EX-4.2



 Exhibit 4.2 
  

 
 MPT OF MISSOURI CITY-DULLES FCER,
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, NATIONAL
ASSOCIATION, 
 as Trustee 
  

 
 SIXTH
SUPPLEMENTAL INDENTURE 
 Dated as of June 30, 2014 

To 
 INDENTURE 

Dated as of October 10, 2013 

5.70% Senior Notes due 2020 
  

 
  







 SIXTH SUPPLEMENTAL INDENTURE 

SIXTH SUPPLEMENTAL INDENTURE (this “Sixth Supplemental Indenture”), dated as of
June 30, 2014, by and among MPT of Missouri City-Dulles FCER, LLC, a Delaware limited liability company (the “New Guaranteeing Subsidiary”), 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”), by that certain Second Supplemental Indenture, dated as of October 30, 2013 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture, dated
as of December 20, 2013 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture, dated as of March 31, 2014 (the “Fourth Supplemental Indenture”), and by that certain Fifth
Supplemental Indenture, dated as of April 17, 2014 (the “Fifth Supplemental Indenture”, and together with the First Supplemental Indenture, the Second Supplemental Indenture, the Third Supplemental Indenture, the Fourth
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 June 19, 2014, the New Guaranteeing Subsidiaries guarantee the Credit Agreement, and pursuant to Section 5.14(a) of
the Indenture, the New Guaranteeing Subsidiary is required to become a Guarantor 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 10.06 of the Indenture, the Trustee is authorized to execute and deliver this Sixth 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 Subsidiary 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
Subsidiary hereby agrees 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 Sixth 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
Sixth 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 Sixth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Sixth Supplemental Indenture. 

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

		 		 		 		 	Name:	 	Emmett E. McLean
		 		 		 		 	Title:	 	Executive Vice President, Chief Operating Officer, Treasurer and Secretary


  

					
	 MPT FINANCE CORPORATION,
 as
Issuer

		
	By:	 	 /s/ Emmett E. McLean

		 	Name:	 	Emmett E. McLean
		 	Title:	 	Assistant Secretary
	
	 MEDICAL PROPERTIES TRUST, INC.,
 as
Parent and a Guarantor

		
	By:	 	 /s/ Emmett E. McLean

		 	Name:	 	Emmett E. McLean
		 	Title:	 	Executive Vice President, Chief Operating Officer, Treasurer and Secretary


 
					
	
	MEDICAL PROPERTIES TRUST, LLC
		
	By:	 	 MEDICAL PROPERTIES TRUST, INC.,
 its
sole member

		
	By:	 	 /s/ Emmett E. McLean

	Name:	 	Emmett E. McLean
	Title:	 	Executive Vice President, Chief Operating Officer, Treasurer and Secretary



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
			
	MPT OF VICTORVILLE, LLC
	MPT OF BUCKS COUNTY, LLC
	MPT OF BLOOMINGTON, LLC
	MPT OF COVINGTON, LLC
	MPT OF REDDING, LLC
	MPT OF CHINO, LLC
	MPT OF DALLAS LTACH, LLC
	MPT OF PORTLAND, 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
	MPT OF DESOTO, LLC
	MPT OF HAUSMAN, LLC



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
			
	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
	MPT OF WEST MONROE, LLC
	MPT OF DALLAS, LLC
	MPT OF LEGACY MONTCLAIR, LLC
	MPT OF ALVIN FCER, LLC
	MPT OF FIRESTONE FCER, LLC
	MPT OF HOUSTON-ELDRIDGE FCER, LLC
	MPT OF CEDAR HILL FCER, LLC
	MPT OF ALLEN FCER, LLC
	MPT OF FRISCO FCER, LLC
	MPT OF BROOMFIELD FCER, LLC
	MPT OF CHAMPION FOREST FCER, LLC
	MPT OF NORTHGATE FCER, LLC



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
			
	MPT OF THORNTON FCER, LLC
	MPT OF FOUNTAIN FCER, LLC
	MPT OF MISSOURI CITY FCER, LLC
	MPT OF PEARLAND FCER, LLC
	MPT OF MISSOURI CITY-DULLES FCER, 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/ Emmett E. McLean

		 		 		 		 	Name:	 	Emmett E. McLean
		 		 		 		 	Title:	 	Executive Vice President, Chief Operating Officer, Treasurer and Secretary


  

									
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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 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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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




  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	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

	
	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

	
	MPT OF LOS ANGELES, L.P.
	By:	 	 MPT OF LOS ANGELES, 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/ Emmett E. McLean

		 		 	Name:	 	Emmett E. McLean
		 		 	Title:	 	Executive Vice President, Chief Operating Officer, Treasurer and Secretary



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
					
	MPT RHM HOLDCO S.à.r.l.
	MPT RHM SONNENWENDE S.à.r.l.
	MPT RHM KLAUS S.à.r.l.
	MPT RHM VESALIUS S.à.r.l.
	MPT RHM PARK S.à.r.l.
	MPT RHM FONTANA S.à.r.l.
	MPT RHM CHRISTIAAN S.à.r.l.
	MPT RHM HILLERSBACH S.à.r.l.
		
	By:	 	 /s/ Leanne McWilliams

		 	Name:	 	Leanne McWilliams
		 	Title:	 	Class A Manager
		
	By:	 	 /s/ James Kevin Hanna

		 	Name:	 	James Kevin Hanna
		 	Title:	 	Class A Manager and Authorized Signatory



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
					
	 WILMINGTON TRUST, NATIONAL ASSOCIATION,

as Trustee,

		
	By:	 	 /s/ Michael H. Wass

		 	Name:	 	Michael H. Wass
		 	Title:	 	Assistant Vice President



  
 SIXTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE