10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

(MARK ONE)

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

For the quarterly period ended March 31, 2017

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 1-9321

UNIVERSAL HEALTH REALTY INCOME TRUST

(Exact name of registrant as specified in its charter)

MARYLAND	23-6858580
(State or other jurisdiction of incorporation or organization)	(I. R. S. Employer Identification No.)
UNIVERSAL CORPORATE CENTER 367 SOUTH GULPH ROAD KING OF PRUSSIA, PENNSYLVANIA	19406
(Address of principal executive offices)	(Zip Code)

Registrant’s telephone number, including area code (610) 265-0688

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  ☒    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  ☒    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	☒	Accelerated Filer	☐
Non-accelerated filer	☐	Smaller reporting company	☐
		Emerging growth company	☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

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

Number of common shares of beneficial interest outstanding at April 30, 2017—13,600,075

UNIVERSAL HEALTH REALTY INCOME TRUST

INDEX

		PAGE NO.
PART I. FINANCIAL INFORMATION
Item 1.	Financial Statements
	Condensed Consolidated Statements of Income—Three Months Ended March 31, 2017 and 2016	3
	Condensed Consolidated Statements of Comprehensive Income—Three Months Ended March 31, 2017 and 2016	4
	Condensed Consolidated Balance Sheets—March 31, 2017 and December 31, 2016	5
	Condensed Consolidated Statements of Cash Flows—Three Months Ended March 31, 2017 and 2016	6
	Notes to Condensed Consolidated Financial Statements	7 through 16
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	17 through 26
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	27
Item 4.	Controls and Procedures	27
PART II. Other Information		28
Item 6.	Exhibits	28
Signatures		29
EXHIBIT INDEX		30

This Quarterly Report on Form 10-Q is for the quarter ended March 31, 2017. In this Quarterly Report, “we,” “us,” “our” and the “Trust” refer to Universal Health Realty Income Trust and its subsidiaries.

As disclosed in this Quarterly Report, including in Note 2 to the Condensed Consolidated Financial Statements—Relationship with Universal Health Services, Inc. (“UHS”) and Related Party Transactions, a wholly-owned subsidiary of UHS (UHS of Delaware, Inc.) serves as our Advisor pursuant to the terms of an annually renewable Advisory Agreement dated December 24, 1986. Our officers are all employees of UHS through its wholly-owned subsidiary, UHS of Delaware, Inc. In addition, three of our hospital facilities are leased to subsidiaries of UHS and seventeenmedical office buildings or free-standing emergency departments, that are either wholly or jointly-owned by us that include tenants which are subsidiaries of UHS. Any reference to “UHS” or “UHS facilities” in this report is referring to Universal Health Services, Inc.’s subsidiaries, including UHS of Delaware, Inc.

In this Quarterly Report, the term “revenues” does not include the revenues of the unconsolidated limited liability companies (“LLCs”) in which we have various non-controlling equity interests ranging from 33% to 95%. We currently account for our share of the income/loss from these investments by the equity method (see Note 5 to the Condensed Consolidated Financial Statements included herein).

Part I. Financial Information

Item I. Financial Statements

Universal Health Realty Income Trust

Condensed Consolidated Statements of Income

For the Three Months Ended March 31, 2017 and 2016

(amounts in thousands, except per share amounts)

(unaudited)

	Three Months Ended
	March 31,
	2017			2016
Revenues:
Base rental - UHS facilities	$	4,080		$	4,081
Base rental - Non-related parties		9,970			8,815
Bonus rental - UHS facilities		1,288			1,246
Tenant reimbursements and other - Non-related parties		2,193			1,873
Tenant reimbursements and other - UHS facilities		219			211
		17,750			16,226
Expenses:
Depreciation and amortization		6,145			5,436
Advisory fees to UHS		866			767
Other operating expenses		4,705			4,400
Transaction costs		70			82
		11,786			10,685
Income before equity in income of unconsolidated limited liability    companies ("LLCs"),  interest expense and gain		5,964			5,541
Equity in income of unconsolidated LLCs		1,077			1,059
Gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC, net		27,196			-
Interest expense, net		(2,675	)		(2,172	)
Net income	$	31,562		$	4,428
Basic earnings per share	$	2.32		$	0.33
Diluted earnings per share	$	2.32		$	0.33
Weighted average number of shares outstanding - Basic		13,580			13,307
Weighted average number of share equivalents		-			7
Weighted average number of shares and equivalents    outstanding - Diluted		13,580			13,314

See accompanying notes to these condensed consolidated financial statements.

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Universal Health Realty Income Trust

Condensed Consolidated Statements of Comprehensive Income

For the Three Months Ended March 31, 2017 and 2016

(dollar amounts in thousands)

(unaudited)

	Three Months Ended
	March 31,
	2017			2016
Net income	$	31,562		$	4,428
Other comprehensive (loss)/income:
Unrealized derivative (losses)/gains on interest rate caps		(18	)		21
Total other comprehensive (loss)/income:		(18	)		21
Total comprehensive income	$	31,544		$	4,449

See accompanying notes to these condensed consolidated financial statements.

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Universal Health Realty Income Trust

Condensed Consolidated Balance Sheets

(dollar amounts in thousands)

(unaudited)

	March 31,			December 31,
	2017			2016
Assets:
Real Estate Investments:
Buildings and improvements and construction in progress	$	536,356		$	534,190
Accumulated depreciation		(143,346	)		(138,588	)
		393,010			395,602
Land		51,645			51,638
Net Real Estate Investments		444,655			447,240
Investments in and advances to limited liability companies ("LLCs")		4,722			35,593
Other Assets:
Cash and cash equivalents		4,067			3,930
Restricted cash		11,253			-
Base and bonus rent receivable from UHS		2,558			2,321
Rent receivable - other		5,515			5,291
Intangible assets (net of accumulated amortization of $27.4 million and    $27.1 million at March 31, 2017 and December 31, 2016, respectively)		22,732			23,815
Deferred charges and other assets, net		6,877			6,560
Total Assets	$	502,379		$	524,750
Liabilities:
Line of credit borrowings	$	169,900		$	201,500
Mortgage notes payable, non-recourse to us, net		103,004			114,217
Accrued interest		563			626
Accrued expenses and other liabilities		9,423			11,809
Tenant reserves, deposits and prepaid rents		5,385			5,321
Total Liabilities		288,275			333,473
Equity:
Preferred shares of beneficial interest,    $.01 par value; 5,000,000 shares authorized;    none issued and outstanding		-			-
Common shares, $.01 par value;    95,000,000 shares authorized; issued and outstanding: 2017 - 13,600,036;    2016 - 13,599,055		136			136
Capital in excess of par value		255,846			255,656
Cumulative net income		604,063			572,501
Cumulative dividends		(646,028	)		(637,121	)
Accumulated other comprehensive income		87			105
Total Equity		214,104			191,277
Total Liabilities and Equity	$	502,379		$	524,750

See accompanying notes to these condensed consolidated financial statements.

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Universal Health Realty Income Trust

Condensed Consolidated Statement of Cash Flows

(dollar amounts in thousands)

(unaudited)

	Three months ended March 31,
	2017			2016
Cash flows from operating activities:
Net income	$	31,562		$	4,428
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization		6,167			5,458
Amortization of debt premium		(68	)		(56	)
Stock-based compensation expense		127			111
Gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC, net		(27,196	)		—
Changes in assets and liabilities:
Rent receivable		(461	)		(511	)
Accrued expenses and other liabilities		(230	)		(1,014	)
Tenant reserves, deposits and prepaid rents		64			574
Accrued interest		(63	)		34
Leasing costs paid		(250	)		(122	)
Other, net		(158	)		192
Net cash provided by operating activities		9,494			9,094
Cash flows from investing activities:
Investments in LLCs		(371	)		(5,386	)
Repayments of advances made to LLC		216			209
Cash distributions in excess of income from LLCs		557			147
Additions to real estate investments, net		(4,181	)		(1,841	)
Cash proceeds received from divestiture of property, net of restricted cash		53,967			—
Net cash paid for acquisition of properties		—			(9,910	)
Cash paid to acquire minority interests in majority-owned LLCs		(7,890	)		—
Net cash provided by/(used in) investing activities		42,298			(16,781	)
Cash flows from financing activities:
Net (repayments)/borrowings on line of credit		(31,600	)		17,500
Repayments of mortgage notes payable		(11,174	)		(790	)
Financing costs paid		(35	)		(35	)
Dividends paid		(8,907	)		(8,596	)
Issuance of shares of beneficial interest, net		61			30
Net cash (used in)/provided by financing activities		(51,655	)		8,109
Increase in cash and cash equivalents		137			422
Cash and cash equivalents, beginning of period		3,930			3,894
Cash and cash equivalents, end of period	$	4,067		$	4,316
Supplemental disclosures of cash flow information:
Interest paid	$	2,673		$	2,072

See accompanying notes to these condensed consolidated financial statements.

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UNIVERSAL HEALTH REALTY INCOME TRUST

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

March 31, 2017

(unaudited)

(1) General

This Quarterly Report on Form 10-Q is for the quarter ended March 31, 2017. In this Quarterly Report, “we,” “us,” “our” and the “Trust” refer to Universal Health Realty Income Trust and its subsidiaries.

In this Quarterly Report on Form 10-Q, the term “revenues” does not include the revenues of the unconsolidated LLCs in which we have various non-controlling equity interests ranging from 33% to 95%.  As of March 31, 2017, we had investments in four jointly-owned LLCs/LPs which own medical office buildings, all of which are accounted for by the equity method (see Note 5). These LLCs are included in our financial statements for all periods presented on an unconsolidated basis since they are not variable interest entities for which we are the primary beneficiary, nor do we hold a controlling voting interest.

The financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the SEC and reflect all normal and recurring adjustments which, in our opinion, are necessary to fairly present results for the interim periods. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. It is suggested that these financial statements be read in conjunction with the financial statements, the notes thereto and accounting policies included in our Annual Report on Form 10-K for the year ended December 31, 2016.

(2) Relationship with Universal Health Services, Inc. (“UHS”) and Related Party Transactions

Leases: We commenced operations in 1986 by purchasing properties of certain subsidiaries from UHS and immediately leasing the properties back to the respective subsidiaries. Most of the leases were entered into at the time we commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. The current base rentals and lease and rental terms for each of the three hospital facilities leased to subsidiaries of UHS are provided below. The base rents are paid monthly and each lease also provides for additional or bonus rents which are computed and paid on a quarterly basis based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The three hospital leases with subsidiaries of UHS are unconditionally guaranteed by UHS and are cross-defaulted with one another.

The combined revenues generated from the leases on the UHS hospital facilities accounted for approximately 23% and 25% of our consolidated revenues for the three months ended March 31, 2017 and 2016, respectively.  Including 100% of the revenues generated at the unconsolidated LLCs in which we have various non-controlling equity interests ranging from 33% to 95%, the leases on the UHS hospital facilities accounted for approximately 19% and 20% of the combined consolidated and unconsolidated revenue for the three months ended March 31, 2017 and 2016, respectively.  In addition, we have seventeen medical office buildings (“MOBs”), or free-standing emergency departments (“FEDs”), that are either wholly or jointly-owned by us, that include tenants which are subsidiaries of UHS.  

Pursuant to the Master Lease Document by and among us and certain subsidiaries of UHS, dated December 24, 1986 (the “Master Lease”), which governs the leases of all hospital properties with subsidiaries of UHS, UHS has the option to renew the leases at the lease terms described below by providing notice to us at least 90 days prior to the termination of the then current term. UHS also has the right to purchase the respective leased facilities at the end of the lease terms or any renewal terms at the appraised fair market value. In addition, the Master Lease, as amended during 2006, includes a change of control provision whereby UHS has the right, upon one month’s notice should a change of control of the Trust occur, to purchase any or all of the three leased hospital properties listed below at their appraised fair market value. Additionally, UHS has rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer.

In June, 2016, three wholly-owned subsidiaries of UHS provided the required notice to us, exercising the 5-year renewal options on the leases related to our acute care hospitals.  The renewals extended the lease terms on these facilities, at existing lease rates, to December, 2021.

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The table below details the existing lease terms and renewal options for our three acute care hospitals operated by wholly-owned subsidiaries of UHS:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2021		10	(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021		10	(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021		10	(b)

(a) UHS has two 5-year renewal options at existing lease rates (through 2031).

(b) UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

Management cannot predict whether the leases with subsidiaries of UHS, which have renewal options at existing lease rates or fair market value lease rates, or any of our other leases, will be renewed at the end of their lease term. If the leases are not renewed at their current rates or the fair market value lease rates, we would be required to find other operators for those facilities and/or enter into leases on terms potentially less favorable to us than the current leases. In addition, if subsidiaries of UHS exercise their options to purchase the respective leased hospital or FED facilities upon expiration of the lease terms, our future revenues could decrease if we were unable to earn a favorable rate of return on the sale proceeds received, as compared to the rental revenue currently earned pursuant to the these leases.  

In April, 2017, the recently constructed Henderson Medical Plaza MOB received its certificate of occupancy. Henderson Medical Plaza is located on the campus of the Henderson Hospital, a newly constructed, 130-bed acute care hospital that is owned and operated by a subsidiary of UHS and was completed and opened during the fourth quarter of 2016. We have invested $10.8 million on the development and construction of this MOB as of March 31, 2017.

Advisory Agreement:    UHS of Delaware, Inc. (the “Advisor”), a wholly-owned subsidiary of UHS, serves as Advisor to us under an Advisory Agreement (the “Advisory Agreement”) dated December 24, 1986. Pursuant to the Advisory Agreement, the Advisor is obligated to present an investment program to us, to use its best efforts to obtain investments suitable for such program (although it is not obligated to present any particular investment opportunity to us), to provide administrative services to us and to conduct our day-to-day affairs. All transactions between us and UHS must be approved by the Trustees who are unaffiliated with UHS (the “Independent Trustees”). In performing its services under the Advisory Agreement, the Advisor may utilize independent professional services, including accounting, legal, tax and other services, for which the Advisor is reimbursed directly by us. The Advisory Agreement may be terminated for any reason upon sixty days written notice by us or the Advisor. The Advisory Agreement expires on December 31 of each year; however, it is renewable by us, subject to a determination by the Independent Trustees, that the Advisor’s performance has been satisfactory. Our advisory fee is 0.70% of our average invested real estate assets, as derived from our consolidated balance sheet. In December of 2016, based upon a review of our advisory fee and other general and administrative expenses as compared to an industry peer group, the Advisory Agreement was renewed for 2017 pursuant to the same terms as the Advisory Agreement in place during 2016.

The average real estate assets for advisory fee calculation purposes exclude certain items from our consolidated balance sheet such as, among other things, accumulated depreciation, cash and cash equivalents, restricted cash, base and bonus rent receivables, deferred charges and other assets. The advisory fee is payable quarterly, subject to adjustment at year-end based upon our audited financial statements. In addition, the Advisor is entitled to an annual incentive fee equal to 20% of the amount by which cash available for distribution to shareholders for each year, as defined in the Advisory Agreement, exceeds 15% of our equity as shown on our consolidated balance sheet, determined in accordance with generally accepted accounting principles without reduction for return of capital dividends. The Advisory Agreement defines cash available for distribution to shareholders as net cash flow from operations less deductions for, among other things, amounts required to discharge our debt and liabilities and reserves for replacement and capital improvements to our properties and investments. No incentive fees were paid during the first three months of 2017 or 2016 since the incentive fee requirements were not achieved. Advisory fees incurred and paid (or payable) to UHS amounted to $866,000 and $767,000 for the three months ended March 31, 2017 and 2016, respectively, and were based upon average invested real estate assets of $495 million and $438 million for the three-month periods ended March 31, 2017 and 2016, respectively.  

Officers and Employees: Our officers are all employees of a wholly-owned subsidiary of UHS and although as of March 31, 2017 we had no salaried employees, our officers do typically receive annual stock-based compensation awards in the form of restricted stock. In special circumstances, if warranted and deemed appropriate by the Compensation Committee of the Board of Trustees, our officers may also receive one-time special compensation awards in the form of restricted stock and/or cash bonuses.

Share Ownership: As of March 31, 2017 and December 31, 2016, UHS owned 5.8% of our outstanding shares of beneficial interest.

8

SEC reporting requirements of UHS: UHS is subject to the reporting requirements of the SEC and is required to file annual reports containing audited financial information and quarterly reports containing unaudited financial information. Since the leases on the hospital facilities leased to wholly-owned subsidiaries of UHS comprised approximately 23% and 25% of our consolidated revenues during the three-month periods ended March 31, 2017 and 2016, respectively, and since a subsidiary of UHS is our Advisor, you are encouraged to obtain the publicly available filings for Universal Health Services, Inc. from the SEC’s website. These filings are the sole responsibility of UHS and are not incorporated by reference herein.

(3) Dividends and Equity Issuance Program

Dividends:

We declared and paid dividends of $8.9 million, or $.655 per share, during the first quarter of 2017 and $8.6 million, or $.645 per share, during the first quarter of 2016.  

Equity Issuance Program:

During the second quarter of 2016, we recommenced our at-the-market (“ATM”) equity issuance program, pursuant to the terms of which we may sell, from time-to-time, common shares of our beneficial interest up to an aggregate sales price of approximately $23.3 million to or through Merrill Lynch, Pierce, Fenner and Smith, Incorporated (“Merrill Lynch”), as sales agent and/or principal. The common shares were offered pursuant to the Registration Statement filed with the Securities and Exchange Commission, which became effective during the fourth quarter of 2015.

There were no shares issued pursuant to the ATM Program during the first quarter of 2017. Since inception of this ATM program, we have issued 829,916 shares at an average price of $48.77 per share, which generated approximately $38.8 million of net proceeds (net of approximately $1.7 million, consisting of compensation of $1.0 million to Merrill Lynch as well as $680,000 of other various fees and expenses).

(4) Acquisitions, Dispositions and New Construction

Three Months Ended March 31, 2017:

Acquisitions:

There were no acquisitions during the first three months of 2017.

Disposition:

During March, 2017, Arlington Medical Properties, LLC, a formerly jointly-owned limited liability company in which we held an 85% noncontrolling ownership interest, sold the real estate assets of St. Mary’s Professional Office Building (“St. Mary’s”) as part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code.  St. Mary’s is a multi-tenant medical office building located in Reno, Nevada.  A third party member owned the remaining 15% of Arlington Medical Properties LLC, which we acquired prior to the divestiture of St. Mary’s for a purchase price of $7.9 million.

In connection with the divestiture of St. Mary’s, we are entitled to an aggregate of approximately $57.3 million of net cash proceeds.  These proceeds, which are net of closing costs and the purchase price paid for the minority member’s ownership interest in the LLC, include repayment to us of a $21.4 million member loan previously extended to Arlington Medical Properties, LLC by us when we held an 85% noncontrolling ownership interest in the LLC. As of March 31, 2017, approximately $11.3 million of the net sale proceeds due to us are being held as restricted cash by a qualified 1031 exchange intermediary in connection with potential future acquisitions, as discussed below. Our results of operations for the three-month period ended March 31, 2017 include a net gain of $27.2 million (net of related transaction costs) recorded in connection with these transactions.  

Tax Deferred Like-Kind Exchange Transactions Under Section 1031 of the Internal Revenue Code:

As part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code, we have completed the divestiture of St. Mary’s Professional Office Building in March, 2017, as discussed above, and the two previously announced 2016 acquisitions, as outlined below. In addition, we may complete other potential 2017 acquisitions, as outlined below.

Acquisitions Previously Completed in 2016:

• 2704 North Tenaya Way, located in Las Vegas, Nevada.  This MOB was acquired in November, 2016 for a total purchase price of approximately $15.3 million, including the assumption of approximately $7.1 million of third-party debt that is non-recourse to us.

9

• Frederick Crestwood Medical Office Building, located in Frederick, Maryland.  This MOB was acquired in September, 2016 for a purchase price of approximately $24.3 million.

Both of these 2016 acquisitions were planned and executed in accordance with the provisions of Section 1031 of the Internal Revenue Code and therefore we believe they qualify as tax deferred like-kind exchange transactions in connection with the above-mentioned divestiture of St. Mary’s in March, 2017.

Other Potential 2017 Acquisitions:

• In addition to the above-mentioned 2016 acquisitions, we may purchase one or more additional properties during 2017, as part of the planned like-kind exchange transactions.  We can provide no assurance that we will complete one or more additional acquisitions during 2017.  Any additional acquisitions completed during 2017 would need to be finalized by mid-September in order to qualify as tax deferred like-kind exchange transactions under the provisions of Section 1031 of the Internal Revenue Code in connection with the divestiture of St. Mary’s.

New Construction:

During the first quarter of 2016, we committed to invest up to $21.1 million in the development and construction of the Henderson Medical Plaza, an MOB located on the campus of the Henderson Hospital Medical Center which is owned by a UHS subsidiary and opened in late October, 2016. The MOB was completed and opened during April, 2017. We have invested $10.8 million on the development and construction for this MOB as of March 31, 2017.

Three Months Ended March 31, 2016:

Acquisition:

In March, 2016, we purchased the Madison Professional Office Building located in Madison, Alabama for approximately $10.1 million. This multi-tenant property was fully occupied with an average remaining lease term of approximately 6.2 years at the time of acquisition.

The aggregate purchase price for this MOB was allocated to the assets acquired and liabilities assumed consisting of tangible property and identified intangible assets, based on the fair value estimated at acquisition as detailed in the table below. Substantially all of the intangible assets include the value of the in-place leases at the MOB at the time of acquisition which is being amortized over the average remaining lease term of approximately 6.2 years at the time of acquisition.

Land	$2,328
Buildings and improvements	6,523
Intangible assets	1,209
Deposit	(150)
Net cash paid	$9,910

Dispositions:  

There were no divestitures during the first three months of 2016.

(5) Summarized Financial Information of Equity Affiliates

In accordance with the Financial Accounting Standards Board’s (“FASB”) standards and guidance relating to accounting for investments and real estate ventures, we account for our unconsolidated investments in LLCs/LPs which we do not control using the equity method of accounting.  The third-party members in these investments have equal voting rights with regards to issues such as, but not limited to: (i) divestiture of property; (ii) annual budget approval, and; (iii) financing commitments. These investments, which represent 33% to 95% non-controlling ownership interests, are recorded initially at our cost and subsequently adjusted for our net equity in the net income, cash contributions to, and distributions from, the investments. Pursuant to certain agreements, allocations of sales proceeds and profits and losses of some of the LLC investments may be allocated disproportionately as compared to ownership interests after specified preferred return rate thresholds have been satisfied.

In the Consolidated Statements of Cash Flows, distributions and equity in net income are presented net as cash flows from operating activities.  Cumulative distributions received exceeding cumulative equity in earnings represent returns of investments and are classified as cash flows from investing activities in the Consolidated Statements of Cash Flows.

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At March 31, 2017, we have non-controlling equity investments or commitments in four jointly-owned LLCs/LPs which own MOBs. As of March 31, 2017, we accounted for these LLCs/LPs on an unconsolidated basis pursuant to the equity method since they are not variable interest entities and we do not have a controlling voting interest. The majority of these entities are joint-ventures between us and non-related parties that manage and hold minority ownership interests in the entities. Each entity is generally self-sustained from a cash flow perspective and generates sufficient cash flow to meet its operating cash flow requirements and service the third-party debt (if applicable) that is non-recourse to us. Although there is typically no ongoing financial support required from us to these entities since they are cash-flow sufficient, we may, from time to time, provide funding for certain purposes such as, but not limited to, significant capital expenditures, leasehold improvements and debt financing. Although we are not obligated to do so, if approved by us at our sole discretion, additional cash fundings are typically advanced as equity or member loans. These entities maintain property insurance on the properties.

During March, 2017, Arlington Medical Properties, LLC, a formerly jointly-owned limited liability company in which we held an 85% noncontrolling ownership interest, sold the real estate assets of St. Mary’s Professional Office Building (“St. Mary’s”) as part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code.  A third party member owned the remaining 15% of Arlington Medical Properties LLC, which we acquired prior to the divestiture of St. Mary’s.

The following property table represents the four LLCs in which we own a noncontrolling interest and were accounted for under the equity method as of March 31, 2017:

Name of LLC/LP	Ownership			Property Owned by LLC
Suburban Properties		33	%	St. Matthews Medical Plaza II
Brunswick Associates (a.)		74	%	Mid Coast Hospital MOB
Grayson Properties (b.)		95	%	Texoma Medical Plaza
FTX MOB Phase II (c.)		95	%	Forney Medical Plaza II

(a.) This LLC has a third-party term loan, which is non-recourse to us, of $8.6 million outstanding as of March 31, 2017.

(b.) This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LLC has a third-party term loan, which is non-recourse to us, of $14.4 million outstanding as of March 31, 2017.

(c.) We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2017.  This LLC has a third-party term loan, which is non-recourse to us, of $5.3 million outstanding as of March 31, 2017.

Below are the condensed combined statements of income (unaudited) for the LLCs accounted for under the equity method during the three months ended March 31, 2017 and 2016.  The three months ended March 31, 2017 include the financial results of Arlington Medical Properties, LLC, through the March 13, 2017 divestiture date.  The three months ended March 31, 2016, include the financial results of Arlington Medical Properties, LLC for the entire three months ended March 31, 2016.      

	Three Months Ended March 31,
	2017		2016
	(amounts in thousands)
Revenues	$	3,583	$	3,736
Operating expenses		1,250		1,353
Depreciation and amortization		643		613
Interest, net		562		657
Net income	$	1,128	$	1,113
Our share of net income (a.)	$	1,077	$	1,059

(a.) Our share of net income for the three months ended March 31, 2017 and 2016 includes approximately $284,000 and $296,000, respectively, of interest income earned by us on an advance made to Arlington Medical Properties, LLC. This advance was repaid to us effective with the previously mentioned Arlington Medical Properties, LLC transaction during March, 2017.

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Below are the condensed combined balance sheets (unaudited) for the four above-mentioned LLCs that were accounted for under the equity method as of March 31, 2017 and the five LLCs (including Arlington Medical Properties, LLC, which was divested during the first quarter of 2017) that were accounted for under the equity method as of December 31, 2016:

	March 31, 2017			December 31, 2016
	(amounts in thousands)
Net property, including CIP	$	33,816		$	60,970
Other assets		3,685			4,598
Total assets	$	37,501		$	65,568
Liabilities	$	2,726		$	3,334
Mortgage notes payable, non-recourse to us		28,222			28,367
Advances payable to us		-			21,638
Equity		6,553			12,229
Total liabilities and equity	$	37,501		$	65,568
Our share of equity in and advances to LLCs reflected as:
Investments in LLCs	$	4,722		$	13,955
Advances to LLCs		-			21,638
Investments in and advances to LLCs before
amounts included in accrued expenses and other liabilities		4,722			35,593
Amounts included in accrued expenses and other liabilities		(1,476	)		(1,862	)
Our share of equity in and advances to LLCs, net	$	3,246		$	33,731

As of March 31, 2017, and December 31, 2016, aggregate principal amounts due on mortgage notes payable by unconsolidated LLCs, which are accounted for under the equity method and are non-recourse to us, are as follows (amounts in thousands):

	Mortgage Loan Balance (a.)
Name of LLC/LP	3/31/2017		12/31/2016		Maturity Date
FTX MOB Phase II	$	5,267	$	5,301	August, 2017 (b.)
Grayson Properties		14,375		14,438	September, 2021
Brunswick Associates		8,580		8,628	December, 2024
	$	28,222	$	28,367

(a.) All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity.

(b.)   This loan is scheduled to mature within the next twelve months, at which time it will be refinanced pursuant to: (i) a new third-party mortgage loan; (ii) a member loan extended from us to the LLC, or; (iii) equity contributions to the LLC by us and the third-party member.  Funds required from us to the LLC for either the member loan or our share of an equity contribution would likely be borrowed under our Credit Agreement.

Pursuant to the operating and/or partnership agreements of the four LLCs/LPs in which we continue to hold non-controlling ownership interests, the third-party member and/or the Trust, at any time, potentially subject to certain conditions, have the right to make an offer (“Offering Member”) to the other member(s) (“Non-Offering Member”) in which it either agrees to: (i) sell the entire ownership interest of the Offering Member to the Non-Offering Member (“Offer to Sell”) at a price as determined by the Offering Member (“Transfer Price”), or; (ii) purchase the entire ownership interest of the Non-Offering Member (“Offer to Purchase”) at the equivalent proportionate Transfer Price. The Non-Offering Member has 60 to 90 days to either: (i) purchase the entire ownership interest of the Offering Member at the Transfer Price, or; (ii) sell its entire ownership interest to the Offering Member at the equivalent proportionate Transfer Price. The closing of the transfer must occur within 60 to 90 days of the acceptance by the Non-Offering Member.

(6) Recent Accounting Pronouncements

In August, 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-15, Classification of Certain Cash Receipts and Cash Payments, which adds or clarifies guidance of the classification of certain cash receipts and payments in the statement of cash flows with the intent to alleviate diversity in practice for classifying various types of cash flows.  This ASU is

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effective for annual and interim reporting periods beginning after December 15, 2017, with early adoption permitted.  We are currently evaluating the impact of this ASU on our statement of cash flows.

In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842), which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. ASU 2016-02 supersedes the previous leases standard, Leases (Topic 840). The standard is effective on January 1, 2019, with early adoption permitted. We are currently in the process of evaluating the impact the adoption of ASU 2016-02 will have on our financial position or results of operations.

In 2014, the FASB issued ASU 2014-09, Revenue From Contracts With Customers (“ASU 2014-09”), which outlines a comprehensive model for entities to use in accounting for revenue arising from contracts with customers. ASU 2014-09 states that “an entity recognizes revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services.” While ASU 2014-09 specifically references contracts with customers, it may apply to certain other transactions such as the sale of real estate or equipment. In 2015, the FASB provided for a one-year deferral of the effective date for ASU 2014-09, which is now effective for us beginning January 1, 2018. We are continuing to evaluate ASU 2014-09 (and related clarifying guidance issued by the FASB); however, we do not expect its adoption to have a significant impact on our consolidated financial statements, as a substantial portion of our revenue consists of rental income from leasing arrangements, which is specifically excluded from ASU 2014-09.

In January, 2017, the FASB issued ASU 2017-01, “Business Combinations (Topic 805) - Clarifying the Definition of a Business” to clarify the definition of a business in order to allow for the evaluation of whether transactions should be accounted for as acquisitions or disposals of assets or businesses. ASU 2017-01 will be effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years.  We expect that future property acquisitions will generally qualify as asset acquisitions under the standard, which permits the capitalization of acquisition costs to the underlying assets. We adopted this new guidance effective January 1, 2017. This new guidance is not expected to have a significant impact on our financial statements.

(7) Debt and Financial Instruments

Debt:

Management routinely monitors and analyzes the Trust’s capital structure in an effort to maintain the targeted balance among capital resources including the level of borrowings pursuant to our $250 million revolving credit facility, the level of borrowings pursuant to non-recourse mortgage debt secured by the real property of our properties and our level of equity including consideration of additional equity issuances pursuant to our ATM equity issuance program.  This ongoing analysis considers factors such as the current debt market and interest rate environment, the current/projected occupancy and financial performance of our properties, the current loan-to-value ratio of our properties, the Trust’s current stock price, the capital resources required for anticipated acquisitions and the expected capital to be generated by anticipated divestitures. This analysis, together with consideration of the Trust’s current balance of revolving credit facility borrowings, non-recourse mortgage borrowings and equity, assists management in deciding which capital resource to utilize when events such as refinancing of specific debt components occur or additional funds are required to finance the Trust’s growth.

On March 27, 2015, we entered into a $185 million revolving credit agreement (“Credit Agreement”) which was amended on May 24, 2016 to, among other things, increase the borrowing capacity to $250 million. The amended Credit Agreement, which is scheduled to mature in March, 2019, includes a $40 million sub limit for letters of credit and a $20 million sub limit for swingline/short-term loans. The Credit Agreement also provides a one-time option to extend the maturity date for an additional one year period, and an option to increase the total facility borrowing capacity up to an additional $50 million, subject to lender agreement. Borrowings under the Credit Agreement are guaranteed by certain subsidiaries of the Trust. In addition, borrowings under the Credit Agreement are secured by first priority security interests in and liens on all equity interests in the Trust’s wholly-owned subsidiaries. Borrowings made pursuant to the Credit Agreement will bear interest, at our option, at one, two, three, or six month LIBOR plus an applicable margin ranging from 1.50% to 2.00% or at the Base Rate plus an applicable margin ranging from 0.50% to 1.00%. The Credit Agreement defines “Base Rate” as the greatest of: (a) the administrative agent’s prime rate; (b) the federal funds effective rate plus 1/2 of 1%, and; (c) one month LIBOR plus 1%. A commitment fee of 0.20% to 0.40% (depending on our total leverage ratio) will be charged on the average unused portion of the revolving credit commitments. The margins over LIBOR, Base Rate and the commitment fee are based upon our

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ratio of debt to total capital. At March 31, 2017, the applicable margin over the LIBOR rate was 1.625%, the margin over the Base Rate was 0.625%, and the commitment fee was 0.25%.

At March 31, 2017, we had $169.9 million of outstanding borrowings and $2.7 million of letters of credit outstanding under our Credit Agreement. We had $77.4 million of available borrowing capacity, net of the outstanding borrowings and letters of credit outstanding as of March 31, 2017.  There are no compensating balance requirements.     

The Credit Agreement contains customary affirmative and negative covenants, including limitations on certain indebtedness, liens, acquisitions and other investments, fundamental changes, asset dispositions and dividends and other distributions. The Credit Agreement also contains restrictive covenants regarding the Trust’s ratio of total debt to total assets, the fixed charge coverage ratio, the ratio of total secured debt to total asset value, the ratio of total unsecured debt to total unencumbered asset value, and minimum tangible net worth, as well as customary events of default, the occurrence of which may trigger an acceleration of amounts outstanding under the Credit Agreement. We are in compliance with all of the covenants at March 31, 2017. We also believe that we would remain in compliance if the full amount of our commitment was borrowed.

The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands):

	Covenant		March 31, 2017
Tangible net worth	$	125,000	$	191,372
Total leverage	< 60%			44.3	%
Secured leverage	< 30%			16.1	%
Unencumbered leverage	< 60%			40.3	%
Fixed charge coverage	> 1.50x		3.6x

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As indicated on the following table, we have fourteen mortgages, all of which are non-recourse to us, included on our condensed consolidated balance sheet as of March 31, 2017, with a combined outstanding balance of $103.0 million, excluding net debt premium of $368,000 and net financing fees of $353,000 (amounts in thousands):

Facility Name	Outstanding Balance (inthousands)(a)			Interest Rate			Maturity Date
Peace Health fixed rate mortgage loan (c.)	$	20,180			5.64	%	April, 2017
Medical Center of Western Connecticut fixed rate    mortgage loan (d.)		4,500			6.00	%	June, 2017
Auburn Medical II floating rate mortgage loan (e.)		6,668			3.53	%	July, 2017
Summerlin Hospital Medical Office Building II fixed    rate mortgage loan (b.)		11,007			5.50	%	October, 2017
Phoenix Children’s East Valley Care Center fixed rate    mortgage loan (b.)		6,164			5.88	%	December, 2017
Centennial Hills Medical Office Building floating rate    mortgage loan (b.)		9,968			4.06	%	January, 2018
Sparks Medical Building/Vista Medical Terrace    floating rate mortgage loan (b.)		4,202			4.06	%	February, 2018
Rosenberg Children’s Medical Plaza fixed rate    mortgage loan		8,103			4.85	%	May, 2018
Vibra Hospital-Corpus Christi fixed rate mortgage loan		2,699			6.50	%	July, 2019
700 Shadow Lane and Goldring MOBs fixed rate    mortgage loan		6,201			4.54	%	June, 2022
BRB Medical Office Building fixed rate mortgage loan		6,269			4.27	%	December, 2022
Desert Valley Medical Center fixed rate mortgage loan		5,047			3.62	%	January, 2023
2704 North Tenaya Way fixed rate mortgage loan		7,105			4.95	%	November, 2023
Tuscan Professional Building fixed rate mortgage loan		4,876			5.56	%	June, 2025
Total, excluding net debt premium and net financing fees		102,989
Less net financing fees		(353	)
Plus net debt premium		368
Total mortgages notes payable, non-recourse to us, net	$	103,004

(a.) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

(b.) This loan is scheduled to mature within the next twelve months, at which time we will decide whether to refinance pursuant to a new mortgage loan or repaid utilizing borrowings under our Credit Agreement.

(c.) During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.

(d.)    Upon its June, 2017 maturity date, we intend to repay this loan utilizing borrowings under our Credit Agreement.

(e.)    The maturity date on this loan has been extended to July, 2017, at which time we intend to repay the loan utilizing borrowings under our Credit Agreement.

On March 31, 2017, upon its maturity, the $10.3 million floating rate mortgage loan on Summerlin Hospital Medical Office Building III was fully repaid.  In April, 2017, we refinanced this property with a $13.2 million, 4.03% fixed rate mortgage, which is non-recourse to us, which matures in April, 2024.

The mortgages are secured by the real property of the buildings as well as property leases and rents. The mortgages have a combined fair value of approximately $105 million as of March 31, 2017. Changes in market rates on our fixed rate debt impacts the fair value of debt, but it has no impact on interest incurred or cash flow.

At December 31, 2016, we had fifteen mortgages, all of which were non-recourse to us, included in our consolidated balance sheet. The combined outstanding balance of these fifteen mortgages was $114.2 million (excluding net debt premium of $436,000 and net financing fees of $381,000), and had a combined fair value of approximately $115.7 million.

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Financial Instruments:

During the third quarter of 2013, we entered into an interest rate cap on a total notional amount of $10 million whereby we paid a premium of $136,000. During the first quarter of 2014, we entered into two additional interest rate cap agreements on a total notional amount of $20 million whereby we paid premiums of $134,500. In exchange for the premium payments, the counterparties agreed to pay us the difference between 1.50% and one-month LIBOR if one-month LIBOR rises above 1.50% during the term of the cap. From inception through the January, 2017 expiration, no payments were made to us by the counterparties pursuant to the terms of these caps.  

During the second quarter of 2016, we entered into an interest rate cap on the total notional amount of $30 million whereby we paid a premium of $115,000.  In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.50% and one-month LIBOR if one-month LIBOR rises above 1.50% during the term of the cap.  This interest rate cap became effective in January, 2017, coinciding with the expiration of the above-mentioned interest rate caps and expires in March, 2019.  

During the third quarter of 2016, we entered into an additional interest rate cap agreement on a total notional amount of $30 million whereby we paid a premium of $55,000.  In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.5% and one-month LIBOR if one-month LIBOR rises above 1.5% during the term of the cap.  This interest rate cap became effective in October, 2016 and expires in March, 2019.

(8) Segment Reporting

Our primary business is investing in and leasing healthcare and human service facilities through direct ownership or through joint ventures, which aggregate into a single reportable segment. We actively manage our portfolio of healthcare and human service facilities and may from time to time make decisions to sell lower performing properties not meeting our long-term investment objectives. The proceeds of sales are typically reinvested in new developments or acquisitions, which we believe will meet our planned rate of return. It is our intent that all healthcare and human service facilities will be owned or developed for investment purposes. Our revenue and net income are generated from the operation of our investment portfolio.

Our portfolio is located throughout the United States, however, we do not distinguish or group our operations on a geographical basis for purposes of allocating resources or measuring performance. We review operating and financial data for each property on an individual basis; therefore, we define an operating segment as our individual properties. Individual properties have been aggregated into one reportable segment based upon their similarities with regard to both the nature and economics of the facilities, tenants and operational processes, as well as long-term average financial performance.

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

Overview

We are a real estate investment trust (“REIT”) that commenced operations in 1986. We invest in healthcare and human service related facilities currently including acute care hospitals, rehabilitation hospitals, sub-acute facilities, surgery centers, free-standing emergency departments, childcare centers and medical office buildings (“MOBs”). As of March 31, 2017, we have sixty-six real estate investments located in twenty states consisting of:

• six hospital facilities consisting of three acute care, one rehabilitation and two sub-acute;

• three free-standing emergency departments (“FEDs”);

• fifty-three medical/office buildings, including four owned by unconsolidated limited liability companies (“LLCs”)/limited liability partnerships (“LPs”), and;

• four pre-school and childcare centers.

Forward Looking Statements and Certain Risk Factors

You should carefully review all of the information contained in this Quarterly Report, and should particularly consider any risk factors that we set forth in this Quarterly Report and in other reports or documents that we file from time to time with the Securities and Exchange Commission (the “SEC”). In this Quarterly Report, we state our beliefs of future events and of our future financial performance. In some cases, you can identify those so-called “forward-looking statements” by words such as “may,” “will,” “should,” “could,” “would,” “predicts,” “potential,” “continue,” “expects,” “anticipates,” “future,” “intends,” “plans,” “believes,” “estimates,” “appears,” “projects” and similar expressions, as well as statements in future tense. You should be aware that those statements are only our predictions. Actual events or results may differ materially. In evaluating those statements, you should specifically consider various factors, including the risks outlined herein and in our Annual Report on Form 10-K for the year ended December 31, 2016 in Item 1A Risk Factors and in Item 7 Management’s Discussion and Analysis of Financial Condition and Results of Operations—Forward Looking Statements. Those factors may cause our actual results to differ materially from any of our forward-looking statements.

Forward-looking statements should not be read as a guarantee of future performance or results, and will not necessarily be accurate indications of the times at, or by which, such performance or results will be achieved. Forward-looking information is based on information available at the time and/or our good faith belief with respect to future events, and is subject to risks and uncertainties that could cause actual performance or results to differ materially from those expressed in the statements. Such factors include, among other things, the following:  

• a substantial portion of our revenues are dependent upon one operator, Universal Health Services, Inc. (“UHS”). We cannot assure you that subsidiaries of UHS will renew the leases on our three acute care hospitals (which are scheduled to expire in December, 2021) and two FEDs at existing lease rates or fair market value lease rates. In addition, if subsidiaries of UHS exercise their options to purchase the respective leased hospital facilities and FEDs upon expiration of the lease terms, our future revenues and results of operations could decrease if we were unable to earn a favorable rate of return on the sale proceeds received, as compared to the rental revenue currently earned pursuant to these leases;

• in certain of our markets, the general real estate market has been unfavorably impacted by increased competition/capacity and decreases in occupancy and rental rates which may adversely impact our operating results and the underlying value of our properties;

• a number of legislative initiatives have recently been passed into law that may result in major changes in the health care delivery system on a national or state level to the operators of our facilities, including UHS. No assurances can be given that the implementation of these new laws will not have a material adverse effect on the business, financial condition or results of operations of our operators;

• a subsidiary of UHS is our Advisor and our officers are all employees of a wholly-owned subsidiary of UHS, which may create the potential for conflicts of interest;

• lost revenues resulting from the exercise of purchase options, lease expirations and renewals, loan repayments and other restructuring;

• our ability to continue to obtain capital on acceptable terms, including borrowed funds, to fund future growth of our business;

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• the outcome of known and unknown litigation, government investigations, and liabilities and other claims asserted against us, UHS or the other operators of our facilities. UHS and its subsidiaries are subject to pending legal actions, purported shareholder class actions, governmental investigations and regulatory actions. Since UHS comprised approximately 31% and 33% of our consolidated revenues for the three-month period ended March 31, 2017 and the year ended December 31, 2016, respectively, and since a subsidiary of UHS is our Advisor, you are encouraged to obtain and review the disclosures contained in the Legal Proceedings section of Universal Health Services, Inc.’s Forms 10-K and 10-Q, as publicly filed with the Securities and Exchange Commission. Those filings are the sole responsibility of UHS and are not incorporated by reference herein;

• failure of UHS or the other operators of our hospital facilities to comply with governmental regulations related to the Medicare and Medicaid licensing and certification requirements could have a material adverse impact on our future revenues and the underlying value of the property;

• the potential unfavorable impact on our business of deterioration in national, regional and local economic and business conditions, including a worsening of credit and/or capital market conditions, which may adversely affect our ability to obtain capital which may be required to fund the future growth of our business and refinance existing debt with near term maturities;

• a deterioration in general economic conditions which could result in increases in the number of people unemployed and/or insured and likely increase the number of individuals without health insurance; as a result, the operators of our facilities may experience decreases in patient volumes which could result in decreased occupancy rates at our medical office buildings;

• a worsening of the economic and employment conditions in the United States could materially affect the business of our operators, including UHS, which may unfavorably impact our future bonus rentals (on the UHS hospital facilities) and may potentially have a negative impact on the future lease renewal terms and the underlying value of the hospital properties;

• real estate market factors, including without limitation, the supply and demand of office space and market rental rates, changes in interest rates as well as an increase in the development of medical office condominiums in certain markets;

• government regulations, including changes in the reimbursement levels under the Medicare and Medicaid programs;

• the issues facing the health care industry that affect the operators of our facilities, including UHS, such as: changes in, or the ability to comply with, existing laws and government regulations; unfavorable changes in the levels and terms of reimbursement by third party payors or government programs, including Medicare (including, but not limited to, the potential unfavorable impact of future reductions to Medicare reimbursements resulting from the Budget Control Act of 2011, as discussed below) and Medicaid (most states have reported significant budget deficits that have, in the past, resulted in the reduction of Medicaid funding to the operators of our facilities, including UHS); demographic changes; the ability to enter into managed care provider agreements on acceptable terms; an increase in uninsured and self-pay patients which unfavorably impacts the collectability of patient accounts; decreasing in-patient admission trends; technological and pharmaceutical improvements that may increase the cost of providing, or reduce the demand for, health care, and; the ability to attract and retain qualified medical personnel, including physicians;

• in August, 2011, the Budget Control Act of 2011 (the “2011 Act”) was enacted into law. The 2011 Act imposed annual spending limits for most federal agencies and programs aimed at reducing budget deficits by $917 billion between 2012 and 2021, according to a report released by the Congressional Budget Office. The 2011 Act provides for new spending on program integrity initiatives intended to reduce fraud and abuse under the Medicare program. Among its other provisions, the law established a bipartisan Congressional committee, known as the Joint Select Committee on Deficit Reduction (the “Joint Committee”), which was tasked with making recommendations aimed at reducing future federal budget deficits by an additional $1.5 trillion over 10 years. The Joint Committee was unable to reach an agreement by the November 23, 2011 deadline and, as a result, across-the-board cuts to discretionary, national defense and Medicare spending were implemented on March 1, 2013 resulting in Medicare payment reductions of up to 2% per fiscal year with a uniform percentage reduction across all Medicare programs. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, continued the 2% reductions to Medicare reimbursement imposed under the 2011 Act.  We cannot predict whether Congress will restructure the implemented Medicare payment reductions or what federal other deficit reduction initiatives may be proposed by Congress going forward. We also cannot predict the effect these enactments will have on operators (including UHS), and, thus, our business;

• in March, 2010, the Health Care and Education Reconciliation Act of 2010 and the Patient Protection and Affordable Care Act (the “ACA”) were enacted into law and created significant changes to health insurance coverage for U.S. citizens as well as material revisions to the federal Medicare and state Medicaid programs. The two combined primary goals of these acts are to provide for increased access to coverage for healthcare and to reduce healthcare-related expenses. Medicare,

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Medicaid and other health care industry changes are scheduled to be implemented at various times during this decade.  Initiatives to repeal the ACA, in whole or in part, to delay elements of implementation or funding, and to offer amendments or supplements to modify its provisions, have been persistent and may increase as a result of the 2016 election.  The ultimate outcomes of legislative attempts to repeal or amend the ACA and legal challenges to the ACA are unknown.  Results of recent Congressional elections and the change of Presidential administrations beginning in 2017 could create a political environment in which substantial portions of the ACA are repealed or revised. 

• The legislation featured provisions that would, in material part (i) eliminate the individual and large employer mandates to obtain or provide health insurance coverage, respectively; (ii) permit insurers to impose a surcharge up to 30 percent on individuals who go uninsured for more than two months and then purchase coverage; (iii) provide tax credits towards the purchase of health insurance, with a phase-out of tax credits according to income level; (iv) expand health savings accounts; (v) impose a per capita cap on federal funding of state Medicaid programs, or, if elected by a state, transition federal funding to a block grant; and (vi) permit states to seek a waiver of certain federal requirements that would allow such states to define essential health benefits differently from federal standards and that would allow certain commercial health plans to take health status, including pre-existing conditions, into account in setting premiums.. The legislation will proceed to the U.S. Senate and, if the provisions of the proposed legislation are ultimately implemented along with other proposed amendments to the ACA, there can be no assurance that any such legislation will not have a negative financial impact on our hospitals, which material effects may include a potential decrease in the market for health care services or a decrease in our hospitals’ ability to receive reimbursement for health care services provided.

• competition for our operators from other REITs;

• the operators of our facilities face competition from other health care providers, including physician owned facilities and other competing facilities, including certain facilities operated by UHS but the real property of which is not owned by us. Such competition is experienced in markets including, but not limited to, McAllen, Texas, the site of our McAllen Medical Center, a 370-bed acute care hospital, and Riverside County, California, the site of our Southwest Healthcare System-Inland Valley Campus, a 132-bed acute care hospital;

• changes in, or inadvertent violations of, tax laws and regulations and other factors than can affect REITs and our status as a REIT;

• should we be unable to comply with the strict income distribution requirements applicable to REITs, utilizing only cash generated by operating activities, we would be required to generate cash from other sources which could adversely affect our financial condition;

• our ownership interest in four LLCs/LPs in which we hold non-controlling equity interests. In addition, pursuant to the operating and/or partnership agreements of the four LLCs/LPs in which we continue to hold non-controlling ownership interests, the third-party member and the Trust, at any time, potentially subject to certain conditions, have the right to make an offer (“Offering Member”) to the other member(s) (“Non-Offering Member”) in which it either agrees to: (i) sell the entire ownership interest of the Offering Member to the Non-Offering Member (“Offer to Sell”) at a price as determined by the Offering Member (“Transfer Price”), or; (ii) purchase the entire ownership interest of the Non-Offering Member (“Offer to Purchase”) at the equivalent proportionate Transfer Price. The Non-Offering Member has 60 to 90 days to either: (i) purchase the entire ownership interest of the Offering Member at the Transfer Price, or; (ii) sell its entire ownership interest to the Offering Member at the equivalent proportionate Transfer Price. The closing of the transfer must occur within 60 to 90 days of the acceptance by the Non-Offering Member.

• fluctuations in the value of our common stock, and;

• other factors referenced herein or in our other filings with the Securities and Exchange Commission.

Given these uncertainties, risks and assumptions, you are cautioned not to place undue reliance on such forward-looking statements. Our actual results and financial condition, including the operating results of our lessees and the facilities leased to subsidiaries of UHS, could differ materially from those expressed in, or implied by, the forward-looking statements.

Forward-looking statements speak only as of the date the statements are made. We assume no obligation to publicly update any forward-looking statements to reflect actual results, changes in assumptions or changes in other factors affecting forward-looking information, except as may be required by law. All forward-looking statements attributable to us or persons acting on our behalf are expressly qualified in their entirety by this cautionary statement.

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Critical Accounting Policies and Estimates

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires us to make estimates and assumptions that affect the amounts reported in our consolidated financial statements and accompanying notes.  

We consider our critical accounting policies to be those that require us to make significant judgments and estimates when we prepare our financial statements, including the following:

Revenue Recognition:  Our revenues consist primarily of rentals received from tenants, which are comprised of minimum rent (base rentals), bonus rentals and reimbursements from tenants for their pro-rata share of expenses such as common area maintenance costs, real estate taxes and utilities.

The minimum rent for our six hospital facilities, which is paid monthly, is fixed over the term of the respective leases which are scheduled to expire in 2019 (2 hospitals) or 2021 (4 hospitals). In addition, for the three hospital facilities leased to subsidiaries of UHS, bonus rents are paid on a quarterly basis, based upon a computation that compares the hospitals’ current quarter net revenues to the corresponding quarter in the base year. Rental income recorded by our other properties, including our consolidated and unconsolidated MOBs, relating to leases in excess of one year in length, is recognized using the straight-line method under which contractual rents are recognized evenly over the lease term regardless of when payments are due. The amount of rental revenue resulting from straight-line rent adjustments is dependent on many factors including the nature and amount of any rental concessions granted to new tenants, stipulated rent increases under existing leases, as well as the acquisitions and sales of properties that have existing in-place leases with terms in excess of one year. As a result, the straight-line adjustments to rental revenue may vary from period-to-period. Tenant reimbursements for operating expenses are accrued as revenue in the same period the related expenses are incurred.

Real Estate Investments: Land, buildings and capital improvements are recorded at cost and stated at cost less accumulated depreciation.  Expenditures for maintenance and repairs are charged to operations as incurred.  Renovations or replacements, which improve or extend the life of an asset, are capitalized and depreciated over their estimated useful lives.

Purchase Accounting for Acquisition of Investments in Real Estate:Purchase accounting is applied to the assets and liabilities related to all real estate investments acquired from third parties. In accordance with current accounting guidance, the fair value of the real estate acquired is allocated to the acquired tangible assets, consisting primarily of land, building and tenant improvements, and identified intangible assets and liabilities, consisting of the value of above-market and below-market leases, and acquired ground leases, based in each case on their fair values. Loan premiums, in the case of above market rate loans, or loan discounts, in the case of below market loans, are recorded based on the fair value of any loans assumed in connection with acquiring the real estate.

The fair values of the tangible assets of an acquired property are determined based on comparable land sales for land and replacement costs adjusted for physical and market obsolescence for the improvements. The fair values of the tangible assets of an acquired property are also determined by valuing the property as if it were vacant, and the “as-if-vacant” value is then allocated to land, building and tenant improvements based on management’s determination of the relative fair values of these assets. Management determines the as-if-vacant fair value of a property based on assumptions that a market participant would use, which is similar to methods used by independent appraisers. In addition, there is intangible value related to having tenants leasing space in the purchased property, which is referred to as in-place lease value. Such value results primarily from the buyer of a leased property avoiding the costs associated with leasing the property and also avoiding rent losses and unreimbursed operating expenses during the hypothetical lease-up period. Factors considered by management in performing these analyses include an estimate of carrying costs during the expected lease-up periods considering current market conditions and costs to execute similar leases. In estimating carrying costs, management includes real estate taxes, insurance and other operating expenses and estimates of lost rental revenue during the expected lease-up periods based on current market demand. Management also estimates costs to execute similar leases including leasing commissions, tenant improvements, legal and other related costs. The value of in-place leases are amortized to expense over the remaining initial terms of the respective leases.

In allocating the fair value of the identified intangible assets and liabilities of an acquired property, above-market and below-market in-place lease values are recorded based on the present value (using an interest rate which reflects the risks associated with the leases acquired) of the difference between (i) the contractual amounts to be paid pursuant to the in-place leases and (ii) estimated fair market lease rates from the perspective of a market participant for the corresponding in-place leases, measured, for above-market leases, over a period equal to the remaining non-cancelable term of the lease and, for below-market leases, over a period equal to the initial term plus any below market fixed rate renewal periods. The capitalized above-market lease values are amortized as a reduction of rental

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income over the remaining non-cancelable terms of the respective leases. The capitalized below-market lease values, also referred to as acquired lease obligations, are amortized as an increase to rental income over the initial terms of the respective leases.

Asset Impairment:We review each of our properties for indicators that its carrying amount may not be recoverable. Examples of such indicators may include a significant decrease in the market price of the property, a change in the expected holding period for the property, a significant adverse change in how the property is being used or expected to be used based on the underwriting at the time of acquisition, an accumulation of costs significantly in excess of the amount originally expected for the acquisition or development of the property, or a history of operating or cash flow losses of the property. When such impairment indicators exist, we review an estimate of the future undiscounted net cash flows (excluding interest charges) expected to result from the real estate investment’s use and eventual disposition and compare that estimate to the carrying value of the property. We consider factors such as future operating income, trends and prospects, as well as the effects of leasing demand, competition and other factors. If our future undiscounted net cash flow evaluation indicates that we are unable to recover the carrying value of a real estate investment, an impairment loss is recorded to the extent that the carrying value exceeds the estimated fair value of the property. These losses have a direct impact on our net income because recording an impairment loss results in an immediate negative adjustment to net income. The evaluation of anticipated cash flows is highly subjective and is based in part on assumptions regarding future occupancy, rental rates and capital requirements that could differ materially from actual results in future periods. Since cash flows on properties considered to be long-lived assets to be held and used are considered on an undiscounted basis to determine whether the carrying value of a property is recoverable, our strategy of holding properties over the long-term directly decreases the likelihood of their carrying values not being recoverable and therefore requiring the recording of an impairment loss. If our strategy changes or market conditions otherwise dictate an earlier sale date, an impairment loss may be recognized and such loss could be material. If we determine that the asset fails the recoverability test, the affected assets must be reduced to their fair value.

We generally estimate the fair value of rental properties utilizing a discounted cash flow analysis that includes projections of future revenues, expenses and capital improvement costs that a market participant would use based on the highest and best use of the asset, which is similar to the income approach that is commonly utilized by appraisers. In certain cases, we may supplement this analysis by obtaining outside broker opinions of value or third party appraisals.

In considering whether to classify a property as held for sale, we consider factors such as whether management has committed to a plan to sell the property, the property is available for immediate sale in its present condition for a price that is reasonable in relation to its current value, the sale of the property is probable, and actions required for management to complete the plan indicate that it is unlikely that any significant changes will made to the plan.  If all the criteria are met, we classify the property as held for sale.  Upon being classified as held for sale, depreciation and amortization related to the property ceases and it is recorded at the lower of its carrying amount or fair value less cost to sell. The assets and related liabilities of the property are classified separately on the consolidated balance sheets for the most recent reporting period. Only those assets held for sale that constitute a strategic shift or that will have a major effect on our operations are classified as discontinued operations. 

