EX-4.19




 Exhibit 4.19 
  

 
 MPT OF COMMERCE CITY FCER, LLC 

MPT OF FORT WORTH FCER, LLC, 
 MPT
OF SUMMERWOOD FCER, LLC 
 MPT OF FAIRMOUNT – ALECTO, LLC 

MPT OF HOOVER – MEDICAL WEST, LLC 

MPT UK HOLDCO 
 MPT BATH 

MPT RHM HOHENLOHE 
 MPT RHM BUCHBERG

 and 
 MPT RHM HEINRICH MANN

 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 COMPANY,

 as Trustee 
  

 
 SIXTEENTH
SUPPLEMENTAL INDENTURE 
 Dated as of October 3, 2014 

To 
 INDENTURE 

Dated as of April 26, 2011 

6.875% Senior Notes due 2021 
  

 








 SIXTEENTH SUPPLEMENTAL INDENTURE 

SIXTEENTH SUPPLEMENTAL INDENTURE (this “Sixteenth Supplemental Indenture”),
dated as of October 3, 2014, by and among MPT of Commerce City FCER, LLC, a Delaware limited liability company, MPT of Fort Worth FCER, LLC, a Delaware limited liability company, MPT of Summerwood FCER, LLC, a Delaware limited liability
company, MPT of Fairmount – Alecto, LLC, a Delaware limited liability company, MPT of Hoover – Medical West, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT UK Holdco, MPT Bath, MPT RHM
Hohenlohe, MPT RHM Buchberg and MPT RHM Heinrich Mann, 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 Company, a Delaware chartered trust company, 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”), by that certain Third Supplemental Indenture, dated as of December 2, 2011 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental
Indenture, dated as of January 19, 2012 (the “Fourth Supplemental Indenture”), by that certain Fifth Supplemental Indenture dated as of April 9, 2012, (the “Fifth Supplemental Indenture”), by that certain
Sixth Supplemental Indenture dated as of June 27, 2012, (the “Sixth Supplemental Indenture”), by that certain Seventh Supplemental Indenture dated as of July 31, 2012 (the “Seventh Supplemental
Indenture”), by that certain Eighth Supplemental Indenture dated as of September 28, 2012 (the “Eighth Supplemental Indenture”), by that certain Ninth Supplement Indenture dated as of December 28, 2012 (the
“Ninth Supplemental Indenture”), by that certain Tenth Supplement Indenture dated as of June 27, 2013 (the “Tenth Supplemental Indenture”), by that certain Eleventh Supplemental Indenture dated as of
August 8, 2013 (the “Eleventh Supplemental Indenture”), by that certain Twelfth Supplemental Indenture dated as of October 30, 2013 (the “Twelfth Supplemental Indenture”), by that certain Thirteenth
Supplemental Indenture dated as of December 20, 2013 (the “Thirteenth Supplemental Indenture”), by that certain Fourteenth Supplemental Indenture dated as of March 31, 2014 (the “Fourteenth Supplemental
Indenture”) and by that certain Fifteenth Supplemental Indenture dates as of June 30, 2014 (the “Fifteenth Supplemental Indenture”, together with the Base Indenture, the First Supplemental Indenture, the Second
Supplemental 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, the Tenth Supplemental Indenture, the Eleventh Supplemental Indenture, the Twelfth Supplemental Indenture, the Thirteenth Supplemental Indenture and the Fourteenth 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 August 6, 2014 and September 30, 2014, the Domestic Guarantors guaranteed the Credit Agreement, and pursuant to
Section 4.14(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 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 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 Sixteenth 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 effective as of September 30, 2014, 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 Sixteenth 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) Effective as of September 30, 2014, the Indenture shall be supplemented and amended
in accordance herewith, and this Sixteenth 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 Sixteenth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented
by this Sixteenth Supplemental Indenture. 
 (c) This Sixteenth Supplemental Indenture shall be deemed to be incorporated in, and made a
part of, the Indenture. The Indenture, as amended and supplemented by this Sixteenth 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 Sixteenth Supplemental Indenture. 
 (d) THIS
SIXTEENTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This
Sixteenth 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 Sixteenth 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



  

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE










 
	
	 MPT OF VICTORVILLE, 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

	 MPT OF HOBOKEN HOSPITAL, LLC




  

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE










 
	
	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 NORTH GATE FCER, LLC
	MPT OF THORNTON FCER, LLC



  

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE










 
	
	 MPT OF FOUNTAIN FCER, LLC

	 MPT OF MISSOURI CITY FCER, LLC

	 MPT OF PEARLAND FCER, LLC

	 MPT OF MISSOURI CITY – DULLES FCER, LLC

	 MPT OF COMMERCE CITY FCER, LLC

	 MPT OF FORT WORTH FCER, LLC

	 MPT OF SUMMERWOOD FCER, LLC

	 MPT OF FAIRMONT – ALECTO, LLC

	 MPT OF HOOVER – MEDICAL WEST, 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 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH 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



  

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE










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

	 Name:
		 Michael H. Wass

	 Title:
		 Assistant Vice President




  

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE