MPW 10-Q Quarterly Report Sept. 30, 2012 | Alphaminr
MEDICAL PROPERTIES TRUST INC

MPW 10-Q Quarter ended Sept. 30, 2012

MEDICAL PROPERTIES TRUST INC
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10-Q 1 d403276d10q.htm 10-Q 10-Q
Table of Contents

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

FORM 10-Q

x QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2012

OR

¨ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from              to

Commission file number 001-32559

MEDICAL PROPERTIES TRUST, INC.

MPT OPERATING PARTNERSHIP, L.P.

(Exact Name of Registrant as Specified in Its Charter)

MARYLAND

DELAWARE

20-0191742

20-0242069

(State or other jurisdiction of

incorporation or organization)

(I. R. S. Employer

Identification No.)

1000 URBAN CENTER DRIVE, SUITE 501

BIRMINGHAM, AL

35242
(Address of principal executive offices) (Zip Code)

REGISTRANT’S TELEPHONE NUMBER, INCLUDING AREA CODE: (205) 969-3755

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

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

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

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

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

As of November 5, 2012, Medical Properties Trust, Inc. had 135,572,131 shares of common stock, par value $.001, outstanding.


Table of Contents

EXPLANATORY NOTE

This report combines the Quarterly Reports on Form 10-Q for the three and nine months ended September 30, 2012 of Medical Properties Trust, Inc., a Maryland corporation, and MPT Operating Partnership, L.P., a Delaware limited partnership, through which Medical Properties Trust, Inc. conducts substantially all of its operations. Unless otherwise indicated or unless the context requires otherwise, all references in this report to “we,” “us,” “our,” “our company,” “Medical Properties,” “MPT,” or “the company” refer to Medical Properties Trust, Inc. together with its consolidated subsidiaries, including MPT Operating Partnership, L.P. Unless otherwise indicated or unless the context requires otherwise, all references to “our operating partnership” or “the operating partnership” refer to MPT Operating Partnership, L.P. together with its consolidated subsidiaries.

2


Table of Contents

MEDICAL PROPERTIES TRUST, INC. AND MPT OPERATING PARTNERSHIP, L.P.

AND SUBSIDIARIES

QUARTERLY REPORT ON FORM 10-Q

FOR THE QUARTERLY PERIOD ENDED September 30, 2012

Table of Contents

Page

PART I — FINANCIAL INFORMATION

4

Item 1 Financial Statements

4

Medical Properties Trust, Inc. and Subsidiaries

4

Condensed Consolidated Balance Sheets at September 30, 2012 and December 31, 2011

4

Condensed Consolidated Statements of Income for the Three Months and Nine Months Ended September  30, 2012 and 2011

5

Condensed Consolidated Statements of Comprehensive Income (Loss) for the Three Months and Nine Months Ended September 30, 2012 and 2011

6

Condensed Consolidated Statements of Cash Flows for the Nine Months Ended September 30, 2012 and 2011

7

MPT Operating Partnership, L.P. and Subsidiaries

8

Condensed Consolidated Balance Sheets at September 30, 2012 and December 31, 2011

8

Condensed Consolidated Statements of Income for the Three Months and Nine Months Ended September  30, 2012 and 2011

9

Condensed Consolidated Statements of Comprehensive Income (Loss) for the Three Months and Nine Months Ended September 30, 2012 and 2011

10

Condensed Consolidated Statements of Cash Flows for the Nine Months Ended September 30, 2012 and 2011

11

Medical Properties Trust, Inc. and MPT Operating Partnership, L.P.

12

Notes to Condensed Consolidated Financial Statements

12

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

34

Item 3 Quantitative and Qualitative Disclosures about Market Risk

41

Item 4 Controls and Procedures

42

PART II — OTHER INFORMATION

42

Item 1 Legal Proceedings

42

Item 1A Risk Factors

42

Item 2 Unregistered Sales of Equity Securities and Use of Proceeds

43

Item 3 Defaults Upon Senior Securities

43

Item 4 Mine Safety Disclosures

43

Item 5 Other Information

44

Item 6 Exhibits

44

SIGNATURE

45

INDEX TO EXHIBITS

46

3


Table of Contents

PART I — FINANCIAL INFORMATION

Item 1. Financial Statements.

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Condensed Consolidated Balance Sheets

September 30,
2012
December 31,
2011
(In thousands, except per share amounts) (Unaudited) (Note 2)

Assets

Real estate assets

Land, buildings and improvements, and intangible lease assets

$ 1,251,909 $ 1,217,559

Real estate held for sale

17,432 48,925

Mortgage loans

368,650 165,000

Net investment in direct financing leases

312,050

Gross investment in real estate assets

1,950,041 1,431,484

Accumulated depreciation and amortization

(120,215 ) (94,822 )

Net investment in real estate assets

1,829,826 1,336,662

Cash and cash equivalents

36,163 102,726

Interest and rent receivable

42,094 29,862

Straight-line rent receivable

38,065 33,993

Other loans

158,177 74,839

Other assets

54,074 43,792

Total Assets

$ 2,158,399 $ 1,621,874

Liabilities and Equity

Liabilities

Debt, net

$ 1,025,183 $ 689,849

Accounts payable and accrued expenses

64,297 51,125

Deferred revenue

20,374 23,307

Lease deposits and other obligations to tenants

15,387 28,778

Total liabilities

1,125,241 793,059

Equity

Preferred stock, $0.001 par value. Authorized 10,000 shares; no shares outstanding

Common stock, $0.001 par value. Authorized 250,000 shares; issued and outstanding — 134,657 shares at September 30, 2012, and 110,786 shares at December 31, 2011

135 111

Additional paid in capital

1,280,769 1,055,256

Distributions in excess of net income

(234,264 ) (214,059 )

Accumulated other comprehensive loss

(13,220 ) (12,231 )

Treasury shares, at cost

(262 ) (262 )

Total equity

1,033,158 828,815

Total Liabilities and Equity

$ 2,158,399 $ 1,621,874

See accompanying notes to condensed consolidated financial statements.

4


Table of Contents

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Income

(Unaudited)

For the Three Months
Ended September 30,
For the Nine Months
Ended September 30,
(In thousands, except per share amounts) 2012 2011 2012 2011

Revenues

Rent billed

$ 31,083 $ 27,760 $ 93,100 $ 81,086

Straight-line rent

2,762 1,643 5,473 5,318

Income from direct financing leases

5,773 12,979

Interest and fee income

14,037 5,229 33,486 15,714

Total revenues

53,655 34,632 145,038 102,118

Expenses

Real estate depreciation and amortization

8,491 7,700 25,392 22,508

Property-related

218 260 1,044 346

General and administrative

7,052 5,737 21,341 20,429

Acquisition expenses

410 530 4,115 3,186

Total operating expenses

16,171 14,227 51,892 46,469

Operating income

37,484 20,405 93,146 55,649

Other income (expense)

Interest and other (expense) income

(23 ) 42 (55 ) (12 )

Earnings from equity and other interests

1,065 9 1,944 70

Debt refinancing costs

(10,425 ) (14,214 )

Interest expense

(15,046 ) (11,935 ) (42,730 ) (32,462 )

Net other expense

(14,004 ) (22,309 ) (40,841 ) (46,618 )

Income (loss) from continuing operations

23,480 (1,904 ) 52,305 9,031

Income from discontinued operations

8,028 2,372 9,169 4,944

Net income

31,508 468 61,474 13,975

Net income attributable to non-controlling interests

(44 ) (43 ) (130 ) (131 )

Net income attributable to MPT common stockholders

$ 31,464 $ 425 $ 61,344 $ 13,844

Earnings per common share — basic and diluted

Income (loss) from continuing operations attributable to MPT common stockholders

$ 0.17 $ (0.02 ) $ 0.39 $ 0.07

Income from discontinued operations attributable to MPT common stockholders

0.06 0.02 0.07 0.05

Net income attributable to MPT common stockholders

$ 0.23 $ $ 0.46 $ 0.12

Weighted average shares outstanding:

Basic

134,781 110,714 131,467 110,568

Diluted

134,782 110,719 131,467 110,576

Dividends declared per common share

$ 0.20 $ 0.20 $ 0.60 $ 0.60

See accompanying notes to condensed consolidated financial statements.

5


Table of Contents

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Comprehensive Income (Loss)

(Unaudited)

For the Three Months
Ended September 30,
For the Nine Months
Ended September 30,
(In thousands) 2012 2011 2012 2011

Net income

$ 31,508 $ 468 $ 61,474 $ 13,975

Other comprehensive income (loss):

Unrealized loss on interest rate swap

(443 ) (5,272 ) (989 ) (8,341 )

Total comprehensive income (loss)

31,065 (4,804 ) 60,485 5,634

Comprehensive income attributable to non-controlling interests

(44 ) (43 ) (130 ) (131 )

Comprehensive income (loss) attributable to MPT common stockholders

$ 31,021 $ (4,847 ) $ 60,355 $ 5,503

See accompanying notes to condensed consolidated financial statements.

6


Table of Contents

MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Cash Flows

(Unaudited)

For the Nine Months
Ended September 30,
2012 2011
(In thousands)

Operating activities

Net income

$ 61,474 $ 13,975

Adjustments to reconcile net income to net cash provided by operating activities

Depreciation and amortization

26,899 25,254

Straight-line rent revenue (net of write-offs)

(4,100 ) (5,606 )

Direct financing lease interest accretion

(2,050 )

Share-based compensation

5,430 5,293

(Gain) loss on sale of real estate

(7,278 ) (5 )

Real estate impairment

564

Amortization and write-off of deferred financing costs and debt discount

2,577 8,523

Premium paid on extinguishment of debt

13,091

Other adjustments

(3,415 ) (4,632 )

Changes in:

Interest and rent receivable

(12,232 ) (2,646 )

Accounts payable and accrued expenses

7,404 13,317

Net cash provided by operating activities

74,709 67,128

Investing activities

Cash paid for acquisitions and other related investments

(606,500 ) (208,913 )

Principal received on loans receivable

9,507 2,898

Net proceeds from sale of real estate

34,100

Investment in loans receivable

(1,293 ) (4,398 )

Construction in progress and other

(35,920 ) (12,297 )

Net cash used for investing activities

(600,106 ) (222,710 )

Financing activities

Revolving credit facilities, net

35,400 39,600

Additions to term debt

300,000 450,000

Payments of term debt

(171 ) (237,810 )

Distributions paid

(76,770 ) (67,194 )

Sale of common stock, net

220,107

Lease deposits and other obligations to tenants

(13,391 ) 7,613

Debt issuance costs paid and other financing activities

(6,341 ) (20,667 )

Net cash provided by financing activities

458,834 171,542

Increase (decrease) in cash and cash equivalents for period

(66,563 ) 15,960

Cash and cash equivalents at beginning of period

102,726 98,408

Cash and cash equivalents at end of period

$ 36,163 $ 114,368

Interest paid

$ 31,350 $ 18,761

Supplemental schedule of non-cash investing activities:

Loan conversion to equity interest

$ 1,648 $

Real estate acquired via assumption of mortgage loan

$ (14,592 )

Mortgage loan issued from sale of real estate

$ 3,650

Supplemental schedule of non-cash financing activities:

Distributions declared, unpaid

$ 27,181 $ 22,407

Assumption of mortgage loan (as part of real estate acquired)

$ 14,592

See accompanying notes to condensed consolidated financial statements.

