Document:

February 22, 2007

To:   MEDICAL PROPERTIES TRUST, INC.
      1000 Urban Center Drive, Suite 501
      Birmingham, Alabama 35242

From: UBS AG, LONDON BRANCH
      c/o UBS Securities LLC
      299 Park Avenue
      New York, New York 10171

From: UBS SECURITIES LLC,
      SOLELY AS AGENT
      tel: (212) 821-2100
      fax: (212) 821-7031

Dear Sirs,

The purpose of this letter agreement (this "Confirmation") is to confirm the
terms and conditions of the transaction entered into between us on the Trade
Date specified below (the "Transaction"). This Confirmation constitutes a
"Confirmation" as referred to in the ISDA Master Agreement specified below.

1.    The definitions and provisions contained in the 2000 ISDA Definitions
      (the "2000 Definitions") and the 2002 ISDA Equity Derivatives
      Definitions (the "2002 Definitions" and, together with the 2000
      Definitions, the "Definitions"), each as published by the International
      Swaps and Derivatives Association, Inc., are incorporated into this
      Confirmation.  In the event of any inconsistency between the 2002
      Definitions and the 2000 Definitions, the 2002 Definitions will
      govern.  In the event of any inconsistency between the Definitions and
      this Confirmation, this Confirmation will govern.

      This Confirmation evidences a complete and binding agreement between Party
      A and Party B as to the terms of the Transaction to which this
      Confirmation relates. This Confirmation shall supplement, form a part of,
      and be subject to an agreement in the form of the 2002 ISDA Master
      Agreement (the "Agreement") as if Party A and Party B had executed an
      agreement in such form on the Trade Date (but without any Schedule except
      for (i) the election of the laws of the State of New York as the governing
      law and (ii) United States dollars as the Termination Currency). In the
      event of any inconsistency between provisions of that Agreement and this
      Confirmation, this Confirmation will prevail for the purpose of the
      Transaction to which this Confirmation relates. The parties hereby agree
      that no Transaction other than the Transaction to which this Confirmation
      relates shall be governed by the Agreement. For purposes of the 2002
      Definitions, the Transaction is a Share Forward Transaction.

      Party A and Party B each represents to the other that it has entered into
      this Transaction in reliance upon such tax, accounting, regulatory, legal,
      and financial advice as it deems necessary and not upon any view expressed
      by the other.

                                       1
<PAGE>

2.    The terms of the particular Transaction to which this Confirmation
      relates are as follows:

      General Terms:
      -------------

<TABLE>
<S>                                 <C>
         Party A:                   UBS AG, London Branch

         Party B:                   Medical Properties Trust, Inc.

         Trade Date:                February 22, 2007

         Effective Date:            February 28, 2007

         Base Amount:               Initially, 1,500,000 Shares.  On each
                                    Settlement Date, the Base Amount shall be
                                    reduced by the number of Settlement
                                    Shares for such Settlement Date.

         Maturity Date:             February 28, 2008 (or, if such date is
                                    not a Scheduled Trading Day, the next
                                    following Scheduled Trading Day).

         Forward Price:             On the Effective Date, the Initial
                                    Forward Price, and on any other day, the
                                    Forward Price as of the immediately
                                    preceding calendar day multiplied by the
                                    sum of (i) 1 and (ii) the Daily Rate for
                                    such day; provided that on each Forward
                                    Price Reduction Date, the Forward Price
                                    in effect on such date shall be the
                                    Forward Price otherwise in effect on such
                                    date minus the Forward Price Reduction
                                    Amount for such Forward Price Reduction
                                    Date.

         Initial Forward Price:     USD $14.82 per Share.

         Daily Rate:                For any day, (i)(A) USD-Federal Funds
                                    Rate for such day MINUS (B) the Spread
                                    DIVIDED by (ii) 365.

         USD-Federal Funds Rate     For any day, the rate set forth for such
                                    day opposite the caption "Federal funds",
                                    as such rate is displayed on the page
                                    "FedsOpen {Index} {GO}" on the BLOOMBERG
                                    Professional Service, or any successor
                                    page; provided that if no rate appears
                                    for any day on such page, the rate for
                                    the immediately preceding day for which a
                                    rate appears shall be used for such day.

         Spread:                    1.00%

         Forward Price Reduction
         Date:                      March 29, 2007, June 14, 2007,
                                    September 14, 2007, and December 13, 2007.

         Forward Price Reduction
         Amount:                    As set forth in Schedule I hereto
</TABLE>

                                       2
<PAGE>

<TABLE>
<S>                                 <C>
         Shares:                    Common Stock, $0.001 par value per share,
                                    of Party B (also referred to herein as
                                    the "Issuer") (Exchange identifier:
                                    "MPW").

         Exchange:                  The New York Stock Exchange.

         Related Exchange(s):       All Exchanges.

         Clearance System:           DTC.

