect the amounts reported in our consolidated financial statements and accompanying notes.

Relationship with Universal Hea

Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions	3 Months Ended
	Mar. 31, 2019
Related Party Transactions [Abstract]
Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions	(2) Relationship with Universal Health Services, Inc. (“UHS”) and Related Party Transactions Leases: We commenced operations in 1986 by purchasing properties from certain subsidiaries of UHS and immediately leasing the properties back to the respective subsidiaries. Most of the leases were entered into at the time we commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. The current base rentals and lease and renewal terms for each of the three hospital facilities leased to subsidiaries of UHS are provided below. The base rents are paid monthly and each lease also provides for additional or bonus rents which are computed and paid on a quarterly basis based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The three hospital leases with subsidiaries of UHS are unconditionally guaranteed by UHS and are cross-defaulted with one another. The combined revenues generated from the leases on the UHS hospital facilities accounted for approximately 22% of our consolidated revenues for each of the three months ended March 31, 2019 and 2018. In addition, we have seventeen medical office buildings (“MOBs”), or free-standing emergency departments (“FEDs”), that are either wholly or jointly-owned by us, that include tenants which are subsidiaries of UHS. The aggregate revenues generated from UHS-related tenants comprised approximately 31% of our consolidated revenues during each of the three-month periods ended March 31, 2019 and 2018. Pursuant to the Master Lease Document by and among us and certain subsidiaries of UHS, dated December 24, 1986 (the “Master Lease”), which governs the leases of all hospital properties with subsidiaries of UHS, UHS has the option to renew the leases at the lease terms described below by providing notice to us at least 90 days prior to the termination of the then current term. UHS also has the right to purchase the respective leased facilities at the end of the lease terms or any renewal terms at the appraised fair market value. In addition, the Master Lease, as amended during 2006, includes a change of control provision whereby UHS has the right, upon one month’s notice should a change of control of the Trust occur, to purchase any or all of the three leased hospital properties listed below at their appraised fair market value. Additionally, UHS has rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer. The table below details the existing lease terms and renewal options for our three acute care hospitals operated by wholly-owned subsidiaries of UHS: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 2026 5 (a) Wellington Regional Medical Center $ 3,030,000 December, 2021 10 (b) Southwest Healthcare System, Inland Valley Campus $ 2,648,000 December, 2021 10 (b) (a) UHS has one 5-year renewal option at the existing lease rate (through 2031). (b) UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031). Management cannot predict whether the leases with subsidiaries of UHS, which have renewal options at existing lease rates or fair market value lease rates, or any of our other leases, will be renewed at the end of their lease term. If the leases are not renewed at their current rates or the fair market value lease rates, we would be required to find other operators for those facilities and/or enter into leases on terms potentially less favorable to us than the current leases. In addition, if subsidiaries of UHS exercise their options to purchase the respective leased hospital or FED facilities upon expiration of the lease terms, our future revenues could decrease if we were unable to earn a favorable rate of return on the sale proceeds received, as compared to the lease revenue currently earned pursuant to the these leases. In connection with our various ground leases for land, we are the lessee on nine ground leases with subsidiaries of UHS. The remaining lease terms on the ground leases with subsidiaries of UHS range from approximately 30 years to approximately 79 years. Our annual aggregate lease payments on these properties are $281,000 for each of the years ended 2019, 2020, 2021, 2022 and 2023, and an aggregate of $15.9 million thereafter. Officers and Employees: Our officers are all employees of a wholly-owned subsidiary of UHS and although as of March 31, 2019 we had no salaried employees, our officers do typically receive annual stock-based compensation awards in the form of restricted stock. In special circumstances, if warranted and deemed appropriate by the Compensation Committee of the Board of Trustees, our officers may also receive one-time special compensation awards in the form of restricted stock and/or cash bonuses. Advisory Agreement: UHS of Delaware, Inc. (the “Advisor”), a wholly-owned subsidiary of UHS, serves as Advisor to us under an advisory agreement dated December 24, 1986, and as amended and restated as of January 1, 2019 (the “Advisory Agreement”). Pursuant to the Advisory Agreement, the Advisor is obligated to present an investment program to us, to use its best efforts to obtain investments suitable for such program (although it is not obligated to present any particular investment opportunity to us), to provide administrative services to us and to conduct our day-to-day affairs. All transactions between us and UHS must be approved by the Trustees who are unaffiliated with UHS (the “Independent Trustees”). In performing its services under the Advisory Agreement, the Advisor may utilize independent professional services, including accounting, legal, tax and other services, for which the Advisor is reimbursed directly by us. The Advisory Agreement may be terminated for any reason upon sixty days written notice by us or the Advisor. The Advisory Agreement expires on December 31 of each year; however, it is renewable by us, subject to a determination by the Independent Trustees, that the Advisor’s performance has been satisfactory. Pursuant to the terms of the original advisory agreement, which was in effect from inception through December 31, 2018, in addition to the advisory fee as discussed below, the Advisor was entitled to an annual incentive fee equal to 20% of the amount by which cash available for distribution to shareholders for each year, as defined in the agreement, exceeded 15% of our equity as shown on our condensed consolidated balance sheet, determined in accordance with generally accepted accounting principles without reduction for return of capital dividends. Cash available for distribution to shareholders was defined as net cash flow from operations less deductions for, among other things, amounts required to discharge our debt and liabilities and reserves for replacement and capital improvements to our properties and investments. Since the incentive fee requirements were not achieved at any time from our inception through December 31, 2018, no incentive fees were paid during that time. Given that the incentive fee requirements had never been achieved, and were deemed unlikely to be achieved in the future, the amended and restated advisory agreement that became effective on January 1, 2019, among other things, eliminated the incentive fee provision. Our advisory fee for the three months ended March 31, 2019 and 2018, was computed at 0.70% of our average invested real estate assets, as derived from our condensed consolidated balance sheet. Based upon a review of our advisory fee and other general and administrative expenses, as compared to an industry peer group, the advisory fee computation remained unchanged for 2019, as compared to the last three years. The average real estate assets for advisory fee calculation purposes exclude certain items from our condensed consolidated balance sheet such as, among other things, accumulated depreciation, cash and cash equivalents, lease receivables, deferred charges and other assets. The advisory fee is payable quarterly, subject to adjustment at year-end based upon our audited financial statements. Advisory fees incurred and paid (or payable) to UHS amounted to $970,000 and $904,000 during the three months ended March 31, 2019 and 2018, respectively and were based upon average invested real estate assets of $554 million and $517 million, respectively. Share Ownership: At each of March 31, 2019 and December 31, 2018, UHS owned 5.7%, of our outstanding shares of beneficial interest. SEC reporting requirements of UHS: UHS is subject to the reporting requirements of the SEC and is required to file annual reports containing audited financial information and quarterly reports containing unaudited financial information. Since the aggregate revenues generated from the UHS-related tenants comprised 31% of our consolidated revenues during each of the three-month periods ended March 31, 2019 and 2018 and since a subsidiary of UHS is our Advisor, you are encouraged to obtain the publicly available filings for Universal Health Services, Inc. from the SEC’s website. These filings are the sole responsibility of UHS and are not incorporated by reference herein

Dividends

Dividends	3 Months Ended
	Mar. 31, 2019
Equity [Abstract]
Dividends	(3) Dividends Dividends: We declared and paid dividends of $9.3 million, or $.675 per share, during the first quarter of 2019. We declared dividends of $9.1 million, or $.665 per share, during the first quarter of 2018, which were paid on April 2, 2018.

