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 September 30, 2022 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 ...

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 June 30, 2022 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 othe ...

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q (MARK ONE) 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) UNIVERSAL CORPORATE CENTER 367 SOUTH GULPH ROAD KING OF PRUSSIA, PENNSYLVANIA 19406-09 ...

Real Estate Investments - As of February 24, 2022, the company has investments in 75 facilities across 21 states, including 6 hospital facilities, 58 medical/office buildings, 4 free-standing emergency departments, 4 childcare centers, and 3 specialty facilities[23]. - The company has a total of 75 real estate investments or commitments, indicating a strategy of market expansion in the healthcare sector[23]. - The company’s facilities include a mix of owned and leased properties, with a focus on healthcare-related services[23]. - The company has six acute and behavioral health care hospitals in its portfolio as of December 31, 2021, up from four in 2020[26]. - The company acquired three hospitals as part of an asset purchase agreement with Universal Health Services on December 31, 2021[26]. - The company paid approximately $2.8 million in cash to Universal Health Services for the acquisition of Aiken Regional Medical Center and Canyon Creek Behavioral Health[28]. - The company is developing Sierra Medical Plaza I, an MOB in Reno, Nevada, with an estimated cost of approximately $34 million[42]. - The company purchased a 5% minority ownership interest in Grayson Properties, LP for approximately $3.1 million, consolidating the LP effective with the purchase date[43]. - The company acquired the Fire Mesa office building in Las Vegas for approximately $12.9 million, fully leased to a subsidiary of UHS[44]. Revenue and Financial Performance - The leases for the six acute and behavioral health care hospitals accounted for approximately 25% of consolidated revenues in 2021, compared to 22% in 2020[26]. - The revenue from the specialty facility lease that expired in 2021 represented about 2% of consolidated revenue for the year ended December 31, 2021[27]. - The combined revenues from leases on three acute care and one behavioral health care hospital facilities leased to subsidiaries of UHS accounted for approximately 23% of the company's consolidated revenue for the five years ended December 31, 2021[32]. - The aggregate revenues generated from UHS-related tenants comprised approximately 32% of the company's consolidated revenue for the five years ended December 31, 2021[32]. - The company entered into an asset purchase and sale agreement with UHS, resulting in a gain of approximately $68.4 million included in the consolidated statement of income for the year ended December 31, 2021[33]. - The annual rental for Aiken Regional Medical Center and Canyon Creek Behavioral Health is approximately $5.6 million, with a 2.25% annual increase starting January 1, 2023[35]. - The lease on Wellington Regional Medical Center was renewed for a 5-year term with an annual fair market value lease rate of $6.3 million, increasing by 2.50% annually starting January 1, 2023[40]. - The company anticipates continued investment in healthcare-related facilities to improve its competitive position in the market[58]. - The company recorded a decrease of $546,000 in net income due to increased interest expense[210]. - For the year ended December 31, 2021, net income was $109.2 million, a significant increase of $89.7 million compared to $19.4 million in 2020[210]. - Total revenues increased by $6.2 million, or 7.9%, during 2021 compared to 2020, primarily driven by rentals from the Clive Behavioral Health facility and increased bonus rentals from hospitals leased to UHS[211]. Lease and Occupancy Information - The average remaining lease term for the six acute and behavioral health care hospitals is 10.6 years, with renewal options ranging from one to ten years[26]. - The combined weighted average Coverage Ratio for the four occupied hospitals owned at the end of 2021 was approximately 7.9, compared to 10.3 at the end of 2020[29]. - The average occupancy rate for the Inland Valley Campus of Southwest Healthcare System was 76% in 2021, up from 63% in 2020[160]. - McAllen Medical Center reported an occupancy rate of 51% in 2021, with a guaranteed payment of $5,485,000 until 2026[160]. - Wellington Regional Medical Center achieved a 75% occupancy rate in 2021, with a guaranteed payment of $6,319,000 and a lease term until 2026[160]. - Clive Behavioral Health reported a low occupancy rate of 16% in 2021, with a guaranteed payment of $2,628,000 until 2040[160]. - The Rosenberg Children's Medical Plaza maintained a 100% occupancy rate in 2021, with a guaranteed payment of $2,265,000 until 2028[161]. - The Texoma Medical Plaza achieved a 96% occupancy rate in 2021, with a guaranteed payment of $1,948,000 until 2030[161]. Regulatory and Compliance Issues - The company qualifies as a REIT and must distribute at least 90% of its annual REIT taxable income to shareholders to maintain this status[52]. - The company must comply with strict income distribution requirements to maintain its REIT status, which could adversely affect its financial condition if not met[131]. - Dividends paid by the company as a REIT may be subject to higher federal income tax rates compared to dividends from regular corporations, potentially affecting share value[130]. - Compliance with REIT requirements may limit the ability to pursue attractive investment opportunities[133]. - The company is subject to federal excise tax, which is 4% of the amount exceeding cash distributions during the calendar year[208]. Market and Economic Risks - The operators of the company's facilities derive a significant portion of their revenue from federal and state healthcare programs, including Medicare and Medicaid, which are subject to changes that could materially affect reimbursement levels[60]. - The company faces risks related to tenants' ability to make timely rent payments, which could adversely affect occupancy levels and revenue[79]. - The Budget Control Act mandated a 2% reduction in Medicare payments, which has been extended through 2030, potentially impacting future revenues[86]. - The uncertainties surrounding healthcare reform could materially affect the company's revenues and net income[88]. - The company has seen significant budget deficits in states where its facilities operate, leading to potential reductions in Medicaid funding[84]. - Changes in government reimbursement programs and private payor negotiations could adversely impact the financial position of the company's hospital operators[85]. - The COVID-19 pandemic has not had a material adverse impact on the company's financial results during 2021, but future developments related to the pandemic are likely to have a material adverse impact on financial results[190]. - The company faces potential risks from increased competition and decreases in occupancy and rental rates in certain markets, which may adversely affect operating results[192]. Advisory and Management Fees - Advisory fees incurred and paid to UHS amounted to $4.4 million in 2021, $4.1 million in 2020, and $4.0 million in 2019, based on average invested real estate assets of $629 million, $592 million, and $568 million respectively[49]. - The advisory agreement with UHS was renewed for 2022 under the same terms as in 2021 and 2020, indicating continuity in the advisory relationship[48]. Future Outlook - The company anticipates that the future operations and financial results will depend on various factors related to the COVID-19 pandemic, including the volume of canceled or rescheduled elective procedures[75]. - The company may experience a decrease in prospective tenants due to COVID-19 restrictions, which could negatively impact new lease volumes and renewal rates[190]. - Legislative initiatives, including the CARES Act and ARPA, have provided funding to healthcare providers, but the impact on tenants' operations remains uncertain[190]. - The company faces increased competition in the healthcare industry, which has resulted in lower revenues and higher costs for operators, including UHS[113].

[PART I. FINANCIAL INFORMATION (unaudited)](index=2&type=section&id=PART%20I.%20FINANCIAL%20INFORMATION%20(unaudited)) Presents the unaudited condensed consolidated financial statements and related notes for the specified periods [Item 1. Financial Statements](index=3&type=section&id=Item%201.%20Financial%20Statements) Presents unaudited condensed consolidated financial statements, including income, comprehensive income, balance sheets, equity, cash flows, and explanatory notes [Condensed Consolidated Statements of Income](index=3&type=section&id=Condensed%20Consolidated%20Statements%20of%20Income) Provides a summary of the company's revenues, expenses, net income, and earnings per share for the specified periods **Condensed Consolidated Statements of Income (amounts in thousands)** | Metric | Three Months Ended Sep 30, 2021 | Three Months Ended Sep 30, 2020 | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :------------------------------ | :------------------------------ | :----------------------------- | :----------------------------- | | Total Revenues | $21,205 | $19,692 | $62,780 | $58,180 | | Total Expenses | $13,914 | $13,052 | $41,308 | $38,815 | | Net Income | $5,344 | $5,193 | $17,551 | $14,447 | | Basic Earnings Per Share | $0.39 | $0.38 | $1.28 | $1.05 | | Diluted Earnings Per Share | $0.39 | $0.38 | $1.27 | $1.05 | [Condensed Consolidated Statements of Comprehensive Income](index=4&type=section&id=Condensed%20Consolidated%20Statements%20of%20Comprehensive%20Income) Details the company's net income and other comprehensive income components, such as unrealized derivative gains/losses **Condensed Consolidated Statements of Comprehensive Income (amounts in thousands)** | Metric | Three Months Ended Sep 30, 2021 | Three Months Ended Sep 30, 2020 | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :------------------------------ | :------------------------------ | :----------------------------- | :----------------------------- | | Net Income | $5,344 | $5,193 | $17,551 | $14,447 | | Unrealized derivative gains/(loss) on cash flow hedges | $471 | $234 | $3,259 | $(5,709) | | Total Comprehensive Income | $5,815 | $5,427 | $20,810 | $8,738 | [Condensed Consolidated Balance Sheets](index=5&type=section&id=Condensed%20Consolidated%20Balance%20Sheets) Presents a snapshot of the company's assets, liabilities, and equity at specific reporting dates **Condensed Consolidated Balance Sheets (amounts in thousands)** | Metric | September 30, 2021 | December 31, 2020 | | :-------------------------------- | :------------------- | :------------------ | | Net Real Estate Investments | $436,458 | $443,801 | | Investments in and advances to LLCs | $23,123 | $4,278 | | Cash and cash equivalents | $9,347 | $5,742 | | Total Assets | $517,681 | $494,009 | | Line of credit borrowings | $276,800 | $236,200 | | Mortgage notes payable, non-recourse to us, net | $57,397 | $58,895 | | Total Liabilities | $365,870 | $335,004 | | Total Equity | $151,811 | $159,005 | [Condensed Consolidated Statements of Changes in Equity](index=6&type=section&id=Condensed%20Consolidated%20Statements%20of%20Changes%20in%20Equity) Outlines the changes in the company's total equity, including net income, dividends, and other comprehensive income **Condensed Consolidated Statements of Changes in Equity (amounts in thousands)** | Metric | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :----------------------------- | :----------------------------- | | Total Equity (Beginning of Period) | $159,005 | $181,734 | | Net Income | $17,551 | $14,447 | | Cumulative Dividends | $(28,868) | $(28,426) | | Unrealized net gain/(loss) on cash flow hedges | $3,259 | $(5,709) | | Total Equity (End of Period) | $151,811 | $162,394 | [Condensed Consolidated Statements of Cash Flows](index=8&type=section&id=Condensed%20Consolidated%20Statements%20of%20Cash%20Flows) Summarizes the cash inflows and outflows from operating, investing, and financing activities **Condensed Consolidated Statements of Cash Flows (amounts in thousands)** | Metric | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :----------------------------- | :----------------------------- | | Net cash provided by operating activities | $36,194 | $32,775 | | Net cash used in investing activities | $(41,155) | $(16,792) | | Net cash provided by/(used in) financing activities | $8,566 | $(15,773) | | Increase in cash and cash equivalents | $3,605 | $210 | | Cash and cash equivalents, end of period | $9,347 | $6,320 | [Notes to Condensed Consolidated Financial Statements](index=9&type=section&id=Notes%20to%20Condensed%20Consolidated%20Financial%20Statements) Provides detailed explanations and disclosures regarding the company's accounting policies and financial statement items [(1) General](index=9&type=section&id=(1)%20General) Describes the Trust's identity, revenue recognition, and the unaudited nature of the financial statements - The Trust refers to Universal Health Realty Income Trust and its subsidiaries[28](index=28&type=chunk) - Revenues do not include unconsolidated LLCs, which are accounted for by the equity method[29](index=29&type=chunk) - Financial statements are unaudited and condensed, prepared in conformity with U.S. GAAP[30](index=30&type=chunk) [(2) Relationship with Universal Health Services, Inc. ("UHS") and Related Party Transactions](index=9&type=section&id=(2)%20Relationship%20with%20Universal%20Health%20Services%2C%20Inc.%20(%22UHS%22)%20and%20Related%20Party%20Transactions) Details the company's relationship with UHS, including tenant revenue, advisory fees, and specific property transactions **UHS-Related Tenant Revenue Contribution** | Period | 2021 | 2020 | | :-------------------------------- | :----- | :----- | | Three Months Ended Sep 30 | 37% | 34% | | Nine Months Ended Sep 30 | 36% | 33% | - UHS of Delaware, Inc., a wholly-owned subsidiary of UHS, serves as the Trust's Advisor under an annually renewable Advisory Agreement[7](index=7&type=chunk)[44](index=44&type=chunk) **Advisory Fees to UHS (amounts in thousands)** | Period | 2021 | 2020 | | :-------------------------------- | :----- | :----- | | Three Months Ended Sep 30 | $1,121 | $1,039 | | Nine Months Ended Sep 30 | $3,272 | $3,082 | - UHS owned **5.7%** of the Trust's outstanding shares of beneficial interest as of September 30, 2021, and December 31, 2020[46](index=46&type=chunk) - UHS plans to terminate the existing lease on Southwest Healthcare System, Inland Valley Campus, by December 31, 2021, and has agreed to exchange it for substitution properties of substantially equal fair market value[36](index=36&type=chunk)[39](index=39&type=chunk)[81](index=81&type=chunk) - In May 2021, the Trust acquired the Fire Mesa office building in Las Vegas, Nevada, for approximately **$12.9 million**, which is 100% leased by a wholly-owned subsidiary of UHS[38](index=38&type=chunk)[54](index=54&type=chunk) [(3) Dividends and Equity Issuance Program](index=13&type=section&id=(3)%20Dividends%20and%20Equity%20Issuance%20Program) Reports on dividends declared and paid, along with activity under the at-the-market equity issuance program **Dividends Declared and Paid (amounts in thousands, except per share)** | Period | 2021 | 2020 | | :-------------------------------- | :----- | :----- | | Three Months Ended Sep 30 | $9,649 ($0.70/share) | $9,501 ($0.69/share) | | Nine Months Ended Sep 30 | $28,868 ($2.095/share) | $28,426 ($2.065/share) | - No shares were issued under the at-the-market (ATM) equity issuance program during the first nine months of 2021[51](index=51&type=chunk)[139](index=139&type=chunk) - Since its commencement in Q2 2020, the ATM program has issued **2,704 shares**, generating approximately **$270 thousand** in net proceeds[51](index=51&type=chunk)[139](index=139&type=chunk) [(4) Acquisitions and Divestitures](index=13&type=section&id=(4)%20Acquisitions%20and%20Divestitures) Summarizes recent property acquisitions and divestitures, including their financial impact - In May 2021, the Fire Mesa office building in Las Vegas, Nevada, was acquired for approximately **$12.9 million** as part of tax-deferred like-kind exchange transactions[54](index=54&type=chunk) - In June 2021, the Children's Clinic at Springdale, AR, was sold for approximately **$3.2 million**, resulting in a gain of **$1.3 million**[55](index=55&type=chunk) - Subsequent to September 30, 2021 (November 1, 2021), the Auburn Medical Office Building II was sold for approximately **$25.1 million**[53](index=53&type=chunk) [(5) Summarized Financial Information of Equity Affiliates](index=14&type=section&id=(5)%20Summarized%20Financial%20Information%20of%20Equity%20Affiliates) Provides financial details for the company's unconsolidated equity investments in jointly-owned LLCs/LPs - As of September 30, 2021, the Trust had non-controlling equity investments in five jointly-owned LLCs/LPs, accounted for under the equity method, with ownership interests ranging from **33% to 95%**[29](index=29&type=chunk)[61](index=61&type=chunk) **Our Share of Net Income from Unconsolidated LLCs (amounts in thousands)** | Period | 2021 | 2020 | | :-------------------------------- | :----- | :----- | | Three Months Ended Sep 30 | $303 | $517 | | Nine Months Ended Sep 30 | $1,341 | $1,371 | - Subsequent to September 30, 2021, the Trust purchased the remaining **5%** minority ownership interest in Grayson Properties, LP for approximately **$3.1 million**, resulting in **100%** ownership and future consolidation[37](index=37&type=chunk)[62](index=62&type=chunk)[71](index=71&type=chunk) **Mortgage Notes Payable by Unconsolidated LLCs/LPs (non-recourse to Trust, amounts in thousands)** | Date | Balance | | :-------------------------------- | :------ | | September 30, 2021 | $22,133 | | December 31, 2020 | $39,735 | [(6) Recent Accounting Pronouncements](index=16&type=section&id=(6)%20Recent%20Accounting%20Pronouncements) Discusses the impact of new FASB guidance on COVID-19 lease concessions and reference rate reform - The FASB issued guidance providing accounting relief for COVID-19 related lease concessions, allowing entities to account for them as if part of existing lease contracts under certain conditions[72](index=72&type=chunk) - The COVID-19 pandemic did not materially affect the Trust's operations or financial results during the three and nine months ended September 30, 2021, or the year ended December 31, 2020[73](index=73&type=chunk) - The FASB issued ASC Topic 848, "Reference Rate Reform," offering optional practical expedients for reference rate reform activities impacting debt, leases, and derivatives[74](index=74&type=chunk) [(7) Lease Accounting](index=17&type=section&id=(7)%20Lease%20Accounting) Explains the company's adoption of ASC 842, disaggregated lease revenue, and significant lease events - The Trust adopted the new lease standard (ASC 842) on January 1, 2019, applying it to leases as both a lessor and lessee[76](index=76&type=chunk) **Lease Revenue Disaggregation (amounts in thousands)** | Category | Three Months Ended Sep 30, 2021 | Three Months Ended Sep 30, 2020 | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :------------------------------ | :------------------------------ | :----------------------------- | :----------------------------- | | Lease revenue - UHS facilities | $7,574 | $6,381 | $21,971 | $18,243 | | Lease revenue - Non-related parties | $13,115 | $12,841 | $39,324 | $38,526 | - UHS has indicated its intent to renew the lease on Wellington Regional Medical Center, which expires December 31, 2021, at fair market value lease rates[80](index=80&type=chunk) - The lease on Kindred Hospital Chicago Central is scheduled to expire on December 31, 2021, and the tenant does not intend to renew, leading to marketing efforts for new tenants[83](index=83&type=chunk) - Two hospital facilities in Evansville, Indiana, and Corpus Christi, Texas, have remained vacant since May/June 2019[84](index=84&type=chunk) [(8) Debt and Financial Instruments](index=19&type=section&id=(8)%20Debt%20and%20Financial%20Instruments) Details the company's revolving credit agreement, mortgage notes, interest rate swaps, and debt covenants - On July 2, 2021, the Trust entered into an amended and restated revolving credit agreement, increasing its aggregate revolving credit commitment to **$375 million** from **$350 million**, maturing on July 2, 2025[88](index=88&type=chunk)[148](index=148&type=chunk) - As of September 30, 2021, the Trust had **$276.8 million** of outstanding borrowings and **$94.6 million** of available borrowing capacity under its credit agreement[91](index=91&type=chunk)[151](index=151&type=chunk) **Mortgage Notes Payable, Non-Recourse (amounts in thousands)** | Date | Balance | | :-------------------------------- | :------ | | September 30, 2021 | $57,397 | | December 31, 2020 | $58,895 | - The Trust has three interest rate swap agreements with a combined notional amount of **$140 million**, designated as cash flow hedges, to manage interest rate risk[95](index=95&type=chunk)[96](index=96&type=chunk)[97](index=97&type=chunk)[164](index=164&type=chunk) - At September 30, 2021, the fair value of the interest rate swaps was a net liability of **$556 thousand**[98](index=98&type=chunk)[161](index=161&type=chunk) - A **1%** change in interest rates would impact net income by approximately **$1.4 million**, based on variable rate debt outstanding and interest rate swaps[165](index=165&type=chunk) **Compliance Ratios (as of September 30, 2021)** | Covenant | Requirement | Actual | | :-------------------------------- | :---------- | :----- | | Tangible net worth | >=$125,000 | $141,419 | | Total leverage | <60% | 45.6% | | Secured leverage | <30% | 8.1% | | Unencumbered leverage | <60% | 47.2% | | Fixed charge coverage | >1.50x | 4.8x | [(9) Segment Reporting](index=21&type=section&id=(9)%20Segment%20Reporting) Explains the company's single reportable segment structure for its healthcare and human service facilities - The Trust's primary business is investing in and leasing healthcare and human service facilities through direct ownership or joint ventures[99](index=99&type=chunk) - The Trust operates as a single reportable segment, aggregating individual properties due to similarities in nature, economics, tenants, and operational processes[99](index=99&type=chunk)[100](index=100&type=chunk) [Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations](index=22&type=section&id=Item%202.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) Management's perspective on financial condition, operating results, liquidity, capital resources, and off-balance sheet arrangements [Overview](index=22&type=section&id=Overview) Introduces Universal Health Realty Income Trust as a REIT investing in healthcare and human service facilities - Universal Health Realty Income Trust is a REIT that invests in healthcare and human service related facilities[102](index=102&type=chunk) - As of November 1, 2021, the portfolio includes **71** real estate investments across **20** states, comprising hospitals, free-standing emergency departments, medical/office buildings, and childcare centers[102](index=102&type=chunk) [Forward Looking Statements and Certain Risk Factors](index=22&type=section&id=Forward%20Looking%20Statements%20and%20Certain%20Risk%20Factors) Discusses potential future impacts from COVID-19, reliance on UHS, regulatory changes, and competition - Future operations and financial results are subject to material impact from COVID-19 related factors, including patient