         Calculation Agent:         UBS AG, London Branch

      Settlement Terms:

         Settlement Date:           Any Scheduled Trading Day following the
                                    Effective Date and up to and including
                                    the Maturity Date, as designated (a) by
                                    Party B in a written notice (a
                                    "Settlement Notice") that satisfies the
                                    Settlement Notice Requirements and is
                                    delivered to Party A (i) at least three
                                    Scheduled Trading Days prior to such
                                    Settlement Date, which may be the
                                    Maturity Date, if Physical Settlement
                                    applies, and (ii) a number of Scheduled
                                    Trading Days prior to such Settlement
                                    Date, which may be the Maturity Date,
                                    equal to the greater of (A) 10 and (B)
                                    the product, rounded up to the nearest
                                    whole number, of (1) the number of Shares
                                    to be settled on such date, divided by
                                    the initial Base Amount, and (2) 40, if
                                    Cash Settlement applies; provided that
                                    (i) the Maturity Date shall be a
                                    Settlement Date if on such date the Base
                                    Amount is greater than zero, (ii) if Cash
                                    Settlement applies and Party A shall have
                                    fully unwound its hedge during an Unwind
                                    Period by a date that is more than three
                                    Scheduled Trading Days prior to a
                                    Settlement Date specified above, Party A
                                    may, by written notice to Party B,
                                    specify any Scheduled Trading Day prior
                                    to such originally specified Settlement
                                    Date as the Settlement Date, (iii) if the
                                    Unwind Period for two Settlement Dates
                                    would overlap, the Unwind Period for the
                                    later Settlement Date shall not begin
                                    until the earlier settlement date has
                                    occurred and (iv) the Settlement Date may
                                    be modified as provided under "Unwind
                                    Period" below; or (b) by Party A pursuant
                                    to "Termination Settlement" below.

         Settlement Shares:         With respect to any Settlement Date, a
                                    number of Shares, not to exceed the Base
                                    Amount, designated as such by Party B in
                                    the related Settlement Notice or by Party
                                    A pursuant to "Termination Settlement"
                                    below; provided that Party B may not
                                    deliver more than two such notices during
                                    the Term of this Transaction and no such
                                    notice shall be delivered with respect to
                                    less than 500,000 Shares; and provided
                                    further that on the Maturity Date the
                                    number of Settlement Shares shall be
                                    equal to the Base Amount on such date.
</TABLE>

                                       3
<PAGE>

<TABLE>
<S>                                 <C>
         Settlement:                Physical Settlement or Cash Settlement,
                                    at the election of Party B as set forth
                                    in a Settlement Notice that satisfies the
                                    Settlement Notice Requirements; provided
                                    that Physical Settlement shall apply (i)
                                    if no Settlement Method is validly
                                    selected, (ii) with respect to any
                                    Settlement Shares in respect of which
                                    Party A is unable, in its judgment, to
                                    unwind its hedge by the end of the Unwind
                                    Period in a manner that, in the judgment
                                    of Party A, is consistent with the
                                    requirements for qualifying for the safe
                                    harbor provided by Rule 10b-18 under the
                                    Exchange Act or due to the lack of
                                    sufficient liquidity in the Shares on any
                                    Scheduled Trading Day during the Unwind
                                    Period, (iii) if, at the time of electing
                                    Cash Settlement or as a result of such
                                    election, Party B would be in default
                                    under the Credit Agreement, dated as of
                                    October 27, 2005, as amended, by and
                                    among MPT Operating Partnership L.P., as
                                    borrower, Merrill Lynch Capital, a
                                    division of Merrill Lynch Business
                                    Financial Services, Inc., as
                                    administrative agent and lender, and the
                                    additional lenders from time to time
                                    party thereto (the "Credit Agreement"),
                                    and (iv) to any Termination Settlement
                                    Date (as defined below under "Termination
                                    Settlement").

         Settlement Notice
         Requirements:              Notwithstanding any other provision
                                    hereof, a Settlement Notice delivered by
                                    Party B that specifies Cash Settlement
                                    will not be effective to establish a
                                    Settlement Date or require Cash
                                    Settlement unless Party B delivers to
                                    Party A with such Settlement Notice a
                                    representation signed by Party B
                                    substantially in the following form: "As
                                    of the date of this Settlement Notice,
                                    Party B is not aware of any material
                                    nonpublic information concerning itself
                                    or the Shares, and is designating the
                                    date contained herein as a Settlement
                                    Date in good faith and not as part of a
                                    plan or scheme to evade compliance with
                                    the federal securities laws."

         Unwind Period:             Each Scheduled Trading Day that is not a
                                    Disrupted Day during the period from and
                                    including the first Scheduled Trading Day
                                    following the date Party B validly elects
                                    Cash Settlement in respect of a
                                    Settlement Date through the third
                                    Scheduled Trading Day preceding such
                                    Settlement Date; subject to "Termination
                                    Settlement" below.

         Exchange Act:              The Securities Exchange Act of 1934, as
                                    amended from time to time.

         Physical Settlement:       On any Settlement Date in respect of
                                    which Physical Settlement applies, Party
                                    B shall deliver to Party A through the
                                    Clearance System the Settlement Shares
                                    for such Settlement Date, and Party A
                                    shall deliver to Party B, by wire
                                    transfer of immediately available funds
                                    to an account designated by Party B, an
                                    amount in cash equal to the Physical
                                    Settlement Amount for such Settlement
                                    Date, on a delivery versus payment basis.
</TABLE>

                                       4
<PAGE>

<TABLE>
<S>                                 <C>
         Physical Settlement
         Amount:                    For any Settlement Date in respect of which
                                    Physical Settlement applies, an amount in
                                    cash equal to the product of (i) the Forward
                                    Price on such Settlement Date and (ii) the
                                    number of Settlement Shares for such
                                    Settlement Date.

         Cash Settlement:           On any Settlement Date in respect of
                                    which Cash Settlement applies, if the
                                    Cash Settlement Amount for such
                                    Settlement Date is a positive number,
                                    Party A will pay such Cash Settlement
                                    Amount to Party B.  If the Cash
                                    Settlement Amount is a negative number,
                                    Party B will pay the absolute value of
                                    such Cash Settlement Amount to Party A.
                                    Such amounts shall be paid on the
                                    Settlement Date.

         Cash Settlement Amount:    For any Settlement Date in respect of
                                    which Cash Settlement applies, an amount
                                    determined by the Calculation Agent equal
                                    to the difference between (1) the product
                                    of (i) (A) the Forward Price on the first
                                    day of the applicable Unwind Period minus
                                    (B) the weighted average of the 10b-18
                                    VWAPs per Share for each Scheduled
                                    Trading Day at which Party A actually
                                    purchases Shares during such Unwind
                                    Period to unwind its hedge, multiplied by
                                    (ii) the number of Settlement Shares for
                                    such Settlement Date, minus (2) the
                                    product of (i) the Forward Price
                                    Reduction Amount for any Forward Price
                                    Reduction Date that occurs during such
                                    Unwind Period multiplied by (ii) the
                                    number of Shares with respect to which
                                    Party A has not unwound its hedge as of
                                    such Forward Price Reduction Date.

         10b-18 VWAP:               For any Scheduled Trading Day during the
                                    Unwind Period which is not a Disrupted
                                    Day, the volume-weighted average price at
                                    which the Shares trade as reported in the
                                    composite transactions for the Exchange
                                    on such Scheduled Trading Day, excluding
                                    (i) trades that do not settle regular
                                    way, (ii) opening (regular way) reported
                                    trades on the Exchange on such Scheduled
                                    Trading Day, (iii) trades that occur in
                                    the last ten minutes before the scheduled
                                    close of trading on the Exchange on such
                                    Scheduled Trading Day and ten minutes
                                    before the scheduled close of the primary
                                    trading session in the market where the
                                    trade is effected, and (iv) trades on
                                    such Scheduled Trading Day that do not
                                    satisfy the requirements of Rule
                                    10b-18(b)(3), as determined in good faith
                                    by the Calculation Agent.  Party B
                                    acknowledges that Party A may refer to
                                    the Bloomberg Page "MPW {Equity} AQR SEC"
                                    (or any successor thereto), in its
                                    discretion, for such Scheduled Trading
                                    Day to determine the 10b-18 VWAP.

         Settlement Currency:       USD.

         Failure to Deliver:        Inapplicable.

      Adjustments:
</TABLE>

                                       5
<PAGE>

<TABLE>
<S>                                 <C>
         Method of Adjustment:       Calculation Agent Adjustment;
                                     notwithstanding anything to the contrary
                                     in the 2002 Definitions, but without
                                     affecting Calculation Agent's
                                     obligations contained in Section 1.40 of
                                     the 2002 Definitions, in effecting any
                                     adjustments contemplated by Section
                                     11.2(c) of the 2002 Definitions, the
                                     Calculation Agent may make an adjustment
                                     pursuant to Calculation Agent Adjustment
                                     to any one or more of the Base Amount,
                                     the Forward Price and any other variable
                                     relevant to the settlement or payment
                                     terms of the Transaction.

         Additional Adjustment:      If, in Party A's sole judgment, the
                                     actual cost to Party A, over any one
                                     month period, of borrowing a number of
                                     Shares equal to the Base Amount to hedge
                                     its exposure to the Transaction exceeds
                                     a weighted average rate equal to 100
                                     basis points per annum, the Calculation
                                     Agent shall reduce the Forward Price in
                                     order to compensate Party A for the
                                     amount by which such cost exceeded a
                                     weighted average rate equal to 100 basis
                                     points per annum during such period.
                                     The Calculation Agent shall notify Party
                                     B prior to making any such adjustment to
                                     the Forward Price and, upon the request
                                     of Party B, Party A shall provide an
                                     itemized list of its stock loan costs
                                     for the applicable one month period.

      Account Details:

         Payments to Party A:       To be advised under separate
                                    cover or telephone confirmed prior to each
                                    Settlement Date.

         Payments  to Party B:      To be advised under separate
                                    cover or telephone confirmed prior to each
                                    Settlement Date.

         Delivery of Shares to
         Party A:                   To be advised.

         Delivery of Shares to
         Party B:                   To be advised.
</TABLE>

3.    Other Provisions:

         Conditions to Effectiveness:

            The effectiveness of this Confirmation on the Effective Date shall
            be subject to (i) the condition that the respective representations
            and warranties of UBS Securities LLC ("UBS Securities") and Party B
            contained in the Underwriting Agreement dated the date hereof among
            Party B, Party A and UBS Securities and Wachovia Capital Markets,
            LLC as Representatives of the Several Underwriters (the
            "Underwriting Agreement") and any certificate delivered pursuant
            thereto by UBS Securities or Party B are true and correct on the
            Effective Date as if made as of the Effective Date, (ii) the
            condition that UBS Securities and Party B have performed all of
            their respective obligations required to be performed by them under
            the Underwriting Agreement on or prior to the Effective Date, (iii)
            the condition that Party B has delivered to Party A resolutions of
            the Board of Directors of Party B authorizing the Transaction, in
            form and substance satisfactory to Party A, (iv) the satisfaction of
            all of the conditions set forth in Section 7 of the Underwriting
            Agreement and (v) the condition that neither of the following has
            occurred (A) Party A is unable to borrow and deliver for sale a
            number of Shares equal to the Base Amount, or (B) in Party A's sole
            judgment either it is impracticable to do so or Party A would incur
            a weighted average stock

                                       6
<PAGE>

            loan cost of more than a rate equal to 150 basis points per annum to
            do so (in either of which events this Confirmation shall be
            effective but the Base Amount for this Transaction shall be the
            number of Shares Party A is required to deliver in accordance with
            Section 1 of the Underwriting Agreement).

         Representations and Agreements of Party B:

            Party B (i) has such knowledge and experience in financial and
            business affairs as to be capable of evaluating the merits and risks
            of entering into this Transaction; (ii) has consulted with its own
            legal, financial, accounting and tax advisors in connection with
            this Transaction; and (iii) is entering into this Transaction for a
            bona fide business purpose.

            Party B is not and has not been the subject of any civil proceeding
            of a judicial or administrative body of competent jurisdiction that
            could reasonably be expected to impair materially Party B's ability
            to perform its obligations hereunder.

            Party B will by the next succeeding New York Business Day notify
            Party A upon obtaining knowledge of the occurrence of any event that
            would constitute an Event of Default, a Potential Event of Default
            or a Potential Adjustment Event.

         Additional Representations, Warranties and Agreements of Party B: Party
         B hereby represents and warrants to, and agrees with, Party A as of the
         date hereof that:

            (a)   Any Shares, when issued and delivered in accordance with the
                  terms of the Transaction, will be duly authorized and validly
                  issued, fully paid and nonassessable, and the issuance thereof
                  will not be subject to any preemptive or similar rights.

            (b)   Party B has reserved and will keep available at all times,
                  free from preemptive rights, out of its authorized but
                  unissued Shares, solely for the purpose of issuance upon
                  settlement of the Transaction as herein provided, the full
                  number of Shares as shall be issuable at such time upon
                  settlement of the Transaction. All Shares so issuable shall,
                  upon such issuance, be accepted for listing or quotation on
                  the Exchange.

            (c)   Subject to the last sentence of this paragraph, Party B agrees
                  to provide Party A at least 30 days' written notice (an
                  "Issuer Repurchase Notice") prior to executing any repurchase
                  of Shares by Party B or any of its subsidiaries (or entering
                  into any contract that would require, or give the option to,
                  Party B or any of its subsidiaries, to purchase or repurchase
                  Shares), whether out of profits or capital or whether the
                  consideration for such repurchase is cash, securities or
                  otherwise (an "Issuer Repurchase"), that alone or in the
                  aggregate would result in the Base Amount Percentage (as
                  defined below) being (i) equal to or greater than 4.5% of the
                  outstanding Shares and (ii) greater by 0.5% or more than the
                  Base Amount Percentage at the time of the immediately
                  preceding Issuer Repurchase Notice (or in the case of the
                  first such Issuer Repurchase Notice, greater than the Base
                  Amount Percentage as of the later of the date hereof or the
                  immediately preceding Settlement Date, if any). The "Base
                  Amount Percentage" as of any day is the fraction (1) the
                  numerator of which is the Base Amount and (2) the denominator
                  of which is the number of Shares outstanding on such day. If
                  Party B reasonably determines that compliance with any notice
                  obligations of Party B contained in this paragraph any delay
                  of related repurchase of Shares could jeopardize Party B's
                  status as a "real estate investment trust" within the meaning
                  of the Internal Revenue Code of 1986, as amended, and the
                  Treasury Regulations promulgated thereunder, then,
                  notwithstanding any such notice obligations, Party B shall be
                  entitled to immediately effect any repurchases of Shares
                  contemplated by Party B's charter ("Charter Repurchases")
                  reasonable necessary to

                                       7
<PAGE>

                  maintain such status and shall use its best efforts to
                  simultaneously notify Party A of such repurchases.

            (d)   Neither the execution and delivery of this Confirmation nor
                  the incurrence or performance of obligations of Party B
                  hereunder will conflict with or result in a breach of the
                  Amended and Restated Articles of Incorporation of Party B, as
                  amended and restated as of the date hereof (the "Articles of
                  Incorporation") or by-laws (or any equivalent documents) of
                  Party B, or any applicable law or regulation, including any
                  provisions of the Maryland General Corporation Law, or any
                  order, writ, injunction or decree of any court or governmental
                  authority or agency, or any agreement or instrument to which
                  the Party B or any of its subsidiaries is a party or by which
                  the Party B or any of its subsidiaries is bound or to which
                  the Party B or any of its subsidiaries is subject, including
                  the Credit Agreement, or constitute a default under, or result
                  in the creation of any lien under, any such agreement or
                  instrument, or breach or constitute a default under any
                  agreements and contracts of the Counterparty and the
                  significant subsidiaries filed as exhibits to the
                  Counterparty's Annual Report on Form 10-K.

            (e)   No filing with, or approval, authorization, consent, license
                  registration, qualification, order or decree of, any court or
                  governmental authority or agency, domestic or foreign, is
                  necessary or required for the execution, delivery and
                  performance by Party B of this Confirmation and the
                  consummation of the Transaction (including, without
                  limitation, the issuance and delivery of Shares on any
                  Settlement Date) except (i) such as have been obtained under
                  the Securities Act, and (ii) as may be required to be obtained
                  under state securities laws.

            (f)   Party B is not insolvent, nor will Party B be rendered
                  insolvent as a result of this Transaction.

