##### Table of Contents



UNITED STATES SECURITIES AND EXCHANGE COMMISSION
 WASHINGTON, D.C. 20549
 FORM 10-Q
 þ
    
    QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
 For the quarterly period ended September 30, 2009
 OR
 o
    
    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.
 (Exact Name of Registrant as Specified in Its Charter)
 MARYLAND
(State or other jurisdiction of 
incorporation or organization)
    
    20-0191742
(I. R. S. Employer
Identification No.)1000 URBAN CENTER DRIVE, SUITE 501BIRMINGHAM, AL
(Address of principal executive offices)
    
    35242
(Zip Code)
 REGISTRANTS TELEPHONE NUMBER, INCLUDING AREA CODE: (205) 969-3755
 þ o
 o o
  Large accelerated filer o
    
    Accelerated filer þ
    
    Non-accelerated filer o
    
    Smaller reporting company o(Do not check if a smaller reporting company)
 o þ




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##### 



MEDICAL PROPERTIES TRUST, INC.
QUARTERLY REPORT ON FORM 10-Q
FOR THE QUARTERLY PERIOD ENDED September 30, 2009
 Table of Contents
 PagePART I  FINANCIAL INFORMATIONItem 1 Financial Statements
    
    
    3Condensed Consolidated Balance Sheets at September 30, 2009 and December 31, 2008
    
    
    3Condensed Consolidated Statements of Income for the Three Months and Nine Months
Ended September 30, 2009 and 2008
    
    
    4Condensed Consolidated Statements of Cash Flows for the Nine Months Ended
September 30, 2009 and 2008
    
    
    5Notes to Condensed Consolidated Financial Statements
    
    
    6Item 2 Managements Discussion and Analysis of Financial Condition and Results of
Operations
    
    
    12Item 3 Quantitative and Qualitative Disclosures about Market Risk
    
    
    18Item 4 Controls and Procedures
    
    
    18PART II  OTHER INFORMATIONItem 1 Legal Proceedings
    
    
    18Item 1A Risk Factors
    
    
    18Item 2 Unregistered Sales of Equity Securities and Use of Proceeds
    
    
    18Item 3 Defaults Upon Senior Securities
    
    
    19Item 4 Submission of Matters to a Vote of Security Holders
    
    
    19Item 5 Other Information
    
    
    19Item 6 Exhibits
    
    
    19SIGNATURE
    
    
    20INDEX TO EXHIBITS
    
    
    21EX-10.1EX-31.1EX-31.2EX-32EX-99.1
  2




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##### Table of Contents



PART I  FINANCIAL INFORMATION
 
 Item 1.
    
    Financial Statements.
 MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES
 
  September 30, 2009
    
    
    December 31, 2008(In thousands, except per share amounts)
    
    (Unaudited)
    
    
    (Note 2)AssetsReal estate assetsLand, buildings and improvements, and intangible lease assets
    
    $
    995,228
    
    
    $
    996,965Mortgage loans
    
    
    185,000
    
    
    
    185,000Gross investment in real estate assets
    
    
    1,180,228
    
    
    
    1,181,965Accumulated depreciation and amortization
    
    
    (54,177
    )
    
    
    (40,334
    )Net investment in real estate assets
    
    
    1,126,051
    
    
    
    1,141,631Cash and cash equivalents
    
    
    13,094
    
    
    
    11,748Interest and rent receivable
    
    
    19,458
    
    
    
    13,837Straight-line rent receivable
    
    
    24,946
    
    
    
    19,003Other loans
    
    
    109,921
    
    
    
    108,523Assets of discontinued operations
    
    
    1,185
    
    
    
    2,385Other assets
    
    
    13,143
    
    
    
    14,246Total Assets
    
    $
    1,307,798
    
    
    $
    1,311,373Liabilities and EquityLiabilitiesDebt
    
    $
    566,185
    
    
    $
    630,557Accounts payable and accrued expenses
    
    
    33,044
    
    
    
    24,718Deferred revenue
    
    
    12,771
    
    
    
    16,110Lease deposits and other obligations to tenants
    
    
    16,792
    
    
    
    13,645Total liabilities
    
    
    628,792
    
    
    
    685,030Medical Properties Trust, Inc. stockholders equityPreferred stock, $0.001 par value. Authorized 10,000 shares; no
shares outstanding
    
    
    
    
    
    
    Common stock, $0.001 par value. Authorized 150,000 shares;
issued and outstanding  78,658 shares at September 30, 2009,
and 65,056 shares at December 31, 2008
    
    
    78
    
    
    
    65Additional paid in capital
    
    
    758,354
    
    
    
    686,238Distributions in excess of net income
    
    
    (79,383
    )
    
    
    (59,941
    )Treasury shares, at cost
    
    
    (262
    )
    
    
    (262
    )Total Medical Properties Trust, Inc. stockholders equity
    
    
    678,787
    
    
    
    626,100Non-controlling interests
    
    
    219
    
    
    
    243Total equity
    
    
    679,006
    
    
    
    626,343Total Liabilities and Equity
    
    $
    1,307,798
    
    
    $
    1,311,373
  3




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##### Table of Contents



MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES
 
 
 For the Three Months Ended September 30,
    
    
    For the Nine Months Ended September 30,(In thousands, except per share amounts)
    
    2009
    
    
    2008
    
    
    2009
    
    
    2008RevenuesRent billed
    
    $
    23,636
    
    
    $
    24,332
    
    
    $
    70,321
    
    
    $
    60,649Straight-line rent
    
    
    3,244
    
    
    
    767
    
    
    
    5,856
    
    
    
    4,707Interest and fee income
    
    
    7,213
    
    
    
    8,018
    
    
    
    21,804
    
    
    
    22,273Total revenues
    
    
    34,093
    
    
    
    33,117
    
    
    
    97,981
    
    
    
    87,629ExpensesReal estate depreciation and amortization
    
    
    6,465
    
    
    
    10,625
    
    
    
    19,419
    
    
    
    19,490Property-related
    
    
    2,252
    
    
    
    338
    
    
    
    4,362
    
    
    
    545General and administrative
    
    
    4,859
    
    
    
    4,652
    
    
    
    16,337
    
    
    
    13,632Total operating expenses
    
    
    13,576
    
    
    
    15,615
    
    
    
    40,118
    
    
    
    33,667Operating income
    
    
    20,517
    
    
    
    17,502
    
    
    
    57,863
    
    
    
    53,962Other income (expense)Interest and other income (expense)
    
    
    (6
    )
    
    
    (37
    )
    
    
    48
    
    
    
    80Interest expense
    
    
    (9,390
    )
    
    
    (10,838
    )
    
    
    (28,284
    )
    
    
    (31,172
    )Net other expense
    
    
    (9,396
    )
    
    
    (10,875
    )
    
    
    (28,236
    )
    
    
    (31,092
    )Income from continuing operations
    
    
    11,121
    
    
    
    6,627
    
    
    
    29,627
    
    
    
    22,870Income (loss) from discontinued operations
    
    
    (736
    )
    
    
    410
    
    
    
    (667
    )
    
    
    8,450Net income
    
    
    10,385
    
    
    
    7,037
    
    
    
    28,960
    
    
    
    31,320Net income attributable to non-controlling
interests
    
    
    (11
    )
    
    
    (17
    )
    
    
    (30
    )
    
    
    (36
    )Net income attributable to MPT
common stockholders
    
    $
    10,374
    
    
    $
    7,020
    
    
    $
    28,930
    
    
    $
    31,284Earnings per common share  basicIncome from continuing operations attributable to
MPT common stockholders
    
    $
    0.14
    
    
    $
    0.09
    
    
    $
    0.37
    
    
    $
    0.35Income (loss) from discontinued operations
attributable to MPT common stockholders
    
    
    (0.01
    )
    
    
    0.01
    
    
    
    (0.01
    )
    
    
    0.14Net income attributable to MPT common
stockholders
    
    $
    0.13
    
    
    $
    0.10
    
    
    $
    0.36
    
    
    $
    0.49Weighted average shares outstanding  basic
    
    
    78,665
    
    
    
    65,059
    
    
    
    77,904
    
    
    
    61,016Earnings per share  dilutedIncome from continuing operations attributable to
MPT common stockholders
    
    $
    0.14
    
    
    $
    0.09
    
    
    $
    0.37
    
    
    $
    0.35Income (loss) from discontinued operations
attributable to MPT common stockholders
    
    
    (0.01
    )
    
    
    0.01
    
    
    
    (0.01
    )
    
    
    0.14Net income attributable to MPT common
stockholders
    
    $
    0.13
    
    
    $
    0.10
    
    
    $
    0.36
    
    
    $
    0.49Weighted average shares outstanding  diluted
    
    
    78,665
    
    
    
    65,066
    
    
    
    77,904
    
    
    
    61,026Dividends declared per common share
    
    $
    0.20
    
    
    $
    0.27
    
    
    $
    0.60
    
    
    $
    0.81
  4




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MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES
 
 
 For the Nine Months Ended September 30,2009
    
    
    2008Operating activitiesNet income
    
    $
    28,960
    
    
    $
    31,320Adjustments to reconcile net income to net cash provided by operating
activitiesDepreciation and amortization
    
    
    19,726
    
    
    
    20,922Straight-line rent revenue
    
    
    (6,935
    )
    
    
    (7,181
    )Share-based compensation
    
    
    4,282
    
    
    
    5,130Gain on sale of real estate
    
    
    
    
    
    
    (9,326
    )Straight-line rent write off/reserve
    
    
    1,079
    
    
    
    11,079Increase (decrease) in accounts payable and accrued liabilities
    
    
    5,560
    
    
    
    7,219Amortization and write-off of deferred financing costs and debt discount
    
    
    4,225
    
    
    
    5,302Other adjustments
    
    
    (6,454
    )
    
    
    (1,647
    )Net cash provided by operating activities
    
    
    50,443
    
    
    
    62,818Investing activitiesReal estate acquired
    
    
    (423
    )
    
    
    (383,880
    )Principal received on loans receivable
    
    
    3,273
    
    
    
    27,829Proceeds from sale of real estate
    
    
    
    
    
    
    89,981Investment in loans receivable
    
    
    (6,317
    )
    
    
    (73,756
    )Construction in progress and other
    
    
    (4,434
    )
    
    
    (3,946
    )Net cash used for investing activities
    
    
    (7,901
    )
    
    
    (343,772
    )Financing activitiesRevolving credit facilities, net
    
    
    (65,800
    )
    
    
    14,014Additions to debt
    
    
    
    
    
    
    110,094Payments of debt
    
    
    (907
    )
    
    
    (570
    )Distributions paid
    
    
    (45,602
    )
    
    
    (47,096
    )Sale of common stock
    
    
    67,843
    
    
    
    128,250Other financing activities
    
    
    3,270
    
    
    
    (8,342
    )Net cash (used) provided by financing activities
    
    
    (41,196
    )
    
    
    196,350Increase (decrease) in cash and cash equivalents for period
    
    
    1,346
    
    
    
    (84,604
    )Cash and cash equivalents at beginning of period
    
    
    11,748
    
    
    
    94,215Cash and cash equivalents at end of period
    
    $
    13,094
    
    
    $
    9,611Interest paid
    
    $
    21,068
    
    
    $
    18,268Supplemental schedule of non-cash investing activities:Interest and other receivables transferred to loans receivable
    
    
    
    
    
    
    78Supplemental schedule of non-cash financing activities:Distributions declared, unpaid
    
    
    16,105
    
    
    
    17,931Other non-cash financing activities
    
    
    5
    
    
    
    38
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MEDICAL PROPERTIES TRUST, INC. AND SUBSIDIARIES
 
 
 1. Organization
    2. Summary of Significant Accounting Policies
 Unaudited Interim Condensed Consolidated Financial Statements
   6




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New Accounting Pronouncements
  Reclassifications:
 3. Real Estate and Lending Activities
 Acquisitions
   7




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For the Nine MonthsEnded September 30,2008Revenues
    
    $
    101,256Net income
    
    
    28,941Earnings per share  diluted
    
    $
    0.45
 Leasing Operations




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##### Table of Contents



4. Debt
  As of September 30,
    
    
    As of December 31,2009
    
    
    2008Balance
    
    
    Interest Rate
    
    
    Balance
    
    
    Interest RateRevolving credit facilities
    
    $
    127,200
    
    
    Variable
    
    $
    193,000
    
    
    VariableSenior unsecured notes  fixed
rate through July and October
2011 due July and October 2016
    
    
    125,000
    
    
    
    7.333% - 7.871
    %
    
    
    125,000
    
    
    
    7.333% - 7.871
    %Exchangeable senior notesPrincipal amount
    
    
    220,000
    
    
    
    6.125% - 9.250
    %
    
    
    220,000
    
    
    
    6.125% - 9.250
    %Unamortized discount
    
    
    (9,082
    )
    
    
    
    
    
    
    (11,418
    )210,918
    
    
    
    
    
    
    
    208,582Term loans
    
    
    103,067
    
    
    Various
    
    
    103,975
    
    
    Various$
    566,185
    
    
    
    
    
    
    $
    630,557
  2009
    
    $
    3042010
    
    
    117,273
    (1)2011
    
    
    211,0902012
    
    
    39,6002013
    
    
    82,000Thereafter
    
    
    125,000Total
    
    $
    575,267
 8




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##### Table of Contents



(1)
    
    $86,000 of the revolving credit facilities
due in 2010 may be extended until 2011
provided that we give written notice to the
Administrative Agent at least 60 days prior
to the termination date and as long as no
default has occurred. If we elect to extend,
we will be required to pay an aggregate
extension fee equal to 0.25% of the existing
revolving commitments.      5. Common Stock
    9




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##### Table of Contents



6. Stock Awards
  7. Fair Value of Financial Instruments
   September 30,
    
    
    December 31,2009
    
    
    2008Book
    
    
    Fair
    
    
    Book
    
    
    FairValue
    
    
    Value
    
    
    Value
    
    
    ValueAsset (Liability)Interest and Rent Receivables
    
    $
    19,458
    
    
    $
    18,223
    
    
    $
    13,837
    
    
    $
    12,475Loans
    
    
    294,921
    
    
    
    283,782
    
    
    
    293,523
    
    
    
    282,459Debt
    
    
    (566,185
    )
    
    
    (503,085
    )
    
    
    (630,557
    )
    
    
    (482,175
    )
 8. Discontinued Operations
    10




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For the Three Months
    
    
    For the Nine MonthsEnded September 30,
    
    
    Ended September 30,2009
    
    
    2008
    
    
    2009
    
    
    2008Revenues
    
    $
    
    
    
    $
    (228
    )
    
    $
    
    
    
    $
    2,477Gain on sale
    
    
    
    
    
    
    (2
    )
    
    
    
    
    
    
    9,326Net income
(loss)
    
    
    (736
    )
    
    
    410
    
    
    
    (667
    )
    
    
    8,450Earnings per share  diluted
    
    $
    (0.01
    )
    
    $
    0.01
    
    
    $
    (0.01
    )
    
    $
    0.14
 9. Earnings Per Share
  For the Three MonthsEnded September 30,2009
    
    
    2008Numerator:Income from continuing operations
    
    $
    11,121
    
    
    $
    6,627Non-controlling interests share in continuing operations
    
    
    (9
    )
    
    
    (18
    )Participating securities share in earnings
    
    
    (372
    )
    
    
    (455
    )Income from continuing operations, less participating securities share in earnings
    
    
    10,740
    
    
    
    6,154Income from discontinued operations
    
    
    (736
    )
    
    
    410Non-controlling interests share in discontinued operations
    
    
    (2
    )
    
    
    1Income from discontinued operations attributable to MPT common stockholders
    
    
    (738
    )
    
    
    411Net income, less participating securities share in earnings
    
    $
    10,002
    
    
    $
    6,565Denominator:Basic weighted-average common shares
    
    
    78,665
    
    
    
    65,059Dilutive stock options
    
    
    
    
    
    
    7Diluted weighted-average common shares
    
    
    78,665
    
    
    
    65,066
 For the Nine MonthsEnded September 30,2009
    
    
    2008Numerator:Income from continuing operations
    
    $
    29,627
    
    
    $
    22,870Non-controlling interests share in continuing operations
    
    
    (27
    )
    
    
    (35
    )Participating securities share in earnings
    
    
    (1,142
    )
    
    
    (1,415
    )Income from continuing operations, less participating securities share in earnings
    
    
    28,458
    
    
    
    21,420
 11




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For the Nine MonthsEnded September 30,2009
    
    
    2008Income from discontinued operations
    
    
    (667
    )
    
    
    8,450Non-controlling interests share in discontinued operations
    
    
    (3
    )
    
    
    (1
    )Income from discontinued operations attributable to MPT common stockholders
    
    
    (670
    )
    
    
    8,449Net income, less participating securities share in earnings
    
    $
    27,788
    
    
    $
    29,869Denominator:Basic weighted-average common shares
    
    
    77,904
    
    
    
    61,016Dilutive stock options
    
    
    
    
    
    
    10Diluted weighted-average common shares
    
    
    77,904
    
    
    
    61,026
  10. Contingencies
    
 Item 2. Managements Discussion and Analysis of Financial Condition and Results of Operations.
  12




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##### Table of Contents



Forward-Looking Statements.
  
    
    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 the 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 impact of the current credit crisis and global economic slowdown, which is having and may continue to
have a negative effect on the following, among other things:
 
    
    the financial condition of our tenants, our lenders, counterparties to
our capped call transactions and institutions that hold our cash
balances, which may expose us to increased risks of default by these
parties;
    
    our ability to obtain debt financing on attractive terms or at all,
which may adversely impact our ability to pursue acquisition and
development opportunities and refinance existing debt 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.
 Overview
   13




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##### Table of Contents



Key Factors that May Affect Our Operations
   
    
    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;
    
    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.
  
    
    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;
    
    potential 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;
    
    other changes to the overall healthcare economy that may result from proposed and future
federal legislation in the United States;
    
    competition from other financing sources; and
    
    the ability of our tenants and borrowers to access funds in the credit markets.
  14




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CRITICAL ACCOUNTING POLICIES
  LIQUIDITY AND CAPITAL RESOURCES
   Short-term Liquidity Requirements:
 Long-term Liquidity Requirements:
  
    
    cash flows from operations;
    
    proceeds from property sales;
    
    issuance of new debt;
    
    replacement or extension of existing credit arrangements; and
    
    sale of equity and equity-linked securities.
  15




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Results of Operations
 Three months Ended September 30, 2009 Compared to September 30, 2008
   Year over% of
    
    
    
    
    
    
    % of
    
    
    Year2009
    
    
    Total
    
    
    2008
    
    
    Total
    
    
    ChangeBase rents
    
    $
    22,837
    
    
    
    67.0
    %
    
    $
    23,373
    
    
    
    70.6
    %
    
    
    -2.3
    %Straight-line rents
    
    
    3,244
    
    
    
    9.5
    %
    
    
    767
    
    
    
    2.3
    %
    
    
    322.9
    %Percentage rents
    
    
    799
    
    
    
    2.3
    %
    
    
    959
    
    
    
    2.9
    %
    
    
    -16.7
    %Fee income
    
    
    37
    
    
    
    0.1
    %
    
    
    111
    
    
    
    0.3
    %
    
    
    -66.7
    %Interest from loans
    
    
    7,176
    
    
    
    21.1
    %
    
    
    7,907
    
    
    
    23.9
    %
    
    
    -9.2
    %Total revenue
    
    $
    34,093
    
    
    
    100.0
    %
    
    $
    33,117
    
    
    
    100.0
    %
    
    
    2.9
    %
       16




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##### Table of Contents



Nine Months Ended September 30, 2009 Compared to September 30, 2008
   Year over% of
    
    
    
    
    
    
    % of
    
    
    Year2009
    
    
    Total
    
    
    2008
    
    
    Total
    
    
    ChangeBase rents
    
    $
    68,691
    
    
    
    70.1
    %
    
    $
    59,610
    
    
    
    68.0
    %
    
    
    15.2
    %Straight-line rents
    
    
    5,856
    
    
    
    6.0
    %
    
    
    4,707
    
    
    
    5.4
    %
    
    
    24.4
    %Percentage rents
    
    
    1,630
    
    
    
    1.7
    %
    
    
    1,040
    
    
    
    1.2
    %
    
    
    56.7
    %Fee income
    
    
    212
    
    
    
    0.2
    %
    
    
    1,204
    
    
    
    1.4
    %
    
    
    -82.4
    %Interest from loans
    
    
    21,592
    
    
    
    22.0
    %
    
    
    21,068
    
    
    
    24.0
    %
    
    
    2.5
    %Total revenue
    
    $
    97,981
    
    
    
    100.0
    %
    
    $
    87,629
    
    
    
    100.0
    %
    
    
    11.8
    %
        Distribution Policy
   Declaration Date
    
    Record Date
    
    Date of Distribution
    
    Distribution per ShareAugust 20, 2009
    
    September 17, 2009
    
    October 15, 2009
    
    $
    0.20May 21, 2009
    
    June 11, 2009
    
    July 14, 2009
    
    $
    0.20February 24, 2009
    
    March 19, 2009
    
    April 9, 2009
    
    $
    0.20December 4, 2008
    
    December 23, 2008
    
    January 22, 2009
    
    $
    0.20
 17




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##### Table of Contents



Declaration Date
    
    Record Date
    
    Date of Distribution
    
    Distribution per ShareAugust 21, 2008
    
    September 18, 2008
    
    October 16, 2008
    
    $
    0.27May 22, 2008
    
    June 13, 2008
    
    July 11, 2008
    
    $
    0.27February 28, 2008
    
    March 13, 2008
    
    April 11, 2008
    
    $
    0.27November 16, 2007
    
    December 13, 2007
    
    January 11, 2008
    
    $
    0.27
  
 Item 3. Quantitative and Qualitative Disclosures About Market Risk.
   
 Item 4. Controls and Procedures.
    
 PART II  OTHER INFORMATION
 
 Item 1. Legal Proceedings.
  
 Item 1A. Risk Factors.
  
 Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
   18




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##### Table of Contents



Item 3. Defaults Upon Senior Securities.
  
 Item 4. Submission of Matters to a Vote of Security Holders.
  
 Item 5. Other Information.
  
 Item 6. Exhibits.
  ExhibitNumber
    
    Description10.1
    
    Revolving Credit and Term Loan Agreement, dated November 30, 2007, among Medical Properties Trust, Inc., MPT
Operating Partnership, L.P., as Borrower, the Several Lenders from Time to Time Parties Thereto, KeyBank
National Association, as Syndication Agent, and JPMorgan Chase Bank, N.A. as Administrative Agent, with J.P.
Morgan Securities Inc. and KeyBank National Association, as Joint Lead Arrangers and Bookrunners31.1
    
    Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 193431.2
    
    Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 193432
    
    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 200299.1
    
    Consolidated Financial Statements of Prime Healthcare Services, Inc.
as of September 30, 2009. Since affiliates of Prime Healthcare
Services, Inc. lease more than 20% of our total assets under triple
net leases, the financial status of Prime may be considered relevant
to investors. Primes most recently available financial statements
(unaudited, as of and for the period ended September 30, 2009) are
attached as Exhibit 99.1 to this Quarterly Report on Form 10-Q. We
have not participated in the preparation of Primes financial
statements nor do we have the right to dictate the form of any
financial statements provided to us by Prime.
 19




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##### Table of Contents



SIGNATURE
  MEDICAL PROPERTIES TRUST, INC.By:
    /s/ R. Steven HamnerR. Steven HamnerExecutive Vice President and Chief Financial Officer(On behalf of the Registrant and as the Registrants Principal
Financial and Accounting Officer)  20




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##### Table of Contents



ExhibitNumber
    
    Description10.1
    
    Revolving Credit and Term Loan Agreement, dated November 30, 2007, among Medical Properties Trust, Inc., MPT
Operating Partnership, L.P., as Borrower, the Several Lenders from Time to Time Parties Thereto, KeyBank
National Association, as Syndication Agent, and JPMorgan Chase Bank, N.A. as Administrative Agent, with J.P.
Morgan Securities Inc. and KeyBank National Association, as Joint Lead Arrangers and Bookrunners31.1
    
    Certification of Chief Executive Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 193431.2
    
    Certification of Chief Financial Officer pursuant to Rule 13a-14(a) under the Securities Exchange Act of 193432
    
    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 200299.1
    
    Consolidated Financial Statements of Prime Healthcare Services, Inc. as of September 30, 2009. Since
affiliates of Prime Healthcare Services, Inc. lease more than 20% of our total assets under triple net
leases, the financial status of Prime may be considered relevant to investors. Primes most recently
available financial statements (unaudited, as of and for the period ended September 30, 2009) are attached
as exhibit 99.1 to this Quarterly Report on Form 10-Q. We have not participated in the preparation of
Primes financial statements nor do we have the right to dictate the form of any financial statements
provided to us by Prime.
 21