An other than temporary impairment of an investment in an LLC is recognized when the carrying value of the investment is not considered recoverable based on evaluation of the severity and duration of the decline in value, including projected declines in cash flow. To the extent impairment has occurred, the excess carrying value of the asset over its estimated fair value is charged to income.

Federal Income Taxes:    No provision has been made for federal income tax purposes since we qualify as a REIT under Sections 856 to 860 of the Internal Revenue Code of 1986, and intend to continue to remain so qualified. As such, we are exempt from federal income taxes and we are required to distribute at least 90% of our real estate investment taxable income to our shareholders.

We are subject to a federal excise tax computed on a calendar year basis. The excise tax equals 4% of the amount by which 85% of our ordinary income plus 95% of any capital gain income for the calendar year exceeds cash distributions during the calendar year, as defined. No provision for excise tax has been reflected in the financial statements as no tax was due.

Earnings and profits, which determine the taxability of dividends to shareholders, will differ from net income reported for financial reporting purposes due to the differences for federal tax purposes in the cost basis of assets and in the estimated useful lives used to compute depreciation and the recording of provision for investment losses.

Results of Operations

During the three-month period ended March 31, 2017, net income increased to $31.6 million, as compared to $4.4 million during the first quarter of 2016.  The $27.1 million increase in net income during the first quarter of 2017, as compared to the comparable prior year quarter, was primarily attributable to:

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• a $27.2 million increase due to the gain on fair value recognition resulting from the purchase of minority interest in a majority-owned LLC and subsequent divestiture of the St. Mary’s Professional Office Building recorded during the first three months of 2017 (in connection with the March, 2017 Arlington Medical Properties, LLC transaction, as discussed herein);

• a $503,000 decrease due to increased interest expense due, in part, to the borrowings utilized to finance various 2016 acquisitions, as well as an increase in our average cost of funds, and;

• $441,000 of other combined net increases due to the increased net income generated at various properties, including the properties acquired during 2016.

Included in our other operating expenses are expenses related to the consolidated medical office buildings, which totaled $4.1 million and $3.9 million for the three-month periods ended March 31, 2017 and 2016, respectively.   A large portion of the expenses associated with our consolidated medical office buildings is passed on directly to the tenants either directly as tenant reimbursements of common area maintenance expenses or included in base rental amounts. Tenant reimbursements for operating expenses are accrued as revenue in the same period the related expenses are incurred and are included as tenant reimbursement revenue in our condensed consolidated statements of income.

Funds from operations (“FFO”) is a widely recognized measure of performance for REITs. We believe that FFO and FFO per diluted share, which are non-GAAP financial measures (“GAAP” is Generally Accepted Accounting Principles in the United States of America), are helpful to our investors as measures of our operating performance. We compute FFO, as reflected below, in accordance with standards established by the National Association of Real Estate Investment Trusts (“NAREIT”), which may not be comparable to FFO reported by other REITs that do not compute FFO in accordance with the NAREIT definition, or that interpret the NAREIT definition differently than we interpret the definition. FFO do not represent cash generated from operating activities in accordance with GAAP and should not be considered to be an alternative to net income determined in accordance with GAAP. In addition, FFO should not be used as: (i) an indication of our financial performance determined in accordance with GAAP; (ii) an alternative to cash flow from operating activities determined in accordance with GAAP; (iii) a measure of our liquidity, or; (iv) an indicator of funds available for our cash needs, including our ability to make cash distributions to shareholders.

Below is a reconciliation of our reported net income to FFO for the three-month periods ended March 31, 2017 and 2016 (in thousands):

	Three Months Ended March 31,
	2017			2016
Net income	$	31,562		$	4,428
Depreciation and amortization expense on consolidated    investments		6,022			5,333
Depreciation and amortization expense on unconsolidated    affiliates		426			450
Gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC, net		(27,196	)		-
Funds From Operations	$	10,814		$	10,211
Weighted average number of shares and equivalents    outstanding - Diluted		13,580			13,314
Funds From Operations per diluted share	$	0.80		$	0.77

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Our FFO increasedto $10.8 million during the three-month period ended March 31, 2017, as compared to $10.2 million during the comparable quarter of 2016.The $603,000 increase in FFO during the first quarter of 2017, as compared to the first quarter of 2016, was primarily attributable to a net increase in the income (beforedepreciation and amortization expense) generated our properties, including the properties acquired at various times during 2016.  

Liquidity and Capital Resources

Net cash provided by operating activities

Net cash provided by operating activities was $9.5 million during the three-month period ended March 31, 2017 as compared to $9.1 million during the comparable period of 2016. The $400,000 net increase was attributable to:

• a favorable change of $651,000 due to an increase in net income plus/minus the adjustments to reconcile net income to net cash provided by operating activities (depreciation and amortization, amortization of debt premium, stock-based compensation and gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC), as discussed above in Results of Operations;

• a favorable change of $784,000 in accrued expenses and other liabilities resulting primarily from the timing of payments of accrued liabilities;

• an unfavorable change of $510,000 in tenant reserves, deposits and prepaid rents resulting primarily from the timing of prepaid rents, and;

• other combined net unfavorable changes of $525,000.

Net cash provided by/(used in) investing activities

Net cash provided by investing activities was $42.3 million during the three months ended March 31, 2017 as compared to $16.8 million of net cash used in investing activities during the three months ended March 31, 2016.

During the three-month period ended March 31, 2017, we funded: (i) $371,000 in equity investments in various unconsolidated LLCs; (ii) $4.2 million in capital additions to real estate investments primarily related construction in progress costs for the Henderson Medical Plaza MOB, as discussed above (this MOB opened in April, 2017), as well as tenant improvements at various MOBs, and; (iii) $7.9 million paid to acquire the minority interest in a majority-owned LLC (Arlington Medical Properties, LLC). In addition, during the three-month period ended March 31, 2017, we received: (i) $54.0 million of net cash proceeds received in connection with the divestiture of St. Mary’s Professional Office Building, as discussed herein (net of closing costs and $11.3 million of restricted cash held by a qualified 1031 exchange intermediary for potential future acquisitions); (ii) $216,000 of installment repayments of member loan advanced to an LLC, and; (iii) $557,000 of cash distributions in excess of income received from our unconsolidated LLCs. The $54.0 million of net cash proceeds received in connection with the divestiture of St. Mary’s Professional Office Building includes repayment of $21.4 million previously extended member loan that was provided by us to Arlington Medical Properties, LLC when we held an 85% noncontrolling ownership interest in the LLC.

During the three-month period ended March 31, 2016, we funded: (i) $5.4 million in equity investments in various unconsolidated LLCs, including $4.8 million to purchase an additional 10% equity interest in the Arlington Medical Properties, LLC; (ii) $1.8 million in capital additions to real estate investments primarily related to tenant improvements at various MOBs, and; (iii) $9.9 million to acquire the real estate assets of a medical office building, as discussed above.  In addition, during the three-month period ended March 31, 2016, we received: (i) $209,000 as an installment repayment of an outstanding member loan advanced to an unconsolidated LLC, and; (ii) $147,000 of cash distributions in excess of income received from our unconsolidated LLCs.

Net cash (used in)/provided by financing activities

Net cash used in financing activities was $51.7 million during the three months ended March 31, 2017, as compared to $8.1 million of net cash provided by financing activities during the three months ended March 31, 2016.

During the three-month period ended March 31, 2017, we paid: (i) $31.6 million of net borrowings on our revolving line of credit; (ii) $11.2 million on mortgages and other notes payable that are non-recourse to us, including the repayment of a $10.3 million mortgage which was refinanced during April, 2017; (iii) $35,000 of financing costs related to the revolving credit facility, and; (iv) $8.9 million of dividends. Additionally, during the three months ended March 31, 2017, we received $61,000 of net cash from the issuance of shares of beneficial interest.

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During the three-month period ended March 31, 2016, we received $17.5 million of additional net borrowings on our revolving line of credit. Additionally, during the three months ended March 31, 2016, we paid: (i) $790,000 on mortgages and other notes payable that are non-recourse to us; (ii) $35,000 of financing costs related to the revolving credit facility, and; (iii) $8.6 million of dividends.

Additional cash flow and dividends paid information for the three-month periods ended March 31, 2017 and 2016:

As indicated on our condensed consolidated statement of cash flows, we generated net cash provided by operating activities of $9.5 million and $9.1 million during the three-month periods ended March 31, 2017 and 2016, respectively. As also indicated on our statement of cash flows, noncash expenses including depreciation and amortization expense, amortization of debt premium, stock-based compensation expense and the gain recorded during the first three months of 2017 are the primary differences between our net income and net cash provided by operating activities during each period. In addition, as reflected in the cash flows from investing activities section, we received $557,000 and $147,000 during the three- month periods ended March 31, 2017 and 2016, respectively, of cash distributions in excess of income from various unconsolidated LLCs which represents our share of the net cash flow distributions from these entities. The cash distributions in excess of income represent operating cash flows net of capital expenditures and debt repayments made by the LLCs.

We therefore generated $10.1 million and $9.2 million of net cash during the three months ended March 31, 2017 and 2016, respectively, related to the operating activities of our properties recorded on a consolidated and an unconsolidated basis. We paid dividends of $8.9 million and $8.6 million during the three months ended March 31, 2017 and 2016, respectively. During the first three months of 2017, the $10.1 million of net cash generated related to the operating activities of our properties was approximately $1.1 million greater than the $8.9 million of dividends paid during the first quarter of 2017. During the first three months of 2016, the $9.2 million of net cash generated related to the operating activities of our properties was $645,000 greater than the $8.6 million of dividends paid during the first quarter of 2016.

As indicated in the cash flows from investing activities and cash flows from financing activities sections of the statements of cash flows, there were various other sources and uses of cash during the three months ended March 31, 2017 and 2016.  From time to time, various other sources and uses of cash may include items such as investments and advances made to/from LLCs, additions to real estate investments, acquisitions/divestiture of properties, net borrowings/repayments of debt, and proceeds generated from the issuance of equity.  Therefore, in any given period, the funding source for our dividend payments is not wholly dependent on the operating cash flow generated by our properties. Rather, our dividends as well as our capital reinvestments into our existing properties, acquisitions of real property and other investments are funded based upon the aggregate net cash inflows or outflows from all sources and uses of cash from the properties we own either in whole or through LLCs, as outlined above.

In determining and monitoring our dividend level on a quarterly basis, our management and Board of Trustees consider many factors in determining the amount of dividends to be paid each period. These considerations primarily include: (i) the minimum required amount of dividends to be paid in order to maintain our REIT status; (ii) the current and projected operating results of our properties, including those owned in LLCs, and; (iii) our future capital commitments and debt repayments, including those of our LLCs. Based upon the information discussed above, as well as consideration of projections and forecasts of our future operating cash flows, management and the Board of Trustees have determined that our operating cash flows have been sufficient to fund our dividend payments. Future dividend levels will be determined based upon the factors outlined above with consideration given to our projected future results of operations.

We expect to finance all capital expenditures and acquisitions and pay dividends utilizing internally generated and additional funds. Additional funds may be obtained through: (i) borrowings under our existing $250 million revolving credit facility agreement (which has $77.4 million of available borrowing capacity, net of outstanding borrowings and letters of credit, as of March 31, 2017); (ii) the issuance of equity pursuant to our at-the-market equity issuance program; (iii) borrowings under or refinancing of existing third-party debt pursuant to mortgage loan agreements entered into by our consolidated and unconsolidated LLCs/LPs, and/or; (iv) the issuance of other long-term debt.

We believe that our operating cash flows, cash and cash equivalents, available borrowing capacity under our revolving credit facility and access to the capital markets provide us with sufficient capital resources to fund our operating, investing and financing requirements for the next twelve months, including providing sufficient capital to allow us to make distributions necessary to enable us to continue to qualify as a REIT under Sections 856 to 860 of the Internal Revenue Code of 1986. In the event we need to access the capital markets or other sources of financing, there can be no assurance that we will be able to obtain financing on acceptable terms or within an acceptable time. Our inability to obtain financing on terms acceptable to us could have a material unfavorable impact on our results of operations, financial condition and liquidity.

Credit facilities and mortgage debt

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Management routinely monitors and analyzes the Trust’s capital structure in an effort to maintain the targeted balance among capital resources including the level of borrowings pursuant to our $250 million revolving credit facility, the level of borrowings pursuant to non-recourse mortgage debt secured by the real property of our properties and our level of equity including consideration of additional equity issuances pursuant to our ATM equity issuance program.  This ongoing analysis considers factors such as the current debt market and interest rate environment, the current/projected occupancy and financial performance of our properties, the current loan-to-value ratio of our properties, the Trust’s current stock price, the capital resources required for anticipated acquisitions and the expected capital to be generated by anticipated divestitures. This analysis, together with consideration of the Trust’s current balance of revolving credit facility borrowings, non-recourse mortgage borrowings and equity, assists management in deciding which capital resource to utilize when events such as refinancing of specific debt components occur or additional funds are required to finance the Trust’s growth.

On March 27, 2015, we entered into a $185 million revolving credit agreement (“Credit Agreement”) which was amended on May 24, 2016 to, among other things, increase the borrowing capacity to $250 million. The amended Credit Agreement, which is scheduled to mature in March, 2019, includes a $40 million sub limit for letters of credit and a $20 million sub limit for swingline/short-term loans. The Credit Agreement also provides a one-time option to extend the maturity date for an additional one year period, and an option to increase the total facility borrowing capacity up to an additional $50 million, subject to lender agreement. Borrowings under the Credit Agreement are guaranteed by certain subsidiaries of the Trust. In addition, borrowings under the Credit Agreement are secured by first priority security interests in and liens on all equity interests in the Trust’s wholly-owned subsidiaries. Borrowings made pursuant to the Credit Agreement will bear interest, at our option, at one, two, three, or six month LIBOR plus an applicable margin ranging from 1.50% to 2.00% or at the Base Rate plus an applicable margin ranging from 0.50% to 1.00%. The Credit Agreement defines “Base Rate” as the greatest of: (a) the administrative agent’s prime rate; (b) the federal funds effective rate plus 1/2 of 1%, and; (c) one month LIBOR plus 1%. A commitment fee of 0.20% to 0.40% (depending on our total leverage ratio) will be charged on the average unused portion of the revolving credit commitments. The margins over LIBOR, Base Rate and the commitment fee are based upon our ratio of debt to total capital. At March 31, 2017, the applicable margin over the LIBOR rate was 1.625%, the margin over the Base Rate was 0.625%, and the commitment fee was 0.25%.

At March 31, 2017, we had $169.9 million of outstanding borrowings and $2.7 million of letters of credit outstanding under our Credit Agreement. We had $77.4 million of available borrowing capacity, net of the outstanding borrowings and letters of credit outstanding as of March 31, 2017.  There are no compensating balance requirements.     

The Credit Agreement contains customary affirmative and negative covenants, including limitations on certain indebtedness, liens, acquisitions and other investments, fundamental changes, asset dispositions and dividends and other distributions. The Credit Agreement also contains restrictive covenants regarding the Trust’s ratio of total debt to total assets, the fixed charge coverage ratio, the ratio of total secured debt to total asset value, the ratio of total unsecured debt to total unencumbered asset value, and minimum tangible net worth, as well as customary events of default, the occurrence of which may trigger an acceleration of amounts outstanding under the Credit Agreement. We are in compliance with all of the covenants at March 31, 2017. We also believe that we would remain in compliance if the full amount of our commitment was borrowed.

The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands): 

	Covenant		March 31, 2017
Tangible net worth	$	125,000	$	191,372
Total leverage	< 60%			44.3	%
Secured leverage	< 30%			16.1	%
Unencumbered leverage	< 60%			40.3	%
Fixed charge coverage	> 1.50x		3.6x

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As indicated on the following table, we have fourteen mortgages, all of which are non-recourse to us, included on our condensed consolidated balance sheet as of March 31, 2017, with a combined outstanding balance of $103.0 million, excluding net debt premium of $368,000 and net financing fees of $353,000 (amounts in thousands):

Facility Name	Outstanding Balance (inthousands)(a)			Interest Rate			Maturity Date
Peace Health fixed rate mortgage loan (c.)	$	20,180			5.64	%	April, 2017
Medical Center of Western Connecticut fixed rate    mortgage loan (d.)		4,500			6.00	%	June, 2017
Auburn Medical II floating rate mortgage loan (e.)		6,668			3.53	%	July, 2017
Summerlin Hospital Medical Office Building II fixed    rate mortgage loan (b.)		11,007			5.50	%	October, 2017
Phoenix Children’s East Valley Care Center fixed rate    mortgage loan (b.)		6,164			5.88	%	December, 2017
Centennial Hills Medical Office Building floating rate    mortgage loan (b.)		9,968			4.06	%	January, 2018
Sparks Medical Building/Vista Medical Terrace    floating rate mortgage loan (b.)		4,202			4.06	%	February, 2018
Rosenberg Children’s Medical Plaza fixed rate    mortgage loan		8,103			4.85	%	May, 2018
Vibra Hospital-Corpus Christi fixed rate mortgage loan		2,699			6.50	%	July, 2019
700 Shadow Lane and Goldring MOBs fixed rate    mortgage loan		6,201			4.54	%	June, 2022
BRB Medical Office Building fixed rate mortgage loan		6,269			4.27	%	December, 2022
Desert Valley Medical Center fixed rate mortgage loan		5,047			3.62	%	January, 2023
2704 North Tenaya Way fixed rate mortgage loan		7,105			4.95	%	November, 2023
Tuscan Professional Building fixed rate mortgage loan		4,876			5.56	%	June, 2025
Total, excluding net debt premium and net financing fees		102,989
Less net financing fees		(353	)
Plus net debt premium		368
Total mortgages notes payable, non-recourse to us, net	$	103,004

(a.) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

(b.) This loan is scheduled to mature within the next twelve months, at which time we will decide whether to refinance pursuant to a new mortgage loan or paid utilizing borrowings under our Credit Agreement.

(c.) During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.  

(d.)    Upon its maturity in June, 2017, we intend to repay this loan utilizing borrowings under our Credit Agreement.

(e.)    The maturity date on this loan has been extended to July, 2017, at which time we intend to repay this loan utilizing borrowings under our Credit Agreement.

On March 31, 2017, upon its maturity, the $10.3 million floating rate mortgage loan on Summerlin Hospital Medical Office Building III was fully repaid.  In April, 2017, we refinanced this property with a $13.2 million, 4.03% fixed rate mortgage, which is non-recourse to us, which matures in April, 2024.

 Off Balance Sheet Arrangements

As of March 31, 2017, we are party to certain off balance sheet arrangements consisting of standby letters of credit and equity and debt financing commitments. Our outstanding letters of credit at March 31, 2017 totaled $2.7 million consisting of: (i) $1.7 million related to Centennial Hills Medical Properties; (ii) $375,000 related to FTX MOB Phase II, LP, and; (iii) $650,000 related to Banburry Medical Properties.

Acquisition and Divestiture Activity

Please see Note 4 to the condensed consolidated financial statements for completed transactions.

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Item 3. Quantitative and Qualitative Disclosures About Market Risk

Reference is made to Item 7A in our Annual Report on Form 10-K for the year ended December 31, 2016. There have been no material changes in the quantitative and qualitative disclosures during the first three months of 2017.

Item 4. Controls and Procedures

As of March 31, 2017, under the supervision and with the participation of our management, including the Trust’s Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”), we performed an evaluation of the effectiveness of our disclosure controls and procedures as defined in Rule 13a-15(e) or Rule 15d-15(e) under the Securities Exchange Act of 1934, as amended (the “1934 Act”).

Based on this evaluation, the CEO and CFO have concluded that our disclosure controls and procedures are effective to ensure that material information is recorded, processed, summarized and reported by management on a timely basis in order to comply with our disclosure obligations under the 1934 Act and the SEC rules thereunder.

There have been no changes in our internal control over financial reporting or in other factors during the first three months of 2017 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II. OTHER INFORMATION

UNIVERSAL HEALTH REALTY INCOME TRUST

Item 1A. Risk Factors

Our Annual Report on Form 10-K for the year ended December 31, 2016 includes a listing of risk factors to be considered by investors in our securities. There have been no material changes in our risk factors from those set forth in our Annual Report on Form 10-K for the year ended December 31, 2016.

Item 6. Exhibits

(a.) Exhibits:

31.1	Certification of the Chief Executive Officer pursuant to Rule 13a-14(a)/15(d)-14(a) under the Securities Exchange Act of 1934, as amended.
31.2	Certification of the Chief Financial Officer pursuant to Rule 13a-14(a)/15(d)-14(a) under the Securities Exchange Act of 1934, as amended.
32.1	Certification of the Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2	Certification of the Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS	XBRL Instance Document
101.SCH	XBRL Taxonomy Extension Schema Document
101.CAL	XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF	XBRL Taxonomy Extension Definition Linkbase Document
101.LAB	XBRL Taxonomy Extension Label Linkbase Document
101.PRE	XBRL Taxonomy Extension Presentation Linkbase Document

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Signatures

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.

Date: May 8, 2017	UNIVERSAL HEALTH REALTY INCOME TRUST (Registrant)
	/s/ Alan B. Miller
	Alan B. Miller,
	Chairman of the Board, President and Chief Executive Officer (Principal Executive Officer)
	/s/ Charles F. Boyle
	Charles F. Boyle, Vice President and Chief Financial Officer (Principal Financial Officer)

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EXHIBIT INDEX

Exhibit No.	Description
31.1	Certification of the Chief Executive Officer pursuant to Rule 13a-14(a)/15(d)-14(a) under the Securities Exchange Act of 1934, as amended.
31.2	Certification of the Chief Financial Officer pursuant to Rule 13a-14(a)/15(d)-14(a) under the Securities Exchange Act of 1934, as amended.
32.1	Certification of the Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
32.2	Certification of the Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS	XBRL Instance Document
101.SCH	XBRL Taxonomy Extension Schema Document
101.CAL	XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF	XBRL Taxonomy Extension Definition Linkbase Document
101.LAB	XBRL Taxonomy Extension Label Linkbase Document
101.PRE	XBRL Taxonomy Extension Presentation Linkbase Document

30

EX-31.1

Exhibit 31.1

CERTIFICATION—Chief Executive Officer

I, Alan B. Miller, certify that:

1. I have reviewed this quarterly report on Form 10-Q of Universal Health Realty Income Trust;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 8, 2017

/s/ Alan B. Miller 

President and Chief Executive Officer

EX-31.2

Exhibit 31.2

CERTIFICATION—Chief Financial Officer

I, Charles F. Boyle, certify that:

1. I have reviewed this quarterly report on Form 10-Q of Universal Health Realty Income Trust;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 8, 2017

/s/ Charles F. Boyle

Vice President and Chief Financial Officer

EX-32.1

Exhibit 32.1

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Universal Health Realty Income Trust (the “Trust”) on Form 10-Q for the quarter ended March 31, 2017, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Alan B. Miller, President and Chief Executive Officer of the Trust, hereby certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge:

(i) the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(ii) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Trust at the end of, and for the period covered by, the Report.

/s/ Alan B. Miller

President and Chief Executive Officer

May 8, 2017

A signed original of this written statement required by Section 906 has been provided to the Trust and will be retained and furnished to the Securities and Exchange Commission or its staff upon request.

EX-32.2

Exhibit 32.2

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Universal Health Realty Income Trust (the “Trust”) on Form 10-Q for the quarter ended March 31, 2017, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Charles F. Boyle, Vice President and Chief Financial Officer of the Trust, hereby certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge:

(i) the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(ii) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Trust at the end of, and for the period covered by, the Report.

/s/ Charles F. Boyle

Vice President and Chief Financial Officer

May 8, 2017

A signed original of this written statement required by Section 906 has been provided to the Trust and will be retained and furnished to the Securities and Exchange Commission or its staff upon request.

XML

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2017	Apr. 30, 2017
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2017
Document Fiscal Year Focus	2017
Document Fiscal Period Focus	Q1
Trading Symbol	UHT
Entity Registrant Name	UNIVERSAL HEALTH REALTY INCOME TRUST
Entity Central Index Key	0000798783
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		13,600,075

XML

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands		3 Months Ended
		Mar. 31, 2017	Mar. 31, 2016
Revenues:
Base rental - UHS facilities		$ 4,080	$ 4,081
Base rental - Non-related parties		9,970	8,815
Bonus rental - UHS facilities		1,288	1,246
Tenant reimbursements and other - Non-related parties		2,193	1,873
Tenant reimbursements and other - UHS facilities		219	211
Revenues, Total		17,750	16,226
Expenses:
Depreciation and amortization		6,145	5,436
Advisory fees to UHS		866	767
Other operating expenses		4,705	4,400
Transaction costs		70	82
Costs and Expenses, Total		11,786	10,685
Income before equity in income of unconsolidated limited liability companies ("LLCs"), interest expense and gain		5,964	5,541
Equity in income of unconsolidated LLCs	[1]	1,077	1,059
Gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC, net		27,196
Interest expense, net		(2,675)	(2,172)
Net income		$ 31,562	$ 4,428
Basic earnings per share		$ 2.32	$ 0.33
Diluted earnings per share		$ 2.32	$ 0.33
Weighted average number of shares outstanding - Basic		13,580	13,307
Weighted average number of share equivalents			7
Weighted average number of shares and equivalents outstanding - Diluted		13,580	13,314

[1] Our share of net income for the three months ended March 31, 2017 and 2016 includes approximately $284,000 and $296,000, respectively, of interest income earned by us on an advance made to Arlington Medical Properties, LLC. This advance was repaid to us effective with the previously mentioned Arlington Medical Properties, LLC transaction during March, 2017.

XML

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 31,562	$ 4,428
Other comprehensive (loss)/income:
Unrealized derivative (losses)/gains on interest rate caps	(18)	21
Total other comprehensive (loss)/income:	(18)	21
Total comprehensive income	$ 31,544	$ 4,449

XML

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2017		Dec. 31, 2016
Real Estate Investments:
Buildings and improvements and construction in progress	$ 536,356		$ 534,190
Accumulated depreciation	(143,346)		(138,588)
Real Estate Investment Property, Net, Total	393,010		395,602
Land	51,645		51,638
Net Real Estate Investments	444,655		447,240
Investments in and advances to limited liability companies ("LLCs")	4,722		35,593
Other Assets:
Cash and cash equivalents	4,067		3,930
Restricted cash	11,253
Base and bonus rent receivable from UHS	2,558		2,321
Rent receivable - other	5,515		5,291
Intangible assets (net of accumulated amortization of $27.4 million and $27.1 million at March 31, 2017 and December 31, 2016, respectively)	22,732		23,815
Deferred charges and other assets, net	6,877		6,560
Total Assets	502,379		524,750
Liabilities:
Line of credit borrowings	169,900		201,500
Mortgage notes payable, non-recourse to us, net	103,004	[1]	114,217
Accrued interest	563		626
Accrued expenses and other liabilities	9,423		11,809
Tenant reserves, deposits and prepaid rents	5,385		5,321
Total Liabilities	288,275		333,473
Equity:
Preferred shares of beneficial interest, $.01 par value; 5,000,000 shares authorized; none issued and outstanding
Common shares, $.01 par value; 95,000,000 shares authorized; issued and outstanding: 2017 - 13,600,036; 2016 - 13,599,055	136		136
Capital in excess of par value	255,846		255,656
Cumulative net income	604,063		572,501
Cumulative dividends	(646,028)		(637,121)
Accumulated other comprehensive income	87		105
Total Equity	214,104		191,277
Total Liabilities and Equity	$ 502,379		$ 524,750

[1] All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

XML

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Mar. 31, 2017	Dec. 31, 2016
Statement Of Financial Position [Abstract]
Intangible assets, accumulated amortization	$ 27.4	$ 27.1
Preferred shares of beneficial interest, par value	$ 0.01	$ 0.01
Preferred shares of beneficial interest, shares authorized	5,000,000	5,000,000
Preferred shares of beneficial interest, issued	0	0
Preferred shares of beneficial interest, outstanding	0	0
Common shares, par value	$ 0.01	$ 0.01
Common shares, shares authorized	95,000,000	95,000,000
Common shares, issued	13,600,036	13,599,055
Common shares, outstanding	13,600,036	13,599,055

XML

Condensed Consolidated Statement of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Cash flows from operating activities:
Net income	$ 31,562	$ 4,428
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	6,167	5,458
Amortization of debt premium	(68)	(56)
Stock-based compensation expense	127	111
Gain on fair value recognition resulting from purchase of minority interest in majority-owned LLC, net	(27,196)
Changes in assets and liabilities:
Rent receivable	(461)	(511)
Accrued expenses and other liabilities	(230)	(1,014)
Tenant reserves, deposits and prepaid rents	64	574
Accrued interest	(63)	34
Leasing costs paid	(250)	(122)
Other, net	(158)	192
Net cash provided by operating activities	9,494	9,094
Cash flows from investing activities:
Investments in LLCs	(371)	(5,386)
Repayments of advances made to LLC	216	209
Cash distributions in excess of income from LLCs	557	147
Additions to real estate investments, net	(4,181)	(1,841)
Cash proceeds received from divestiture of property, net of restricted cash	53,967
Net cash paid for acquisition of properties		(9,910)
Cash paid to acquire minority interests in majority-owned LLCs	(7,890)
Net cash provided by/(used in) investing activities	42,298	(16,781)
Cash flows from financing activities:
Net (repayments)/borrowings on line of credit	(31,600)	17,500
Repayments of mortgage notes payable	(11,174)	(790)
Financing costs paid	(35)	(35)
Dividends paid	(8,907)	(8,596)
Issuance of shares of beneficial interest, net	61	30
Net cash (used in)/provided by financing activities	(51,655)	8,109
Increase in cash and cash equivalents	137	422
Cash and cash equivalents, beginning of period	3,930	3,894
Cash and cash equivalents, end of period	4,067	4,316
Supplemental disclosures of cash flow information:
Interest paid	$ 2,673	$ 2,072

XML

General

3 Months Ended

Mar. 31, 2017

Organization Consolidation And Presentation Of Financial Statements [Abstract]

General

(1) General

This Quarterly Report on Form 10-Q is for the quarter ended March 31, 2017. In this Quarterly Report, “we,” “us,” “our” and the “Trust” refer to Universal Health Realty Income Trust and its subsidiaries.

In this Quarterly Report on Form 10-Q, the term “revenues” does not include the revenues of the unconsolidated LLCs in which we have various non-controlling equity interests ranging from 33% to 95%.  As of March 31, 2017, we had investments in four jointly-owned LLCs/LPs which own medical office buildings, all of which are accounted for by the equity method (see Note 5). These LLCs are included in our financial statements for all periods presented on an unconsolidated basis since they are not variable interest entities for which we are the primary beneficiary, nor do we hold a controlling voting interest.

The financial statements included herein have been prepared by us, without audit, pursuant to the rules and regulations of the SEC and reflect all normal and recurring adjustments which, in our opinion, are necessary to fairly present results for the interim periods. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted pursuant to such rules and regulations, although we believe that the accompanying disclosures are adequate to make the information presented not misleading. It is suggested that these financial statements be read in conjunction with the financial statements, the notes thereto and accounting policies included in our Annual Report on Form 10-K for the year ended December 31, 2016.

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Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions

3 Months Ended

Mar. 31, 2017

Related Party Transactions [Abstract]

Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions

(2) Relationship with Universal Health Services, Inc. (“UHS”) and Related Party Transactions

Leases: We commenced operations in 1986 by purchasing properties of certain subsidiaries from UHS and immediately leasing the properties back to the respective subsidiaries. Most of the leases were entered into at the time we commenced operations and provided for initial terms of 13 to 15 years with up to six additional 5-year renewal terms. The current base rentals and lease and rental terms for each of the three hospital facilities leased to subsidiaries of UHS are provided below. The base rents are paid monthly and each lease also provides for additional or bonus rents which are computed and paid on a quarterly basis based upon a computation that compares current quarter revenue to a corresponding quarter in the base year. The three hospital leases with subsidiaries of UHS are unconditionally guaranteed by UHS and are cross-defaulted with one another.

The combined revenues generated from the leases on the UHS hospital facilities accounted for approximately 23% and 25% of our consolidated revenues for the three months ended March 31, 2017 and 2016, respectively.  Including 100% of the revenues generated at the unconsolidated LLCs in which we have various non-controlling equity interests ranging from 33% to 95%, the leases on the UHS hospital facilities accounted for approximately 19% and 20% of the combined consolidated and unconsolidated revenue for the three months ended March 31, 2017 and 2016, respectively.  In addition, we have seventeen medical office buildings (“MOBs”), or free-standing emergency departments (“FEDs”), that are either wholly or jointly-owned by us, that include tenants which are subsidiaries of UHS.  

Pursuant to the Master Lease Document by and among us and certain subsidiaries of UHS, dated December 24, 1986 (the “Master Lease”), which governs the leases of all hospital properties with subsidiaries of UHS, UHS has the option to renew the leases at the lease terms described below by providing notice to us at least 90 days prior to the termination of the then current term. UHS also has the right to purchase the respective leased facilities at the end of the lease terms or any renewal terms at the appraised fair market value. In addition, the Master Lease, as amended during 2006, includes a change of control provision whereby UHS has the right, upon one month’s notice should a change of control of the Trust occur, to purchase any or all of the three leased hospital properties listed below at their appraised fair market value. Additionally, UHS has rights of first refusal to: (i) purchase the respective leased facilities during and for 180 days after the lease terms at the same price, terms and conditions of any third-party offer, or; (ii) renew the lease on the respective leased facility at the end of, and for 180 days after, the lease term at the same terms and conditions pursuant to any third-party offer.

In June, 2016, three wholly-owned subsidiaries of UHS provided the required notice to us, exercising the 5-year renewal options on the leases related to our acute care hospitals.  The renewals extended the lease terms on these facilities, at existing lease rates, to December, 2021.

The table below details the existing lease terms and renewal options for our three acute care hospitals operated by wholly-owned subsidiaries of UHS:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2021		10	(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021		10	(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021		10	(b)

(a) UHS has two 5-year renewal options at existing lease rates (through 2031).

(b) UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

Management cannot predict whether the leases with subsidiaries of UHS, which have renewal options at existing lease rates or fair market value lease rates, or any of our other leases, will be renewed at the end of their lease term. If the leases are not renewed at their current rates or the fair market value lease rates, we would be required to find other operators for those facilities and/or enter into leases on terms potentially less favorable to us than the current leases. In addition, if subsidiaries of UHS exercise their options to purchase the respective leased hospital or FED facilities upon expiration of the lease terms, our future revenues could decrease if we were unable to earn a favorable rate of return on the sale proceeds received, as compared to the rental revenue currently earned pursuant to the these leases.  

In April, 2017, the recently constructed Henderson Medical Plaza MOB received its certificate of occupancy. Henderson Medical Plaza is located on the campus of the Henderson Hospital, a newly constructed, 130-bed acute care hospital that is owned and operated by a subsidiary of UHS and was completed and opened during the fourth quarter of 2016. We have invested $10.8 million on the development and construction of this MOB as of March 31, 2017.

Advisory Agreement:    UHS of Delaware, Inc. (the “Advisor”), a wholly-owned subsidiary of UHS, serves as Advisor to us under an Advisory Agreement (the “Advisory Agreement”) dated December 24, 1986. Pursuant to the Advisory Agreement, the Advisor is obligated to present an investment program to us, to use its best efforts to obtain investments suitable for such program (although it is not obligated to present any particular investment opportunity to us), to provide administrative services to us and to conduct our day-to-day affairs. All transactions between us and UHS must be approved by the Trustees who are unaffiliated with UHS (the “Independent Trustees”). In performing its services under the Advisory Agreement, the Advisor may utilize independent professional services, including accounting, legal, tax and other services, for which the Advisor is reimbursed directly by us. The Advisory Agreement may be terminated for any reason upon sixty days written notice by us or the Advisor. The Advisory Agreement expires on December 31 of each year; however, it is renewable by us, subject to a determination by the Independent Trustees, that the Advisor’s performance has been satisfactory. Our advisory fee is 0.70% of our average invested real estate assets, as derived from our consolidated balance sheet. In December of 2016, based upon a review of our advisory fee and other general and administrative expenses as compared to an industry peer group, the Advisory Agreement was renewed for 2017 pursuant to the same terms as the Advisory Agreement in place during 2016.

The average real estate assets for advisory fee calculation purposes exclude certain items from our consolidated balance sheet such as, among other things, accumulated depreciation, cash and cash equivalents, restricted cash, base and bonus rent receivables, deferred charges and other assets. The advisory fee is payable quarterly, subject to adjustment at year-end based upon our audited financial statements. In addition, the Advisor is entitled to an annual incentive fee equal to 20% of the amount by which cash available for distribution to shareholders for each year, as defined in the Advisory Agreement, exceeds 15% of our equity as shown on our consolidated balance sheet, determined in accordance with generally accepted accounting principles without reduction for return of capital dividends. The Advisory Agreement defines cash available for distribution to shareholders as net cash flow from operations less deductions for, among other things, amounts required to discharge our debt and liabilities and reserves for replacement and capital improvements to our properties and investments. No incentive fees were paid during the first three months of 2017 or 2016 since the incentive fee requirements were not achieved. Advisory fees incurred and paid (or payable) to UHS amounted to $866,000 and $767,000 for the three months ended March 31, 2017 and 2016, respectively, and were based upon average invested real estate assets of $495 million and $438 million for the three-month periods ended March 31, 2017 and 2016, respectively.  

Officers and Employees: Our officers are all employees of a wholly-owned subsidiary of UHS and although as of March 31, 2017 we had no salaried employees, our officers do typically receive annual stock-based compensation awards in the form of restricted stock. In special circumstances, if warranted and deemed appropriate by the Compensation Committee of the Board of Trustees, our officers may also receive one-time special compensation awards in the form of restricted stock and/or cash bonuses.

Share Ownership: As of March 31, 2017 and December 31, 2016, UHS owned 5.8% of our outstanding shares of beneficial interest.

SEC reporting requirements of UHS: UHS is subject to the reporting requirements of the SEC and is required to file annual reports containing audited financial information and quarterly reports containing unaudited financial information. Since the leases on the hospital facilities leased to wholly-owned subsidiaries of UHS comprised approximately 23% and 25% of our consolidated revenues during the three-month periods ended March 31, 2017 and 2016, respectively, and since a subsidiary of UHS is our Advisor, you are encouraged to obtain the publicly available filings for Universal Health Services, Inc. from the SEC’s website. These filings are the sole responsibility of UHS and are not incorporated by reference herein.

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Dividends and Equity Issuance Program

3 Months Ended

Mar. 31, 2017

Equity [Abstract]

Dividends and Equity Issuance Program

(3) Dividends and Equity Issuance Program

Dividends:

We declared and paid dividends of $8.9 million, or $.655 per share, during the first quarter of 2017 and $8.6 million, or $.645 per share, during the first quarter of 2016.  