            (g)   Neither Party B nor any of its affiliates shall take or
                  refrain from taking any action (including, without limitation,
                  any direct purchases by Party B or any of its affiliates or
                  any purchases by a party to a derivative transaction with
                  Party B or any of its affiliates), either under this
                  Confirmation, under an agreement with another party or
                  otherwise, that might cause any purchases of Shares by Party A
                  or any of its affiliates in connection with any Cash
                  Settlement of this Transaction not to meet the requirements of
                  the safe harbor provided by Rule 10b-18 under the Exchange Act
                  if such purchases were made by Party B.

            (h)   Party B will not engage in any "distribution" (as defined in
                  Regulation M under the Exchange Act) that would cause a
                  "restricted period" (as defined in Regulation M) to occur
                  during any Unwind Period.

            (i)   Party B is an "eligible contract participant" (as such term is
                  defined in Section 1(a)(12) of the Commodity Exchange Act, as
                  amended).

            (j)   In addition to any other requirements set forth herein, Party
                  B agrees not to elect Physical Settlement or Cash Settlement
                  if, in the reasonable judgment of either Party A or Party B,
                  such settlement or Party A's related market activity would
                  result in a violation of the U.S. federal securities laws or
                  any other federal or state law or regulation applicable to
                  Party B.

         Covenant of Party B:

            The parties acknowledge and agree that any Shares delivered by Party
            B to Party A on any Settlement Date will be newly issued Shares and
            when delivered by Party A (or an affiliate of Party A) to securities
            lenders from whom Party A (or an affiliate of Party A) borrowed
            Shares in connection with hedging its exposure to the Transaction
            will be freely saleable without further registration or other
            restrictions under the Securities Act of 1933, as amended (the
            "Securities Act"), in the hands of those securities lenders,
            irrespective of whether such stock loan is effected

                                       8
<PAGE>

            by Party A or an affiliate of Party A. Accordingly, Party B agrees
            that the Settlement Shares that it delivers to Party A on each
            Settlement Date will not bear a restrictive legend and that such
            Settlement Shares will be deposited in, and the delivery thereof
            shall be effected through the facilities of, the Clearance System.

         Covenants of Party A:

            (a)   Unless the provisions set forth below under "Private Placement
                  Procedures" shall be applicable, Party A shall use any Shares
                  delivered by Party B to Party A on any Settlement Date to
                  return to securities lenders to close out open stock loans, if
                  any, with respect to Shares.

            (b)   In connection with bids and purchases of Shares in connection
                  with any Cash Settlement of this Transaction, Party A shall
                  use its reasonable best efforts to conduct its activities, or
                  cause its affiliates to conduct their activities, in a manner
                  consistent with the requirements of the safe harbor provided
                  by Rule 10b-18 under the Exchange Act, as if such provisions
                  were applicable to such purchases.

         Insolvency Filing:

         Notwithstanding anything to the contrary herein, in the Agreement or in
         the Definitions, upon any Insolvency Filing in respect of the Issuer,
         the Transaction shall automatically terminate on the date thereof
         without further liability of either party to this Confirmation to the
         other party (except for any liability in respect of any breach of
         representation or covenant by a party under this Confirmation prior to
         the date of such Insolvency Filing).

         Extraordinary Dividends:

         If an ex-dividend date for an Extraordinary Dividend occurs on or after
         the Trade Date and on or prior to the Maturity Date, Party B shall pay
         an amount, as determined by the Calculation Agent, in cash equal to the
         product of such Extraordinary Dividend and the Base Amount on the
         record date for such dividend to Party A on the earlier of (i) the date
         on which such Extraordinary Dividend is paid by the Issuer to holders
         of record of the Shares or (ii) the Maturity Date. "Extraordinary
         Dividend" means the per Share amount of any cash dividend or
         distribution declared by the Issuer with respect to the Shares that is
         specified by the board of directors of the Issuer as an "extraordinary"
         dividend.

         Acceleration Events:

         The following events shall each constitute an "Acceleration Event":

            (a)   Stock Borrow Events. In the reasonable judgment of Party A (i)
                  Party A is unable to hedge Party A's exposure to the
                  Transaction because (A) of the lack of sufficient Shares being
                  made available for Share borrowing by lenders, or (B) it is
                  otherwise commercially impracticable or (ii) Party A would
                  incur a cost to borrow Shares to hedge its exposure to the
                  Transaction that is greater than a rate equal to 150 basis
                  points per annum (each of (i) and (ii) a "Stock Borrow
                  Event");

            (b)   Dividends and Other Distributions. On any day occurring after
                  the Trade Date Party B declares a distribution, issue or
                  dividend to existing holders of the Shares of (i) any cash
                  dividend (other than an Extraordinary Dividend) to the extent
                  all cash dividends having an ex-dividend date during the
                  period from and including any Forward Price Reduction Date
                  (with each of the Trade Date and the Maturity Date being a
                  Forward Price Reduction Date having a Forward Price Reduction
                  Amount equal to $0.00 for purposes of this clause (b)

                                       9
<PAGE>

                  only) to but excluding the next subsequent Forward Price
                  Reduction Date exceeds, on a per Share basis, the sum of the
                  Forward Price Reduction Amount and $0.01, or (ii) share
                  capital or securities of another issuer acquired or owned
                  (directly or indirectly) by Party B as a result of a spin-off
                  or other similar transaction or (iii) any other type of
                  securities (other than Shares), rights or warrants or other
                  assets, for payment (cash or other consideration) at less than
                  the prevailing market price as determined by Party A;