7


Table of Contents

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Condensed Consolidated Balance Sheets

September 30,
2012
December 31,
2011
(In thousands) (Unaudited) (Note 2)

Assets

Real estate assets

Land, buildings and improvements, and intangible lease assets

$ 1,251,909 $ 1,217,559

Real estate held for sale

17,432 48,925

Mortgage loans

368,650 165,000

Net investment in direct financing leases

312,050

Gross investment in real estate assets

1,950,041 1,431,484

Accumulated depreciation and amortization

(120,215 ) (94,822 )

Net investment in real estate assets

1,829,826 1,336,662

Cash and cash equivalents

36,163 102,726

Interest and rent receivable

42,094 29,862

Straight-line rent receivable

38,065 33,993

Other loans

158,177 74,839

Other assets

54,074 43,792

Total Assets

$ 2,158,399 $ 1,621,874

Liabilities and Capital

Liabilities

Debt, net

$ 1,025,183 $ 689,849

Accounts payable and accrued expenses

37,157 28,780

Deferred revenue

20,374 23,307

Lease deposits and other obligations to tenants

15,387 28,778

Payable due to Medical Properties Trust, Inc.

26,750 21,955

Total liabilities

1,124,851 792,669

Capital

General Partner — issued and outstanding — 1,345 units at September 30, 2012 and 1,107 units at December 31, 2011

10,431 8,418

Limited Partners:

Common units — issued and outstanding — 133,312 units at September 30, 2012 and 109,679 units at December 31, 2011

1,036,337 833,018

LTIP units — issued and outstanding — 150 units at September 30, 2012 and at December 31, 2011

Accumulated other comprehensive loss

(13,220 ) (12,231 )

Total capital

1,033,548 829,205

Total Liabilities and Capital

$ 2,158,399 $ 1,621,874

See accompanying notes to condensed consolidated financial statements.

8


Table of Contents

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Condensed Consolidated Statements of Income

(Unaudited)

For the Three Months
Ended September 30,
For the Nine Months
Ended September 30,
(In thousands, except per unit amounts) 2012 2011 2012 2011

Revenues

Rent billed

$ 31,083 $ 27,760 $ 93,100 $ 81,086

Straight-line rent

2,762 1,643 5,473 5,318

Income from direct financing leases

5,773 12,979

Interest and fee income

14,037 5,229 33,486 15,714

Total revenues

53,655 34,632 145,038 102,118

Expenses

Real estate depreciation and amortization

8,491 7,700 25,392 22,508

Property-related

218 260 1,044 346

General and administrative

7,052 5,719 21,341 20,367

Acquisition expenses

410 530 4,115 3,186

Total operating expenses

16,171 14,209 51,892 46,407

Operating income

37,484 20,423 93,146 55,711

Other income (expense)

Interest and other income (expense)

(23 ) 42 (55 ) (12 )

Earnings from equity and other interests

1,065 9 1,944 70

Debt refinancing costs

(10,425 ) (14,214 )

Interest expense

(15,046 ) (11,935 ) (42,730 ) (32,462 )

Net other expense

(14,004 ) (22,309 ) (40,841 ) (46,618 )

Income (loss) from continuing operations

23,480 (1,886 ) 52,305 9,093

Income from discontinued operations

8,028 2,372 9,169 4,944

Net income

31,508 486 61,474 14,037

Net income attributable to non-controlling interests

(44 ) (43 ) (130 ) (131 )

Net income attributable to MPT Operating Partnership partners

$ 31,464 $ 443 $ 61,344 $ 13,906

Earnings per units — basic and diluted

Income (loss) from continuing operations attributable to MPT Operating Partnership partners

$ 0.17 $ (0.02 ) $ 0.39 $ 0.07

Income from discontinued operations attributable to MPT Operating Partnership partners

0.06 0.02 0.07 0.05

Net income attributable to MPT Operating Partnership Partners

$ 0.23 $ $ 0.46 $ 0.12

Weighted average units outstanding:

Basic

134,781 110,714 131,467 110,568

Diluted

134,782 110,719 131,467 110,576

Dividends declared per unit

$ 0.20 $ 0.20 $ 0.60 $ 0.60

See accompanying notes to condensed consolidated financial statements.

9


Table of Contents

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Condensed Consolidated Statements of Comprehensive Income (Loss)

(Unaudited)

For the Three Months
Ended September 30,
For the Nine Months
Ended September 30,
(In thousands) 2012 2011 2012 2011

Net income

$ 31,508 $ 486 $ 61,474 $ 14,037

Other comprehensive income (loss):

Unrealized loss on interest rate swap

(443 ) (5,272 ) (989 ) (8,341 )

Total comprehensive income (loss)

31,065 (4,786 ) 60,485 5,696

Comprehensive income attributable to non-controlling interests

(44 ) (43 ) (130 ) (131 )

Comprehensive income (loss) attributable to MPT Operating Partnership partners

$ 31,021 $ (4,829 ) $ 60,355 $ 5,565

See accompanying notes to condensed consolidated financial statements.

10


Table of Contents

MPT OPERATING PARTNERSHIP, L.P. AND SUBSIDIARIES

Condensed Consolidated Statements of Cash Flows

(Unaudited)

For the Nine Months
Ended September 30,
2012 2011
(In thousands)

Operating activities

Net income

$ 61,474 $ 14,037

Adjustments to reconcile net income to net cash provided by operating activities

Depreciation and amortization

26,899 25,254

Straight-line rent revenue (net of write-offs)

(4,100 ) (5,606 )

Direct financing lease interest accretion

(2,050 )

Share-based compensation

5,430 5,293

(Gain) loss on sale of real estate

(7,278 ) (5 )

Real estate impairment

564

Amortization and write-off of deferred financing costs and debt discount

2,577 8,523

Premium paid on extinguishment of debt

13,091

Other adjustments

(3,415 ) (4,694 )

Changes in:

Interest and rent receivable

(12,232 ) (2,646 )

Accounts payable and accrued expenses

7,404 13,317

Net cash provided by operating activities

74,709 67,128

Investing activities

Cash paid for acquisitions and other related investments

(606,500 ) (208,913 )

Principal received on loans receivable

9,507 2,898

Net proceeds from sale of real estate

34,100

Investment in loans receivable

(1,293 ) (4,398 )

Construction in progress and other

(35,920 ) (12,297 )

Net cash used for investing activities

(600,106 ) (222,710 )

Financing activities

Revolving credit facilities, net

35,400 39,600

Additions to term debt

300,000 450,000

Payments of term debt

(171 ) (237,810 )

Distributions paid

(76,770 ) (67,194 )

Sale of common stock, net

220,107

Lease deposits and other obligations to tenants

(13,391 ) 7,613

Debt issuance costs paid and other financing activities

(6,341 ) (20,667 )

Net cash provided by financing activities

458,834 171,542

Increase (decrease) in cash and cash equivalents for period

(66,563 ) 15,960

Cash and cash equivalents at beginning of period

102,726 98,408

Cash and cash equivalents at end of period

$ 36,163 $ 114,368

Interest paid

$ 31,350 $ 18,761

Supplemental schedule of non-cash investing activities:

Loan conversion to equity interest

$ 1,648 $

Real estate acquired via assumption of mortgage loan

$ (14,592 )

Mortgage loan issued from sale of real estate

$ 3,650

Supplemental schedule of non-cash financing activities:

Distributions declared, unpaid

$ 27,181 $ 22,407

Assumption of mortgage loan (as part of real estate acquired)

$ 14,592

See accompanying notes to condensed consolidated financial statements.

11


Table of Contents

MEDICAL PROPERTIES TRUST, INC., AND MPT OPERATING PARTNERSHIP, L.P.

AND SUBSIDIARIES

Notes to Condensed Consolidated Financial Statements

(Unaudited)

1. Organization

Medical Properties Trust, Inc., a Maryland corporation, was formed on August 27, 2003 under the General Corporation Law of Maryland 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., 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 accordingly, elected REIT status upon the filing in September 2005 of the calendar year 2004 federal income tax return. Accordingly, we will not be subject to U.S. federal income tax, provided that we continue to qualify as a REIT and our distributions to our stockholders equal or exceed our taxable income. Certain activities we undertake must be conducted by entities which we elected to be treated as taxable REIT subsidiaries (“TRSs”). Our TRSs are subject to both federal and state income taxes.

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.

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 United States for interim financial information, including rules and regulations of the Securities and Exchange Commission. Accordingly, they do not include all of the information and footnotes required by generally accepted accounting principles 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 and nine month periods ended September 30, 2012 are not necessarily indicative of the results that may be expected for the year ending December 31, 2012. The condensed consolidated balance sheet at December 31, 2011 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 United States 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, as amended, for the year ended December 31, 2011. During the three and nine months ended September 30, 2012, there were no material changes to these policies, except we began using direct financing lease (“DFL”) accounting with the acquisition and lease of the real estate of Ernest Health, Inc. (“Ernest”) and the acquisition and lease of two acute care hospitals to Prime Healthcare Services, Inc. (“Prime”). Under DFL accounting, future minimum lease payments are recorded as a receivable. Unearned income, which represents the net investment in the DFL less the sum of minimum lease payments receivable and the estimated residual values of the leased properties, is deferred and amortized to income over the lease term to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unamortized and unearned income. DFLs are placed on non-accrual status when management determines that the collectability of contractual amounts is not reasonably assured. While on non-accrual status, DFLs are accounted for on a cash basis, in which income is recognized only upon receipt of cash.

For our equity interest in Ernest and related loans (as more fully described in Note 3), 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 equity interests or loans made in or prior to 2012.

12


Table of Contents

Variable Interest Entities

In regard to the Ernest Transaction (defined in Note 3), we have determined that Ernest is a variable interest entity (“VIE”); however, we are not the primary beneficiary as we lack the ability to direct the activities of Ernest that most significantly impact the entity’s economic performance. At September 30, 2012, we had loans to and/or equity investments in several VIEs for which we are not the primary beneficiary. 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 September 30, 2012 (in thousands):

VIE Type

Maximum Loss
Exposure(1)
Asset Type
Classification
Carrying
Amount(2)

Loans, net

$ 274,073 Mortgage and other loans $ 230,105

Equity investments

$ 13,764 Other assets $ 3,179

(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 rents receivable), 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 September 30, 2012, we were not required to provide financial support through a liquidity arrangement or otherwise to our unconsolidated VIEs, including circumstances in which it 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 for additional description of the nature, purpose and activities of our more significant VIEs and interests therein.

3. Real Estate and Lending Activities

Acquisitions

2012 Activity

On September 19, 2012, we acquired the real estate of the 380 bed St. Mary’s Regional Medical Center, an acute care hospital in Reno, Nevada for $80 million and the real estate of the 140 bed Roxborough Memorial Hospital in Pennsylvania for $30 million. The acquired facilities are leased to Prime pursuant to a master lease agreement, which is more fully described below in the Leasing Operations section.

On July 3, 2012, we funded a $100 million mortgage loan secured by the real property of Centinela Hospital Medical Center. Centinela is a 369 bed acute care facility that is operated by Prime. This mortgage loan is cross-defaulted with other mortgage loans to Prime and the master lease agreements.

On February 29, 2012, we made loans to and acquired assets from Ernest for a combined purchase price and investment of $396.5 million, consisting of $200 million to purchase real estate assets, a first mortgage loan of $100 million, an acquisition loan for $93.2 million and a capital contribution of $3.3 million (“Ernest Transaction”).

Real Estate Acquisition and Mortgage Loan Financing

Pursuant to a definitive real property asset purchase agreement (the “Purchase Agreement”), we acquired from Ernest and certain of its subsidiaries (i) a portfolio of five rehabilitation facilities (including a ground lease interest relating to a community-based acute rehabilitation facility in Wyoming), (ii) seven long-term acute care facilities located in seven states and (iii) undeveloped land in Provo, Utah (collectively, the “Acquired Facilities”) for an aggregate purchase price of $200 million, subject to certain adjustments. The Acquired Facilities are leased to subsidiaries of Ernest pursuant to a master lease agreement. The master lease agreement has a 20-year term with three five-year extension options and provides for an initial rental rate of 9%, with consumer price-indexed increases, limited to a 2% floor and 5% ceiling annually thereafter. In addition, we made Ernest a $100 million loan secured by a first mortgage interest in four subsidiaries of Ernest, which has terms similar to the leasing terms described above.