Acquisitions and Dispositions

Acquisitions and Dispositions	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Acquisitions and Dispositions	(4) Acquisitions and Dispositions Three Months Ended March 31, 2019: Acquisitions: There were no acquisitions during the first three months of 2019. Dispositions: There were no dispositions during the first three months of 2019. Three Months Ended March 31, 2018: Acquisitions: There were no acquisitions during the first three months of 2018. Dispositions: There were no dispositions during the first three months of 2018.

Summarized Financial Informatio

Summarized Financial Information of Equity Affiliates	3 Months Ended
	Mar. 31, 2019
Equity Method Investments And Joint Ventures [Abstract]
Summarized Financial Information of Equity Affiliates	(5) Summarized Financial Information of Equity Affiliates In accordance with the accounting principles generally accepted in the United States of America (U.S. GAAP) and guidance relating to accounting for investments and real estate ventures, we account for our unconsolidated investments in LLCs/LPs, which we do not control, using the equity method of accounting. The third-party members in these investments have equal voting rights with regards to issues such as, but not limited to: (i) divestiture of property; (ii) annual budget approval, and; (iii) financing commitments. These investments, which represent 33% to 95% non-controlling ownership interests, are recorded initially at our cost and subsequently adjusted for our net equity in the net income, cash contributions to, and distributions from, the investments. Pursuant to certain agreements, allocations of sales proceeds and profits and losses of some of the LLC investments may be allocated disproportionately as compared to ownership interests after specified preferred return rate thresholds have been satisfied. In the condensed consolidated statements of cash flows, distributions and equity in net income are presented net as cash flows from operating activities. Cumulative distributions received exceeding cumulative equity in earnings represent returns of investments and are classified as cash flows from investing activities in the condensed consolidated statements of cash flows. At March 31, 2019, we have non-controlling equity investments or commitments in four jointly-owned LLCs/LPs which own MOBs. As of March 31, 2019, we accounted for these LLCs/LPs on an unconsolidated basis pursuant to the equity method since they are not variable interest entities which we are the primary beneficiary nor do we have a controlling voting interest. The majority of these entities are joint-ventures between us and non-related parties that hold minority ownership interests in the entities. Each entity is generally self-sustained from a cash flow perspective and generates sufficient cash flow to meet its operating cash flow requirements and service the third-party debt (if applicable) that is non-recourse to us. Although there is typically no ongoing financial support required from us to these entities since they are cash-flow sufficient, we may, from time to time, provide funding for certain purposes such as, but not limited to, significant capital expenditures, leasehold improvements and debt financing. Although we are not obligated to do so, if approved by us at our sole discretion, additional cash fundings are typically advanced as equity or member loans. These entities maintain property insurance on the properties. The following property table represents the four LLCs in which we own a noncontrolling interest and were accounted for under the equity method as of March 31, 2019: Name of LLC/LP Ownership Property Owned by LLC/LP Suburban Properties 33 % St. Matthews Medical Plaza II Brunswick Associates (a.) 74 % Mid Coast Hospital MOB Grayson Properties (b.) 95 % Texoma Medical Plaza FTX MOB Phase II (c.) 95 % Forney Medical Plaza II (a.) This LLC has a third-party term loan, which is non-recourse to us, of $8.2 million outstanding as of March 31, 2019. (b.) This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LP has a third-party term loan, which is non-recourse to us, of $13.9 million outstanding as of March 31, 2019. (c.) We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2019. This LP has a third-party term loan, which is non-recourse to us, of $5.0 million outstanding as of March 31, 2019. Below are the condensed combined statements of income (unaudited) for the LLCs/LPs accounted for under the equity method during the three months ended March 31, 2019 and 2018. Three Months Ended March 31, 2019 2018 (amounts in thousands) Revenues $ 2,460 $ 2,462 Operating expenses 1,012 958 Depreciation and amortization 398 457 Interest, net 322 328 Net income $ 728 $ 719 Our share of net income $ 430 $ 429 Below are the condensed combined balance sheets (unaudited) for the four above-mentioned LLCs that were accounted for under the equity method as of March 31, 2019 and December 31, 2018: March 31, 2019 December 31, 2018 (amounts in thousands) Net property, including construction in progress $ 31,432 $ 31,818 Other assets 6,951 3,251 Total assets $ 38,383 $ 35,069 Other liabilities $ 6,005 $ 2,717 Mortgage notes payable, non-recourse to us 27,103 27,256 Equity 5,275 5,096 Total liabilities and equity $ 38,383 $ 35,069 Investments in LLCs before amounts included in accrued expenses and other liabilities $ 4,944 $ 5,019 Amounts included in accrued expenses and other liabilities (1,933 ) (2,258 ) Our share of equity in LLCs, net $ 3,011 $ 2,761 As of March 31, 2019, and December 31, 2018, aggregate principal amounts due on mortgage notes payable by unconsolidated LLCs, which are accounted for under the equity method and are non-recourse to us, are as follows (amounts in thousands): Mortgage Loan Balance (a.) Name of LLC/LP 3/31/2019 12/31/2018 Maturity Date FTX MOB Phase II (5.00% fixed rate mortgage loan) $ 5,032 $ 5,067 October, 2020 Grayson Properties (5.034% fixed rate mortgage loan) 13,860 13,929 September, 2021 Brunswick Associates (3.64% fixed rate mortgage loan) 8,211 8,260 December, 2024 $ 27,103 $ 27,256 (a.) All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity. Pursuant to the operating and/or partnership agreements of the four LLCs/LPs in which we continue to hold non-controlling ownership interests, the third-party member and/or the Trust, at any time, potentially subject to certain conditions, have the right to make an offer (“Offering Member”) to the other member(s) (“Non-Offering Member”) in which it either agrees to: (i) sell the entire ownership interest of the Offering Member to the Non-Offering Member (“Offer to Sell”) at a price as determined by the Offering Member (“Transfer Price”), or; (ii) purchase the entire ownership interest of the Non-Offering Member (“Offer to Purchase”) at the equivalent proportionate Transfer Price. The Non-Offering Member has 60 to 90 days to either: (i) purchase the entire ownership interest of the Offering Member at the Transfer Price, or; (ii) sell its entire ownership interest to the Offering Member at the equivalent proportionate Transfer Price. The closing of the transfer must occur within 60 to 90 days of the acceptance by the Non-Offering Member.

Recent Accounting Pronouncement

Recent Accounting Pronouncements	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Recent Accounting Pronouncements	(6) Recent Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02 - Leases (Topic 842), 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 guidance amended the existing accounting standards, including the requirement that lessees recognize right-of-use assets and lease liabilities for leases with terms greater than twelve months on their condensed consolidated balance sheet. It also requires disclosures designed to give financial statement users information regarding amount, timing, and uncertainty of cash flows arising from leases. The FASB issued ASU 2018-11, "Leases (Topic 842) Targeted Improvements" in July 2018, which provides lessors with a practical expedient, by class of underlying assets, to not separate non-lease components from the related lease components, and, instead, to account for those components as a single lease component, if certain criteria are met. We adopted Topic 842 on January 1, 2019, the date it became effective for public companies, and applied the new leasing standard to leases in place as of the effective date using the modified retrospective transition method. W e applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. we are the lessee with various third parties, including subsidiaries of UHS, at fourteen of our consolidated properties on the condensed consolidated balance sheet. See Note 7 for further disclosure around our adoption of the new lease standard.