Equity Issuance Program:

During the second quarter of 2016, we recommenced our at-the-market (“ATM”) equity issuance program, pursuant to the terms of which we may sell, from time-to-time, common shares of our beneficial interest up to an aggregate sales price of approximately $23.3 million to or through Merrill Lynch, Pierce, Fenner and Smith, Incorporated (“Merrill Lynch”), as sales agent and/or principal. The common shares were offered pursuant to the Registration Statement filed with the Securities and Exchange Commission, which became effective during the fourth quarter of 2015.

There were no shares issued pursuant to the ATM Program during the first quarter of 2017. Since inception of this ATM program, we have issued 829,916 shares at an average price of $48.77 per share, which generated approximately $38.8 million of net proceeds (net of approximately $1.7 million, consisting of compensation of $1.0 million to Merrill Lynch as well as $680,000 of other various fees and expenses).

XML

Acquisitions, Dispositions and New Construction

3 Months Ended

Mar. 31, 2017

Business Combinations [Abstract]

Acquisitions, Dispositions and New Construction

(4) Acquisitions, Dispositions and New Construction

Three Months Ended March 31, 2017:

Acquisitions:

There were no acquisitions during the first three months of 2017.

Disposition:

During March, 2017, Arlington Medical Properties, LLC, a formerly jointly-owned limited liability company in which we held an 85% noncontrolling ownership interest, sold the real estate assets of St. Mary’s Professional Office Building (“St. Mary’s”) as part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code.  St. Mary’s is a multi-tenant medical office building located in Reno, Nevada.  A third party member owned the remaining 15% of Arlington Medical Properties LLC, which we acquired prior to the divestiture of St. Mary’s for a purchase price of $7.9 million.

In connection with the divestiture of St. Mary’s, we are entitled to an aggregate of approximately $57.3 million of net cash proceeds.  These proceeds, which are net of closing costs and the purchase price paid for the minority member’s ownership interest in the LLC, include repayment to us of a $21.4 million member loan previously extended to Arlington Medical Properties, LLC by us when we held an 85% noncontrolling ownership interest in the LLC. As of March 31, 2017, approximately $11.3 million of the net sale proceeds due to us are being held as restricted cash by a qualified 1031 exchange intermediary in connection with potential future acquisitions, as discussed below. Our results of operations for the three-month period ended March 31, 2017 include a net gain of $27.2 million (net of related transaction costs) recorded in connection with these transactions.  

Tax Deferred Like-Kind Exchange Transactions Under Section 1031 of the Internal Revenue Code:

As part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code, we have completed the divestiture of St. Mary’s Professional Office Building in March, 2017, as discussed above, and the two previously announced 2016 acquisitions, as outlined below. In addition, we may complete other potential 2017 acquisitions, as outlined below.

Acquisitions Previously Completed in 2016:

• 2704 North Tenaya Way, located in Las Vegas, Nevada.  This MOB was acquired in November, 2016 for a total purchase price of approximately $15.3 million, including the assumption of approximately $7.1 million of third-party debt that is non-recourse to us.

• Frederick Crestwood Medical Office Building, located in Frederick, Maryland.  This MOB was acquired in September, 2016 for a purchase price of approximately $24.3 million.

Both of these 2016 acquisitions were planned and executed in accordance with the provisions of Section 1031 of the Internal Revenue Code and therefore we believe they qualify as tax deferred like-kind exchange transactions in connection with the above-mentioned divestiture of St. Mary’s in March, 2017.

Other Potential 2017 Acquisitions:

• In addition to the above-mentioned 2016 acquisitions, we may purchase one or more additional properties during 2017, as part of the planned like-kind exchange transactions.  We can provide no assurance that we will complete one or more additional acquisitions during 2017.  Any additional acquisitions completed during 2017 would need to be finalized by mid-September in order to qualify as tax deferred like-kind exchange transactions under the provisions of Section 1031 of the Internal Revenue Code in connection with the divestiture of St. Mary’s.

New Construction:

During the first quarter of 2016, we committed to invest up to $21.1 million in the development and construction of the Henderson Medical Plaza, an MOB located on the campus of the Henderson Hospital Medical Center which is owned by a UHS subsidiary and opened in late October, 2016. The MOB was completed and opened during April, 2017. We have invested $10.8 million on the development and construction for this MOB as of March 31, 2017.

Three Months Ended March 31, 2016:

Acquisition:

In March, 2016, we purchased the Madison Professional Office Building located in Madison, Alabama for approximately $10.1 million. This multi-tenant property was fully occupied with an average remaining lease term of approximately 6.2 years at the time of acquisition.

The aggregate purchase price for this MOB was allocated to the assets acquired and liabilities assumed consisting of tangible property and identified intangible assets, based on the fair value estimated at acquisition as detailed in the table below. Substantially all of the intangible assets include the value of the in-place leases at the MOB at the time of acquisition which is being amortized over the average remaining lease term of approximately 6.2 years at the time of acquisition.

Land	$2,328
Buildings and improvements	6,523
Intangible assets	1,209
Deposit	(150)
Net cash paid	$9,910

Dispositions:  

There were no divestitures during the first three months of 2016.

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Summarized Financial Information of Equity Affiliates

3 Months Ended

Mar. 31, 2017

Equity Method Investments And Joint Ventures [Abstract]

Summarized Financial Information of Equity Affiliates

(5) Summarized Financial Information of Equity Affiliates

In accordance with the Financial Accounting Standards Board’s (“FASB”) standards and guidance relating to accounting for investments and real estate ventures, we account for our unconsolidated investments in LLCs/LPs which we do not control using the equity method of accounting.  The third-party members in these investments have equal voting rights with regards to issues such as, but not limited to: (i) divestiture of property; (ii) annual budget approval, and; (iii) financing commitments. These investments, which represent 33% to 95% non-controlling ownership interests, are recorded initially at our cost and subsequently adjusted for our net equity in the net income, cash contributions to, and distributions from, the investments. Pursuant to certain agreements, allocations of sales proceeds and profits and losses of some of the LLC investments may be allocated disproportionately as compared to ownership interests after specified preferred return rate thresholds have been satisfied.

In the Consolidated Statements of Cash Flows, distributions and equity in net income are presented net as cash flows from operating activities.  Cumulative distributions received exceeding cumulative equity in earnings represent returns of investments and are classified as cash flows from investing activities in the Consolidated Statements of Cash Flows.

At March 31, 2017, we have non-controlling equity investments or commitments in four jointly-owned LLCs/LPs which own MOBs. As of March 31, 2017, we accounted for these LLCs/LPs on an unconsolidated basis pursuant to the equity method since they are not variable interest entities and we do not have a controlling voting interest. The majority of these entities are joint-ventures between us and non-related parties that manage and hold minority ownership interests in the entities. Each entity is generally self-sustained from a cash flow perspective and generates sufficient cash flow to meet its operating cash flow requirements and service the third-party debt (if applicable) that is non-recourse to us. Although there is typically no ongoing financial support required from us to these entities since they are cash-flow sufficient, we may, from time to time, provide funding for certain purposes such as, but not limited to, significant capital expenditures, leasehold improvements and debt financing. Although we are not obligated to do so, if approved by us at our sole discretion, additional cash fundings are typically advanced as equity or member loans. These entities maintain property insurance on the properties.

During March, 2017, Arlington Medical Properties, LLC, a formerly jointly-owned limited liability company in which we held an 85% noncontrolling ownership interest, sold the real estate assets of St. Mary’s Professional Office Building (“St. Mary’s”) as part of a series of planned tax deferred like-kind exchange transactions pursuant to Section 1031 of the Internal Revenue Code.  A third party member owned the remaining 15% of Arlington Medical Properties LLC, which we acquired prior to the divestiture of St. Mary’s.

The following property table represents the four LLCs in which we own a noncontrolling interest and were accounted for under the equity method as of March 31, 2017:

Name of LLC/LP	Ownership			Property Owned by LLC
Suburban Properties		33	%	St. Matthews Medical Plaza II
Brunswick Associates (a.)		74	%	Mid Coast Hospital MOB
Grayson Properties (b.)		95	%	Texoma Medical Plaza
FTX MOB Phase II (c.)		95	%	Forney Medical Plaza II

(a.) This LLC has a third-party term loan, which is non-recourse to us, of $8.6 million outstanding as of March 31, 2017.

(b.) This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LLC has a third-party term loan, which is non-recourse to us, of $14.4 million outstanding as of March 31, 2017.

(c.) We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2017.  This LLC has a third-party term loan, which is non-recourse to us, of $5.3 million outstanding as of March 31, 2017.

Below are the condensed combined statements of income (unaudited) for the LLCs accounted for under the equity method during the three months ended March 31, 2017 and 2016.  The three months ended March 31, 2017 include the financial results of Arlington Medical Properties, LLC, through the March 13, 2017 divestiture date.  The three months ended March 31, 2016, include the financial results of Arlington Medical Properties, LLC for the entire three months ended March 31, 2016.    

	Three Months Ended March 31,
	2017		2016
	(amounts in thousands)
Revenues	$	3,583	$	3,736
Operating expenses		1,250		1,353
Depreciation and amortization		643		613
Interest, net		562		657
Net income	$	1,128	$	1,113
Our share of net income (a.)	$	1,077	$	1,059

(a.) Our share of net income for the three months ended March 31, 2017 and 2016 includes approximately $284,000 and $296,000, respectively, of interest income earned by us on an advance made to Arlington Medical Properties, LLC. This advance was repaid to us effective with the previously mentioned Arlington Medical Properties, LLC transaction during March, 2017.

Below are the condensed combined balance sheets (unaudited) for the four above-mentioned LLCs that were accounted for under the equity method as of March 31, 2017 and the five LLCs (including Arlington Medical Properties, LLC, which was divested during the first quarter of 2017) that were accounted for under the equity method as of December 31, 2016:

	March 31, 2017			December 31, 2016
	(amounts in thousands)
Net property, including CIP	$	33,816		$	60,970
Other assets		3,685			4,598
Total assets	$	37,501		$	65,568
Liabilities	$	2,726		$	3,334
Mortgage notes payable, non-recourse to us		28,222			28,367
Advances payable to us		-			21,638
Equity		6,553			12,229
Total liabilities and equity	$	37,501		$	65,568
Our share of equity in and advances to LLCs reflected as:
Investments in LLCs	$	4,722		$	13,955
Advances to LLCs		-			21,638
Investments in and advances to LLCs before
amounts included in accrued expenses and other liabilities		4,722			35,593
Amounts included in accrued expenses and other liabilities		(1,476	)		(1,862	)
Our share of equity in and advances to LLCs, net	$	3,246		$	33,731

As of March 31, 2017, and December 31, 2016, aggregate principal amounts due on mortgage notes payable by unconsolidated LLCs, which are accounted for under the equity method and are non-recourse to us, are as follows (amounts in thousands):

	Mortgage Loan Balance (a.)
Name of LLC/LP	3/31/2017		12/31/2016		Maturity Date
FTX MOB Phase II	$	5,267	$	5,301	August, 2017 (b.)
Grayson Properties		14,375		14,438	September, 2021
Brunswick Associates		8,580		8,628	December, 2024
	$	28,222	$	28,367

(a.) All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity.

(b.)   This loan is scheduled to mature within the next twelve months, at which time it will be refinanced pursuant to: (i) a new third-party mortgage loan; (ii) a member loan extended from us to the LLC, or; (iii) equity contributions to the LLC by us and the third-party member.  Funds required from us to the LLC for either the member loan or our share of an equity contribution would likely be borrowed under our Credit Agreement.

Pursuant to the operating and/or partnership agreements of the four LLCs/LPs in which we continue to hold non-controlling ownership interests, the third-party member and/or the Trust, at any time, potentially subject to certain conditions, have the right to make an offer (“Offering Member”) to the other member(s) (“Non-Offering Member”) in which it either agrees to: (i) sell the entire ownership interest of the Offering Member to the Non-Offering Member (“Offer to Sell”) at a price as determined by the Offering Member (“Transfer Price”), or; (ii) purchase the entire ownership interest of the Non-Offering Member (“Offer to Purchase”) at the equivalent proportionate Transfer Price. The Non-Offering Member has 60 to 90 days to either: (i) purchase the entire ownership interest of the Offering Member at the Transfer Price, or; (ii) sell its entire ownership interest to the Offering Member at the equivalent proportionate Transfer Price. The closing of the transfer must occur within 60 to 90 days of the acceptance by the Non-Offering Member.

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Recent Accounting Pronouncements

3 Months Ended

Mar. 31, 2017

New Accounting Pronouncements And Changes In Accounting Principles [Abstract]

Recent Accounting Pronouncements

(6) Recent Accounting Pronouncements

In August, 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-15, Classification of Certain Cash Receipts and Cash Payments, which adds or clarifies guidance of the classification of certain cash receipts and payments in the statement of cash flows with the intent to alleviate diversity in practice for classifying various types of cash flows.  This ASU is effective for annual and interim reporting periods beginning after December 15, 2017, with early adoption permitted.  We are currently evaluating the impact of this ASU on our statement of cash flows.

In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842), which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. ASU 2016-02 supersedes the previous leases standard, Leases (Topic 840). The standard is effective on January 1, 2019, with early adoption permitted. We are currently in the process of evaluating the impact the adoption of ASU 2016-02 will have on our financial position or results of operations.

In 2014, the FASB issued ASU 2014-09, Revenue From Contracts With Customers (“ASU 2014-09”), which outlines a comprehensive model for entities to use in accounting for revenue arising from contracts with customers. ASU 2014-09 states that “an entity recognizes revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services.” While ASU 2014-09 specifically references contracts with customers, it may apply to certain other transactions such as the sale of real estate or equipment. In 2015, the FASB provided for a one-year deferral of the effective date for ASU 2014-09, which is now effective for us beginning January 1, 2018. We are continuing to evaluate ASU 2014-09 (and related clarifying guidance issued by the FASB); however, we do not expect its adoption to have a significant impact on our consolidated financial statements, as a substantial portion of our revenue consists of rental income from leasing arrangements, which is specifically excluded from ASU 2014-09.

In January, 2017, the FASB issued ASU 2017-01, “Business Combinations (Topic 805) - Clarifying the Definition of a Business” to clarify the definition of a business in order to allow for the evaluation of whether transactions should be accounted for as acquisitions or disposals of assets or businesses. ASU 2017-01 will be effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years.  We expect that future property acquisitions will generally qualify as asset acquisitions under the standard, which permits the capitalization of acquisition costs to the underlying assets. We adopted this new guidance effective January 1, 2017. This new guidance is not expected to have a significant impact on our financial statements.

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Debt and Financial Instruments

3 Months Ended

Mar. 31, 2017

Debt Disclosure [Abstract]

Debt and Financial Instruments

(7) Debt and Financial Instruments

Debt:

Management routinely monitors and analyzes the Trust’s capital structure in an effort to maintain the targeted balance among capital resources including the level of borrowings pursuant to our $250 million revolving credit facility, the level of borrowings pursuant to non-recourse mortgage debt secured by the real property of our properties and our level of equity including consideration of additional equity issuances pursuant to our ATM equity issuance program.  This ongoing analysis considers factors such as the current debt market and interest rate environment, the current/projected occupancy and financial performance of our properties, the current loan-to-value ratio of our properties, the Trust’s current stock price, the capital resources required for anticipated acquisitions and the expected capital to be generated by anticipated divestitures. This analysis, together with consideration of the Trust’s current balance of revolving credit facility borrowings, non-recourse mortgage borrowings and equity, assists management in deciding which capital resource to utilize when events such as refinancing of specific debt components occur or additional funds are required to finance the Trust’s growth.

On March 27, 2015, we entered into a $185 million revolving credit agreement (“Credit Agreement”) which was amended on May 24, 2016 to, among other things, increase the borrowing capacity to $250 million. The amended Credit Agreement, which is scheduled to mature in March, 2019, includes a $40 million sub limit for letters of credit and a $20 million sub limit for swingline/short-term loans. The Credit Agreement also provides a one-time option to extend the maturity date for an additional one year period, and an option to increase the total facility borrowing capacity up to an additional $50 million, subject to lender agreement. Borrowings under the Credit Agreement are guaranteed by certain subsidiaries of the Trust. In addition, borrowings under the Credit Agreement are secured by first priority security interests in and liens on all equity interests in the Trust’s wholly-owned subsidiaries. Borrowings made pursuant to the Credit Agreement will bear interest, at our option, at one, two, three, or six month LIBOR plus an applicable margin ranging from 1.50% to 2.00% or at the Base Rate plus an applicable margin ranging from 0.50% to 1.00%. The Credit Agreement defines “Base Rate” as the greatest of: (a) the administrative agent’s prime rate; (b) the federal funds effective rate plus 1/2 of 1%, and; (c) one month LIBOR plus 1%. A commitment fee of 0.20% to 0.40% (depending on our total leverage ratio) will be charged on the average unused portion of the revolving credit commitments. The margins over LIBOR, Base Rate and the commitment fee are based upon our ratio of debt to total capital. At March 31, 2017, the applicable margin over the LIBOR rate was 1.625%, the margin over the Base Rate was 0.625%, and the commitment fee was 0.25%.

At March 31, 2017, we had $169.9 million of outstanding borrowings and $2.7 million of letters of credit outstanding under our Credit Agreement. We had $77.4 million of available borrowing capacity, net of the outstanding borrowings and letters of credit outstanding as of March 31, 2017.  There are no compensating balance requirements.     

The Credit Agreement contains customary affirmative and negative covenants, including limitations on certain indebtedness, liens, acquisitions and other investments, fundamental changes, asset dispositions and dividends and other distributions. The Credit Agreement also contains restrictive covenants regarding the Trust’s ratio of total debt to total assets, the fixed charge coverage ratio, the ratio of total secured debt to total asset value, the ratio of total unsecured debt to total unencumbered asset value, and minimum tangible net worth, as well as customary events of default, the occurrence of which may trigger an acceleration of amounts outstanding under the Credit Agreement. We are in compliance with all of the covenants at March 31, 2017. We also believe that we would remain in compliance if the full amount of our commitment was borrowed.

The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands):

	Covenant		March 31, 2017
Tangible net worth	$	125,000	$	191,372
Total leverage	< 60%			44.3	%
Secured leverage	< 30%			16.1	%
Unencumbered leverage	< 60%			40.3	%
Fixed charge coverage	> 1.50x		3.6x

As indicated on the following table, we have fourteen mortgages, all of which are non-recourse to us, included on our condensed consolidated balance sheet as of March 31, 2017, with a combined outstanding balance of $103.0 million, excluding net debt premium of $368,000 and net financing fees of $353,000 (amounts in thousands):

Facility Name	Outstanding Balance (inthousands)(a)			Interest Rate			Maturity Date
Peace Health fixed rate mortgage loan (c.)	$	20,180			5.64	%	April, 2017
Medical Center of Western Connecticut fixed rate    mortgage loan (d.)		4,500			6.00	%	June, 2017
Auburn Medical II floating rate mortgage loan (e.)		6,668			3.53	%	July, 2017
Summerlin Hospital Medical Office Building II fixed    rate mortgage loan (b.)		11,007			5.50	%	October, 2017
Phoenix Children’s East Valley Care Center fixed rate    mortgage loan (b.)		6,164			5.88	%	December, 2017
Centennial Hills Medical Office Building floating rate    mortgage loan (b.)		9,968			4.06	%	January, 2018
Sparks Medical Building/Vista Medical Terrace    floating rate mortgage loan (b.)		4,202			4.06	%	February, 2018
Rosenberg Children’s Medical Plaza fixed rate    mortgage loan		8,103			4.85	%	May, 2018
Vibra Hospital-Corpus Christi fixed rate mortgage loan		2,699			6.50	%	July, 2019
700 Shadow Lane and Goldring MOBs fixed rate    mortgage loan		6,201			4.54	%	June, 2022
BRB Medical Office Building fixed rate mortgage loan		6,269			4.27	%	December, 2022
Desert Valley Medical Center fixed rate mortgage loan		5,047			3.62	%	January, 2023
2704 North Tenaya Way fixed rate mortgage loan		7,105			4.95	%	November, 2023
Tuscan Professional Building fixed rate mortgage loan		4,876			5.56	%	June, 2025
Total, excluding net debt premium and net financing fees		102,989
Less net financing fees		(353	)
Plus net debt premium		368
Total mortgages notes payable, non-recourse to us, net	$	103,004

(a.) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

(b.) This loan is scheduled to mature within the next twelve months, at which time we will decide whether to refinance pursuant to a new mortgage loan or repaid utilizing borrowings under our Credit Agreement.

(c.) During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.

(d.)    Upon its June, 2017 maturity date, we intend to repay this loan utilizing borrowings under our Credit Agreement.

(e.)    The maturity date on this loan has been extended to July, 2017, at which time we intend to repay the loan utilizing borrowings under our Credit Agreement.

On March 31, 2017, upon its maturity, the $10.3 million floating rate mortgage loan on Summerlin Hospital Medical Office Building III was fully repaid.  In April, 2017, we refinanced this property with a $13.2 million, 4.03% fixed rate mortgage, which is non-recourse to us, which matures in April, 2024.

The mortgages are secured by the real property of the buildings as well as property leases and rents. The mortgages have a combined fair value of approximately $105 million as of March 31, 2017. Changes in market rates on our fixed rate debt impacts the fair value of debt, but it has no impact on interest incurred or cash flow.

At December 31, 2016, we had fifteen mortgages, all of which were non-recourse to us, included in our consolidated balance sheet. The combined outstanding balance of these fifteen mortgages was $114.2 million (excluding net debt premium of $436,000 and net financing fees of $381,000), and had a combined fair value of approximately $115.7 million.

Financial Instruments:

During the third quarter of 2013, we entered into an interest rate cap on a total notional amount of $10 million whereby we paid a premium of $136,000. During the first quarter of 2014, we entered into two additional interest rate cap agreements on a total notional amount of $20 million whereby we paid premiums of $134,500. In exchange for the premium payments, the counterparties agreed to pay us the difference between 1.50% and one-month LIBOR if one-month LIBOR rises above 1.50% during the term of the cap. From inception through the January, 2017 expiration, no payments were made to us by the counterparties pursuant to the terms of these caps.  

During the second quarter of 2016, we entered into an interest rate cap on the total notional amount of $30 million whereby we paid a premium of $115,000.  In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.50% and one-month LIBOR if one-month LIBOR rises above 1.50% during the term of the cap.  This interest rate cap became effective in January, 2017, coinciding with the expiration of the above-mentioned interest rate caps and expires in March, 2019.  

During the third quarter of 2016, we entered into an additional interest rate cap agreement on a total notional amount of $30 million whereby we paid a premium of $55,000.  In exchange for the premium payment, the counterparties agreed to pay us the difference between 1.5% and one-month LIBOR if one-month LIBOR rises above 1.5% during the term of the cap.  This interest rate cap became effective in October, 2016 and expires in March, 2019.

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Segment Reporting

3 Months Ended

Mar. 31, 2017

Segment Reporting [Abstract]

Segment Reporting

(8) Segment Reporting

Our primary business is investing in and leasing healthcare and human service facilities through direct ownership or through joint ventures, which aggregate into a single reportable segment. We actively manage our portfolio of healthcare and human service facilities and may from time to time make decisions to sell lower performing properties not meeting our long-term investment objectives. The proceeds of sales are typically reinvested in new developments or acquisitions, which we believe will meet our planned rate of return. It is our intent that all healthcare and human service facilities will be owned or developed for investment purposes. Our revenue and net income are generated from the operation of our investment portfolio.

Our portfolio is located throughout the United States, however, we do not distinguish or group our operations on a geographical basis for purposes of allocating resources or measuring performance. We review operating and financial data for each property on an individual basis; therefore, we define an operating segment as our individual properties. Individual properties have been aggregated into one reportable segment based upon their similarities with regard to both the nature and economics of the facilities, tenants and operational processes, as well as long-term average financial performance.

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Recent Accounting Pronouncements (Policies)

3 Months Ended

Mar. 31, 2017

Accounting Policies [Abstract]

Recent Accounting Pronouncements

Recent Accounting Pronouncements

In August, 2016, the Financial Accounting Standards Board (“FASB”) issued ASU No. 2016-15, Classification of Certain Cash Receipts and Cash Payments, which adds or clarifies guidance of the classification of certain cash receipts and payments in the statement of cash flows with the intent to alleviate diversity in practice for classifying various types of cash flows.  This ASU is effective for annual and interim reporting periods beginning after December 15, 2017, with early adoption permitted.  We are currently evaluating the impact of this ASU on our statement of cash flows.

In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842), which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. The new standard requires lessors to account for leases using an approach that is substantially equivalent to existing guidance for sales-type leases, direct financing leases and operating leases. ASU 2016-02 supersedes the previous leases standard, Leases (Topic 840). The standard is effective on January 1, 2019, with early adoption permitted. We are currently in the process of evaluating the impact the adoption of ASU 2016-02 will have on our financial position or results of operations.

In 2014, the FASB issued ASU 2014-09, Revenue From Contracts With Customers (“ASU 2014-09”), which outlines a comprehensive model for entities to use in accounting for revenue arising from contracts with customers. ASU 2014-09 states that “an entity recognizes revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services.” While ASU 2014-09 specifically references contracts with customers, it may apply to certain other transactions such as the sale of real estate or equipment. In 2015, the FASB provided for a one-year deferral of the effective date for ASU 2014-09, which is now effective for us beginning January 1, 2018. We are continuing to evaluate ASU 2014-09 (and related clarifying guidance issued by the FASB); however, we do not expect its adoption to have a significant impact on our consolidated financial statements, as a substantial portion of our revenue consists of rental income from leasing arrangements, which is specifically excluded from ASU 2014-09.

In January, 2017, the FASB issued ASU 2017-01, “Business Combinations (Topic 805) - Clarifying the Definition of a Business” to clarify the definition of a business in order to allow for the evaluation of whether transactions should be accounted for as acquisitions or disposals of assets or businesses. ASU 2017-01 will be effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years.  We expect that future property acquisitions will generally qualify as asset acquisitions under the standard, which permits the capitalization of acquisition costs to the underlying assets. We adopted this new guidance effective January 1, 2017. This new guidance is not expected to have a significant impact on our financial statements.

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Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions (Tables)

3 Months Ended

Mar. 31, 2017

Related Party Transactions [Abstract]

Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities

The table below details the existing lease terms and renewal options for our three acute care hospitals operated by wholly-owned subsidiaries of UHS:

Hospital Name	Annual Minimum Rent		End of Lease Term	Renewal Term (years)
McAllen Medical Center	$	5,485,000	December, 2021		10	(a)
Wellington Regional Medical Center	$	3,030,000	December, 2021		10	(b)
Southwest Healthcare System, Inland Valley Campus	$	2,648,000	December, 2021		10	(b)

(a) UHS has two 5-year renewal options at existing lease rates (through 2031).

(b) UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

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Acquisitions, Dispositions and New Construction (Tables)

3 Months Ended

Mar. 31, 2017

Business Combinations [Abstract]

Allocation of Purchase Price to Assets Acquired and Liabilities Assumed

The aggregate purchase price for this MOB was allocated to the assets acquired and liabilities assumed consisting of tangible property and identified intangible assets, based on the fair value estimated at acquisition as detailed in the table below.

Land	$2,328
Buildings and improvements	6,523
Intangible assets	1,209
Deposit	(150)
Net cash paid	$9,910

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Summarized Financial Information of Equity Affiliates (Tables)

3 Months Ended

Mar. 31, 2017

Equity Method Investments And Joint Ventures [Abstract]

Limited Liability Companies Accounted for Under Equity Method

The following property table represents the four LLCs in which we own a noncontrolling interest and were accounted for under the equity method as of March 31, 2017:

Name of LLC/LP	Ownership			Property Owned by LLC
Suburban Properties		33	%	St. Matthews Medical Plaza II
Brunswick Associates (a.)		74	%	Mid Coast Hospital MOB
Grayson Properties (b.)		95	%	Texoma Medical Plaza
FTX MOB Phase II (c.)		95	%	Forney Medical Plaza II

(a.) This LLC has a third-party term loan, which is non-recourse to us, of $8.6 million outstanding as of March 31, 2017.

(b.) This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LLC has a third-party term loan, which is non-recourse to us, of $14.4 million outstanding as of March 31, 2017.

(c.) We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2017.  This LLC has a third-party term loan, which is non-recourse to us, of $5.3 million outstanding as of March 31, 2017.

Condensed Combined Statements of Income (Unaudited) for Limited Liability Companies Accounted for Under Equity Method

Below are the condensed combined statements of income (unaudited) for the LLCs accounted for under the equity method during the three months ended March 31, 2017 and 2016.  The three months ended March 31, 2017 include the financial results of Arlington Medical Properties, LLC, through the March 13, 2017 divestiture date.  The three months ended March 31, 2016, include the financial results of Arlington Medical Properties, LLC for the entire three months ended March 31, 2016.    

	Three Months Ended March 31,
	2017		2016
	(amounts in thousands)
Revenues	$	3,583	$	3,736
Operating expenses		1,250		1,353
Depreciation and amortization		643		613
Interest, net		562		657
Net income	$	1,128	$	1,113
Our share of net income (a.)	$	1,077	$	1,059

(a.) Our share of net income for the three months ended March 31, 2017 and 2016 includes approximately $284,000 and $296,000, respectively, of interest income earned by us on an advance made to Arlington Medical Properties, LLC. This advance was repaid to us effective with the previously mentioned Arlington Medical Properties, LLC transaction during March, 2017.

Condensed Combined Balance Sheets (Unaudited) for LLCs Accounted for Under Equity Method

Below are the condensed combined balance sheets (unaudited) for the four above-mentioned LLCs that were accounted for under the equity method as of March 31, 2017 and the five LLCs (including Arlington Medical Properties, LLC, which was divested during the first quarter of 2017) that were accounted for under the equity method as of December 31, 2016:

	March 31, 2017			December 31, 2016
	(amounts in thousands)
Net property, including CIP	$	33,816		$	60,970
Other assets		3,685			4,598
Total assets	$	37,501		$	65,568
Liabilities	$	2,726		$	3,334
Mortgage notes payable, non-recourse to us		28,222			28,367
Advances payable to us		-			21,638
Equity		6,553			12,229
Total liabilities and equity	$	37,501		$	65,568
Our share of equity in and advances to LLCs reflected as:
Investments in LLCs	$	4,722		$	13,955
Advances to LLCs		-			21,638
Investments in and advances to LLCs before
amounts included in accrued expenses and other liabilities		4,722			35,593
Amounts included in accrued expenses and other liabilities		(1,476	)		(1,862	)
Our share of equity in and advances to LLCs, net	$	3,246		$	33,731

Aggregate Principal Amounts due on Mortgage and Construction Notes Payable by Unconsolidated LLC's Accounted Under Equity Method

As of March 31, 2017, and December 31, 2016, aggregate principal amounts due on mortgage notes payable by unconsolidated LLCs, which are accounted for under the equity method and are non-recourse to us, are as follows (amounts in thousands):

	Mortgage Loan Balance (a.)
Name of LLC/LP	3/31/2017		12/31/2016		Maturity Date
FTX MOB Phase II	$	5,267	$	5,301	August, 2017 (b.)
Grayson Properties		14,375		14,438	September, 2021
Brunswick Associates		8,580		8,628	December, 2024
	$	28,222	$	28,367

(a.) All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity.

(b.)   This loan is scheduled to mature within the next twelve months, at which time it will be refinanced pursuant to: (i) a new third-party mortgage loan; (ii) a member loan extended from us to the LLC, or; (iii) equity contributions to the LLC by us and the third-party member.  Funds required from us to the LLC for either the member loan or our share of an equity contribution would likely be borrowed under our Credit Agreement.

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Debt and Financial Instruments (Tables)

3 Months Ended

Mar. 31, 2017

Debt Disclosure [Abstract]

Summary of Required Compliance Ratios Giving Effect to New Covenants in Credit Agreement

The following table includes a summary of the required compliance ratios, giving effect to the covenants contained in the Credit Agreement (dollar amounts in thousands):

	Covenant		March 31, 2017
Tangible net worth	$	125,000	$	191,372
Total leverage	< 60%			44.3	%
Secured leverage	< 30%			16.1	%
Unencumbered leverage	< 60%			40.3	%
Fixed charge coverage	> 1.50x		3.6x

Outstanding Mortgages, Excluding Net Debt Premium

Facility Name	Outstanding Balance (inthousands)(a)			Interest Rate			Maturity Date
Peace Health fixed rate mortgage loan (c.)	$	20,180			5.64	%	April, 2017
Medical Center of Western Connecticut fixed rate    mortgage loan (d.)		4,500			6.00	%	June, 2017
Auburn Medical II floating rate mortgage loan (e.)		6,668			3.53	%	July, 2017
Summerlin Hospital Medical Office Building II fixed    rate mortgage loan (b.)		11,007			5.50	%	October, 2017
Phoenix Children’s East Valley Care Center fixed rate    mortgage loan (b.)		6,164			5.88	%	December, 2017
Centennial Hills Medical Office Building floating rate    mortgage loan (b.)		9,968			4.06	%	January, 2018
Sparks Medical Building/Vista Medical Terrace    floating rate mortgage loan (b.)		4,202			4.06	%	February, 2018
Rosenberg Children’s Medical Plaza fixed rate    mortgage loan		8,103			4.85	%	May, 2018
Vibra Hospital-Corpus Christi fixed rate mortgage loan		2,699			6.50	%	July, 2019
700 Shadow Lane and Goldring MOBs fixed rate    mortgage loan		6,201			4.54	%	June, 2022
BRB Medical Office Building fixed rate mortgage loan		6,269			4.27	%	December, 2022
Desert Valley Medical Center fixed rate mortgage loan		5,047			3.62	%	January, 2023
2704 North Tenaya Way fixed rate mortgage loan		7,105			4.95	%	November, 2023
Tuscan Professional Building fixed rate mortgage loan		4,876			5.56	%	June, 2025
Total, excluding net debt premium and net financing fees		102,989
Less net financing fees		(353	)
Plus net debt premium		368
Total mortgages notes payable, non-recourse to us, net	$	103,004

(a.) All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

(b.) This loan is scheduled to mature within the next twelve months, at which time we will decide whether to refinance pursuant to a new mortgage loan or repaid utilizing borrowings under our Credit Agreement.

(c.) During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.

(d.)    Upon its June, 2017 maturity date, we intend to repay this loan utilizing borrowings under our Credit Agreement.

(e.)    The maturity date on this loan has been extended to July, 2017, at which time we intend to repay the loan utilizing borrowings under our Credit Agreement.

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General - Additional Information (Detail)	Mar. 31, 2017 Property
5 Unconsolidated Limited Liability Companies | Minimum
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Non-controlling equity interest, ownership percentage	33.00%
5 Unconsolidated Limited Liability Companies | Maximum
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Non-controlling equity interest, ownership percentage	95.00%
Medical office buildings | Limited Liability Companies
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Number of real estate investments	4

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Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions - Additional Information (Detail)	1 Months Ended	3 Months Ended
	Jun. 30, 2016 Subsidiary	Mar. 31, 2017 USD ($) Property Time	Mar. 31, 2016 USD ($)	Dec. 31, 2016
Related Party Transaction [Line Items]
Annual advisory fee as percentage of average invested real estate assets		0.70%
Advisory fee		$ 866,000	$ 767,000
Minimum | 5 Unconsolidated Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling equity interest, ownership percentage		33.00%
Maximum | 5 Unconsolidated Limited Liability Companies
Related Party Transaction [Line Items]
Non-controlling equity interest, ownership percentage		95.00%
Universal Health Services, Inc
Related Party Transaction [Line Items]
Number of term renewal options | Time		6
Additional renewal terms		5 years
Number of medical office buildings and free standing emergency departments | Property		17
Option to renew lease, notice period prior to termination date of current term		90 days
Period to purchase respective leased facilities at same price after lease terms		180 days
Renewal period of respective leased facilities at same price after lease terms		180 days
Number of wholly-owned subsidiaries | Subsidiary	3
Extended lease terms at existing lease rates		2021-12
Number of renewal options at existing lease rates | Time		3
Percentage ownership of outstanding shares		5.80%		5.80%
Universal Health Services, Inc | Henderson Medical Plaza
Related Party Transaction [Line Items]
Amount invested in MOB under construction		$ 10,800,000
Universal Health Services, Inc | Customer Concentration Risk | Revenues
Related Party Transaction [Line Items]
Percentage of revenues generated from leases		23.00%	25.00%
Universal Health Services, Inc | Customer Concentration Risk | Combined consolidated and unconsolidated revenue
Related Party Transaction [Line Items]
Percentage of revenues generated from leases		19.00%	20.00%
Universal Health Services, Inc | Hospital Facilities Leased
Related Party Transaction [Line Items]
Number of hospital facilities leased | Property		3
Universal Health Services, Inc | Minimum
Related Party Transaction [Line Items]
Initial lease terms		13 years
Universal Health Services, Inc | Maximum
Related Party Transaction [Line Items]
Initial lease terms		15 years
Universal Health Services of Delaware Inc
Related Party Transaction [Line Items]
Annual incentive fee to Advisor as percentage of cash available for distribution		20.00%
Incentive fees		$ 0	$ 0
Advisory fee		866,000	767,000
Average invested real estate assets		$ 495,000,000	$ 438,000,000
Universal Health Services of Delaware Inc | Minimum
Related Party Transaction [Line Items]
Percentage of equity to be exceeded for incentive distribution		15.00%

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Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities (Detail)	3 Months Ended
	Mar. 31, 2017 USD ($)
McAllen Medical Center
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 5,485,000
End of Lease Term	2021-12
Renewal Term (years)	10 years	[1]
Wellington Regional Medical Center
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 3,030,000
End of Lease Term	2021-12
Renewal Term (years)	10 years	[2]
Southwest Healthcare System, Inland Valley Campus
Operating Leased Assets [Line Items]
Annual Minimum Rent	$ 2,648,000
End of Lease Term	2021-12
Renewal Term (years)	10 years	[2]

[1] UHS has two 5-year renewal options at existing lease rates (through 2031).

[2] UHS has two 5-year renewal options at fair market value lease rates (2022 through 2031).

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Existing Lease Terms and Renewal Options for Each of UHS Hospital Facilities (Parenthetical) (Detail) - Universal Health Services, Inc	3 Months Ended
	Mar. 31, 2017 Time RenewalOption
Operating Leased Assets [Line Items]
Number of renewal options at existing lease rates	3
McAllen Medical Center
Operating Leased Assets [Line Items]
Number of renewal options at existing lease rates	2
Renewal options term at existing lease rates	5 years
Renewal options at existing lease rates expiration year	2031
Wellington Regional Medical Center And Southwest Healthcare System
Operating Leased Assets [Line Items]
Number of renewal options at fair market value lease rates | RenewalOption	2
Renewal options term at fair market value lease rates	5 years
Wellington Regional Medical Center And Southwest Healthcare System | Minimum
Operating Leased Assets [Line Items]
Renewal options at fair market value lease rates expiration year	2022
Wellington Regional Medical Center And Southwest Healthcare System | Maximum
Operating Leased Assets [Line Items]
Renewal options at fair market value lease rates expiration year	2031

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Dividends and Equity Issuance Program - Additional Information (Detail) - USD ($)	3 Months Ended		42 Months Ended
	Mar. 31, 2017	Mar. 31, 2016	Mar. 31, 2017	Jun. 30, 2016
Dividends and Equity Issuance [Line Items]
Dividends declared and paid	$ 8,907,000	$ 8,596,000
Declared and paid dividends, per share	$ 0.655	$ 0.645
Securities, aggregate sales price				$ 23,300,000
At-The-Market (ATM) Equity Issuance Program
Dividends and Equity Issuance [Line Items]
Share issued	0		829,916
Average sale price per share			$ 48.77
Net cash proceeds from stock issued			$ 38,800,000
Payment of stock issuance cost			1,700,000
Payments for stock issuance			1,000,000
At-The-Market (ATM) Equity Issuance Program | Other Expense
Dividends and Equity Issuance [Line Items]
Payments for stock issuance			$ 680,000

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Acquisitions, Dispositions and New Construction - Additional Information (Detail)	1 Months Ended			3 Months Ended
	Nov. 30, 2016 USD ($)	Sep. 30, 2016 USD ($)	Mar. 31, 2016 USD ($)	Mar. 31, 2017 USD ($) Acquisition	Mar. 31, 2016 USD ($)	Mar. 12, 2017
Business Acquisitions And Dispositions [Line Items]
Number of acquisitions | Acquisition				0
Cash received for property exchange transaction					$ 0
Henderson Medical Plaza | Universal Health Services, Inc
Business Acquisitions And Dispositions [Line Items]
Maximum amount of investment for development and construction			$ 21,100,000		$ 21,100,000
Amount invested in MOB under construction				$ 10,800,000
2704 North Tenaya Way
Business Acquisitions And Dispositions [Line Items]
Total purchase price	$ 15,300,000
Non-recourse third-party debt	$ 7,100,000
Frederick Crestwood Medical Office Building
Business Acquisitions And Dispositions [Line Items]
Total purchase price		$ 24,300,000
Madison Professional Office Building
Business Acquisitions And Dispositions [Line Items]
Total purchase price			$ 10,100,000
Madison Professional Office Building | Lease Agreements
Business Acquisitions And Dispositions [Line Items]
Renewal Term (years)			6 years 2 months 12 days
Medical office buildings
Business Acquisitions And Dispositions [Line Items]
Acquired intangible assets include in-place leases amortization period			6 years 2 months 12 days
St. Mary's Professional Office Building
Business Acquisitions And Dispositions [Line Items]
Entitled to aggregate of net cash proceeds from divestiture				57,300,000
Net sale proceeds due				11,300,000
Gain on divestiture of property				$ 27,200,000
Arlington Medical Properties
Business Acquisitions And Dispositions [Line Items]
Ownership prior to minority interest purchase				85.00%
Remaining percentage owned by third party member						15.00%
Total purchase price				$ 7,900,000
Repayment of loan				$ 21,400,000

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Allocation of Purchase Price to Assets Acquired and Liabilities Assumed (Detail) - Medical office buildings $ in Thousands	Mar. 31, 2016 USD ($)
Business Acquisition [Line Items]
Land	$ 2,328
Buildings and improvements	6,523
Intangible assets	1,209
Deposit	(150)
Net cash paid	$ 9,910

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Summarized Financial Information of Equity Affiliates - Additional Information (Detail) - Property	3 Months Ended
	Mar. 31, 2017	Mar. 12, 2017
Limited Liability Companies | Medical office buildings
Schedule Of Equity Method Investments [Line Items]
Number of real estate investments	4
Minimum
Schedule Of Equity Method Investments [Line Items]
Number of days for Non-Offering Member either to purchase or sell its entire ownership interest to or from Offering Member	60 days
Maximum
Schedule Of Equity Method Investments [Line Items]
Number of days for Non-Offering Member either to purchase or sell its entire ownership interest to or from Offering Member	90 days
4 Unconsolidated Limited Liability Companies / Limited Partner | Minimum
Schedule Of Equity Method Investments [Line Items]
Non-controlling equity interest, ownership percentage	33.00%
4 Unconsolidated Limited Liability Companies / Limited Partner | Maximum
Schedule Of Equity Method Investments [Line Items]
Non-controlling equity interest, ownership percentage	95.00%
Arlington Medical Properties
Schedule Of Equity Method Investments [Line Items]
Non-controlling equity interest, ownership percentage	85.00%
Remaining percentage owned by third party member		15.00%

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Limited Liability Companies Accounted for Under Equity Method (Detail) - Equity Method Investments	3 Months Ended
	Mar. 31, 2017
Suburban Properties
Schedule Of Equity Method Investments [Line Items]
Ownership	33.00%
Property Owned by LLC	St. Matthews Medical Plaza II
Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Ownership	74.00%	[1]
Property Owned by LLC	Mid Coast Hospital MOB	[1]
Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Ownership	95.00%	[2]
Property Owned by LLC	Texoma Medical Plaza	[2]
FTX MOB Phase II limited partnership
Schedule Of Equity Method Investments [Line Items]
Ownership	95.00%	[3]
Property Owned by LLC	Forney Medical Plaza II	[3]

[1] This LLC has a third-party term loan, which is non-recourse to us, of $8.6 million outstanding as of March 31, 2017.

[2] This building is on the campus of a UHS hospital and has tenants that include subsidiaries of UHS. This LLC has a third-party term loan, which is non-recourse to us, of $14.4 million outstanding as of March 31, 2017.

[3] We have committed to invest up to $2.5 million in equity and debt financing, of which $2.1 million has been funded as of March 31, 2017. This LLC has a third-party term loan, which is non-recourse to us, of $5.3 million outstanding as of March 31, 2017.

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Limited Liability Companies Accounted for Under Equity Method (Parenthetical) (Detail) $ in Millions	Mar. 31, 2017 USD ($)
Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	$ 8.6
Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	14.4
FTX MOB Phase II limited partnership
Schedule Of Equity Method Investments [Line Items]
Third-party term loan	5.3
Committed investment in equity and debt financing, funded	2.1
Commitment to investment	$ 2.5

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Condensed Combined Statement of Income for Limited Liabilities Accounted for under Equity Method (Detail) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2017	Mar. 31, 2016
Equity Method Investments And Joint Ventures [Abstract]
Revenues		$ 3,583	$ 3,736
Operating expenses		1,250	1,353
Depreciation and amortization		643	613
Interest, net		562	657
Net income		1,128	1,113
Our share of net income	[1]	$ 1,077	$ 1,059

[1] Our share of net income for the three months ended March 31, 2017 and 2016 includes approximately $284,000 and $296,000, respectively, of interest income earned by us on an advance made to Arlington Medical Properties, LLC. This advance was repaid to us effective with the previously mentioned Arlington Medical Properties, LLC transaction during March, 2017.

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Condensed Combined Statement of Income for Limited Liabilities Accounted for under Equity Method (Parenthetical) (Detail) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Arlington Medical Properties
Schedule Of Equity Method Investments [Line Items]
Interest income earned on various advances made to LLCs	$ 284,000	$ 296,000

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Condensed Combined Balance Sheets of Limited Liabilities Accounted for under Equity Method (Detail) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Equity Method Investments And Joint Ventures [Abstract]
Net property, including CIP	$ 33,816	$ 60,970
Other assets	3,685	4,598
Total assets	37,501	65,568
Liabilities	2,726	3,334
Mortgage notes payable, non-recourse to us	28,222	28,367
Advances payable to us		21,638
Equity	6,553	12,229
Total liabilities and equity	37,501	65,568
Our share of equity in and advances to LLCs reflected as:
Investments in LLCs	4,722	13,955
Advances to LLCs		21,638
Investments in and advances to LLCs before amounts included in accrued expenses and other liabilities	4,722	35,593
Amounts included in accrued expenses and other liabilities	(1,476)	(1,862)
Our share of equity in and advances to LLCs, net	$ 3,246	$ 33,731

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Aggregate Principal Amounts Due on Mortgage Notes Payable by Unconsolidated LLCs, Accounted Under Equity Method (Detail) - USD ($) $ in Thousands		3 Months Ended
		Mar. 31, 2017	Dec. 31, 2016
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance		$ 28,222	$ 28,367
Equity Method Investments
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	28,222	28,367
Equity Method Investments | FTX MOB Phase II
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 5,267	5,301
Maturity Date	[2]	2017-08
Equity Method Investments | Grayson Properties
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 14,375	14,438
Maturity Date		2021-09
Equity Method Investments | Brunswick Associates
Schedule Of Equity Method Investments [Line Items]
Mortgage Loan Balance	[1]	$ 8,580	$ 8,628
Maturity Date		2024-12

[1] All mortgage loans require monthly principal payments through maturity and include a balloon principal payment upon maturity.

[2] This loan is scheduled to mature within the next twelve months, at which time it will be refinanced pursuant to: (i) a new third-party mortgage loan; (ii) a member loan extended from us to the LLC, or; (iii) equity contributions to the LLC by us and the third-party member. Funds required from us to the LLC for either the member loan or our share of an equity contribution would likely be borrowed under our Credit Agreement.

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Debt and Financial Instruments - Additional Information (Detail)				1 Months Ended	3 Months Ended
	Mar. 31, 2017 USD ($) MortgageLoan		Mar. 27, 2015 USD ($) Option	Apr. 30, 2017 USD ($)	Mar. 31, 2017 USD ($) MortgageLoan		Sep. 30, 2016 USD ($) Derivative	Jun. 30, 2016 USD ($) Derivative	Mar. 31, 2016 USD ($)	Mar. 31, 2014 USD ($) Derivative	Sep. 30, 2013 USD ($) Derivative	Dec. 31, 2016 USD ($) MortgageLoan	May 24, 2016 USD ($)
Debt Instrument [Line Items]
Outstanding borrowings under revolving credit agreement	$ 169,900,000				$ 169,900,000							$ 201,500,000
Outstanding borrowings under letter of credit	2,700,000				2,700,000
Available borrowing capacity	$ 77,400,000				$ 77,400,000
Number of non-recourse mortgages | MortgageLoan	14				14							15
Balance of Non Recourse Mortgages	$ 102,989,000	[1]			$ 102,989,000	[1]						$ 114,200,000
Mortgage and other notes payable, non-recourse to us, debt premium	368,000	[1]			368,000	[1]						436,000
Financing fees net	353,000	[1]			353,000	[1]						381,000
Repayments of mortgage loan					11,174,000				$ 790,000
Mortgage loan fair value	105,000,000				105,000,000							$ 115,700,000
Interest Rate Cap
Debt Instrument [Line Items]
Number of interest rate cap agreements | Derivative							1	1		2	1
Notional amount							$ 30,000,000	$ 30,000,000		$ 20,000,000	$ 10,000,000
Premium paid							$ 55,000	$ 115,000		$ 134,500	$ 136,000
Expiration date of interest rate cap							Mar. 31, 2019	Mar. 31, 2019		Jan. 31, 2017	Jan. 31, 2017
Summerlin Hospital Medical Office Building III floating rate mortgage loan
Debt Instrument [Line Items]
Repayments of mortgage loan	10,300,000
Summerlin Hospital Medical Office Building III fixed rate mortgage loan | Subsequent Event
Debt Instrument [Line Items]
Refinanced this property with fixed rate mortgage loan				$ 13,200,000
Maturity Date				2024-04
Loan interest rate fixed percentage				4.03%
LIBOR | Interest Rate Cap
Debt Instrument [Line Items]
Derivative instruments, LIBOR rate							1.50%	1.50%		1.50%	1.50%
Revolving Credit Facility
Debt Instrument [Line Items]
Outstanding borrowing	$ 250,000,000				$ 250,000,000
Credit Agreement
Debt Instrument [Line Items]
Outstanding borrowing			$ 185,000,000										$ 250,000,000
Unsecured revolving amended credit agreement terminated date			2019-03
Number of additional one year extension options | Option			1
Proceeds from Lines of Credit			$ 50,000,000
Credit facility, Interest Rate Terms					One, two, three, or six month LIBOR plus an applicable margin ranging from 1.50% to 2.00% or at the Base Rate plus an applicable margin ranging from 0.50% to 1.00%.
Base rate description					The greatest of: (a)?the administrative agent?s prime rate; (b)?the federal funds effective rate plus 1/2 of 1%, and; (c)?one month LIBOR plus 1%.
Fee payable on unused portion of commitment	0.25%
Credit Agreement | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate	1.625%
Credit Agreement | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate	0.625%
Credit Agreement | Swingline/Short-Term Loans
Debt Instrument [Line Items]
Outstanding borrowing			20,000,000
Credit Agreement | Letters of Credit
Debt Instrument [Line Items]
Outstanding borrowing			$ 40,000,000
Credit Agreement | Minimum
Debt Instrument [Line Items]
Fee payable on unused portion of commitment			0.20%
Credit Agreement | Minimum | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate			1.50%
Margin points added to the base rate			1.00%
Credit Agreement | Minimum | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate			0.50%
Credit Agreement | Minimum | Federal Funds Effective Rate
Debt Instrument [Line Items]
Margin points added to the base rate			0.50%
Credit Agreement | Maximum
Debt Instrument [Line Items]
Fee payable on unused portion of commitment			0.40%
Credit Agreement | Maximum | LIBOR
Debt Instrument [Line Items]
Margin points added to the reference rate			2.00%
Credit Agreement | Maximum | Base Rate
Debt Instrument [Line Items]
Margin points added to the reference rate			1.00%

[1] All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

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Summary of Required Compliance Ratios in Connection with Terms of Credit Agreement (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2017 USD ($)
Debt Instrument [Line Items]
Covenant, Tangible net worth	$ 125,000
Tangible net worth	$ 191,372
Total leverage	44.30%
Secured leverage	16.10%
Unencumbered leverage	40.30%
Fixed charge coverage	3.70%
Maximum
Debt Instrument [Line Items]
Covenant, Total leverage	60.00%
Covenant, Secured leverage	30.00%
Covenant, Unencumbered leverage	60.00%
Minimum
Debt Instrument [Line Items]
Covenant, Fixed charge coverage	1.50%

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Summary of Outstanding Mortgages, Excluding Net Debt Premium (Detail) - USD ($)		3 Months Ended
		Mar. 31, 2017		Dec. 31, 2016
Debt Instrument [Line Items]
Outstanding Balance		$ 102,989,000	[1]	$ 114,200,000
Less net financing fees		(353,000)	[1]	(381,000)
Plus net debt premium		368,000	[1]	436,000
Total mortgages notes payable, non-recourse to us, net		103,004,000	[1]	$ 114,217,000
Peace Health fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[2]	$ 20,180,000
Debt Instrument Interest Rate Stated Percentage	[2]	5.64%
Maturity Date	[2]	2017-04
Medical Center of Western Connecticut fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[3]	$ 4,500,000
Debt Instrument Interest Rate Stated Percentage	[3]	6.00%
Maturity Date	[3]	2017-06
Auburn Medical II floating rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[4]	$ 6,668,000
Debt Instrument Interest Rate Stated Percentage	[4]	3.53%
Maturity Date	[4]	2017-07
Summerlin Hospital Medical Office Building II fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[5]	$ 11,007,000
Debt Instrument Interest Rate Stated Percentage	[5]	5.50%
Maturity Date	[5]	2017-10
Phoenix Children's East Valley Care Center Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[5]	$ 6,164,000
Debt Instrument Interest Rate Stated Percentage	[5]	5.88%
Maturity Date	[5]	2017-12
Centennial Hills Medical Office Building floating rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[5]	$ 9,968,000
Debt Instrument Interest Rate Stated Percentage	[5]	4.06%
Maturity Date	[5]	2018-01
Sparks Medical Building/Vista Medical Terrace Floating Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1],[5]	$ 4,202,000
Debt Instrument Interest Rate Stated Percentage	[5]	4.06%
Maturity Date	[5]	2018-02
Rosenberg Children's Medical Plaza Fixed Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 8,103,000
Debt Instrument Interest Rate Stated Percentage		4.85%
Maturity Date		2018-05
Vibra Hospital-Corpus Christi fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 2,699,000
Debt Instrument Interest Rate Stated Percentage		6.50%
Maturity Date		2019-07
700 Shadow Lane and Goldring MOBs fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 6,201,000
Debt Instrument Interest Rate Stated Percentage		4.54%
Maturity Date		2022-06
BRB Medical Office Building fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 6,269,000
Debt Instrument Interest Rate Stated Percentage		4.27%
Maturity Date		2022-12
Desert Valley Medical Center Floating Rate Mortgage Loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 5,047,000
Debt Instrument Interest Rate Stated Percentage		3.62%
Maturity Date		2023-01
2704 North Tenaya Way fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 7,105,000
Debt Instrument Interest Rate Stated Percentage		4.95%
Maturity Date		2023-11
Tuscan Professional Building fixed rate mortgage loan
Debt Instrument [Line Items]
Outstanding Balance	[1]	$ 4,876,000
Debt Instrument Interest Rate Stated Percentage		5.56%
Maturity Date		2025-06

[1] All mortgage loans require monthly principal payments through maturity and either fully amortize or include a balloon principal payment upon maturity.

[2] During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.

[3] Upon its June, 2017 maturity date, we intend to repay this loan utilizing borrowings under our Credit Agreement.

[4] The maturity date on this loan has been extended to July, 2017, at which time we intend to repay the loan utilizing borrowings under our Credit Agreement.

[5] This loan is scheduled to mature within the next twelve months, at which time we will decide whether to refinance pursuant to a new mortgage loan or repaid utilizing borrowings under our Credit Agreement.

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Summary of Outstanding Mortgages, Excluding Net Debt Premium (Parenthetical) (Detail) - USD ($) $ in Thousands		1 Months Ended	3 Months Ended
		Apr. 30, 2017	Mar. 31, 2017	Mar. 31, 2016
Debt Instrument [Line Items]
Repayments of mortgage loan			$ 11,174	$ 790
Peace Health fixed rate mortgage loan
Debt Instrument [Line Items]
Maturity date	[1]		2017-04
Peace Health fixed rate mortgage loan | Subsequent Event
Debt Instrument [Line Items]
Repayments of mortgage loan		$ 20,200
Medical Center of Western Connecticut fixed rate mortgage loan
Debt Instrument [Line Items]
Maturity date	[2]		2017-06
Auburn Medical II floating rate mortgage loan
Debt Instrument [Line Items]
Maturity date	[3]		2017-07

[1] During April, 2017, upon its maturity, this $20.2 million fixed rate mortgage loan on the Peace Health Medical Clinic was repaid utilizing borrowings under our Credit Agreement.

[2] Upon its June, 2017 maturity date, we intend to repay this loan utilizing borrowings under our Credit Agreement.

[3] The maturity date on this loan has been extended to July, 2017, at which time we intend to repay the loan utilizing borrowings under our Credit Agreement.

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Segment Reporting - Additional Information (Detail)	3 Months Ended
	Mar. 31, 2017 Segment
Segment Reporting [Abstract]
Number of reportable segments	1