EX-4.7




 Exhibit 4.7 
  

 
 WICHITA HEALTH ASSOCIATES LIMITED
PARTNERSHIP 
 as Guarantor, 

MPT OF WICHITA, LLC 
 as Guarantor,

 MPT DESOTO HOSPITAL, LLC 
 as
Guarantor, 
 MPT OF HOBOKEN TRS, LLC 

as Guarantor, 
 MPT OPERATING
PARTNERSHIP, L.P. 
 and 
 MPT
FINANCE CORPORATION, 
 as Issuers, 

MEDICAL PROPERTIES TRUST, INC., 

as Parent and a Guarantor, 
 the
other GUARANTORS named herein, 
 as Guarantors, 

and 
 WILMINGTON
TRUST COMPANY, 
 as Trustee 
  

 
 FOURTH
SUPPLEMENTAL INDENTURE 
 Dated as of January 19, 2012 

To 
 INDENTURE 

Dated as of April 26, 2011 

6.875% Senior Notes due 2021 
  

 








 FOURTH SUPPLEMENTAL INDENTURE 

FOURTH SUPPLEMENTAL INDENTURE (this “Fourth Supplemental Indenture”), dated as
of January 19, 2012, by and among Wichita Health Associates Limited Partnership, a Delaware limited partnership, MPT of Wichita, LLC, a Delaware limited liability company, MPT DeSoto Hospital, LLC, a Delaware limited liability company and MPT
of Hoboken TRS, LLC, a Delaware limited liability company (the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware
corporation (“Finco” and, together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the
Indenture), as Guarantors, and Wilmington Trust Company, existing under the laws of the United States of America, as Trustee (the “Trustee”). 

WITNESSETH 
 WHEREAS, the
Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of April 26, 2011 (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture, dated as of August 10, 2011
(the “First Supplemental Indenture”), by that certain Second Supplemental Indenture, dated as of October 3, 2011 (the “Second Supplemental Indenture”) and by that certain Third Supplemental Indenture, dated as
of December 2, 2011 (the “Third Supplemental Indenture,” together with the Base Indenture, the First Supplemental Indenture and the Second Supplemental Indenture, the “Indenture”), providing for the issuance by
the Issuers of the 6.875% Senior Notes due 2021 (the “Notes”); 
 WHEREAS, pursuant to Section 9.01(a)(4) of the
Indenture, the Issuers, the Guarantors and the Trustee may supplement the Indenture without the consent of any Holders in order to add Guarantees with respect to the Notes; 

WHEREAS, as of November 4, 2011, the New Guaranteeing Subsidiaries guaranteed the Credit Agreement, and pursuant to Section 4.14(a)
of the Indenture, the New Guaranteeing Subsidiaries are required to become Guarantors under the Indenture; 
 WHEREAS, the Indenture
requires that an entity that constitutes a Guarantor shall join the Issuers and the existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which such entity shall unconditionally Guarantee, on a joint and
several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the Notes on a senior basis and all other obligations under the Indenture; and 

WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is authorized to execute and deliver this Fourth Supplemental Indenture.









 NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration,
the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to
them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein. 
 2.
AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide unconditional Guarantees on the terms and subject to the conditions set forth in the Indenture including but not limited
to Article 10 thereof. 
 3. MISCELLANEOUS PROVISIONS. 

(a) The Trustee makes no undertaking or representation in respect of, and shall not be responsible in any manner whatsoever for and in respect
of, the validity or sufficiency of this Fourth Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and statements
are made solely by the Issuers. 
 (b) On the date hereof, the Indenture shall be supplemented and amended in accordance herewith, and this
Fourth Supplemental Indenture shall form part of the Indenture for all purposes, and the Holder of every Note heretofore or hereafter authenticated and delivered under the Indenture shall be bound thereby. The Trustee accepts the trusts created by
the Indenture, as amended and supplemented by this Fourth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Fourth Supplemental Indenture. 

(c) This Fourth Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended and
supplemented by this Fourth Supplemental Indenture, shall be read, taken and construed as one and the same instrument and all the provisions of the Indenture shall remain in full force and effect in accordance with the terms thereof and as amended
and supplemented by this Fourth Supplemental Indenture. 
 (d) THIS FOURTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This Fourth Supplemental Indenture may be executed in any number of
counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but one and the same instrument. 

[Signature Pages Follow] 

  
 3 









 IN WITNESS WHEREOF, the parties hereto have caused this Fourth Supplemental Indenture to be duly
executed and attested, all as of the date first above written. 
  

					
	MPT OPERATING PARTNERSHIP, L.P.,
	as Issuer,
		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	 MPT FINANCE CORPORATION,
 as
Issuer,

		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	 MEDICAL PROPERTIES TRUST, INC.,
 as
Parent and a Guarantor,

		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MEDICAL PROPERTIES TRUST, INC.
		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
	