Acquisition Loan and Equity Contribution

Through an affiliate of one of our TRSs, we made investments of approximately $96.5 million in Ernest Health Holdings, LLC (“Ernest Holdings”), which is the owner of Ernest. These investments, which are structured as a $93.2 million loan and a $3.3 million equity contribution generally provide that we will receive a preferential return of 15% of the loan amount and approximately 79% of

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the remaining earnings of Ernest. Ernest is required to pay us a minimum of 6% and 7% of the loan amount in years one and two, respectively, and 10% thereafter, although there are provisions in the loan agreement that are expected to result in full payment of the 15% preference when funds are sufficient. Any of the 15% in excess of the minimum that is not paid may be accrued and paid upon the occurrence of a capital or liquidity event and is payable at maturity. The loan may be prepaid without penalty at any time.

Financing of Ernest Transaction

To finance the Ernest Transaction, we completed equity and senior unsecured notes offerings in February 2012. See Notes 4 and 5 for more information on these financing activities.

2011 Activity

On January 4, 2011, we acquired the real estate of the 19-bed, 4-year old Gilbert Hospital in a suburb of Phoenix, Arizona area for $17.1 million. Gilbert Hospital is operated by affiliates of Visionary Health, LLC. We acquired this asset subject to an existing lease that expires in May 2022.

On January 31, 2011, we acquired for $23.5 million the real estate of the 60-bed Atrium Medical Center at Corinth in the Dallas area, a long-term acute care hospital that was completed in 2009 and is subject to a lease that expires in June 2024. In addition, through one of our affiliates, we invested $1.3 million to acquire approximately 19% of a joint venture arrangement with an affiliate of Vibra Healthcare, LLC (“Vibra”) that will manage and has acquired a 51% interest in the operations of the facility. We also made a $5.2 million working capital loan to the joint venture. The former operators of the hospital, comprised primarily of local physicians, retained ownership of 49% of the operating entity.

On February 4, 2011, we purchased for $58 million the real estate of Bayonne Medical Center, a 6-story, 278-bed acute care hospital in the New Jersey area of metropolitan New York, and leased the facility to the operator under a 15-year lease, with six 5-year extension options. The operator is an affiliate of a private hospital operating company that acquired the hospital in 2008.

On February 9, 2011, we acquired the real estate of the 306-bed Alvarado Hospital in San Diego, California for $70 million from Prime who is the operator of the facility.

On February 14, 2011, we completed the acquisition of the Northland LTACH Hospital located in Kansas City, a 35-bed hospital that opened in April 2008 and has a lease that expires in 2028. This hospital is currently being operated by Kindred Healthcare Inc. The purchase price of this hospital was $19.5 million, which included the assumption of a mortgage loan.

On July 18, 2011, we acquired the real estate of the 40-bed Vibra Specialty Hospital of DeSoto in Desoto, Texas for $13.0 million. Vibra Specialty Hospital of DeSoto is a long-term acute care hospital. This facility is leased to a subsidiary of Vibra for a fixed term of 15 years with options to extend. In addition, we made a $2.5 million equity investment in the operator of this facility for a 25% equity ownership.

On September 30, 2011, we purchased the real estate of a 40-bed long-term acute care facility in New Braunfels, Texas for $10.0 million. This facility is leased to an affiliate of Post Acute Medical, LLC for a fixed term of 15 years with options to extend. In addition, we made a $1.4 million equity investment for a 25% equity ownership in the operator of this facility and funded a $2.0 million working capital loan.

As part of these acquisitions, we purchased and invested in the following assets during the first nine months: (dollar amounts in thousands)

2012 2011

Assets Acquired

Land

$ $ 17,218

Building

178,535

Intangible lease assets — subject to amortization (weighted average useful life of 13.5 years in 2011)

15,351

Net investments in direct financing leases

310,000

Mortgage loans

200,000

Other loans

93,200 7,233

Equity investments

3,300 5,168

Total assets acquired

$ 606,500 $ 223,505

Total liabilities assumed

(14,592 )

Net assets acquired

$ 606,500 $ 208,913

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From the respective acquisition dates, the properties and mortgage loans acquired in 2012 contributed $14.1 million and $29.1 million of revenue and income (excluding related acquisition expenses) for the three and nine month periods ended September 30, 2012, respectively. In addition, we incurred $0.1 million and $3.8 million of acquisition related costs on the 2012 acquisitions for the three and nine months ended September 30, 2012.

From the respective acquisition dates, the seven hospitals acquired in 2011 contributed $5.5 million and $14.0 million of revenue and $3.7 million and $9.1 million of income (excluding related acquisition expenses) for the three and nine months ended September 30, 2011, respectively. In addition, we incurred $0.5 million and $3.2 million of acquisition related costs on consummated and non-consummated deals for the three and nine months ended September 30, 2011.

The results of operations for each of the properties acquired are included in our consolidated results from the effective date of each acquisition. The following table sets forth certain unaudited pro forma consolidated financial data for 2012 and 2011, as if each acquisition in 2012 and 2011 were consummated on the same terms at the beginning of 2011. Supplemental pro forma earnings were adjusted to exclude acquisition-related costs on consummated deals incurred in the three and nine months ended September 30, 2012 and 2011 (dollar amounts in thousands except per share/unit data).

For the Three Months Ended
September 30,
For the Nine Months Ended
September 30,
2012 2011 2012 2011

Total revenues

$ 56,557 $ 53,943 $ 166,952 $ 162,593

Net income

33,834 13,846 82,822 56,733

Net income per share/unit — diluted

$ 0.25 $ 0.10 $ 0.61 $ 0.42

Development Activities

On June 13, 2012, we entered into an agreement with Ernest to develop and lease a 40-bed rehabilitation hospital in Lafayette, Indiana. Total development cost is estimated to be $16.6 million and the facility is expected to be completed in the 2013 second quarter. We have funded $7.2 million through the third quarter of 2012.

On May 4, 2012, we amended the current lease on our Victoria, Texas facility with Post Acute Medical to extend the current lease term into 2028, and we agreed to develop and lease a 26-bed facility next to the current facility. Total development cost of the new facility is estimated to be $9.4 million and it is expected to be completed in the third quarter of 2013.

On March 1, 2012, we received a certificate of occupancy for our recently constructed Florence acute care facility near Phoenix, Arizona. With this, we started recognizing rent on this facility in March 2012. During the construction period, we accrued and deferred rent based on the cost paid during the construction period. In March 2012, we began recognizing a portion of the accrued construction period rent along with interest on the unpaid amount. This accrued construction period rent will be recognized in our income statement and paid over the 25 year lease term. Land and building costs associated with this property approximates $30 million.

In addition to the new development projects, our other three development projects, which will be leased to Emerus Holding, Inc., are expected to be completed between October 2012 and early 2013. Estimated total development cost for these three facilities is $30 million. We have funded $17.6 million through the third quarter of 2012. In regard to our River Oaks facility, re-development efforts continue and we currently expect this facility to be partially occupied starting in the first quarter of 2013.

Disposals

During the third quarter of 2012, we entered into a definitive agreement to sell the real estate of two LTACH facilities, Thornton and New Bedford, to Vibra for total cash proceeds of $42 million. The sale of Thornton was completed on September 28, 2012, resulting in a gain of $8.4 million. Due to this sale, we wrote-off $1.6 million in straight-line rent receivables. The sale of New Bedford was completed on October 22, 2012, resulting in a gain of approximately $7.0 million. Associated with this sale, we will write-off $4.1 million in straight-line rent receivables in the fourth quarter 2012. At September 30, 2012, our New Bedford facility is classified as held for sale, which required us to reclassify the operating results of this facility for the current and all prior periods to discontinued operations and reclassify the related real estate to Real Estate Held for Sale.

On August 21, 2012, we sold our Denham Springs facility for $5.2 million, resulting in a gain of $0.3 million. Due to this sale, the operating results of this facility for the current and all prior periods have been included in discontinued operations, and we have reclassified the related real estate to Real Estate Held for Sale.

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On June 15, 2012, we sold the HealthSouth Rehabilitation Hospital of Fayetteville in Fayetteville, Arkansas for $16 million, resulting in a loss of $1.4 million. Due to this sale, the operating results of this facility for the current and all prior periods have been included in discontinued operations, and we have reclassified the related real estate to Real Estate Held for Sale. In connection with this sale, HealthSouth Corporation agreed to extend the lease on our Wichita, Kansas property, which is now set to end in March 2022.

Leasing Operations

On July 3, 2012, we entered into master lease agreements with certain subsidiaries of Prime, which replaced the then current leases with the same tenants covering the same properties. The master leases are for 10 years and contain two renewal options of five years each. The initial lease rate is generally consistent with the blended average rate of the prior lease agreements. However, the annual escalators, which in the prior leases were limited, have been increased to reflect 100% of CPI increases, along with a minimum floor. The master leases include repurchase options substantially similar to those in the prior leases, including provisions establishing minimum repurchase prices equal to our total investment.

As noted previously, we are accounting for the master lease of 12 Ernest facilities and our Roxborough and Reno facilities as a DFL. The components of our net investment in DFL consisted of the following (dollars in thousands):

As of September 30,
2012

Minimum lease payments receivable

$ 1,279,818

Estimated residual values

200,000

Less unearned income

(1,167,768 )

Net investment in direct financing leases

$ 312,050

Monroe facility

As of September 30, 2012, we have advanced $29.9 million to the operator/lessee of Monroe Hospital in Bloomington, Indiana pursuant to a working capital loan agreement, but no additional advances were made during the 2012 third quarter. In addition, as of September 30, 2012, we have $19.0 million of rent, interest and other charges owed to us by the operator, of which $5.8 million of interest receivables are significantly more than 90 days past due. Because the operator has not made all payments required by the working capital loan agreement and the related real estate lease agreement, we consider the loan to be impaired. During 2010, we recorded a $12 million impairment charge on the working capital loan and recorded a valuation allowance for unbilled straight-line rent in the amount of $2.5 million. We have not recognized any interest income on the Monroe loan since it was considered impaired and have not recorded any unbilled rent since 2010.

At September 30, 2012, our net investment (exclusive of the related real estate) of approximately $37 million is our maximum exposure to Monroe and the amount is deemed collectible/recoverable. In making this determination, we considered our first priority secured interest in approximately (i) $5 million in hospital patient receivables, (ii) cash balances of approximately $0.1 million, (iii) our assessment of the realizable value of our other collateral and (iv) continued improvement in operational revenue statistics compared to previous years. However, no assurances can be made that we will not have additional charges for further impairment of our working capital loan in the future.

On September 4, 2012, Monroe Hospital entered into a four-year agreement with St. Vincent Health, Inc. whereby St. Vincent will manage the operations of the hospital. At the same time we agreed with St. Vincent to exclusively negotiate the terms of a possible sale or lease of the hospital real estate by the end of such four year term. St. Vincent is a member of Ascension Health, the largest Catholic health care system in the country. However, there is no assurance that we will reach a satisfactory agreement with St. Vincent and St. Vincent has certain rights to terminate the management agreement during the four year term.

Other Loan Activity

On March 1, 2012, pursuant to our convertible note agreement, we converted $1.6 million of our $5.0 million convertible note into a 9.9% equity interest in the operator of our Hoboken University Medical Center facility. At September 30, 2012, $3.4 million remains outstanding on the convertible note, and we retain the option, through November 2014, to convert this remainder into a 15.1% of equity interest in the operator.

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Concentrations of Credit Risk

For the three and nine months ended September 30, 2012, revenue from affiliates of Ernest (including rent and interest from mortgage and acquisition loans) accounted for 20.8% and 18.1%, respectively, of total revenue. However, from an investment concentration perspective, Ernest represented 18.4% of our total assets at September 30, 2012.

For the three months ended September 30, 2012 and 2011, revenue from affiliates of Prime (including rent and interest from mortgage loans) accounted for 28.9% and 31.9%, respectively, of total revenue. For the nine months ended September 30, 2012 and 2011, revenue from affiliates of Prime (including rent and interest from mortgage loans) accounted for 26.3% and 31.7%, respectively, of total revenue. However, from an investment concentration perspective, Prime represented 28.7% and 25.3% of our total assets at September 30, 2012 and December 31, 2011, respectively.

On an individual property basis, we had no investment of any single property greater than 5% of our total assets as of September 30, 2012.

From a geographic perspective, all of our properties are located in the United States with 25.9% of our total assets at September 30, 2012 located in California.

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4. Debt

The following is a summary of debt, net of discounts (dollar amounts in thousands):

As of September 30,
2012
As of December 31,
2011
Balance Interest Rate Balance Interest Rate

Revolving credit facilities (A)

$ 125,000 Variable $ 89,600 Variable

2006 Senior Unsecured Notes

125,000 Various 125,000 Various

2011 Senior Unsecured Notes

450,000 6.875 % 450,000 6.875 %

2012 Senior Unsecured Notes

200,000 6.375 %

Exchangeable senior notes:

Principal amount

11,000 9.250 % 11,000 9.250 %

Unamortized discount

(75 ) (180 )

10,925 10,820

Term loans

114,258 Various 14,429 6.200 %

$ 1,025,183 $ 689,849

(A) Our $42 million collateralized revolving credit facility expired in June 2012.

As of September 30, 2012, principal payments due for our debt (which exclude the effects of any discounts recorded) are as follows (in thousands):

2012

$ 61

2013

11,249

2014

265

2015

125,283

2016

225,299

Thereafter

663,101

Total

$ 1,025,258

To help fund the 2012 acquisitions disclosed in Note 3, on February 17, 2012, we completed a $200 million offering of senior unsecured notes (“2012 Senior Unsecured Notes”), resulting in net proceeds, after underwriting discount, of $196.5 million. These 2012 senior unsecured notes accrue interest at a fixed rate of 6.375% per year and mature on February 15, 2022. The 2012 Senior Unsecured Notes include covenants substantially consistent with our 2011 Senior Unsecured Notes.

In addition, on March 9, 2012, we closed on a $100 million senior unsecured term loan facility (“2012 Term Loan”) and exercised the $70 million accordion feature on our revolving credit facility, increasing its capacity from $330 million to $400 million ($125.0 million outstanding at September 30, 2012). The 2012 Term Loan facility has an interest rate option of (1) LIBOR plus an initial spread of 2.25% or (2) the higher of the “prime rate”, federal funds rate plus 0.5%, or Eurodollar rate plus 1.0%, plus an initial spread of 1.25%. The 2012 Term Loan facility is scheduled to mature on March 9, 2016, but we have the option to extend the facility one year to March 9, 2017.

During the second quarter 2010, we entered into an interest rate swap to fix $65 million of our 2006 Senior Unsecured Notes, which started July 31, 2011 (date on which the interest rate turned variable) through maturity date (or July 2016), at a rate of 5.507%. We also entered into an interest rate swap to fix $60 million of our 2006 Senior Unsecured Notes which started October 31, 2011 (date on which the related interest rate turned variable) through the maturity date (or October 2016) at a rate of 5.675%. At September 30, 2012 and December 31, 2011, the fair value of the interest rate swaps was $13.2 million and $12.2 million, respectively, which is reflected in accounts payable and accrued expenses on the condensed consolidated balance sheets.

We designated our interest rate swaps as cash flow hedges. Accordingly, the effective portion of changes in the fair value of our swaps is recorded as a component of accumulated other comprehensive income/loss on the balance sheet and reclassified into earnings in the same period, or periods, during which the hedged transactions effect earnings, while any ineffective portion is recorded through earnings immediately. We did not have any hedge ineffectiveness in the periods; therefore, there was no income statement effect recorded during the three and nine month periods ended September 30, 2012 or 2011. We do not expect any of the current losses included in accumulated other comprehensive loss to be reclassified into earnings in the next 12 months. At September 30, 2012 and December 31, 2011, we had $6.7 million and $6.3 million, respectively, posted as collateral, which is currently reflected in other assets on our consolidated balance sheets.

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Our debt facilities impose certain restrictions on us, including restrictions on our ability to: incur debts; create or incur liens; provide guarantees in respect of obligations of any other entity; make redemptions and repurchases of our capital stock; prepay, redeem or repurchase debt; engage in mergers or consolidations; enter into affiliated transactions; dispose of real estate or other assets; and change our business. In addition, the credit agreements governing our revolving credit facility and 2012 Term Loan 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. Through the quarter ending June 30, the dividend restriction was 115% of normalized adjusted FFO. Thereafter, a similar dividend restriction exists but the percentage drops each quarter (110% for quarter ending September 30, 2012) until reaching 95% at September 30, 2013. The indentures governing our 2011 and 2012 Senior Unsecured Notes also limit the amount of dividends we can pay based on the sum of 95% of funds from operations, proceeds of equity issuances and certain other net cash proceeds. Finally, our 2011 and 2012 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 revolving credit facility and 2012 Term Loan contain customary financial and operating covenants, including covenants relating to our total leverage ratio, fixed charge coverage ratio, mortgage secured leverage ratio, recourse mortgage secured leverage ratio, consolidated adjusted net worth, facility leverage ratio, and borrowing base interest coverage ratio. This 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 facility, the entire outstanding balance may become immediately due and payable. At September 30, 2012, we were in compliance with all such financial and operating covenants.

5. Common Stock/Partner’s Capital

Medical Properties Trust, Inc.

To help fund the 2012 acquisitions disclosed in Note 3, on February 7, 2012, we completed an offering of 23,575,000 shares of our common stock (including 3,075,000 shares sold pursuant to the exercise in full of the underwriters’ overallotment option) at a price of $9.75 per share, resulting in net proceeds (after underwriting discount) of $220.1 million.

MPT Operating Partnership, L.P.

At September 30, 2012, the Company has a 99.8% ownership interest in Operating Partnership with the remainder owned by three other partners, two of which are employees and one of which is a director. During the nine months ended September 30, 2012, the partnership issued 23,575,000 units in direct response to the common stock offering by Medical Properties Trust, Inc.

6. Stock Awards

Our Second Amended and Restated Medical Properties Trust, Inc. 2004 Equity Incentive Plan (the “Equity Incentive Plan”) authorizes the issuance of common stock options, restricted stock, restricted stock units, deferred stock units, stock appreciation rights, performance units and awards of interests in our Operating Partnership. The Equity Incentive Plan is administered by the Compensation Committee of the Board of Directors. We have reserved 7,441,180 shares of common stock for awards under the Equity Incentive Plan for which 1,436,693 shares remain available for future stock awards as of September 30, 2012. We awarded the following during 2012 and 2011:

Time-based awards — We granted 275,464 and 292,803 shares in 2012 and 2011, respectively, of time-based restricted stock to management, independent directors, and certain employees (2011 only). These awards vest quarterly based on service, over three years, in equal amounts.

Performance-based awards — Our management team and certain employees (2011 only) were awarded 252,566 and 253,655 performance based awards in 2012 and 2011, respectively. These awards vest ratably over a three year period based on the achievement of certain total shareholder return measures, with a carry-back and carryforward provision through December 31, 2015 (for the 2011 awards) and December 31, 2016 (for the 2012 awards). Dividends on these awards are paid only upon achievement of the performance measures.

Multi-year Performance-based awards — We awarded 649,793 and 600,000 shares in 2012 and 2011, respectively, of multi-year performance-based awards to management and certain employees. These shares are subject to three-year cumulative performance hurdles based on total shareholder return. At the end of the third-year performance period, any earned shares will be subject to an additional two years of ratable time-based vesting on an annual basis. Dividends are paid on these shares only upon achievement of the performance measures.

7. Fair Value of Financial Instruments

We have various assets and liabilities that are considered financial instruments. We estimate that the carrying value of cash and cash equivalents, and accounts payable and accrued expenses approximate their fair values. Included in our accounts payable and accrued expenses are our interest rate swaps, which are recorded at fair value based on Level 2 observable market assumptions using standardized derivative pricing models. We estimate the fair value of our interest and rent receivables using Level 2 inputs such as

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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 is generally estimated by using Level 2 and Level 3 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 exchangeable notes and 2011 and 2012 Senior Unsecured Notes, using Level 2 inputs such as quotes from securities dealers and market makers. We estimate the fair value of our 2006 Senior Unsecured Notes, revolving credit facilities, and term loans using Level 2 inputs based on the present value of future payments, discounted at a rate which we consider appropriate for such debt.

Fair value estimates are made at a specific point in time, are subjective in nature, and involve uncertainties and matters of significant judgment. Settlement of such fair value amounts may not be possible and may not be a prudent management decision. The following table summarizes fair value estimates for our financial instruments (in thousands):

September 30,
2012
December 31,
2011

Asset (Liability)

Book
Value
Fair
Value
Book
Value
Fair
Value

Interest and rent receivables

$ 42,094 $ 34,166 $ 29,862 $ 22,866

Loans (1)

333,627 333,275 239,839 243,272

Debt, net

(1,025,183 ) (1,080,514 ) (689,849 ) (688,032 )

(1) Excludes loans related to the Ernest Transaction since they are recorded at fair value and discussed below.

Items Measured at Fair Value on a Recurring Basis

As discussed in Note 2, our equity interest in Ernest and related loans are being measured at fair value on a recurring basis. At September 30, 2012, these amounts were as follows (in thousands):

Asset Type

Fair
Value
Cost Asset Type
Classification

Mortgage loans

$ 100,000 $ 100,000 Mortgage loans

Acquisition loan

93,200 93,200 Other loans

Equity investments

3,300 3,300 Other assets

$ 196,500 $ 196,500

Our mortgage loans with Ernest are recorded at fair value based on Level 3 inputs by discounting the estimated cash flows using the current rates which similar loans would be made to borrowers with similar credit ratings and the same remaining maturities. Our acquisition loan and equity investments are 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 discount rates based on the risk profile of comparable companies. We classify these loans and equity investments as Level 3, as we use certain unobservable inputs to the valuation methodology that are significant to the fair value measurement, and the valuation requires management judgment due to the absence of quoted market prices. For these cash flow models, our observable inputs include capitalization rates and market interest rates, and our unobservable input includes our adjustment for minority discount, which was 500 basis points at September 30, 2012.

For the quarter and nine month period ended September 30, 2012, we had no gains/losses from fair value adjustments in our income statement. However, we recorded $5.7 million and $13.5 million of interest on these loans during the three and nine months ended September 30, 2012, respectively.

8. Discontinued Operations

As disclosed in Note 3, we sold our Thornton facility in Colorado and our Denham Springs facility in Louisiana in the 2012 third quarter and our HealthSouth Rehabilitation Hospital of Fayetteville in Fayetteville, Arkansas during the 2012 second quarter. In addition, our New Bedford facility was sold in October 2012, and at September 30, 2012, we reclassified the New Bedford facility as held for sale.

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On December 30, 2011, we sold Mountain View Regional Rehabilitation Hospital in Morgantown, West Virginia to HealthSouth Corporation for $21.1 million, resulting in a gain of $2.3 million. We also sold Sherman Oaks Hospital in Sherman Oaks, California to Prime, on December 30, 2011 for $20.0 million, resulting in a gain of $3.1 million. Due to this sale, we wrote-off $1.2 million in straight-line rent receivables.

The following table presents the results of discontinued operations, which include the revenue and expenses of the previously-owned facilities noted above, for the three and nine months ended September 30, 2012 and 2011 (dollar amounts in thousands except per share/unit amounts):

For the Three Months
Ended September 30,
For the Nine Months
Ended September 30,
2012 2011 2012 2011

Revenues

$ (342 ) $ 3,159 $ 3,455 $ 7,820

Gain on sale

8,726 7,280 5

Income

8,028 2,372 9,169 4,944

Earnings per share/unit — diluted

$ 0.06 $ 0.02 $ 0.07 $ 0.05

9. Earnings Per Share/Common Unit

Medical Properties Trust, Inc.

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

For the Three Months
Ended September 30,
2012 2011

Numerator:

Income (loss) from continuing operations

$ 23,480 $ (1,904 )

Non-controlling interests’ share in continuing operations

(44 ) (43 )

Participating securities’ share in earnings

(225 ) (264 )

Income (loss) from continuing operations, less participating securities’ share in earnings

23,211 (2,211 )

Income from discontinued operations attributable to MPT common stockholders

8,028 2,372

Net income, less participating securities’ share in earnings

$ 31,239 $ 161

For the Three Months
Ended September 30,
2012 2011

Denominator

Basic weighted-average common shares

134,781 110,714

Dilutive share options

1 5

Dilutive weighted-average common shares

134,782 110,719

For the Nine Months
Ended September 30,
2012 2011

Numerator:

Income from continuing operations

$ 52,305 $ 9,031

Non-controlling interests’ share in continuing operations

(130 ) (131 )

Participating securities’ share in earnings

(715 ) (860 )

Income from continuing operations, less participating securities’ share in earnings

51,460 8,040

Income from discontinued operations attributable to MPT common stockholders

9,169 4,944

Net income, less participating securities’ share in earnings

$ 60,629 $ 12,984

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For the Nine Months
Ended September 30,
2012 2011

Denominator

Basic weighted-average common shares

131,467 110,568

Dilutive share options

8

Dilutive weighted-average common shares

131,467 110,576

MPT Operating Partnership, L.P.

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

For the Three Months
Ended September 30,
2012 2011

Numerator:

Income (loss) from continuing operations

$ 23,480 $ (1,886 )

Non-controlling interests’ share in continuing operations

(44 ) (43 )

Participating securities’ share in earnings

(225 ) (264 )

Income (loss) from continuing operations, less participating securities’ share in earnings

23,211 (2,193 )

Income from discontinued operations attributable to MPT Operating Partnership partners

8,028 2,372

Net income, less participating securities’ share in earnings

$ 31,239 $ 179

Denominator

Basic weighted-average units

134,781 110,714

Dilutive options

1 5

Dilutive weighted-average units

134,782 110,719

For the Nine Months
Ended September 30,
2012 2011

Numerator:

Income from continuing operations

$ 52,305 $ 9,093

Non-controlling interests’ share in continuing operations

(130 ) (131 )

Participating securities’ share in earnings

(715 ) (860 )

Income from continuing operations, less participating securities’ share in earnings

51,460 8,102

Income from discontinued operations attributable to MPT Operating Partnership partners

9,169 4,944

Net income, less participating securities’ share in earnings

$ 60,629 $ 13,046

Denominator

Basic weighted-average units

131,467 110,568

Dilutive options

8

Dilutive weighted-average units

131,467 110,576

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For the three and nine months ended September 30, 2012 and 2011, 0.1 million of options were excluded from the diluted earnings per share/unit calculation as they were not determined to be dilutive. Shares/units that may be issued in the future in accordance with our exchangeable senior notes were excluded from the diluted earnings per share/unit calculation as they were not determined to be dilutive.

10. 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.

11. Subsequent Events

In October 2012, we agreed to fund the construction of an inpatient rehabilitation hospital in Spartanburg, SC that will be operated by Ernest. The estimated cost for the development is $18 million, and the construction is expected to be completed by the third quarter of 2013.

12. Condensed Consolidating Financial Information

The following tables present the condensed consolidating financial information for (a) Medical Properties Trust, Inc. (“Parent” and a guarantor to our 2011 and 2012 Senior Unsecured Notes), (b) MPT Operating Partnership, L.P. and MPT Finance Corporation (“Subsidiary Issuer”), (c) on a combined basis, the guarantors of our 2011 and 2012 Senior Unsecured Notes (“Subsidiary Guarantors”), and (d) on a combined basis, the non-guarantor subsidiaries (“Non-Guarantor Subsidiaries”). Separate financial statements of the Subsidiary Guarantors are not presented because the guarantee by each 100% owned Subsidiary Guarantor is joint and several, and we believe separate financial statements and other disclosures regarding the Subsidiary Guarantors are not material to investors. Furthermore, there are no significant legal restrictions on the Parent’s ability to obtain funds from its subsidiaries by dividend or loan.

The guarantees by the Subsidiary Guarantors may be released and discharged upon: (1) any sale, exchange or transfer of all of the capital stock of a Subsidiary Guarantor; (2) the merger or consolidation of a Subsidiary Guarantor with a Subsidiary Issuer or any other Subsidiary Guarantor; (3) the proper designation of any Subsidiary Guarantor by the Subsidiary Issuers as “unrestricted” for covenant purposes under the indenture governing the 2011 and 2012 Senior Unsecured Notes; (4) the legal defeasance or covenant defeasance or satisfaction and discharge of the indenture; (5) a liquidation or dissolution of a Subsidiary Guarantor permitted under the indenture governing the 2011 and 2012 Senior Unsecured Notes; or (6) the release or discharge of the Subsidiary Guarantor from its guarantee obligations under our revolving credit facility.

Subsequent to December 31, 2011, certain of our subsidiaries were re-designated as guarantors of our 2011 and 2012 Senior Unsecured Notes (such subsidiaries were non-guarantors in 2011), while other subsidiaries have been re-designated as non-guarantors as the underlying properties were sold in 2012 (such subsidiaries were guarantors during 2011). With these re-designations, we have restated the 2011 condensed consolidating financial information below to reflect these changes.

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Condensed Consolidated Balance Sheet

September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Assets

Real estate assets

Land, buildings and improvements and intangible lease assets

$ $ 42 $ 1,185,920 $ 65,947 $ $ 1,251,909

Real estate held for sale

17,432 17,432

Mortgage loans

268,650 100,000 368,650

Net investment in direct financing leases

110,000 202,050 312,050

Gross investment in real estate assets

42 1,582,002 367,997 1,950,041

Accumulated depreciation and amortization

(114,188 ) (6,027 ) (120,215 )

Net investment in real estate assets

42 1,467,814 361,970 1,829,826

Cash & cash equivalents

34,371 1,565 227 36,163

Interest and rent receivable

540 27,881 13,673 42,094

Straight-line rent receivable

31,882 6,183 38,065

Other loans

176 158,001 158,177

Net intercompany receivable (payable)

26,750 1,410,629 (1,039,740 ) (397,639 )

Investment in subsidiaries

1,033,548 602,443 43,693 (1,679,684 )

Other assets

32,330 1,148 20,596 54,074

Total Assets

$ 1,060,298 $ 2,080,531 $ 534,243 $ 163,011 $ (1,679,684 ) $ 2,158,399

Liabilities and Equity

Liabilities

Debt, net

$ $ 1,010,925 $ $ 14,258 $ $ 1,025,183

Accounts payable and accrued expenses

27,140 35,958 731 468 64,297

Deferred revenue

100 18,796 1,478 20,374

Lease deposits and other obligations to tenants

14,372 1,015 15,387

Total liabilities

27,140 1,046,983 33,899 17,219 1,125,241

Total equity

1,033,158 1,033,548 500,344 145,792 (1,679,684 ) 1,033,158

Total Liabilities and Equity

$ 1,060,298 $ 2,080,531 $ 534,243 $ 163,011 $ (1,679,684 ) $ 2,158,399

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Condensed Consolidated Statements of Income

For the Three Months Ended September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Revenues

Rent billed

$ $ $ 29,256 $ 4,162 $ (2,335 ) $ 31,083

Straight-line rent

2,387 375 2,762

Income from direct financing leases

5,238 5,394 (4,859 ) 5,773

Interest and fee income

5,242 8,917 6,943 (7,065 ) 14,037

Total revenues

5,242 45,798 16,874 (14,259 ) 53,655

Expenses

Real estate depreciation and amortization

8,066 425 8,491

Property-related

88 121 7,203 (7,194 ) 218

General and administrative

6,332 720 7,052

Acquisition expenses

410 410

Total operating expenses

6,830 8,187 8,348 (7,194 ) 16,171

Operating income (expense)

(1,588 ) 37,611 8,526 (7,065 ) 37,484

Other income (expense)

Interest and other income (expense)

(21 ) (2 ) (23 )

Earnings from equity and other interests

330 735 1,065

Interest expense

(15,203 ) 389 (7,297 ) 7,065 (15,046 )

Net other income (expense)

(15,224 ) 719 (6,564 ) 7,065 (14,004 )

Income (loss) from continuing operations

(16,812 ) 38,330 1,962 23,480

Income (loss) from discontinued operations

1,069 6,959 8,028

Equity in earnings of consolidated subsidiaries net of income taxes

31,508 48,320 1,129 (80,957 )

Net income (loss)

31,508 31,508 40,528 8,921 (80,957 ) 31,508

Net income (loss) attributable to non-controlling interests

(44 ) (44 ) 44 (44 )

Net income (loss) attributable to MPT common stockholders

$ 31,464 $ 31,464 $ 40,528 $ 8,921 $ (80,913 ) $ 31,464

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Condensed Consolidated Statements of Income

For the Nine Months Ended September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Revenues

Rent billed

$ $ $ 87,579 $ 12,447 $ (6,926 ) $ 93,100

Straight-line rent

4,354 1,119 5,473

Income from direct financing leases

11,730 12,600 (11,351 ) 12,979

Interest and fee income

13,219 20,621 17,357 (17,711 ) 33,486

Total revenues

13,219 124,284 43,523 (35,988 ) 145,038

Expenses

Real estate depreciation and amortization

24,117 1,275 25,392

Property-related

349 597 18,375 (18,277 ) 1,044

General and administrative

20,067 1,274 21,341

Acquisition expenses

4,115 4,115

Total operating expenses

24,531 24,714 20,924 (18,277 ) 51,892

Operating income (expense)

(11,312 ) 99,570 22,599 (17,711 ) 93,146

Other income (expense)

Interest and other income (expense)

(49 ) (2 ) (4 ) (55 )

Earnings from equity and other interests

783 1,161 1,944

Interest expense

(42,905 ) 867 (18,403 ) 17,711 (42,730 )

Net other income (expense)

(42,954 ) 1,648 (17,246 ) 17,711 (40,841 )

Income (loss) from continuing operations

(54,266 ) 101,218 5,353 52,305

Income (loss) from discontinued operations

2,363 6,806 9,169

Equity in earnings of consolidated subsidiaries net of income taxes

61,474 115,740 3,367 (180,581 )

Net income (loss)

61,474 61,474 106,948 12,159 (180,581 ) 61,474

Net income (loss) attributable to non-controlling interests

(130 ) (130 ) 130 (130 )

Net income (loss) attributable to MPT common stockholders

$ 61,344 $ 61,344 $ 106,948 $ 12,159 $ (180,451 ) $ 61,344

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Condensed Consolidated Statements of Comprehensive Income (Loss)

For the Three Months Ended September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Net income

$ 31,508 $ 31,508 $ 40,528 $ 8,921 $ (80,957 ) $ 31,508

Other comprehensive income:

Unrealized loss on interest rate swap

(443 ) (443 ) 443 (443 )

Total comprehensive income

31,065 31,065 40,528 8,921 (80,514 ) 31,065

Comprehensive income attributable to non-controlling interests

(44 ) (44 ) 44 (44 )

