EX-4.19



 EXHIBIT 4.19 
  

 
 MPT OF LOS ANGELES, L.P. 

MPT OF 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, 

MPT OF THORNTON FCER, LLC, 
 MPT OF
FOUNTAIN FCER, LLC, 
 MPT OF MISSOURI CITY FCER, LLC 

and 
 MPT OF PEARLAND FCER, LLC,

 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 
  

 
 FOURTH
SUPPLEMENTAL INDENTURE 
 Dated as of March 31, 2014 

To 
 INDENTURE 

Dated as of October 10, 2013 

5.70% Senior Notes due 2020 
  

 







 FOURTH SUPPLEMENTAL INDENTURE 

FOURTH SUPPLEMENTAL INDENTURE (this “Fourth Supplemental Indenture”), dated as
of March 31, 2014, by and among MPT of Los Angeles, L.P., a Delaware limited partnership, MPT of Montclair, LLC, a Delaware limited liability company, MPT of Alvin FCER, LLC, a Delaware limited liability company, MPT of Firestone FCER, LLC, a
Delaware limited liability company, MPT of Houston-Eldridge FCER, LLC, a Delaware limited liability company, MPT of Cedar Hill FCER, LLC, a Delaware limited liability company, MPT of Allen FCER, LLC, a Delaware limited liability company, MPT of
Frisco FCER, LLC, a Delaware limited liability company, MPT of Broomfield FCER, LLC, a Delaware limited liability company, MPT of Champion Forest FCER, LLC, a Delaware limited liability company, MPT of Northgate FCER, LLC, a Delaware limited
liability company, MPT of Thornton FCER, LLC, a Delaware limited liability company, MPT of Fountain FCER, LLC, a Delaware limited liability company, MPT of Missouri City FCER, LLC, a Delaware limited liability company and MPT of Pearland FCER, 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, 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”) and by that certain Third Supplemental Indenture,
dated as of December 20, 2013 (the “Third Supplemental Indenture”, and together with the First Supplemental Indenture, the Second 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 March 31, 2014, the New Guaranteeing Subsidiaries guarantee the Credit Agreement, and
pursuant to Section 5.14(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 10.06 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 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 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. 
  







 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:	 	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



  
 FOURTH
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 

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 MPT OF ALVARADO, LLC 

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 

MPT OF WEST MONROE, LLC 

MPT OF DALLAS, LLC 

MPT OF 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 

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 








 
									
	 MPT OF FRISCO FCER, LLC
 MPT OF
BROOMFIELD FCER, LLC
 MPT OF CHAMPION FOREST FCER, LLC
 MPT OF
NORTHGATE FCER, LLC
 MPT OF THORNTON FCER, LLC
 MPT OF FOUNTAIN
FCER, LLC
 MPT OF MISSOURI CITY FCER, LLC
 MPT OF PEARLAND
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



  
 FOURTH
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



  
 FOURTH
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




  
 FOURTH
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



  
 FOURTH
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



  
 FOURTH
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



  
 FOURTH
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




  
 FOURTH
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



  
 FOURTH
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



  
 FOURTH
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



  
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	 /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
		
	 /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


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

	Name:	 	Michael H. Waas
	Title:	 	Assistant Vice President



  
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