            (d)   ISDA Early Termination Date. Either Party A or Party B has the
                  right to designate an Early Termination Date pursuant to
                  Section 6 of the Agreement;

            (e)   Other ISDA Events. The occurrence of an Announcement Date in
                  respect of an Extraordinary Event; the occurrence of any
                  Change in Law or Delisting; provided that in case of a
                  Delisting, in addition to the provisions of Section
                  12.6(a)(iii) of the 2002 Definitions, it will also constitute
                  a Delisting if the Exchange is located in the United States
                  and the Shares are not immediately re-listed, re-traded or
                  re-quoted on any of the New York Stock Exchange, the American
                  Stock Exchange or the NASDAQ National Market (or their
                  respective successors); or

            (f)   Issuer Repurchases. Party B publicly announces or discloses
                  any Issuer Repurchase (whether or not subsequently amended)
                  that alone, or in the aggregate, results in, or could result
                  in, the Base Amount representing more than 4.5% of the total
                  outstanding Shares (assuming the consummation of such proposed
                  Issuer Repurchase).

         Termination Settlement:

            Upon the occurrence of any Acceleration Event, Party A shall have
            the right to designate, upon at least one Scheduled Trading Day's
            notice, any Scheduled Trading Day following such occurrence to be a
            Settlement Date hereunder (a "Termination Settlement Date") to which
            Physical Settlement shall apply, and to select the number of
            Settlement Shares relating to such Termination Settlement Date;
            provided that (i) in the case of an Acceleration Event arising out
            of a Stock Borrow Event, the number of Settlement Shares so
            designated by Party A shall not exceed the number of Shares as to
            which such Stock Borrow Event exists and (ii) in the case of an
            Acceleration Event arising out of an Issuer Repurchase, the number
            of Settlement Shares so designated by Party A shall not exceed the
            number of Shares necessary to cause the Base Amount to be less than
            4.5% of the total outstanding Shares (assuming consummation of such
            proposed Issuer Repurchase). If, upon designation of a Termination
            Settlement Date by Party A pursuant to the preceding sentence, Party
            B fails to deliver the Settlement Shares relating to such
            Termination Settlement Date when due, such failure shall constitute
            an Event of Default with respect to Party B and Section 6 of the
            Agreement shall apply. If an Acceleration Event occurs during an
            Unwind Period relating to a number of Settlement Shares to which
            Cash Settlement applies, then on the Termination Settlement Date
            relating to such Acceleration Event, notwithstanding any election to
            the contrary by Party B, Cash Settlement shall apply to the portion
            of the Settlement Shares relating to such Unwind Period as to which
            Party A has unwound its hedge and Physical Settlement shall apply in
            respect of the remainder (if any) of such Settlement Shares, in
            addition to the Settlement Shares designated by Party A in respect
            of such Termination Settlement Date.

         Private Placement Procedures

            If Party B is unable to comply with the provisions of "Covenant of
            Party B" above because of a change in law or a change in the policy
            of the Securities and Exchange Commission or its staff, or Party A
            otherwise determines that in its reasonable opinion any Settlement
            Shares to be delivered to Party A by Party B may not be freely
            returned by Party A or its affiliates to securities lenders as

                                       10
<PAGE>

            described under "Covenant of Party B" above, then delivery of any
            such Settlement Shares (the "Restricted Shares") shall be effected
            pursuant to Annex A hereto, unless waived by Party A.

         Rule 10b5-1:

            It is the intent of Party A and Party B that following any election
            of Cash Settlement by Party B, the purchase of Shares by Party A
            during any Unwind Period comply with the requirements of Rule
            10b5-1(c)(1)(i)(B) of the Exchange Act and that this Confirmation
            shall be interpreted to comply with the requirements of Rule
            10b5-1(c).

            Party B acknowledges that (i) during any Unwind Period Party B does
            not have, and shall not attempt to exercise, any influence over how,
            when or whether to effect purchases of Shares by Party A (or its
            agent or affiliate) in connection with this Confirmation and (ii)
            Party B is entering into the Agreement and this Confirmation in good
            faith and not as part of a plan or scheme to evade compliance with
            federal securities laws including, without limitation, Rule 10b-5
            promulgated under the Exchange Act.

            Party B hereby agrees with Party A that during any Unwind Period
            Party B shall not communicate, directly or indirectly, any Material
            Non-Public Information (as defined herein) to any EDG Personnel (as
            defined below). For purposes of this Transaction, "Material
            Non-Public Information" means information relating to Party B or the
            Shares that (a) has not been widely disseminated by wire service, in
            one or more newspapers of general circulation, by communication from
            Party B to its shareholders or in a press release, or contained in a
            public filing made by Party B with the Securities and Exchange
            Commission and (b) a reasonable investor might consider to be of
            importance in making an investment decision to buy, sell or hold
            Shares. For the avoidance of doubt and solely by way of
            illustration, information should be presumed "material" if it
            relates to such matters as dividend increases or decreases, earnings
            estimates, changes in previously released earnings estimates,
            significant expansion or curtailment of operations, a significant
            increase or decline of orders, significant merger or acquisition
            proposals or agreements, significant new products or discoveries,
            extraordinary borrowing, major litigation, liquidity problems,
            extraordinary management developments, purchase or sale of
            substantial assets, or other similar information. For purposes of
            this Transaction, "EDG Personnel" means any employee on the trading
            side of the Equity Derivatives Group of UBS Securities and does not
            include Adam Frieman, Dmitriy Mandel, Akshay Mansukhani, Paul
            Stowell, Xi Huang or Gordon Kiesling (or any other person or persons
            designated from time to time by the respective Compliance Groups of
            Party A).

         Maximum Share Delivery:

            Notwithstanding any other provision of this Confirmation, in no
            event will Party B be required to deliver on any Settlement Date,
            whether pursuant to Physical Settlement, Termination Settlement or
            any Private Placement Settlement, more than 6,000,000 Shares to
            Party A, subject to reduction by the amount of any Shares delivered
            by Party B on any prior Settlement Date.

         Market Disruption Event:

            Section 6.3(a) of the 2002 Definitions is amended by deleting the
            words "at any time during the one hour period that ends at the
            relevant Valuation Time, Latest Exercise Time, Knock-in Valuation
            Time or Knock-out Valuation Time, as the case may be,".

         Assignment:

                                       11
<PAGE>

                  Party A may assign or transfer any of its rights or delegate
                  any of its duties hereunder to any affiliate of Party A or any
                  entity organized or sponsored by Party A without the prior
                  written consent of Party B. Notwithstanding any other
                  provision of this Confirmation to the contrary requiring or
                  allowing Party A to purchase or receive any Shares from Party
                  B, Party A may designate any of its affiliates to purchase or
                  receive such Shares or otherwise to perform Party A's
                  obligations in respect of this Transaction and any such
                  designee may assume such obligations, and Party A shall be
                  discharged of its obligations to Party B solely to the extent
                  of any such performance.

              Matters Relating to Agent:

                  Each party agrees and acknowledges that (i) UBS Securities, as
                  agent, (the "Agent") acts solely as agent on a disclosed basis
                  with respect to the transactions contemplated hereunder, and
                  (ii) the Agent has no obligation, by guaranty, endorsement or
                  otherwise, with respect to the obligations of either Party B
                  or Party A hereunder, either with respect to the delivery of
                  cash or Shares, either at the beginning or the end of the
                  transactions contemplated hereby. In this regard, each of
                  Party A and Party B acknowledges and agrees to look solely to
                  the other for performance hereunder, and not to the Agent.

              Indemnity

                  Party B agrees to indemnify Party A and its affiliates and
                  their respective directors, officers, agents and controlling
                  parties (Party A and each such affiliate or person being an
                  "Indemnified Party") from and against any and all losses,
                  claims, damages and liabilities incurred by or asserted
                  against such Indemnified Party arising out of, in connection
                  with, or relating to, any breach of any covenant or
                  representation made by Party B in this Confirmation or the
                  Agreement, the consummation of the transactions contemplated
                  hereby or any breach of the Articles of Incorporation, and
                  will reimburse any Indemnified Party for all reasonable
                  expenses (including reasonable legal fees and expenses) as
                  they are incurred in connection with the investigation of,
                  preparation for, or defense of any pending or threatened claim
                  or any action or proceeding arising therefrom, whether or not
                  such Indemnified Party is a party thereto. Party B will not be
                  liable under this Indemnity paragraph to the extent that any
                  loss, claim, damage, liability or expense is found in a
                  judgment by a court to have resulted from Party A's gross
                  negligence, willful misconduct or breach of any representation
                  or covenant of Party A contained in this Confirmation of the
                  Agreement.

              Notice

                  Non-Reliance:                               Applicable

                  Additional Acknowledgments:                 Applicable

                  Agreements and Acknowledgments
                  Regarding Hedging Activities:               Applicable

4.       The Agreement is further supplemented by the following provisions:

              No Collateral or Setoff.:

                  Notwithstanding Section 6(f) or any other provision of the
                  Agreement or any other agreement between the parties to the
                  contrary, the obligations of Party B hereunder are not secured
                  by any collateral. Obligations under this Transaction shall
                  not be set off against any other obligations of

                                       12
<PAGE>

                  the parties, whether arising under the Agreement, this
                  Confirmation, under any other agreement between the parties
                  hereto, by operation of law or otherwise, and no other
                  obligations of the parties shall be set off against
                  obligations under this Transaction, whether arising under the
                  Agreement, this Confirmation, under any other agreement
                  between the parties hereto, by operation of law or otherwise,
                  and each party hereby waives any such right of setoff. In
                  calculating any amounts under Section 6(e) of the Agreement,
                  notwithstanding anything to the contrary in the Agreement, (a)
                  separate amounts shall be calculated as set forth in such
                  Section 6(e) with respect to (i) this Transaction and (ii) all
                  other Transactions, and (b) such separate amounts shall be
                  payable pursuant to Section 6(d)(ii) of the Agreement.

              Status of Claims in Bankruptcy:

                  Party A acknowledges and agrees that this confirmation is not
                  intended to convey to Party A rights with respect to the
                  transactions contemplated hereby that are senior to the claims
                  of common stockholders in any U.S. bankruptcy proceedings of
                  Party B; provided, however, that nothing herein shall limit or
                  shall be deemed to limit Party A's right to pursue remedies in
                  the event of a breach by Party B of its obligations and
                  agreements with respect to this Confirmation and the
                  Agreement; and provided further, that nothing herein shall
                  limit or shall be deemed to limit Party A's rights in respect
                  of any transaction other than the Transaction.