	 MPT OF DESOTO, LLC
 MPT OF VICTORVILLE, LLC

MPT OF BUCKS COUNTY, LLC
 MPT OF BLOOMINGTON, LLC

MPT OF COVINGTON, LLC
 MPT OF DENHAM SPRINGS, LLC

MPT OF REDDING, LLC
 MPT OF CHINO, LLC

MPT OF DALLAS LTACH, LLC
 MPT OF PORTLAND, LLC

MPT OF WARM SPRINGS, LLC
 MPT OF VICTORIA, LLC

MPT OF LULING, LLC
 MPT OF HUNTINGTON BEACH, LLC

MPT OF WEST ANAHEIM, LLC
 MPT OF LA PALMA, LLC

MPT OF PARADISE VALLEY, LLC
 MPT OF SOUTHERN CALIFORNIA, LLC

MPT OF TWELVE OAKS, LLC
 MPT OF SHASTA, LLC

MPT OF WEBSTER, LLC
 MPT OF TUCSON, LLC

MPT OF BOSSIER CITY, LLC
 MPT OF WEST VALLEY CITY, LLC

MPT OF IDAHO FALLS, LLC
 MPT OF POPLAR BLUFF, LLC

MPT OF BENNETTSVILLE, LLC
 MPT OF DETROIT, LLC

MPT OF BRISTOL, LLC
 MPT OF NEWINGTON, LLC

MPT OF ENFIELD, LLC
 MPT OF PETERSBURG, LLC

MPT OF FAYETTEVILLE, LLC
 4499 ACUSHNET AVENUE, LLC

8451 PEARL STREET, LLC
 MPT OF GARDEN GROVE HOSPITAL, LLC

MPT OF GARDEN GROVE MOB, LLC
 MPT OF SAN DIMAS HOSPITAL, LLC

MPT OF SAN DIMAS MOB, LLC
 MPT OF CHERAW, LLC

MPT OF FT. LAUDERDALE, LLC.
 MPT OF PROVIDENCE, LLC

MPT OF SPRINGFIELD, LLC
 MPT OF WARWICK, LLC

MPT OF RICHARDSON, LLC
 MPT OF ROUND ROCK, LLC




  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	MPT OF SHENANDOAH, LLC
	MPT OF HILLSBORO, LLC
	MPT OF FLORENCE, LLC
	MPT OF CLEAR LAKE, LLC
	MPT OF TOMBALL, LLC
	MPT OF GILBERT, LLC
	MPT OF CORINTH, LLC
	MPT OF BAYONNE, LLC
	MPT OF ALVARADO, LLC
		
	By:	 	 MPT OPERATING PARTNERSHIP, L.P.,

sole member of each of the above entities

			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF DESOTO, L.P.
	By:	 	MPT OF DESOTO, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF BUCKS COUNTY, L.P.
	By:	 	MPT OF BUCKS COUNTY, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF DALLAS LTACH, L.P.
	By:	 	MPT OF DALLAS LTACH, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC
		 		 		 		 	its sole member
	
	MPT OF WARM SPRINGS, L.P.
	By:	 	MPT OF WARM SPRINGS, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF VICTORIA, L.P.
	By:	 	MPT OF VICTORIA, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF LULING, L.P.
	By:	 	MPT OF LULING, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF HUNTINGTON BEACH, L.P.
	By:	 	MPT OF HUNTINGTON BEACH, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF WEST ANAHEIM, L.P.
	By:	 	MPT OF WEST ANAHEIM, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF LA PALMA, L.P.
	By:	 	MPT OF LA PALMA, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF PARADISE VALLEY, L.P.
	By:	 	MPT OF PARADISE VALLEY, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF SOUTHERN CALIFORNIA, L.P.
	By:	 	MPT OF SOUTHERN CALIFORNIA, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF TWELVE OAKS, L.P.
	By:	 	MPT OF TWELVE OAKS, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF SHASTA, L.P.
	By:	 	MPT OF SHASTA, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF WEBSTER, L.P.
	By:	 	MPT OF WEBSTER, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF GARDEN GROVE HOSPITAL, L.P.
	By:	 	MPT OF GARDEN GROVE HOSPITAL, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF GARDEN GROVE MOB, L.P.
	By:	 	MPT OF GARDEN GROVE MOB, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF SAN DIMAS HOSPITAL, L.P.
	By:	 	MPT OF SAN DIMAS HOSPITAL, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF SAN DIMAS MOB, L.P.
	By:	 	MPT OF SAN DIMAS MOB, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF RICHARDSON, L.P.
	By:	 	MPT OF RICHARDSON, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF ROUND ROCK, L.P.
	By:	 	MPT OF ROUND ROCK, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF SHENANDOAH, L.P.
	By:	 	MPT OF SHENANDOAH, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF HILLSBORO, L.P.
	By:	 	MPT OF HILLSBORO, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF CLEAR LAKE, L.P.
	By:	 	MPT OF CLEAR LAKE, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF TOMBALL, L.P.
	By:	 	MPT OF TOMBALL, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
	
	MPT OF CORINTH, L.P.
	By:	 	MPT OF CORINTH, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
													
	MPT OF ALVARADO, L.P.
	By:	 	MPT OF ALVARADO, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
						
		 		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF MOUNTAIN VIEW, LLC
	By:	 	MPT OF IDAHO FALLS, LLC, its managing member
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 		 	its sole member
						
		 		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	MPT OF HAUSMAN, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President
		 		 		 		 		 	and Chief Financial Officer
	
	MPT OF HOBOKEN HOSPITAL, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF HOBOKEN REAL ESTATE, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	MPT OF OVERLOOK PARKWAY, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF NEW BRAUNFELS, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF WESTOVER HILLS, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
													
	WICHITA HEALTH ASSOCIATES LIMITED PARTNERSHIP
	By:	 	MPT OF WICHITA, LLC, its general partner
			
		 	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 		 	its sole member
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC, its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC, its sole member
						
		 		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF WICHITA, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC, its sole member
						
		 		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	MPT DESOTO HOSPITAL, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT OF HOBOKEN TRS, LLC
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	its sole member
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
					
	WILMINGTON TRUST COMPANY, as Trustee,
		
	By:	 	 /s/ Michael H. Wass

		 	Name:	 	Michael H. Wass
		 	Title:	 	Financial Services Officer



  

FOURTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE