EX-4.31




 Exhibit 4.31 
  

 
 MPT OF NACOGDOCHES FCER, LLC, 

MPT OF MESA, LLC 
 MPT OF PORT
ARTHUR, LLC, 
 MPT OF WEST MONROE, LLC, 

MPT OF DALLAS, LLC 
 MPT RHM HOLDCO,

 MPT RHM SONNENWENDE, 
 MPT RHM
KLAUS, 
 MPT RHM VESALIUS, 
 MPT
RHM PARK, 
 MPT RHM FONTANA, 

MPT RHM HILLERSBACH 
 and 

MPT RHM CHRISTIAAN, 
 as Guarantors,

 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, NATIONAL ASSOCIATION, 

as Trustee 
  

 
 THIRD
SUPPLEMENTAL INDENTURE 
 Dated as of December 20, 2013 

To 
 INDENTURE 

Dated as of October 10, 2013 

5.70% Senior Notes due 2020 
  

 








 THIRD SUPPLEMENTAL INDENTURE 

THIRD SUPPLEMENTAL INDENTURE (this “Third Supplemental Indenture”), dated as of
December 20, 2013, by and among MPT of Nacogdoches FCER, LLC, a Delaware limited liability company, MPT of Mesa, LLC, a Delaware limited liability company, MPT of Port Arthur, LLC, a Delaware limited liability company, MPT of West Monroe, LLC,
a Delaware limited liability company, MPT of Dallas, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT RHM Holdco, MPT RHM Sonnenwende, MPT RHM Klaus, MPT RHM Vesalius, MPT RHM Park, MPT RHM Fontana, MPT
RHM Hillersbach, MPT RHM Christiaan, each a société à responsabilité limitée incorporated and existing under the laws of the Grand Duchy of Luxembourg (the “Lux Guarantors” and together with
the Domestic Guarantors, 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, National Association, 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 October 10, 2013 (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture, dated as of October 10,
2013 (the “First Supplemental Indenture”) and by that certain Second Supplemental Indenture, dated October 30, 2013 (the “Second Supplemental Indenture”, and together with the First Supplemental Indenture and
the Base Indenture, the “Indenture”), providing for the issuance by the Issuers of the 5.750% Senior Notes due 2020 (the “Notes”); 

WHEREAS, pursuant to Section 10.01(a)(4) of the Indenture, the Parent, the Issuers, the Guarantors and the Trustee, together, may
supplement the Indenture without notice to or the consent of any Holders or any other party to the Indenture in order to add Guarantees with respect to the Notes; 

WHEREAS, as of November 21, 2013, the Domestic Guarantors guaranteed the Credit Agreement, with the exception of MPT of Dallas, LLC, and
pursuant to Section 5.14(a) of the Indenture, the Domestic Guarantors 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; 
 WHEREAS, the Lux Guarantors and MPT of Dallas, LLC wish to join
the Issuers and the existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which the Lux Guarantors and MPT of Dallas, LLC 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 10.06 of the Indenture, the Trustee is authorized to execute and deliver this Third
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 11 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 Third 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
Third 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 Third Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Third Supplemental Indenture. 

(c) This Third Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended and
supplemented by this Third 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 Third Supplemental Indenture. 
 (d) THIS THIRD SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND
CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 








 (e) This Third 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. 








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

											
	MPT OPERATING PARTNERSHIP, L.P., as Issuer
			
		 	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 FINANCE CORPORATION,
 as
Issuer

		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	President, Secretary and General Manager
	
	 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, LLC
		
	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


  

	
	 


  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 










	
	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 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 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 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
	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



  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
	
	MPT OF DESOTO, LLC
	 MPT OF HAUSMAN, LLC
 MPT OF HOBOKEN HOSPITAL,
LLC
 MPT OF HOBOKEN REAL ESTATE, LLC
 MPT OF OVERLOOK PARKWAY,
LLC
 MPT OF NEW BRAUNFELS, LLC
 MPT OF WESTOVER HILLS,
LLC

	MPT OF WICHITA, LLC
	MPT OF BILLINGS, LLC
	MPT OF BOISE, LLC
	MPT OF BROWNSVILLE, LLC
	MPT OF CASPER, LLC
	MPT OF COMAL COUNTY, LLC
	MPT OF GREENWOOD, LLC
	MPT OF JOHNSTOWN, LLC
	MPT OF LAREDO, LLC
	MPT OF LAS CRUCES, LLC
	MPT OF MESQUITE, LLC
	MPT OF POST FALLS, LLC
	MPT OF PRESCOTT VALLEY, LLC
	MPT OF PROVO, LLC
	MPT OF NORTH CYPRESS, LLC
	MPT OF LAFAYETTE, LLC
	MPT OF INGLEWOOD LLC
	MPT OF RENO, LLC
	MPT OF ROXBOROUGH, LLC
	MPT OF ALTOONA, LLC
	MPT OF HAMMOND, LLC
	MPT OF SPARTANBURG, LLC
	MPT OF WYANDOTTE COUNTY, LLC
	MPT OF LEAVENWORTH, LLC
	MPT OF CORPUS CHRISTI, LLC
	MPT OF BRODIE FCER, LLC
	MPT OF LITTLE ELM FCER, LLC
	MPT OF OGDEN, LLC
	MPT OF NACOGDOCHES FCER, LLC
	MPT OF MESA, LLC
	MPT OF PORT ARTHUR, LLC



  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	 MPT OF WEST MONROE, LLC
 MPT OF
DALLAS, 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
	
	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




  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	MPT OF WARM SPRINGS, L.P.
	By:	 	MPT OF WARM SPRINGS, 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 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



  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	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



  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
											
	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
	
	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




  

THIRD SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	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
	
	 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




  

THIRD 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




  

SECOND 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



  

SECOND 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



  

SECOND 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
	
	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 MOUNTAIN VIEW LLC
	By:	 	MPT OF IDAHO FALLS, LLC, its sole 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



  

SECOND 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
	
	MPT OF NORTH CYPRESS, L.P.
	By:	 	MPT OF NORTH CYPRESS, 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 INGLEWOOD, L.P.
	By:	 	MPT OF INGLEWOOD, 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



  

SECOND SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









 
									
	MPT OF ROXBOROUGH, L.P.
	By:	 	MPT OF ROXBOROUGH, 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
	
	MEDICAL PROPERTIES TRUST, LLC
	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


  

									
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Holdco	 		 	MPT RHM Holdco
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Sonnenwende	 		 	MPT RHM Sonnenwende
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Klaus	 		 	MPT RHM Klaus
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Vesalius	 		 	MPT RHM Vesalius
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Park	 		 	MPT RHM Park
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager


  

SECOND SUPPLEMENTAL INDENTURE SIGNATURE PAGE 










									
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Fontana	 		 	MPT RHM Fontana
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Hillersbach	 		 	MPT RHM Hillersbach
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager
			
	 /s/ Leanne McWilliams
	 		 	 /s/ James Kevin Hanna

	MPT RHM Christiaan	 		 	MPT RHM Christiaan
	By:	 	Leanne McWilliams	 		 	By:	 	James Kevin Hanna
	Title:	 	Manager	 		 	Title:	 	Manager


  

SECOND SUPPLEMENTAL INDENTURE SIGNATURE PAGE 









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

		 	Name:	 	Michael H. Wass
		 	Title:	 	Assistant Vice President



  

SECOND SUPPLEMENTAL INDENTURE SIGNATURE PAGE