Lease Accounting

Lease Accounting	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lease Accounting	(7) Lease Accounting As Lessor: We lease our operating properties to customers under agreements that are classified as operating leases. We recognize the total minimum lease payments provided for under the leases on a straight-line basis over the lease term. Generally, under the terms of our leases, the majority of our rental expenses, including common area maintenance, real estate taxes and insurance, are recovered from our customers. We record amounts reimbursed by customers in the period that the applicable expenses are incurred, which is generally ratably throughout the term of the lease. We have elected the package of practical expedients that allows lessors to not separate lease and non-lease components by class of underlying asset. This practical expedient allowed us to not separate expenses reimbursed by our customers (“tenant reimbursements”) from the associated rental revenue if certain criteria were met. We assessed these criteria and concluded that the timing and pattern of transfer for rental revenue and the associated tenant reimbursements are the same, and as our leases qualify as operating leases, we accounted for and presented rental revenue and tenant reimbursements as a single component under Lease revenue in our condensed consolidated statements of income for the three months ended March 31, 2019. As a result of our adoption of this practical expedient, we presented $4.2 million of base rental revenue for UHS facilities, $1.3 million of bonus rental revenue for UHS facilities and $233,000 of tenant reimbursement revenue for UHS facilities as a single component (“Lease revenue – UHS facilities”) in the condensed consolidated statements of income for the three months ended March 31, 2018 to conform to the 2019 new presentation. Additionally, we presented $10.3 million of base rental revenues from non-related parties and $2.2 million of tenant reimbursements as a single component (“Lease revenue – Non-related parties”) in the condensed consolidated statements of income for the three months ended March 31, 2018 to conform to the 2019 new presentation. Minimum future lease revenue from base rents from non-cancelable leases related to properties included in our financial statements on a consolidated basis, excluding increases from changes in the consumer price index, bonus rents and the impact of straight line rent adjustments, are as follows (amounts in thousands): March 31, 2019 December 31, 2018 Year ending, 2019 $ 43,744 $ 56,494 2020 52,546 50,291 2021 47,343 45,357 2022 31,678 30,089 2023 26,326 24,972 Thereafter 68,766 67,288 Total minimum base rents $ 270,403 $ 274,491 ASU 2016-02 requires that lessors expense certain initial direct costs, which were capitalizable under the previous leasing standard, as incurred. Upon adoption, only the incremental costs of signing a lease will be capitalizable, which was consistent to our historical practice. As Lessee: We are the lessee with various third parties, including subsidiaries of UHS, in connection with ground leases for land at fourteen of our consolidated properties. Our right-of-use land assets represent our right to use the land for the lease term and our lease liabilities represent our obligation to make lease payments arising from the leases. Right-of-use assets and lease liabilities were recognized upon adoption of Topic 842 based on the present value of lease payments over the lease term. We use our estimated incremental borrowing rate, which is derived from information available at the lease commencement date, in determining the present value of lease payments. As of March 31, 2019, our condensed consolidated balance sheet includes right-of-use land assets of approximately $8.8 million and ground lease liabilities of approximately $8.8 million. The components of lease expenses payments were as follows (in thousands): Three months ended March 31, 2019 Operating lease cost $ 118 Total lease cost $ 118 During the three months ended March 31, 2019, the cash paid for amounts included in the measurement of lease liabilities related to our operating leases was approximately $118,000, which is included as an operating cash outflow within the condensed consolidated statement of cash flows and included in other operating expenses within the condensed consolidated statements of income. As of and during the three months ended March 31, 2019, we did not enter into any lease agreements set to commence in the future and there were no newly leased assets for which a right-of-use asset was recorded in exchange for a new lease liability. Supplemental balance sheet information related to leases was as follows (in thousands): March 31, 2019 Operating Leases Right-of-use land assets-operating leases $ 8,848 Total lease liabilities $ 8,848 Weighted Average remaining lease term, years Operating leases 59.0 Weighted Average discount rate Operating leases 5.07 % The following table summarizes the fixed, future minimum rental payments, excluding variable costs, which are discounted by our incremental borrowing rate to calculate the lease liabilities for our operating leases in which we are the lessee. Maturities of lease liabilities were as follows (in thousands): March 31, 2019 December 31, 2018 Year ending, 2019 $ 356 $ 474 2020 475 474 2021 475 474 2022 475 474 2023 475 474 Later years 25,640 25,582 Total undiscounted lease payments $ 27,896 $ 27,952 less imputed interest 19,048 Total $ 8,848

Debt and Financial Instruments

Debt and Financial Instruments	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Debt and Financial Instruments	(8) Debt and Financial Instruments Debt: Management routinely monitors and analyzes the Trust’s capital structure in an effort to maintain the targeted balance among capital resources including the level of borrowings pursuant to our $300 million revolving credit agreement, the level of borrowings pursuant to non-recourse mortgage debt secured by the real property of our properties and our level of equity including consideration of additional equity issuances. This ongoing analysis considers factors such as the current debt market and interest rate environment, the current/projected occupancy and financial performance of our properties, the current loan-to-value ratio of our properties, the Trust’s current stock price, the capital resources required for anticipated acquisitions and the expected capital to be generated by anticipated divestitures. This analysis, together with consideration of the Trust’s current balance of revolving credit agreement borrowings, non-recourse mortgage borrowings and equity, assists management in deciding which capital resource to utilize when events such as refinancing of specific debt components occur or additional funds are required to finance the Trust’s growth. On March 27, 2018, we entered into a revolving credit agreement (“Credit Agreement”) which, among other things, increased our borrowing capacity by $50 million to $300 million and extended the maturity date from our previously existing facility. The replacement Credit Agreement, which is scheduled to mature in March 2022, includes a $40 million sublimit for letters of credit and a $30 million sublimit for swingline/short-term loans. The Credit Agreement also provides for options to extend the maturity date for two additional six month periods. Additionally, the Credit Agreement includes an option to increase the total facility borrowing capacity up to an additional $50 million, subject to lender agreement. Borrowings under the Credit Agreement are guaranteed by certain subsidiaries of the Trust. In addition, borrowings under the Credit Agreement are secured by first priority security interests in and liens on all equity interests in certain of the Trust’s wholly-owned subsidiaries. Borrowings made pursuant to the Credit Agreement will bear interest, at our option, at one, two, three, or six month LIBOR plus an applicable margin ranging from 1.10% to 1.35% or at the Base Rate plus an applicable margin ranging from 0.10% to 0.35%. The Credit Agreement defines “Base Rate” as the greater of: (a) the administrative agent’s prime rate; (b) the federal funds effective rate plus 1/2 of 1%, and; (c) one month LIBOR plus 1%. A facility fee of 0.15% to 0.35% will be charged on the total commitment of the Credit Agreement. The margins over LIBOR, Base Rate and the facility fee are based upon our total leverage ratio. At March 31, 2019, the applicable margin over the LIBOR rate was 1.20%, the margin over the Base Rate was 0.20%, and the facility fee was 0.20%. At March 31, 2019, we had $200.3 million of outstanding borrowings under our Credit Agreement and $99.7 million of available borrowing capacity. At December 31, 2018, we had $196.4 million of outstanding borrowings outstanding against our revolving credit agreement and $103.6 million of available borrowing capacity. There are no compensating balance requirements. The Credit Agreement contains customary affirmative and negative covenants, including limitations on certain indebtedness, liens, acquisitions and other investments, fundamental changes, asset dispositions and dividends and other distributions. The Credit Agreement also contains restrictive covenants regarding the Trust’s ratio of total debt to total assets, the fixed charge coverage ratio, the ratio of total secured debt to total asset value, the ratio of total unsecured debt to total unencumbered asset value, and minimum tangible net worth, as well as customary events of default, the occurrence of which may trigger an acceleration of amounts outstanding under the Credit Agreement. We are in compliance with all of the covenants at March 31, 2019 and December 31, 2018. We also believe that we would remain in compliance if the full amount of our commitment was borrowed. The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands): Covenant March 31, 2019 December 31, 2018 Tangible net worth > =$125,000 $ 177,062 $ 181,203 Total leverage < 60% 41.9 % 41.3 % Secured leverage < 30% 9.8 % 9.8 % Unencumbered leverage < 60% 38.5 % 37.6 % Fixed charge coverage > 1.50x 4.2x 4.3x As indicated on the following table, we have various mortgages, all of which are non-recourse to us, included on our condensed consolidated balance sheet as of March 31, 2019 (amounts in thousands): Facility Name Outstanding Balance (in Interest Rate Maturity Date Vibra Hospital-Corpus Christi fixed rate mortgage loan (b.) $ 2,492 6.50 % July, 2019 700 Shadow Lane and Goldring MOBs fixed rate mortgage loan 5,810 4.54 % June, 2022 BRB Medical Office Building fixed rate mortgage loan 5,877 4.27 % December, 2022 Desert Valley Medical Center fixed rate mortgage loan 4,771 3.62 % January, 2023 2704 North Tenaya Way fixed rate mortgage loan 6,835 4.95 % November, 2023 Summerlin Hospital Medical Office Building III fixed rate mortgage loan 13,197 4.03 % April, 2024 Tuscan Professional Building fixed rate mortgage loan 3,890 5.56 % June, 2025 Phoenix Children’s East Valley Care Center fixed rate mortgage loan 9,136 3.95 % January, 2030 Rosenberg Children's Medical Plaza fixed rate mortgage loan 12,895 4.42 % September, 2033 Total, excluding net debt premium and net financing fees 64,903 Less net financing fees (681 ) Plus net debt premium 234 Total mortgages notes payable, non-recourse to us, net $ 64,456 (a) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity. (b) On April 2, 2019, a $2.5 million fixed rate mortgage loan on Vibra Hospital – Corpus Christi was fully repaid utilizing borrowings under our Credit Agreement. The mortgages are secured by the real property of the buildings as well as property leases and rents. The mortgages outstanding as of March 31, 2019 had a combined fair value of approximately $65.8 million. At December 31, 2018, we had various mortgages, all of which were non-recourse to us, included in our condensed consolidated balance sheet. The combined outstanding balance of these various mortgages was $65.3 million and had a combined fair value of approximately $64.9 million. The fair value of our debt was computed based upon quotes received from financial institutions. We consider these to be “level 2” in the fair value hierarchy as outlined in the authoritative guidance for disclosure in connection with debt instruments. Changes in market rates on our fixed rate debt impacts the fair value of debt, but it has no impact on interest incurred or cash flow. Financial Instruments: During the second quarter of 2016, we entered into an interest rate cap on the total notional amount of $30 million whereby we paid a premium of $115,000. In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.50% and one-month LIBOR if one-month LIBOR rises above 1.50% during the term of the cap. This interest rate cap became effective in January, 2017 and expired in March 2019. From inception through March 31, 2019, we received or accrued approximately $205,000 in payments made to us by the counterparties ($61,000 of which was received during the first three months of 2019 and $144,000 of which was received during 2018) pursuant to the terms of this cap. During the third quarter of 2016, we entered into an additional interest rate cap agreement on a total notional amount of $30 million whereby we paid a premium of $55,000. In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.5% and one-month LIBOR if one-month LIBOR rises above 1.5% during the term of the cap. This interest rate cap became effective in October, 2016 and expired in March, 2019. From inception through March 31, 2019, we received or accrued approximately $205,000 in payments made to us by the counterparties ($61,000 of which was received during the first three months of 2019 and $144,000 of which was received during 2018) pursuant to the terms of this cap. Although we can provide no assurance that we will ultimately do so, we are currently monitoring the interest rate environment and evaluating the terms of potential replacement interest rate cap and/or swap agreements that we may enter into for a large portion, or potentially all, of the $60 million total notional amount of interest rate caps that expired in March, 2019.

Segment Reporting

Segment Reporting	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Segment Reporting	(9) Segment Reporting Our primary business is investing in and leasing healthcare and human service facilities through direct ownership or through joint ventures, which aggregate into a single reportable segment. We actively manage our portfolio of healthcare and human service facilities and may from time to time make decisions to sell lower performing properties not meeting our long-term investment objectives. The proceeds of sales are typically reinvested in new developments or acquisitions, which we believe will meet our planned rate of return. It is our intent that all healthcare and human service facilities will be owned or developed for investment purposes. Our revenue and net income are generated from the operation of our investment portfolio. Our portfolio is located throughout the United States, however, we do not distinguish or group our operations on a geographical basis for purposes of allocating resources or measuring performance. We review operating and financial data for each property on an individual basis; therefore, we define an operating segment as our individual properties. Individual properties have been aggregated into one reportable segment based upon their similarities with regard to both the nature and economics of the facilities, tenants and operational processes, as well as long-term average financial performance. No individual property meets the requirements necessary to be considered its own segment.

Impact of Hurricane Harvey

Impact of Hurricane Harvey	3 Months Ended
	Mar. 31, 2019
Extraordinary And Unusual Items [Abstract]
Impact of Hurricane Harvey	(10) Impact of Hurricane Harvey In late August 2017, five of our medical office buildings located in the Houston, Texas area incurred extensive water damage as a result of Hurricane Harvey. Until various times during the second quarter of 2018, these properties were temporarily closed and non-operational as we continued to reconstruct and restore them to operational condition. As of June 30, 2018, reconstruction on all of the occupied space in these properties had been completed and operations resumed. During 2018, pursuant to the terms of a global settlement with our commercial property insurance carrier, we received $5.5 million of additional insurance recovery proceeds bringing the aggregate hurricane-related insurance recoveries to $12.5 million. The aggregate insurance recovery proceeds, which are net of applicable deductibles, covered substantially all of the costs incurred related to the remediation, repair and reconstruction of each of these properties, as well as business interruption recoveries for the lost income related to each of these properties during the period they were non-operational. Included in our financial results for the three months ended March 31, 2018 are approximately $968,000 of business interruption insurance recovery proceeds, covering the period of late August, 2017 through March, 2018, approximately $500,000 of which related to 2017. These business interruption insurance recovery proceeds are included in net cash provided by operating activities in our condensed consolidated statement of cash flows for the three-month period ended March 31, 2018. Additionally, the three months ended March 31, 2018 includes approximately $4.5 million of hurricane insurance recoveries in excess of damaged property write-downs, which are included in net cash provided by investing activities in our condensed consolidated statement of cash flows for the three-month period ended March 31, 2018.

Recent Accounting Pronounceme_2

Recent Accounting Pronouncements (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Recent Accounting Pronouncements	In February 2016, the FASB issued ASU No. 2016-02 - Leases (Topic 842), 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 guidance amended the existing accounting standards, including the requirement that lessees recognize right-of-use assets and lease liabilities for leases with terms greater than twelve months on their condensed consolidated balance sheet. It also requires disclosures designed to give financial statement users information regarding amount, timing, and uncertainty of cash flows arising from leases. The FASB issued ASU 2018-11, "Leases (Topic 842) Targeted Improvements" in July 2018, which provides lessors with a practical expedient, by class of underlying assets, to not separate non-lease components from the related lease components, and, instead, to account for those components as a single lease component, if certain criteria are met. We adopted Topic 842 on January 1, 2019, the date it became effective for public companies, and applied the new leasing standard to leases in place as of the effective date using the modified retrospective transition method. W e applied Topic 842 to all leases as of January 1, 2019 with comparative periods continuing to be reported under Topic 840. we are the lessee with various third parties, including subsidiaries of UHS, at fourteen of our consolidated properties on the condensed consolidated balance sheet. See Note 7 for further disclosure around our adoption of the new lease standard.

Relationship with Universal H_2

Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions (Tables)	3 Months Ended
	Mar. 31, 2019
Related Party Transactions [Abstract]
Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities	The table below details the existing lease terms and renewal options for our three acute care hospitals operated by wholly-owned subsidiaries of UHS: Hospital Name Annual Minimum Rent End of Lease Term Renewal Term (years) McAllen Medical Center $ 5,485,000 December, 2026 5 (a) Wellington Regional Medical Center $ 3,030,000 December, 2021 10 (b) Southwest Healthcare System, Inland Valley Campus $ 2,648,000 December, 2021 10 (b) (a) UHS has one 5-year renewal option at the existing lease rate (through 2031). (b) UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

Summarized Financial Informat_2

Summarized Financial Information of Equity Affiliates (Tables)	3 Months Ended
	Mar. 31, 2019
Equity Method Investments And Joint Ventures [Abstract]
Limited Liability Companies Accounted for Under Equity Method	The following property table represents the four LLCs in which we own a noncontrolling interest and were accounted for under the equity method as of March 31, 2019: Name of LLC/LP Ownership Property Owned by LLC/LP Suburban Properties 33 % St. Matthews Medical Plaza II Brunswick Associates (a.) 74 % Mid Coast Hospital MOB Grayson Properties (b.) 95 % Texoma Medical Plaza FTX MOB Phase II (c.) 95 % Forney Medical Plaza II (a.) This LLC has a third-party term loan, which is non-recourse to us, of $8.2 million outstanding as of March 31, 2019. (b.) This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LP has a third-party term loan, which is non-recourse to us, of $13.9 million outstanding as of March 31, 2019. (c.) We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2019. This LP has a third-party term loan, which is non-recourse to us, of $5.0 million outstanding as of March 31, 2019.
Condensed Combined Statements of Income (Unaudited) for LLCs/LPs Accounted Under Equity Method	Below are the condensed combined statements of income (unaudited) for the LLCs/LPs accounted for under the equity method during the three months ended March 31, 2019 and 2018. Three Months Ended March 31, 2019 2018 (amounts in thousands) Revenues $ 2,460 $ 2,462 Operating expenses 1,012 958 Depreciation and amortization 398 457 Interest, net 322 328 Net income $ 728 $ 719 Our share of net income $ 430 $ 429
Condensed Combined Balance Sheets (Unaudited) for LLCs Accounted Under Equity Method	Below are the condensed combined balance sheets (unaudited) for the four above-mentioned LLCs that were accounted for under the equity method as of March 31, 2019 and December 31, 2018: March 31, 2019 December 31, 2018 (amounts in thousands) Net property, including construction in progress $ 31,432 $ 31,818 Other assets 6,951 3,251 Total assets $ 38,383 $ 35,069 Other liabilities $ 6,005 $ 2,717 Mortgage notes payable, non-recourse to us 27,103 27,256 Equity 5,275 5,096 Total liabilities and equity $ 38,383 $ 35,069 Investments in LLCs before amounts included in accrued expenses and other liabilities $ 4,944 $ 5,019 Amounts included in accrued expenses and other liabilities (1,933 ) (2,258 ) Our share of equity in LLCs, net $ 3,011 $ 2,761
Aggregate Principal Amounts due on Mortgage and Construction Notes Payable by Unconsolidated LLC's Accounted Under Equity Method	As of March 31, 2019, and December 31, 2018, aggregate principal amounts due on mortgage notes payable by unconsolidated LLCs, which are accounted for under the equity method and are non-recourse to us, are as follows (amounts in thousands): Mortgage Loan Balance (a.) Name of LLC/LP 3/31/2019 12/31/2018 Maturity Date FTX MOB Phase II (5.00% fixed rate mortgage loan) $ 5,032 $ 5,067 October, 2020 Grayson Properties (5.034% fixed rate mortgage loan) 13,860 13,929 September, 2021 Brunswick Associates (3.64% fixed rate mortgage loan) 8,211 8,260 December, 2024 $ 27,103 $ 27,256 (a.) All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity.

Lease Accounting (Tables)

Lease Accounting (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Schedule of Minimum Future Base Rents from Non-Cancelable Leases	Minimum future lease revenue from base rents from non-cancelable leases related to properties included in our financial statements on a consolidated basis, excluding increases from changes in the consumer price index, bonus rents and the impact of straight line rent adjustments, are as follows (amounts in thousands): March 31, 2019 December 31, 2018 Year ending, 2019 $ 43,744 $ 56,494 2020 52,546 50,291 2021 47,343 45,357 2022 31,678 30,089 2023 26,326 24,972 Thereafter 68,766 67,288 Total minimum base rents $ 270,403 $ 274,491
Components of Lease Expenses Payments	The components of lease expenses payments were as follows (in thousands): Three months ended March 31, 2019 Operating lease cost $ 118 Total lease cost $ 118
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases was as follows (in thousands): March 31, 2019 Operating Leases Right-of-use land assets-operating leases $ 8,848 Total lease liabilities $ 8,848 Weighted Average remaining lease term, years Operating leases 59.0 Weighted Average discount rate Operating leases 5.07 %
Schedule of Maturities of lease liabilities	Maturities of lease liabilities were as follows (in thousands): March 31, 2019 December 31, 2018 Year ending, 2019 $ 356 $ 474 2020 475 474 2021 475 474 2022 475 474 2023 475 474 Later years 25,640 25,582 Total undiscounted lease payments $ 27,896 $ 27,952 less imputed interest 19,048 Total $ 8,848

Debt and Financial Instruments

Debt and Financial Instruments (Tables)	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Summary of Required Compliance Ratios Giving Effect to New Covenants in Credit Agreement	The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands): Covenant March 31, 2019 December 31, 2018 Tangible net worth > =$125,000 $ 177,062 $ 181,203 Total leverage < 60% 41.9 % 41.3 % Secured leverage < 30% 9.8 % 9.8 % Unencumbered leverage < 60% 38.5 % 37.6 % Fixed charge coverage > 1.50x 4.2x 4.3x
Outstanding Mortgages, Excluding Net Debt Premium	As indicated on the following table, we have various mortgages, all of which are non-recourse to us, included on our condensed consolidated balance sheet as of March 31, 2019 (amounts in thousands): Facility Name Outstanding Balance (in Interest Rate Maturity Date Vibra Hospital-Corpus Christi fixed rate mortgage loan (b.) $ 2,492 6.50 % July, 2019 700 Shadow Lane and Goldring MOBs fixed rate mortgage loan 5,810 4.54 % June, 2022 BRB Medical Office Building fixed rate mortgage loan 5,877 4.27 % December, 2022 Desert Valley Medical Center fixed rate mortgage loan 4,771 3.62 % January, 2023 2704 North Tenaya Way fixed rate mortgage loan 6,835 4.95 % November, 2023 Summerlin Hospital Medical Office Building III fixed rate mortgage loan 13,197 4.03 % April, 2024 Tuscan Professional Building fixed rate mortgage loan 3,890 5.56 % June, 2025 Phoenix Children’s East Valley Care Center fixed rate mortgage loan 9,136 3.95 % January, 2030 Rosenberg Children's Medical Plaza fixed rate mortgage loan 12,895 4.42 % September, 2033 Total, excluding net debt premium and net financing fees 64,903 Less net financing fees (681 ) Plus net debt premium 234 Total mortgages notes payable, non-recourse to us, net $ 64,456 (a) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity. (b) On April 2, 2019, a $2.5 million fixed rate mortgage loan on Vibra Hospital – Corpus Christi was fully repaid utilizing borrowings under our Credit Agreement.

General - Additional Informatio

General - Additional Information (Detail)	Mar. 31, 2019Property
4 Unconsolidated Limited Liability Companies / Limited Partner | Minimum
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Non-controlling equity interest, ownership percentage	33.00%
4 Unconsolidated Limited Liability Companies / Limited Partner | Maximum
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Non-controlling equity interest, ownership percentage	95.00%
Medical office buildings | Limited Liability Companies
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Number of real estate investments	4

Relationship with Universal H_3

Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions - Additional Information (Detail)	3 Months Ended		12 Months Ended
	Mar. 31, 2019USD ($)PropertyTimeLease	Mar. 31, 2018USD ($)	Dec. 31, 2018USD ($)
Related Party Transaction [Line Items]
Remaining lease terms on ground leases	59 years
Aggregate lease payments for 2019	$ 356,000
Aggregate lease payments for 2020	475,000		$ 474,000
Aggregate lease payments for 2021	475,000		474,000
Aggregate lease payments for 2022	475,000		474,000
Aggregate lease payments for 2023	475,000		474,000
Aggregate lease payments for thereafter	$ 25,640,000		$ 25,582,000
Annual advisory fee as percentage of average invested real estate assets	0.70%	0.70%
Universal Health Services, Inc
Related Party Transaction [Line Items]
Number of term renewal options | Time	6
Additional renewal terms	5 years
Number of medical office buildings and free standing emergency departments | Property	17
Option to renew lease, notice period prior to termination date of current term	90 days
Period to purchase respective leased facilities at same price after lease terms	180 days
Renewal period of respective leased facilities at same price after lease terms	180 days
Number of renewal options at existing lease rates | Time	3
Number of ground leases | Lease	9
Aggregate lease payments for 2019	$ 281,000
Aggregate lease payments for 2020	281,000
Aggregate lease payments for 2021	281,000
Aggregate lease payments for 2022	281,000
Aggregate lease payments for 2023	281,000
Aggregate lease payments for thereafter	$ 15,900,000
Percentage ownership of outstanding shares	5.70%		5.70%
Universal Health Services, Inc | Customer Concentration Risk | Revenues
Related Party Transaction [Line Items]
Percentage of revenues generated from leases and tenants	22.00%	22.00%
Universal Health Services, Inc | Customer Concentration Risk | Revenues | Tenants
Related Party Transaction [Line Items]
Percentage of revenues generated from leases and tenants	31.00%	31.00%
Universal Health Services, Inc | Hospital Facilities Leased
Related Party Transaction [Line Items]
Number of hospital facilities leased | Property	3
Universal Health Services, Inc | Minimum
Related Party Transaction [Line Items]
Initial lease terms	13 years
Remaining lease terms on ground leases	30 years
Universal Health Services, Inc | Maximum
Related Party Transaction [Line Items]
Initial lease terms	15 years
Remaining lease terms on ground leases	79 years
Universal Health Services of Delaware Inc
Related Party Transaction [Line Items]
Annual incentive fee to Advisor as percentage of cash available for distribution			20.00%
Incentive fees			$ 0
Advisory fee	$ 970,000	$ 904,000
Type of Cost, Good or Service [Extensible List]	us-gaap:ManagementServiceMember	us-gaap:ManagementServiceMember
Average invested real estate assets	$ 554,000,000	$ 517,000,000
Universal Health Services of Delaware Inc | Minimum
Related Party Transaction [Line Items]
Percentage of equity to be exceeded for incentive distribution			15.00%

Existing Lease Terms and Renewa

Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities (Detail) - Universal Health Services, Inc	3 Months Ended
	Mar. 31, 2019USD ($)
McAllen Medical Center
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 5,485,000
End of Lease Term	2026-12
Renewal Term (years)	5 years	[1]
Wellington Regional Medical Center
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 3,030,000
End of Lease Term	2021-12
Renewal Term (years)	10 years	[2]
Southwest Healthcare System, Inland Valley Campus
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 2,648,000
End of Lease Term	2021-12
Renewal Term (years)	10 years	[2]
[1]	UHS has one 5-year renewal option at the existing lease rate (through 2031).
[2]	UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

Existing Lease Terms and Rene_2

Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities (Parenthetical) (Detail) - Universal Health Services, Inc	3 Months Ended
	Mar. 31, 2019TimeRenewalOption
Operating Leased Assets [Line Items]
Number of renewal option at existing lease rates	3
McAllen Medical Center
Operating Leased Assets [Line Items]
Number of renewal option at existing lease rates	1
Renewal option term at existing lease rates	5 years
Renewal option at existing lease rates expiration year	2031
Wellington Regional Medical Center And Southwest Healthcare System
Operating Leased Assets [Line Items]
Number of renewal options at fair market value lease rates | RenewalOption	2
Renewal options term at fair market value lease rates	5 years
Wellington Regional Medical Center And Southwest Healthcare System | Maximum
Operating Leased Assets [Line Items]
Renewal option at fair market value lease rates expiration year	2031
Wellington Regional Medical Center And Southwest Healthcare System | Minimum
Operating Leased Assets [Line Items]
Renewal option at fair market value lease rates expiration year	2022

Dividends - Additional Informat

Dividends - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Equity [Abstract]
Dividends declared and paid	$ 9,279	$ 9,100
Declared and paid dividends, per share	$ 0.675	$ 0.665
Dividends payable, date to be paid	Apr. 2, 2018

Acquisitions and Dispositions -

Acquisitions and Dispositions - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019AcquisitionDisposition	Mar. 31, 2018AcquisitionDisposition
Business Combinations [Abstract]
Number of acquisitions | Acquisition	0	0
Number of dispositions | Disposition	0	0