Comprehensive income attributable to MPT common stockholders

$ 31,021 $ 31,021 $ 40,528 $ 8,921 $ (80,470 ) $ 31,021

Condensed Consolidated Statements of Comprehensive Income (Loss)

For the Nine Months Ended September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Net income

$ 61,474 $ 61,474 $ 106,948 $ 12,159 $ (180,581 ) $ 61,474

Other comprehensive income:

Unrealized loss on interest rate swap

(989 ) (989 ) 989 (989 )

Total comprehensive income

60,485 60,485 106,948 12,159 (179,592 ) 60,485

Comprehensive income attributable to non-controlling interests

(130 ) (130 ) 130 (130 )

Comprehensive income attributable to MPT common stockholders

$ 60,355 $ 60,355 $ 106,948 $ 12,159 $ (179,462 ) $ 60,355

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Condensed Consolidated Statements of Cash Flows

For the Nine Months Ended September 30, 2012

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Operating Activities

Net cash provided by (used in) operating activities

$ 16 $ (38,780 ) $ 114,073 $ (600 ) $ $ 74,709

Investing Activities

Cash paid for acquisitions and other related investments

(410,000 ) (196,500 ) (606,500 )

Principal received on loans receivable

5,491 4,016 9,507

Net proceeds from sales of real estate

800 33,300 34,100

Investments in and advances to subsidiaries

(143,554 ) (540,016 ) 377,472 162,560 143,538

Investments in loans receivable

(1,293 ) (1,293 )

Construction in progress and other

(59 ) (34,349 ) (1,512 ) (35,920 )

Net cash provided by (used in) investing activities

(143,554 ) (540,075 ) (60,586 ) 571 143,538 (600,106 )

Financing Activities

Revolving credit facilities, net

75,000 (39,600 ) 35,400

Additions to term debt

300,000 300,000

Payments of term debt

(171 ) (171 )

Distributions paid

(76,569 ) (76,770 ) 76,569 (76,770 )

Sale of common stock, net

220,107 220,107 (220,107 ) 220,107

Lease deposits and other obligations to tenants

(13,731 ) 340 (13,391 )

Debt issuance costs paid and other financing activities

(6,341 ) (6,341 )

Net cash provided by (used in) financing activities

143,538 511,996 (53,331 ) 169 (143,538 ) 458,834

Increase in cash and cash equivalents for period

(66,859 ) 156 140 (66,563 )

Cash and cash equivalents at beginning of period

101,230 1,409 87 102,726

Cash and cash equivalents at end of period

$ $ 34,371 $ 1,565 $ 227 $ $ 36,163

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Condensed Consolidated Balance Sheet

December 31, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Assets

Real estate assets

Land, buildings and improvements and intangible lease assets

$ $ 37 $ 1,151,574 $ 65,948 $ $ 1,217,559

Real estate held for sale

22,008 26,917 48,925

Mortgage loans

165,000 165,000

Gross investment in real estate assets

37 1,338,582 92,865 1,431,484

Accumulated depreciation and amortization

(90,072 ) (4,750 ) (94,822 )

Net investment in real estate assets

37 1,248,510 88,115 1,336,662

Cash & cash equivalents

101,230 1,409 87 102,726

Interest and rent receivable

399 22,528 6,935 29,862

Straight-line rent receivable

27,388 6,605 33,993

Other loans

178 5,491 69,170 74,839

Net intercompany receivable (payable)

21,955 872,380 (862,281 ) (32,054 )

Investment in subsidiaries

829,205 489,858 43,008 (1,362,071 )

Other assets

27,285 2,151 14,356 43,792

Total Assets

$ 851,160 $ 1,491,367 $ 488,204 $ 153,214 $ (1,362,071 ) $ 1,621,874

Liabilities and Equity

Liabilities

Debt, net

$ $ 635,820 $ 39,600 $ 14,429 $ $ 689,849

Accounts payable and accrued expenses

22,345 25,783 2,578 419 51,125

Deferred revenue

559 21,372 1,376 23,307

Lease deposits and other obligations to tenants

28,103 675 28,778

Total liabilities

22,345 662,162 91,653 16,899 793,059

Total equity

828,815 829,205 396,551 136,315 (1,362,071 ) 828,815

Total Liabilities and Equity

$ 851,160 $ 1,491,367 $ 488,204 $ 153,214 $ (1,362,071 ) $ 1,621,874

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Condensed Consolidated Statements of Income

For the Three Months Ended September 30, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Revenues

Rent billed

$ $ $ 25,903 $ 2,188 $ (331 ) $ 27,760

Straight-line rent

1,219 424 1,643

Interest and fee income

1,351 4,146 920 (1,188 ) 5,229

Total revenues

1,351 31,268 3,532 (1,519 ) 34,632

Expenses

Real estate depreciation and amortization

7,212 488 7,700

Property-related

87 171 333 (331 ) 260

General and administrative

18 6,348 (629 ) 5,737

Acquisition expenses

513 469 (452 ) 530

Total operating expenses

18 6,948 7,852 (260 ) (331 ) 14,227

Operating income (loss)

(18 ) (5,597 ) 23,416 3,792 (1,188 ) 20,405

Other income (expense)

Interest and other income (expense)

44


(2 ) 42

Earnings from equity and other interests

84 (75 ) 9

Debt refinancing costs

(10,425 ) (10,425 )

Interest expense

(11,735 ) 63 (1,451 ) 1,188 (11,935 )

Net other income (expense)

(22,116 ) 147 (1,528 ) 1,188 (22,309 )

Income (loss) from continuing operations

(18 ) (27,713 ) 23,563 2,264 (1,904 )

Income (loss) from discontinued operations

787 1,585 2,372

Equity in earnings of consolidated subsidiaries net of income taxes

486 28,199 1,112 (29,797 )

Net income (loss)

468 486 25,462 3,849 (29,797 ) 468

Net income (loss) attributable to non-controlling interests

(43 ) (43 ) 43 (43 )

Net income attributable to MPT common stockholders

$ 425 $ 443 $ 25,462 $ 3,849 $ (29,754 ) $ 425

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Condensed Consolidated Statements of Income

For the Nine Months Ended September 30, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Revenues

Rent billed

$ $ $ 76,284 $ 5,796 $ (994 ) $ 81,086

Straight-line rent

3,974 1,344 5,318

Interest and fee income

4,118 13,087 2,597 (4,088 ) 15,714

Total revenues

4,118 93,345 9,737 (5,082 ) 102,118

Expenses

Real estate depreciation and amortization

21,216 1,292 22,508

Property-related

87 213 1,040 (994 ) 346

General and administrative

62 18,356 2,011 20,429

Acquisition expenses

2,717 469 3,186

Total operating expenses

62 21,160 21,898 4,343 (994 ) 46,469

Operating income (loss)

(62 ) (17,042 ) 71,447 5,394 (4,088 ) 55,649

Other income (expense)

Interest income and other

42 2 (56 ) (12 )

Earnings from equity and other interests

84 (14 ) 70

Debt refinancing costs

(14,109 ) (105 ) (14,214 )

Interest expense

(31,750 ) (31 ) (4,769 ) 4,088 (32,462 )

Net other income (expense)

(45,817 ) (50 ) (4,839 ) 4,088 (46,618 )

Income (loss) from continuing operations

(62 ) (62,859 ) 71,397 555 9,031

Income (loss) from discontinued operations

263 4,681 4,944

Equity in earnings of consolidated subsidiaries net of income taxes

14,037 76,896 3,457 (94,390 )

Net income (loss)

13,975 14,037 75,117 5,236 (94,390 ) 13,975

Net income (loss) attributable to non-controlling interests

(131 ) (131 ) 131 (131 )

Net income attributable to MPT common stockholders

$ 13,844 $ 13,906 $ 75,117 $ 5,236 $ (94,259 ) $ 13,844

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Condensed Consolidated Statements of Comprehensive Income (Loss)

For the Three Months Ended September 30, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Net income (loss)

$ 468 $ 486 $ 25,462 $ 3,849 $ (29,797 ) $ 468

Other comprehensive income (loss):

Unrealized loss on interest rate swap

(5,272 ) (5,272 ) 5,272 (5,272 )

Total comprehensive income (loss)

(4,804 ) (4,786 ) 25,462 3,849 (24,525 ) (4,804 )

Comprehensive income attributable to non-controlling interests

(43 ) (43 ) 43 (43 )

Comprehensive income (loss) attributable to MPT common stockholders

$ (4,847 ) $ (4,829 ) $ 25,462 $ 3,849 $ (24,482 ) $ (4,847 )

Condensed Consolidated Statements of Comprehensive Income (Loss)

For the Nine Months Ended September 30, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Net income

$ 13,975 $ 14,037 $ 75,117 $ 5,236 $ (94,390 ) $ 13,975

Other comprehensive income:

Unrealized loss on interest rate swap

(8,341 ) (8,341 ) 8,341 (8,341 )

Total comprehensive income

5,634 5,696 75,117 5,236 (86,049 ) 5,634

Comprehensive income attributable to non-controlling interests

(131 ) (131 ) 131 (131 )

Comprehensive income attributable to MPT common stockholders

$ 5,503 $ 5,565 $ 75,117 $ 5,236 $ (85,918 ) $ 5,503

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Condensed Consolidated Statements of Cash Flows

For the Nine Months Ended September 30, 2011

(in thousands)

Parent Subsidiary
Issuers
Subsidiary
Guarantors
Non-Guarantor
Subsidiaries
Eliminations Total
Consolidated

Operating Activities

Net cash provided by (used in) operating activities

$ (124 ) $ (26,727 ) $ 86,364 $ 7,615 $ $ 67,128

Investing Activities

Cash paid for acquisitions and other related investments

(191,625 ) (17,288 ) (208,913 )

Principal received on loans receivable

2,898 2,898

Investments in and advances to subsidiaries

67,126 (89,763 ) 81,565 8,074 (67,002 )

Investments in loans receivable

(205 ) (3,314 ) (879 ) (4,398 )

Construction in progress and other

(12,297 ) (12,297 )

Net cash provided by (used in) investing activities

67,126 (89,968 ) (125,671 ) (7,195 ) (67,002 ) (222,710 )

Financing Activities

Revolving credit facilities, net

39,600 39,600

Additions to term debt

450,000 450,000

Payments of term debt

(229,271 ) (8,433 ) (106 ) (237,810 )

Distributions paid

(67,002 ) (67,194 ) 67,002 (67,194 )

Lease deposits and other obligations to tenants

8,140 (527 ) 7,613

Debt issuance costs paid and other financing activities

(20,530 ) (137 ) (20,667 )

Net cash provided by (used in) financing activities

(67,002 ) 133,005 39,307 (770 ) 67,002 171,542

Increase (decrease) in cash and cash equivalents for period

16,310 (350 ) 15,960

Cash and cash equivalents at beginning of period

96,822 1,586 98,408

Cash and cash equivalents at end of period

$ $ 113,132 $ $ 1,236 $ $ 114,368

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

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

The discussion and analysis of the consolidated financial condition and consolidated results of operations should be read together with the condensed consolidated financial statements and notes thereto contained in this Form 10-Q and the financial statements and notes thereto contained in our Annual Report on Form 10-K (as amended) for the year ended December 31, 2011.

Forward-Looking Statements.

This report on Form 10-Q contains certain “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Such forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause our actual results or future performance, achievements or

transactions or events to be materially different from those expressed or implied by such forward-looking statements, including, but not limited to, the risks described in our Annual Report on Form 10-K for the year ended December 31, 2011, as amended and as updated in our Quarterly Report on Form 10-Q for the quarter ended June 30, 2012, filed with the Securities and Exchange Commission (SEC) under the Securities Exchange Act of 1934. Such factors include, among others, the following:

national and local economic, business, real estate and other market conditions;

the competitive environment in which we operate;

the execution of our business plan;

financing risks;

acquisition and development risks;

potential environmental contingencies and other liabilities;

other factors affecting real estate industry generally or the healthcare real estate industry in particular;

our ability to maintain our status as a REIT for federal and state income tax purposes;

our ability to attract and retain qualified personnel;

federal and state healthcare regulatory requirements; and

the continuing impact of the recent economic recession, which may have a negative effect on the following, among other things:

the financial condition of our tenants, our lenders, and institutions that hold our cash balances, which may expose us to increased risks of default by these parties;

our ability to obtain equity and debt financing on attractive terms or at all, which may adversely impact our ability to pursue acquisition and development opportunities and our future interest expense; and

the value of our real estate assets, which may limit our ability to dispose of assets at attractive prices or obtain or maintain debt financing secured by our properties or on an unsecured basis.

Key Factors that May Affect Our Operations

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

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

the historical and prospective operating margins (measured by a tenant’s earnings before interest, taxes, depreciation, amortization and facility rent) of each tenant or borrower and at each facility;

the ratio of our tenants’ and borrowers’ operating earnings both to facility rent and to facility rent plus other fixed costs, including debt costs;

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trends in the source of our tenants’ or borrowers’ revenue, including the relative mix of Medicare, Medicaid/MediCal, managed care, commercial insurance, and private pay patients; and

the effect of evolving healthcare regulations on our tenants’ and borrowers’ profitability, including recent healthcare reform and legislation.

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

trends in the cost and availability of capital, including market interest rates, that our prospective tenants may use for their real estate assets instead of financing their real estate assets through lease structures;

changes in healthcare regulations that may limit the opportunities for physicians to participate in the ownership of healthcare providers and healthcare real estate;

reductions in reimbursements from Medicare, state healthcare programs, and commercial insurance providers that may reduce our tenants’ profitability and our lease rates;

competition from other financing sources; and

the ability of our tenants and borrowers to access funds in the credit markets.

CRITICAL ACCOUNTING POLICIES

Refer to our 2011 Annual Report on Form 10-K, as amended, for a discussion of our critical accounting policies, which include revenue recognition, investment in real estate, purchase price allocation, loans, losses from rent receivables, stock-based compensation, exchangeable senior notes, and our accounting policy on consolidation. During the nine months ended September 30, 2012, there were no material changes to these policies, except we began using direct financing lease (“DFL”) accounting with the acquisition and lease of the real estate of Ernest along with that of the Reno and Roxborough facilities. Under DFL accounting, future minimum lease payments are recorded as a receivable. Unearned income, which represents the net investment in the DFL less the sum of minimum lease payments receivable and the estimated residual values of the leased properties, is deferred and amortized to income over the lease term to provide a constant yield when collectability of the lease payments is reasonably assured. Investments in DFLs are presented net of unamortized and unearned income. DFLs are placed on non-accrual status when management determines that the collectability of contractual amounts is not reasonably assured. While on non-accrual status, DFLs are accounted for on a cash basis, in which income is recognized only upon receipt of cash.

Overview

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

At September 30, 2012, our portfolio consisted of 81 properties: 67 facilities (of the 73 facilities that we own, of which two are subject to long-term ground leases) are leased to 21 tenants, one was not under lease as it is under re-development, five were under development, and the remaining assets are in the form of first mortgage loans to three operators. Our facilities consisted of 30 general acute care hospitals, 26 long-term acute care hospitals, 17 inpatient rehabilitation hospitals, two medical office buildings, and six wellness centers.

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All of our investments are currently located in the United States. The following is our revenue by operating type (dollar amounts in thousands):

Revenue by property type:

For the Three
Months Ended
September 30,
2012
% of
Total
For the Three
Months Ended
September 30,
2011
% of
Total

General Acute Care Hospitals

$ 29,219 54.5 % $ 21,987 63.5 %

Long-term Acute Care Hospitals

13,576 25.3 % 8,257 23.8 %

Rehabilitation Hospitals

9,947 18.5 % 3,540 10.2 %

Medical Office Buildings

498 0.9 % 433 1.3 %

Wellness Centers

415 0.8 % 415 1.2 %

Total revenue

$ 53,655 100.0 % $ 34,632 100.0 %

For the Nine
Months Ended
September 30,
2012

% of
Total
For the Nine
Months Ended
September 30,
2011
% of
Total

General Acute Care Hospitals

$ 79,410 54.8 % $ 65,020 63.7 %

Long-term Acute Care Hospitals

37,307 25.7 % 23,937 23.4 %

Rehabilitation Hospitals

25,685 17.7 % 10,617 10.4 %

Medical Office Buildings

1,390 1.0 % 1,298 1.3 %

Wellness Centers

1,246 0.8 % 1,246 1.2 %

Total revenue

$ 145,038 100.0 % $ 102,118 100.0 %

We have 33 employees as of November 5, 2012. We believe that any currently anticipated increase in the number of our employees will have only immaterial effects on our operations and general and administrative expenses. We believe that our relations with our employees are good. None of our employees are members of any labor union.

Results of Operations

Three Months Ended September 30, 2012 Compared to September 30, 2011

Net income for the three months ended September 30, 2012 was $31.5 million, compared to $0.4 million for the three months ended September 30, 2011. This increase was primarily the result of acquisitions made subsequent to September 2011 and the refinancing charges that were incurred in 2011. Funds from operations (“FFO”), after adjusting for certain items (as more fully described in Reconciliation of Non-GAAP Financial Measures), was $33.4 million, or $0.25 per diluted share for the 2012 third quarter as compared to $19.5 million, or $0.18 per diluted share for the 2011 third quarter. These increases were primarily the result of the acquisitions made subsequent to September 2011.

A comparison of revenues for the three month periods ended September 30, 2012 and 2011 is as follows, as adjusted in 2011 for discontinued operations (dollar amounts in thousands):

2012 % of
Total
2011 % of
Total
Year over
Year
Change

Base rents

$ 30,599 57.0 % $ 27,283 78.8 % 12.2 %

Straight-line rents

2,762 5.1 % 1,643 4.7 % 68.1 %

Percentage rents

484 0.9 % 477 1.4 % 1.5 %

Fee income

187 0.4 % 21 0.1 % 790.4 %

Income from direct financing leases

5,773 10.8 % % 100.0 %

Interest from loans

13,850 25.8 % 5,208 15.0 % 165.9 %

Total revenue

$ 53,655 100.0 % $ 34,632 100.0 % 54.9 %

Base rents for the 2012 third quarter increased 12.2% versus the prior year as a result of the additional rent generated from annual escalation provisions in our leases and $2.8 million of incremental revenue from properties acquired or completed since September 2011. Income from direct financing leases is related to the Ernest Transaction and the Roxborough and Reno facilities.

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Interest from loans is higher than the prior year due to the $5.7 million and $2.6 million of additional interest related to the Ernest and Centinela loans, respectively.

Real estate depreciation and amortization during the third quarter of 2012 increased to $8.5 million from $7.7 million in the same period of 2011, due to the incremental depreciation from the properties acquired since September 2011.

General and administrative expenses totaled $7.1 million for the 2012 third quarter, which is 13.1% of total revenues, down from 16.6% of revenues in the prior year third quarter. The drop in general and administrative expenses as a percentage of revenue is primarily due to our business model as we can generally increase our revenues substantially without significantly increasing our headcount and related expenses. On a dollar basis, our general and administrative costs are up over the 2011 third quarter primarily due to higher travel costs.

In the 2012 third quarter, we recognized $1.1 million of earnings from equity and other interests in certain of our tenants, which is a substantial increase from the 2011 third quarter. This increase is primarily related to having a full three months of returns from certain equity investees along with improved results from each of our profit and equity interests.

Interest expense (including debt refinancing costs) for the quarters ended September 30, 2012 and 2011 totaled $15.0 million and $22.4 million, respectively. This decrease is primarily related to the debt refinancing costs in 2011 of $10.4 million partially offset by higher debt balances associated with our 2012 Senior Unsecured Notes and 2012 Term Loan. See Note 4 to our Condensed Consolidated Financial Statements in Item 1 to this Form 10-Q for further information on our debt activities.

In addition to the items noted above, net income for the third quarter of 2012 and 2011, was impacted by discontinued operations. See Note 8 to our Condensed Consolidated Financial Statements in Item 1 to this Form 10-Q for further information.

Nine Months Ended September 30, 2012 Compared to September 30, 2011

Net income for the nine months ended September 30, 2012, was $61.3 million compared to net income of $13.8 million for the nine months ended September 30, 2011. This increase was primarily related to acquisitions made subsequent to September 2011 and the debt refinancing charges that were incurred in 2011, partially offset by higher interest expense due to additional debt incurred in 2012. FFO, after adjusting for certain items (as more fully described in Reconciliation of Non-GAAP Financial Measures), was $85.5 million, or $0.65 per diluted share for the first nine months in 2012 as compared to $57.5 million, or $0.52 per diluted share for the first nine months of 2011. These increases are primarily the result of the acquisitions made since September 2011.

A comparison of revenues for the nine month periods ended September 30, 2012 and 2011 is as follows (dollar amounts in thousands):

2012 % of
Total
2011 % of
Total
Year over
Year
Change

Base rents

$ 91,233 62.9 % $ 79,300 77.7 % 15.0 %

Straight-line rents

5,473 3.8 % 5,318 5.2 % 2.9 %

Percentage rents

1,867 1.3 % 1,786 1.7 % 4.5 %

Fee income

343 0.2 % 99 0.1 % 250.0 %

Income from direct financing leases

12,979 8.9 % % 100.0 %

Interest from loans

33,143 22.9 % 15,615 15.3 % 112.3 %

Total revenue

$ 145,038 100.0 % $ 102,118 100.0 % 42.0 %

Base rents for the 2012 first nine months of 2012 increased 15.0% versus the prior year as a result of the additional rent generated from annual escalation provisions in our leases and $10.5 million of incremental revenue from the properties acquired or completed since September 2011. Income from direct financing leases is solely related to the Ernest Transaction and the new Roxborough and Reno facilities. Interest from loans is higher than the prior year due to the $13.5 million, $1.4 million, and $2.6 million of additional interest related to the Ernest, Hoboken, and Centinela loans, respectively.

Acquisition expenses increased from $3.2 million to $4.1 million primarily as a result of the Ernest Transaction in 2012.

Real estate depreciation and amortization during the first nine months of 2012 was $25.4 million, compared to $22.5 million in the same period of 2011 due to the incremental depreciation from the properties acquired since September 2011.

General and administrative expenses in the first three quarters of 2012 totaled $21.3 million, which is 14.7% of revenues down from 20.0% of revenues in the prior year as revenues are up significantly over the prior year due to the acquisitions, while, on a dollar basis, our costs have been basically flat.

We recognized $1.9 million of earnings from equity and other interests in certain of our tenants in the first nine months of 2012, which is up significantly over the 2011 same period due to the timing of when these investments were made in the prior year along with improved results from each of our profit and equity investees during the first nine months of 2012.

Interest expense (including debt refinancing costs) for the first nine months of 2012 and 2011 totaled $42.7 million and $46.7 million, respectively. In 2011, we recorded a charge of $14.2 million related to our debt refinancing activities. This is partially offset by higher debt balances associated with our 2012 Senior Unsecured Notes and 2012 Term Loan. See Note 4 to our Condensed Consolidated Financial Statements in Item 1 to this Form 10-Q for further information on our debt activities.

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In addition to the items noted above, net income for the nine month periods of 2012 and 2011 was impacted by discontinued operations. See Note 8 to our Condensed Consolidated Financial Statements in Item 1 to this Form 10-Q for further information.

Reconciliation of Non-GAAP Financial Measures

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

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

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

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The following table presents a reconciliation of FFO to net income attributable to MPT common stockholders for the three and nine months ended September 30, 2012 and 2011 ($ amounts in thousands except per share data):

For the Three Months Ended For the Nine Months Ended
September 30,
2012
September 30,
2011
September 30,
2012
September 30,
2011

FFO information:

Net income attributable to MPT common stockholders

$ 31,464 $ 425 $ 61,344 $ 13,844

Participating securities’ share in earnings

(225 ) (264 ) (715 ) (860 )

Net income, less participating securities’ share in earnings

$ 31,239 $ 161 $ 60,629 $ 12,984

Depreciation and amortization:

Continuing operations

8,491 7,700 25,392 22,508

Discontinued operations

311 729 1,021 2,169

Loss (gain) on sale of real estate

(8,726 ) (7,280 ) (5 )

Real estate impairment charge

564

Funds from operations

$ 31,315 $ 8,590 $ 79,762 $ 38,220

Write-off of straight line rent

1,640 1,640

Acquisition costs

410 530 4,115 3,186

Debt refinancing costs

10,425 14,214

Write-off of other receivables

1,846

Normalized funds from operations

$ 33,365 $ 19,545 $ 85,517 $ 57,466

Per diluted share data:

Net income, less participating securities’ share in earnings

$ 0.23 $ $ 0.46 $ 0.12

Depreciation and amortization:

Continuing operations

0.06 0.07 0.19 0.20

Discontinued operations

0.01 0.01 0.02

Real estate impairment charge

0.01

Loss (gain) on sale of real estate

(0.06 ) (0.05 )

Funds from operations

$ 0.23 $ 0.08 $ 0.61 $ 0.35

Write-off of straight line rent

0.01 0.01

Acquisition costs

0.01 0.01 0.03 0.03

Debt refinancing costs

0.09 0.13

Write-off of other receivables

0.01

Normalized funds from operations

$ 0.25 $ 0.18 $ 0.65 $ 0.52

LIQUIDITY AND CAPITAL RESOURCES

During the first nine months of 2012, operating cash flows, which primarily consisted of rent and interest from mortgage and working capital loans, were $74.7 million, which with cash on-hand, were principally used to fund our dividends of $76.8 million and working capital needs.

To fund the Ernest Transaction disclosed in Note 3 to our Condensed Consolidated Financial Statements in Item 1 to this Form 10-Q, on February 7, 2012, we completed an offering of 23,575,000 shares of our common stock (including 3,075,000 shares sold pursuant to the exercise in full of the underwriters’ overallotment option), resulting in net proceeds (after underwriting discount) of $220.1 million. In addition, on February 17, 2012, we completed a $200 million offering of senior unsecured notes, resulting in net proceeds, after underwriting discount, of $196.5 million, which we also used to fund the Ernest Transaction. On March 9, 2012, we closed on a $100 million senior unsecured term loan facility and exercised the $70 million accordion feature on our revolving credit facility. Proceeds from the new term loan facility, our revolving credit facility and property sales were used to fund the $210 million of investments in the third quarter and further cash outlays on our development projects.

During the first nine months of 2011, operating cash flows, which primarily consisted of rent and interest from mortgage and working capital loans, approximated $67.1 million, which, along with cash on hand, draws on our revolvers and issuance of our 2011 Senior Unsecured Notes, were principally used to fund our dividends of $67.2 million and investing activities of $222.7 million.

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Short-term Liquidity Requirements: At November 6, 2012, our availability under our 2010 amended revolving credit facility plus cash on-hand approximated $310 million. We have only nominal principal payments due and no significant maturities in 2012– see five-year debt maturity schedule below. We believe that the liquidity available to us, along with our current monthly cash receipts from rent and loan interest, is sufficient to provide the resources necessary for operations, debt and interest obligations, our firm commitments (including capital expenditures, if any), dividends in order to comply with REIT requirements and to fund our current investment strategies for the next twelve months. In addition, we have an at-the-market equity offering program in place under which we may sell up to $50 million in shares (of which $10 million has been sold to-date) which may be used for general corporate purposes as needed.

Long-term Liquidity Requirements: As of September 30, 2012, we had less than $12 million in debt principal payments due before 2015 – see five-year debt maturity schedule below. With our current liquidity along with our current monthly cash receipts from rent and loan interest, and availability under our at-the-market equity offering program, we believe we have the liquidity available to us to fund our operations, debt and interest obligations, dividends in order to comply with REIT requirements, firm commitments (including capital expenditures, if any) and investment strategies for the foreseeable future.

As of November 6, 2012, principal payments due for our debt (which exclude the effects of any discounts recorded) are as follows (in thousands):

2012

$ 21

2013

11,249

2014

265

2015

125,283

2016

225,299

Thereafter

663,101

Total

$ 1,025,218

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Distribution Policy

The table below is a summary of our distributions declared during the two year period ended September 30, 2012:

Declaration Date

Record Date Date of Distribution Distribution
per Share

August 16, 2012

September 13, 2012 October 11, 2012 $ 0.20

May 17, 2012

June 14, 2012 July 12, 2012 $ 0.20

February 16, 2012

March 15, 2012 April 12, 2012 $ 0.20

November 10, 2011

December 8, 2011 January 5, 2012 $ 0.20

August 18, 2011

September 15, 2011 October 13, 2011 $ 0.20

May 19, 2011

June 16, 2011 July 14, 2011 $ 0.20

February 17, 2011

March 17, 2011 April 14, 2011 $ 0.20

November 11, 2010

December 9, 2010 January 6, 2011 $ 0.20

We intend to pay to our stockholders, within the time periods prescribed by the Internal Revenue Code (“Code”), all or substantially all of our annual taxable income, including taxable gains from the sale of real estate and recognized gains on the sale of securities. It is our policy to make sufficient cash distributions to stockholders in order for us to maintain our status as a REIT under the Code and to avoid corporate income and excise taxes on undistributed income. See Note 4 to our condensed consolidated financial statements in Item 1 to this Form 10-Q for any restrictions placed on dividends by our existing credit facility.

Item 3. Quantitative and Qualitative Disclosures About Market Risk.

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

Our primary exposure to market risks relates to fluctuations in interest rates and equity prices. The following analyses present the sensitivity of the market value, earnings and cash flows of our significant financial instruments to hypothetical changes in interest rates and equity prices as if these changes had occurred. The hypothetical changes chosen for these analyses reflect our view of changes that are reasonably possible over a one year period. These forward looking disclosures are selective in nature and only address the potential impact from financial instruments. They do not include other potential effects which could impact our business as a result of changes in market conditions.

Interest Rate Sensitivity

For fixed rate debt, interest rate changes affect the fair market value but do not impact net income to common stockholders or cash flows. Conversely, for floating rate debt, interest rate changes generally do not affect the fair market value but do impact net income to common stockholders and cash flows, assuming other factors are held constant. At September 30, 2012, our outstanding debt totaled $1,025.2 million, which consisted of fixed-rate debt of $800.2 million (including $125.0 million of floating debt swapped to fixed) and variable rate debt of $225.0 million. If market interest rates increase by one-percentage point, the fair value of our fixed rate debt, after considering the effects of the interest rate swaps entered into in 2010, would decrease by $35.4 million. Changes in the fair value of our fixed rate debt will not have any impact on us unless we decided to repurchase the debt in the open markets.

If market rates of interest on our variable rate debt increase by 1%, the increase in annual interest expense on our variable rate debt would decrease future earnings and cash flows by $2.3 million per year. If market rates of interest on our variable rate debt decrease by 1%, the decrease in interest expense on our variable rate debt would increase future earnings and cash flows by $2.3 million per year. This assumes that the average amount outstanding under our variable rate debt for a year is $225.0 million, the balance of our 2012 Term Loan and revolving credit facility at September 30, 2012.

Share Price Sensitivity

At November 6, 2012, we have $11 million in 2008 exchangeable notes outstanding. These notes have a conversion adjustment feature, which could affect their stated exchange ratio of 80.8898 common shares per $1,000 principal amount of notes, equating to an exchange price of $12.36 per common share. Our dividends declared since we sold the 2008 exchangeable notes have not adjusted our conversion price as of September 30, 2012. Future changes to the conversion price will depend on our level of dividends which cannot be predicted at this time. Any adjustments for dividend increases until the 2008 exchangeable notes are settled in 2013 will affect the

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price of the notes and the number of shares for which they may eventually be settled. Using the outstanding notes and, assuming a price of $20 per share, we would be required to issue an additional 0.3 million shares. At $25 per share, we would be required to issue an additional 0.4  million shares.

Item 4. Controls and Procedures.

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

As required by Rule 13a-15(b), under the Securities Exchange Act of 1934, as amended, we have carried out an evaluation, under the supervision and with the participation of management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of the design and operation of our disclosure controls and procedures as of the end of the quarter covered by this report. Based on the foregoing, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective in timely alerting them to material information required to be disclosed by us in the reports that we file with the SEC.

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

PART II — OTHER INFORMATION

Item 1. Legal Proceedings.

None.

Item 1A. Risk Factors.

There have been no material changes to the Risk Factors as presented in our Annual Report on Form 10-K, as amended, for the year ended December 31, 2011 and as updated in our Quarterly Report on Form 10-Q filed for the quarter ended June 30, 2012.

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Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.

(a) None.

(b) Not applicable.

(c) None.

Item 3. Defaults Upon Senior Securities.

None.

Item 4. Mine Safety Disclosures.

None.

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Item 5. Other Information.

(a) None.

(b) None.

Item 6. Exhibits.

Exhibit

Number

Description

10.1 Master Lease Agreement I between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment and Master Lease Agreement II between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment.
31.1 Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.2 Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.3 Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
31.4 Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
32.1 Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (Medical Properties Trust, Inc.)
32.2 Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (MPT Operating Partnership, L.P.)
Exhibit 101.INS XBRL Instance Document
Exhibit 101.SCH XBRL Taxonomy Extension Schema Document
Exhibit 101.CAL XBRL Taxonomy Extension Calculation Linkbase Document
Exhibit 101.DEF XBRL Taxonomy Extension Definition Linkbase Document
Exhibit 101.LAB XBRL Taxonomy Extension Label Linkbase Document
Exhibit 101.PRE XBRL Taxonomy Extension Presentation Linkbase Document

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SIGNATURE

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

MEDICAL PROPERTIES TRUST, INC.
By:

/s/ R. Steven Hamner

R. Steven Hamner

Executive Vice President and Chief Financial Officer

(Principal Financial and Accounting Officer)

MPT OPERATING PARTNERSHIP, L.P.
By:

/s/ R. Steven Hamner

R. Steven Hamner

Executive Vice President and Chief

Financial Officer of the sole member of

the general partner of

MPT Operating Partnership, L.P.

(Principal Financial and Accounting Officer)

Date: November 9, 2012

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INDEX TO EXHIBITS

Exhibit

Number

Description

10.1 Master Lease Agreement I between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment and Master Lease Agreement II between certain subsidiaries of MPT Operating Partnership, LP, as Lessor, and certain subsidiaries of Prime Healthcare Services, Inc., as Lessee and related first amendment.
31.1 Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.2 Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (Medical Properties Trust, Inc.)
31.3 Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
31.4 Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 1934. (MPT Operating Partnership, L.P.)
32.1 Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (Medical Properties Trust, Inc.)
32.2 Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) under the Securities Exchange Act of 1934 and 18 U.S.C. Section 1350 as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. (MPT Operating Partnership, L.P.)
Exhibit 101.INS XBRL Instance Document
Exhibit 101.SCH XBRL Taxonomy Extension Schema Document
Exhibit 101.CAL XBRL Taxonomy Extension Calculation Linkbase Document
Exhibit 101.DEF XBRL Taxonomy Extension Definition Linkbase Document
Exhibit 101.LAB XBRL Taxonomy Extension Label Linkbase Document
Exhibit 101.PRE XBRL Taxonomy Extension Presentation Linkbase Document

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