EX-4.3



 Exhibit 4.3 

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 

TWELFTH SUPPLEMENTAL INDENTURE 

Dated as of June 30, 2014 

To 
 INDENTURE 

Dated as of February 17, 2012 

6.375% Senior Notes due 2022 
  

 







 TWELFTH SUPPLEMENTAL INDENTURE 

TWELFTH SUPPLEMENTAL INDENTURE (this “Twelfth 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 February 17, 2012, (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture dated as of April 9, 2012
(the “First Supplemental Indenture”), by that certain Second Supplemental Indenture dated as of June 27, 2012 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture dated as of
July 31, 2012 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture dated as of September 28, 2012 (the “Fourth Supplemental Indenture”), by that certain Fifth Supplemental
Indenture dated as of December 28, 2012 (the “Fifth Supplemental Indenture”), by that certain Sixth Supplemental Indenture dated as of June 27, 2013, by that certain Seventh Supplemental Indenture dated as of
August 8, 2013 (the “Seventh Supplemental Indenture”), by that certain Eighth Supplemental Indenture dated as of August 20, 2013 (the “Eighth Supplemental Indenture”), by that certain Ninth Supplemental
Indenture dated as of October 30, 2013 (the “Ninth Supplemental Indenture”), by that certain Tenth Supplemental Indenture dated as of December 20, 2013 (the “Tenth Supplemental Indenture”), and by that
certain Eleventh Supplemental Indenture dated as of March 31, 2014 (the “Eleventh Supplemental Indenture”, together with the Base Indenture, the First Supplemental Indenture, the Second Supplement Indenture, the Third
Supplemental Indenture, the Fourth Supplemental Indenture, the Fifth Supplemental Indenture, the Sixth Supplemental Indenture, the Seventh Supplemental Indenture, the Eighth Supplemental Indenture, the Ninth Supplemental Indenture and the Tenth
Supplemental Indenture, the “Indenture”), providing for the issuance by the Issuers of the 6.375% Senior Notes due 2022 (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 June 19, 2014, the New
Guaranteeing Subsidiary guaranteed the Credit Agreement, and pursuant to Section 4.14(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 9.01 of the Indenture, the Trustee is authorized to execute and
deliver this Twelfth 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 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 Twelfth 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
Twelfth 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 Twelfth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Twelfth Supplemental Indenture. 

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







 IN WITNESS WHEREOF, the parties hereto have caused this Twelfth 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



  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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




  
 TWELFTH
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



  
 TWELFTH
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



  
 TWELFTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
					
	 WILMINGTON TRUST, NATIONAL ASSOCIATION,

as Trustee,

		
	By:	 	 /s/ Michael H. Wass

		 	Name:	 	Michael H. Wass
		 	Title:	 	Assistant Vice President



  
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SUPPLEMENTAL INDENTURE SIGNATURE PAGE