volumes, government regulations, and economic conditions[104](index=104&type=chunk)[105](index=105&type=chunk) - A substantial portion of revenues (**37%** for Q3 2021, **36%** for 9M 2021) is dependent on one operator, Universal Health Services, Inc. (UHS)[106](index=106&type=chunk) - New CMS and OSHA mandates for COVID-19 vaccinations for healthcare staff by January 4, 2022, could adversely affect staffing, patient volumes, and labor costs for operators[106](index=106&type=chunk) - Risks include potential inability to complete tax-deferred like-kind exchange transactions under Section 1031, leading to unfavorable tax consequences[108](index=108&type=chunk) - Competition for properties and tenants, changes in healthcare regulations, and reimbursement levels (Medicare/Medicaid) are significant risk factors[109](index=109&type=chunk)[112](index=112&type=chunk) [Critical Accounting Policies and Estimates](index=26&type=section&id=Critical%20Accounting%20Policies%20and%20Estimates) Explains the company's accounting for real estate acquisitions and its qualification as a REIT - The Trust applies purchase accounting for real estate acquisitions, allocating fair value to tangible assets (land, building, tenant improvements) and identified intangible assets and liabilities (above/below-market leases, acquired ground leases)[113](index=113&type=chunk)[116](index=116&type=chunk) - The Trust qualifies as a REIT under Sections 856 to 860 of the Internal Revenue Code, generally exempting it from federal income tax on distributed income[118](index=118&type=chunk)[119](index=119&type=chunk) - The Trust is subject to a **4%** federal excise tax if **85%** of ordinary income plus **95%** of capital gain income for the calendar year exceeds cash distributions[120](index=120&type=chunk) [Results of Operations](index=28&type=section&id=Results%20of%20Operations) Analyzes the company's net income, total revenues, Funds From Operations (FFO), and interest expense **Net Income (amounts in thousands)** | Period | 2021 | 2020 | Change | | :-------------------------------- | :----- | :----- | :----- | | Three Months Ended Sep 30 | $5,344 | $5,193 | +$151 | | Nine Months Ended Sep 30 | $17,551 | $14,447 | +$3,104 | **Total Revenues (amounts in thousands)** | Period | 2021 | 2020 | Change | % Change | | :-------------------------------- | :----- | :----- | :----- | :------- | | Three Months Ended Sep 30 | $21,205 | $19,692 | +$1,513 | +7.7% | | Nine Months Ended Sep 30 | $62,780 | $58,180 | +$4,600 | +7.9% | - Revenue increases were primarily driven by the Clive Behavioral Health facility (completed Dec 2020) and increased bonus rentals from UHS hospital facilities[122](index=122&type=chunk) **Funds From Operations (FFO) (amounts in thousands, except per share)** | Period | 2021 | 2020 | Change | | :-------------------------------- | :----- | :----- | :----- | | Three Months Ended Sep 30 | $12,617 ($0.92/diluted share) | $11,882 ($0.86/diluted share) | +$735 (+$0.06/diluted share) | | Nine Months Ended Sep 30 | $37,994 ($2.76/diluted share) | $34,476 ($2.50/diluted share) | +$3,518 (+$0.26/diluted share) | **Interest Expense, Net (amounts in thousands)** | Period | 2021 | 2020 | Change | | :-------------------------------- | :----- | :----- | :----- | | Three Months Ended Sep 30 | $2,250 | $1,964 | +$286 | | Nine Months Ended Sep 30 | $6,566 | $6,289 | +$277 | - The increase in interest expense was primarily due to higher average outstanding borrowings on the revolving credit agreement and increased interest rate swap expenses, partially offset by a decrease in the average cost of borrowings for the nine-month period[129](index=129&type=chunk)[131](index=131&type=chunk) [Liquidity and Capital Resources](index=30&type=section&id=Liquidity%20and%20Capital%20Resources) Examines the company's cash flows, borrowing capacity, and strategies for funding operations and investments **Net Cash Flows (amounts in thousands)** | Activity | Nine Months Ended Sep 30, 2021 | Nine Months Ended Sep 30, 2020 | | :-------------------------------- | :----------------------------- | :----------------------------- | | Operating Activities | $36,194 | $32,775 | | Investing Activities | $(41,155) | $(16,792) | | Financing Activities | $8,566 | $(15,773) | - Net cash used in investing activities increased significantly in 2021 due to the acquisition of the Fire Mesa office building (**$13.0 million**), additions to real estate investments (**$11.5 million**), and equity investments in unconsolidated LLCs (**$16.1 million**)[134](index=134&type=chunk) - The amended revolving credit agreement increased the commitment to **$375 million**, with **$94.6 million** of available borrowing capacity as of September 30, 2021[144](index=144&type=chunk)[148](index=148&type=chunk)[151](index=151&type=chunk) - Operating cash flows have been sufficient to fund dividend payments, and the Trust expects to finance capital expenditures and acquisitions using internal and additional funds[143](index=143&type=chunk)[144](index=144&type=chunk) - The Trust is in compliance with all covenants in its Credit Agreement as of September 30, 2021[92](index=92&type=chunk)[152](index=152&type=chunk) [Off Balance Sheet Arrangements](index=33&type=section&id=Off%20Balance%20Sheet%20Arrangements) Discloses the company's off-balance sheet commitments, including outstanding standby letters of credit - As of September 30, 2021, off-balance sheet arrangements included **$3.6 million** in outstanding standby letters of credit related to Grayson Properties II[155](index=155&type=chunk) [Acquisition and Divestiture Activity](index=33&type=section&id=Acquisition%20and%20Divestiture%20Activity) Refers to detailed information on property acquisitions and divestitures provided in the financial notes - Refer to Note 4 for details on completed acquisition and divestiture transactions[156](index=156&type=chunk) [Item 3. Quantitative and Qualitative Disclosures About Market Risk](index=34&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk) Discusses the company's exposure to interest rate risk and its management through financial instruments and sensitivity analysis - The Trust uses interest rate swap agreements with a total notional amount of **$140 million** as cash flow hedges to manage interest rate risk[158](index=158&type=chunk)[159](index=159&type=chunk)[160](index=160&type=chunk)[164](index=164&type=chunk) - At September 30, 2021, the fair value of the interest rate swaps was a net liability of **$556 thousand**[161](index=161&type=chunk) - A **1%** change in interest rates would impact the Trust's net income by approximately **$1.4 million**, based on variable rate debt and interest rate swaps[165](index=165&type=chunk) **Long-term Debt and Interest Rate Swaps (amounts in thousands, as of Sep 30, 2021)** | Category | Total | Average Interest Rate | | :-------------------------------- | :------ | :-------------------- | | Fixed rate debt | $57,681 | 4.3% | | Variable rate debt | $276,800 | 1.3% | | Interest rate swaps (notional amount) | $140,000 | 1.070% | [Item 4. Controls and Procedures](index=35&type=section&id=Item%204.%20Controls%20and%20Procedures) Confirms the effectiveness of disclosure controls and procedures and the absence of material changes in internal control over financial reporting - The CEO and CFO concluded that the disclosure controls and procedures were effective as of September 30, 2021[167](index=167&type=chunk) - There have been no material changes in internal control over financial reporting during the first nine months of 2021[168](index=168&type=chunk) [PART II. OTHER INFORMATION](index=36&type=section&id=PART%20II.%20OTHER%20INFORMATION) Presents additional information not included in the financial statements, such as risk factors and exhibits [Item 1A. Risk Factors](index=36&type=section&id=Item%201A.%20Risk%20Factors) States that there are no material changes to the risk factors previously disclosed in the annual report - No material changes in risk factors from those set forth in the Annual Report on Form 10-K for the year ended December 31, 2020[171](index=171&type=chunk) [Item 6. Exhibits](index=36&type=section&id=Item%206.%20Exhibits) Lists the documents filed as exhibits, including credit agreements and certifications - Includes the Amended and Restated Credit Agreement dated July 2, 2021[172](index=172&type=chunk) - Contains certifications from the Chief Executive Officer and Chief Financial Officer pursuant to SEC rules and the Sarbanes-Oxley Act[172](index=172&type=chunk) - Includes Inline XBRL Instance Document and Taxonomy Extension Documents[172](index=172&type=chunk) [SIGNATURES](index=37&type=section&id=SIGNATURES) Contains the official signatures of the registrant's authorized officers, confirming the report's submission - The report was signed on November 8, 2021, by Alan B. Miller (Chairman of the Board, President and Chief Executive Officer) and Charles F. Boyle (Vice President and Chief Financial Officer)[174](index=174&type=chunk)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the quarterly period ended June 30, 2021 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OR Washington, D.C. 20549 ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 FORM 10-Q (MARK ONE) 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 othe ...

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-Q (MARK ONE) For the quarterly period ended March 31, 2021 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) UNIVERSAL CORPORATE CENTER 367 SOUTH GUL ...

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 10-K ☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2020 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 No. 1-9321 UNIVERSAL HEALTH REALTY INCOME TRUST (Exact name of registrant as specified in its charter) Maryland 23-6858580 (State or other jurisdiction of ...

Real Estate Investments - As of October 31, 2020, the company has 71 real estate investments or commitments located in 20 states, including 7 hospital facilities, 4 free-standing emergency departments, and 56 medical/office buildings[103]. Financial Performance - Net income for the three-month period ended September 30, 2020, was $5.2 million, an increase of $540,000 from $4.7 million in the same period of 2019[125]. - For the nine-month period ended September 30, 2020, net income was $14.4 million, up $1.3 million from $13.1 million in the comparable period of 2019[125]. - Total revenues decreased by $174,000, or 0.9%, during the three-month period ended September 30, 2020, compared to the same quarter in 2019[125]. - Total revenues also decreased by $124,000, or 0.2%, during the nine-month period ended September 30, 2020, compared to the same period in 2019[125]. - The revenue decrease was primarily due to $842,000 and $1.74 million recorded in the three and nine-month periods ended September 30, 2019, respectively, from two hospital facilities that had lease expirations and vacancies[125]. - Funds From Operations (FFO) for Q3 2020 was $11.882 million, an increase of $519,000 or 4.6% compared to $11.363 million in Q3 2019[128]. - FFO per diluted share increased to $0.86 in Q3 2020 from $0.83 in Q3 2019[128]. - FFO for the first nine months of 2020 increased by $1.2 million, or $0.08 per diluted share, compared to the same period in 2019[129]. COVID-19 Impact - The COVID-19 pandemic is expected to materially impact future operations and financial results, including potential declines in patient volumes and revenues at hospital facilities[105]. - The company may experience a decrease in prospective tenants due to COVID-19 restrictions, which could adversely affect new lease volumes and renewal rates[107]. - The company is unable to fully quantify the financial impact of COVID-19 on its results for 2020, but anticipates a material adverse effect[107]. - Approximately 99% of tenants paid their rent through September 30, 2020, indicating minimal adverse impact from COVID-19 on operations[136]. Operating Expenses and Cash Flow - Operating expenses related to consolidated medical office buildings totaled $4.8 million for Q3 2020, compared to $4.9 million in Q3 2019[126]. - Net cash provided by operating activities was $32.8 million for the nine-month period ended September 30, 2020, compared to $31.7 million in the same period of 2019[141]. - During the nine-month period ended September 30, 2020, the company generated net cash provided by operating activities of $32.8 million, compared to $31.7 million for the same period in 2019, reflecting a year-over-year increase of approximately 3.5%[148]. Debt and Financing - The company had $227.1 million of outstanding borrowings and $5.6 million of letters of credit under its Credit Agreement as of September 30, 2020, with $117.3 million of available borrowing capacity remaining[159]. - The company entered into an amendment to its revolving credit agreement, increasing the total commitment to $350 million from $300 million, with a maturity scheduled for March 2022[156]. - The company expects to finance all capital expenditures and acquisitions using internally generated funds and additional funds from its $350 million revolving credit agreement, which had $117.3 million available as of September 30, 2020[152]. - The company received $14.2 million of net borrowings on its revolving credit agreement during the nine months ended September 30, 2020, compared to $9.3 million in the same period of 2019[145][146]. - The company incurred approximately $507,000 in fees and expenses related to the commencement of its at-the-market equity issuance program[147]. Regulatory and Market Risks - The company faces risks related to the potential inability of tenants to make timely rent payments, which could affect occupancy levels and cash flow[106]. - The general real estate market has been negatively impacted by increased competition and decreases in occupancy and rental rates, which may adversely affect operating results[108]. - The company is subject to risks associated with changes in government regulations, including Medicare and Medicaid reimbursement levels, which could impact revenues[108]. - The company’s ability to obtain capital on acceptable terms for future growth may be adversely affected by deteriorating economic conditions[108]. Interest Rate and Leverage - Each 1% change in interest rates would impact the company's net income by approximately $871,000[173]. - The company entered into interest rate swap agreements totaling a notional amount of $140 million, with fixed rates ranging from 0.565% to 1.4975%[171]. - The average interest rate for fixed-rate debt is approximately 4.3%[172]. - The total leverage ratio stood at 44.0%, below the covenant limit of 60%[161]. - The company has a total long-term debt of $286.8 million as of September 30, 2020[170].

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 June 30, 2020 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 othe ...