Summarized Financial Informat_3

Summarized Financial Information of Equity Affiliates - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019Property
Limited Liability Companies | Medical office buildings
Schedule Of Equity Method Investments [Line Items]
Number of real estate investments	4
Minimum
Schedule Of Equity Method Investments [Line Items]
Number of days for Non-Offering Member either to purchase or sell its entire ownership interest to or from Offering Member	60 days
Maximum
Schedule Of Equity Method Investments [Line Items]
Number of days for Non-Offering Member either to purchase or sell its entire ownership interest to or from Offering Member	90 days
4 Unconsolidated Limited Liability Companies / Limited Partner | Minimum
Schedule Of Equity Method Investments [Line Items]
Non-controlling equity interest, ownership percentage	33.00%
4 Unconsolidated Limited Liability Companies / Limited Partner | Maximum
Schedule Of Equity Method Investments [Line Items]
Non-controlling equity interest, ownership percentage	95.00%

Limited Liability Companies Acc

Limited Liability Companies Accounted for Under Equity Method (Detail) - Equity Method Investments	3 Months Ended
	Mar. 31, 2019
Suburban Properties
Schedule Of Equity Method Investments [Line Items]
Ownership	33.00%
Property Owned by LLC	St. Matthews Medical Plaza II
Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Ownership	74.00%	[1]
Property Owned by LLC	Mid Coast Hospital MOB	[1]
Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Ownership	95.00%	[2]
Property Owned by LLC	Texoma Medical Plaza	[2]
FTX MOB Phase II limited partnership
Schedule Of Equity Method Investments [Line Items]
Ownership	95.00%	[3]
Property Owned by LLC	Forney Medical Plaza II	[3]
[1]	This LLC has a third-party term loan, which is non-recourse to us, of $8.2 million outstanding as of March 31, 2019.
[2]	This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LP has a third-party term loan, which is non-recourse to us, of $13.9 million outstanding as of March 31, 2019.
[3]	We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2019. This LP has a third-party term loan, which is non-recourse to us, of $5.0 million outstanding as of March 31, 2019.

Limited Liability Companies A_2

Limited Liability Companies Accounted for Under Equity Method (Parenthetical) (Detail) $ in Millions	Mar. 31, 2019USD ($)
Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	$ 8.2
Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	13.9
FTX MOB Phase II limited partnership
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	5
Committed investment in equity and debt financing, funded	2.5
Commitment to investment	$ 2.1

Condensed Combined Statement of

Condensed Combined Statement of Income for LLCs/LPs Accounted Under Equity Method (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Equity Method Investments And Joint Ventures [Abstract]
Revenues	$ 2,460	$ 2,462
Operating expenses	1,012	958
Depreciation and amortization	398	457
Interest, net	322	328
Net income	728	719
Our share of net income	$ 430	$ 429

Condensed Combined Balance Shee

Condensed Combined Balance Sheets for LLCs Accounted Under Equity Method (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Equity Method Investments And Joint Ventures [Abstract]
Net property, including construction in progress	$ 31,432	$ 31,818
Other assets	6,951	3,251
Total assets	38,383	35,069
Other liabilities	6,005	2,717
Mortgage notes payable, non-recourse to us	27,103	27,256
Equity	5,275	5,096
Total liabilities and equity	38,383	35,069
Investments in LLCs before amounts included in accrued expenses and other liabilities	4,944	5,019
Amounts included in accrued expenses and other liabilities	(1,933)	(2,258)
Our share of equity in LLCs, net	$ 3,011	$ 2,761

Aggregate Principal Amounts Due

Aggregate Principal Amounts Due on Mortgage Notes Payable by Unconsolidated LLCs, Accounted Under Equity Method (Detail) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2019	Dec. 31, 2018
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance		$ 27,103	$ 27,256
Equity Method Investments
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	27,103	27,256
Equity Method Investments | FTX MOB Phase II
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 5,032	5,067
Maturity Date		2020-10
Equity Method Investments | Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 13,860	13,929
Maturity Date		2021-09
Equity Method Investments | Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 8,211	$ 8,260
Maturity Date		2024-12
[1]	All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity

Aggregate Principal Amounts D_2

Aggregate Principal Amounts Due on Mortgage Notes Payable by Unconsolidated LLCs, Accounted Under Equity Method (Parenthetical) (Detail)	Mar. 31, 2019
5.00% Fixed Rate Mortgage Loan | FTX MOB Phase II
Schedule Of Equity Method Investments [Line Items]
Loan interest rate fixed percentage	5.00%
5.034% Fixed Rate Mortgage Loan | Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Loan interest rate fixed percentage	5.034%
3.64% Fixed Rate Mortgage Loan | Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Loan interest rate fixed percentage	3.64%

Recent Accounting Pronounceme_3

Recent Accounting Pronouncements - Additional Information (Detail)	Mar. 31, 2019Property
Accounting Policies [Abstract]
Number of properties subject to ground leases	14

Lease Accounting - Additional I

Lease Accounting - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019USD ($)Land
Leases Disclosure [Line Items]
Tenant reimbursement revenue	$ 2,200,000
Base rental revenue from non-related parties	$ 10,300,000
Lessee in connection with ground leases for land | Land	14
Right-of-use land assets	$ 8,848,000
Ground lease liabilities	8,848,000
Measurement of lease liabilities related to operating leases	118,000
Topic 842
Leases Disclosure [Line Items]
Right-of-use land assets	8,800,000
Ground lease liabilities	8,800,000
Universal Health Services, Inc
Leases Disclosure [Line Items]
Base rental revenue	4,200,000
Bonus rental revenue	1,300,000
Tenant reimbursement revenue	$ 233,000

Schedule of Minimum Future Base

Schedule of Minimum Future Base Rents from Non-cancelable Leases (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Leases [Abstract]
2019	$ 43,744
2019		$ 56,494
2020	52,546	50,291
2021	47,343	45,357
2022	31,678	30,089
2023	26,326	24,972
Thereafter	68,766	67,288
Total minimum base rents	$ 270,403	$ 274,491

Components of Lease Expenses Pa

Components of Lease Expenses Payments (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases [Abstract]
Operating lease cost	$ 118
Total lease cost	$ 118

Schedule of Supplemental Balanc

Schedule of Supplemental Balance Sheet Information Related to Leases (Detail) $ in Thousands	Mar. 31, 2019USD ($)
Operating Leases
Right-of-use land assets	$ 8,848
Ground lease liabilities	$ 8,848
Weighted Average remaining lease term, years
Operating leases	59 years
Weighted Average discount rate
Operating leases	5.07%

Schedule of Maturities of lease

Schedule of Maturities of lease liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Leases [Abstract]
2019	$ 356
2019		$ 474
2020	475	474
2021	475	474
2022	475	474
2023	475	474
Later years	25,640	25,582
Total undiscounted lease payments	27,896	$ 27,952
less imputed interest	19,048
Ground lease liabilities	$ 8,848

Debt and Financial Instrument_2

Debt and Financial Instruments - Additional Information (Detail)	Mar. 27, 2018USD ($)Option	Mar. 31, 2019USD ($)	Sep. 30, 2016USD ($)Derivative	Jun. 30, 2016USD ($)Derivative	Dec. 31, 2018USD ($)	Mar. 31, 2019USD ($)	Mar. 31, 2019USD ($)
Debt Instrument [Line Items]
Outstanding borrowings under revolving credit agreement		$ 200,300,000			$ 196,400,000	$ 200,300,000	$ 200,300,000
Available borrowing capacity		99,700,000			103,600,000	99,700,000	99,700,000
Interest Rate Cap
Debt Instrument [Line Items]
Number of interest rate cap agreements | Derivative			1	1
Notional amount		$ 60,000,000	$ 30,000,000	$ 30,000,000		60,000,000	60,000,000
Premium paid			$ 55,000	$ 115,000
Expiration date of interest rate cap		Mar. 31, 2019	Mar. 31, 2019	Mar. 31, 2019
Derivative interest rate cap, payment received or accrued from counterparties		$ 61,000			144,000	205,000	205,000
Level 2
Debt Instrument [Line Items]
Mortgage loan fair value		65,800,000			64,900,000	65,800,000	65,800,000
Mortgage debt					$ 65,300,000
LIBOR | Interest Rate Cap
Debt Instrument [Line Items]
Derivative instruments, LIBOR rate			1.50%	1.50%
Credit Agreement
Debt Instrument [Line Items]
Outstanding borrowing	$ 300,000,000	$ 300,000,000				$ 300,000,000	$ 300,000,000
Increase in borrowing capacity	$ 50,000,000
Unsecured revolving amended credit agreement terminated date	2022-03
Number of additional six month extension options | Option	2
Proceeds from Lines of Credit	$ 50,000,000
Credit facility, Interest Rate Terms		one, two, three, or six month LIBOR plus an applicable margin ranging from 1.10% to 1.35% or at the Base Rate plus an applicable margin ranging from 0.10% to 0.35%.
Base rate description		the greater of: (a) the administrative agent’s prime rate; (b) the federal funds effective rate plus 1/2 of 1%, and; (c) one month LIBOR plus 1%.
Facility fee payable on commitment		0.20%
Credit Agreement | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate		1.20%
Credit Agreement | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate		0.20%
Credit Agreement | Swingline/Short-Term Loans
Debt Instrument [Line Items]
Outstanding borrowing	30,000,000
Credit Agreement | Letters of Credit
Debt Instrument [Line Items]
Outstanding borrowing	$ 40,000,000
Credit Agreement | Minimum
Debt Instrument [Line Items]
Facility fee payable on commitment	0.15%
Credit Agreement | Minimum | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate	1.10%
Margin points added to the base rate	1.00%
Credit Agreement | Minimum | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate	0.10%
Credit Agreement | Minimum | Federal Funds Effective Rate
Debt Instrument [Line Items]
Margin points added to the base rate	0.50%
Credit Agreement | Maximum
Debt Instrument [Line Items]
Facility fee payable on commitment	0.35%
Credit Agreement | Maximum | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate	1.35%
Credit Agreement | Maximum | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate	0.35%

Summary of Required Compliance

Summary of Required Compliance Ratios in Connection with Terms of Credit Agreement (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Covenant, Tangible net worth	$ 125,000
Tangible net worth	$ 177,062	$ 181,203
Total leverage	41.90%	41.30%
Secured leverage	9.80%	9.80%
Unencumbered leverage	38.50%	37.60%
Fixed charge coverage	4.20%	4.30%
Maximum
Debt Instrument [Line Items]
Covenant, Total leverage	60.00%
Covenant, Secured leverage	30.00%
Covenant, Unencumbered leverage	60.00%
Minimum
Debt Instrument [Line Items]
Covenant, Fixed charge coverage	1.50%

Summary of Outstanding Mortgage

Summary of Outstanding Mortgages, Excluding Net Debt Premium (Detail) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2019		Dec. 31, 2018
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 64,903
Less net financing fees	[1]	(681)
Plus net debt premium	[1]	234
Total mortgages notes payable, non-recourse to us, net		64,456	[1]	$ 64,881
Vibra Hospital-Corpus Christi Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[2]	$ 2,492
Debt Instrument Interest Rate Stated Percentage	[2]	6.50%
Maturity Date	[2]	2019-07
700 Shadow Lane and Goldring MOBs Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 5,810
Debt Instrument Interest Rate Stated Percentage		4.54%
Maturity Date		2022-06
BRB Medical Office Building Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 5,877
Debt Instrument Interest Rate Stated Percentage		4.27%
Maturity Date		2022-12
Desert Valley Medical Center Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 4,771
Debt Instrument Interest Rate Stated Percentage		3.62%
Maturity Date		2023-01
2704 North Tenaya Way Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 6,835
Debt Instrument Interest Rate Stated Percentage		4.95%
Maturity Date		2023-11
Summerlin Hospital Medical Office Building III Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 13,197
Debt Instrument Interest Rate Stated Percentage		4.03%
Maturity Date		2024-04
Tuscan Professional Building Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 3,890
Debt Instrument Interest Rate Stated Percentage		5.56%
Maturity Date		2025-06
Phoenix Children’s East Valley Care Center Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 9,136
Debt Instrument Interest Rate Stated Percentage		3.95%
Maturity Date		2030-01
Rosenberg Children's Medical Plaza Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 12,895
Debt Instrument Interest Rate Stated Percentage		4.42%
Maturity Date		2033-09
[1]	All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.
[2]	On April 2, 2019, a $2.5 million fixed rate mortgage loan on Vibra Hospital – Corpus Christi was fully repaid utilizing borrowings under our Credit Agreement.

Summary of Outstanding Mortga_2

Summary of Outstanding Mortgages, Excluding Net Debt Premium (Parenthetical) (Detail) - USD ($) $ in Thousands	Apr. 02, 2019	Mar. 31, 2019	Mar. 31, 2018
Debt Instrument [Line Items]
Repayments of mortgage loan		$ 442	$ 4,596
Vibra Hospital-Corpus Christi Fixed Rate Mortgage Loan | Subsequent Event
Debt Instrument [Line Items]
Repayments of mortgage loan	$ 2,500

Segment Reporting - Additional

Segment Reporting - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2019Segment
Segment Reporting [Abstract]
Number of reportable segments	1

Impact of Hurricane Harvey - Ad

Impact of Hurricane Harvey - Additional Information (Detail)	3 Months Ended	4 Months Ended	7 Months Ended	12 Months Ended
	Mar. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Mar. 31, 2018USD ($)	Dec. 31, 2018USD ($)	Aug. 31, 2017Building
Unusual Or Infrequent Item [Line Items]
Hurricane related insurance recoveries	$ 968,000
Hurricane insurance recoveries in excess of damaged property write-downs	4,535,000
Hurricane Harvey, Extensive Water Damage | Houston, Texas
Unusual Or Infrequent Item [Line Items]
Number of medical office buildings | Building					5
Hurricane Harvey
Unusual Or Infrequent Item [Line Items]
Additional insurance recovery proceeds				$ 5,500,000
Hurricane related insurance recoveries				$ 12,500,000
Hurricane insurance recoveries in excess of damaged property write-downs	$ 4,500,000
Hurricane Harvey | Business Interruption
Unusual Or Infrequent Item [Line Items]
Hurricane related insurance recoveries			$ 968,000
Hurricane Harvey | 2017 business interruption
Unusual Or Infrequent Item [Line Items]
Hurricane related insurance recoveries		$ 500,000