              Limit on Beneficial Ownership:

                  Notwithstanding any other provisions hereof, Party A shall not
                  be entitled to receive Shares or any other class of voting
                  securities of the Issuer hereunder (whether in connection with
                  the purchase of Shares on any Settlement Date or any
                  Termination Settlement Date, any Private Placement Settlement
                  or otherwise) to the extent (but only to the extent) that such
                  receipt would result in UBS AG or any of its affiliates or
                  associates directly or indirectly beneficially owning (as such
                  term is defined for purposes of Section 13(d) of the Exchange
                  Act) at any time in excess of 4.5% of the outstanding Shares
                  or any other class of voting securities of the Issuer. Any
                  purported delivery hereunder shall be void and have no effect
                  to the extent (but only to the extent) that such delivery
                  would result in UBS AG or any of its affiliates or associates
                  directly or indirectly so beneficially owning in excess of
                  4.5% of the outstanding Shares or any other class of voting
                  securities of the Issuer. If any delivery owed to Party A
                  hereunder is not made, in whole or in part, as a result of
                  this provision, Party B's obligation to make such delivery
                  shall not be extinguished and Party B shall make such delivery
                  as promptly as practicable after, but in no event later than
                  one Clearance System Business Day after, Party A gives notice
                  to Party B that such delivery would not result in UBS AG or
                  any of its affiliates or associates directly or indirectly so
                  beneficially owning in excess of 4.5% of the outstanding
                  Shares or any other class of voting securities of the Issuer.

              Miscellaneous:

                  (a) Addresses for Notices. For the purpose of Section 12(a) of
                  the Agreement:

                      Address for notices or communications to Party A:

                             Address:         UBS AG, London Branch
                                              c/o UBS Securities LLC
                                              299 Park Avenue
                                              New York, New York 10171
                             Attention:       Equity Derivatives Group
                             Telephone No.:   (212) 821-2100
                             Facsimile No.:   (212) 821-7031

                                       13
<PAGE>

                             With a copy to:

                             Address:         Equities Legal Department
                                              677 Washington Boulevard
                                              Stamford, CT 06901
                             Attention:       David Kelly and Gordon Kiesling
                             Telephone No.:   (203) 719-0268
                             Facsimile No.:   (203) 719-5627

                      Address for notices or communications to Party B:

                             Address:         Medical Properties Trust, Inc.
                                              1000 Urban Center Drive, Suite 501
                                              Birmingham, Alabama 35242
                             Attention:       Charles Lambert
                             Telephone No.:   (205) 969-3755
                             Facsimile No.:   (205) 969-3756

                  (b)   WAIVER OF RIGHT TO TRIAL BY JURY. EACH PARTY WAIVES, TO
                        THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY
                        RIGHT IT MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY
                        SUIT, ACTION OR PROCEEDING RELATING TO THIS
                        CONFIRMATION. Each party (i) certifies that no
                        representative, agent or attorney of the other party has
                        represented, expressly or otherwise, that such other
                        party would not, in the event of such a suit action or
                        proceeding, seek to enforce the foregoing waiver and
                        (ii) acknowledges that it and the other party have been
                        induced to enter into this Confirmation by, among other
                        things, the mutual waivers and certifications herein.

                  (c)   London Branch. Party A is entering into this
                        Confirmation and the Agreement through its London
                        branch. Notwithstanding the foregoing, Party A
                        represents to Party B that the obligations of Party A
                        are the same as if it had entered into this Confirmation
                        and the Agreement through its head or home office in New
                        York.

              Acknowledgments.

                  The parties hereto intend for:

                  (a)   this Transaction to be a "securities contract" as
                        defined in Section 741(7) of Title 11 of the United
                        States Code (the "Bankruptcy Code"), qualifying for the
                        protections under Section 555 of the Bankruptcy Code;

                  (b)   a party's right to liquidate this Transaction and to
                        exercise any other remedies upon the occurrence of any
                        Event of Default under the Agreement with respect to the
                        other party to constitute a "contractual right" as
                        defined in the Bankruptcy Code;

                  (c)   Party A to be a "financial institution" within the
                        meaning of Section 101(22) of the Bankruptcy Code; and

                  (d)   all payments for, under or in connection with this
                        Transaction, all payments for the Shares and the
                        transfer of such Shares to constitute "settlement
                        payments" as defined in the Bankruptcy Code.

                                       14
<PAGE>

              Severability.

                  If any term, provision, covenant or condition of this
                  Confirmation, or the application thereof to any party or
                  circumstance, shall be held to be invalid or unenforceable in
                  whole or in part for any reason, the remaining terms,
                  provisions, covenants, and conditions hereof shall continue in
                  full force and effect as if this Confirmation had been
                  executed with the invalid or unenforceable provision
                  eliminated, so long as this Confirmation as so modified
                  continues to express, without material change, the original
                  intentions of the parties as to the subject matter of this
                  Confirmation and the deletion of such portion of this
                  Confirmation will not substantially impair the respective
                  benefits or expectations of parties to this Agreement;
                  provided, however, that this severability provision shall not
                  be applicable if any provision of Section 2, 5, 6 or 13 of the
                  Agreement (or any definition or provision in Section 14 to the
                  extent that it relates to, or is used in or in connection with
                  any such Section) shall be so held to be invalid or
                  unenforceable.

                               [Remainder of page intentionally left blank]

                                       15
<PAGE>

Please confirm that the foregoing correctly sets forth the terms of our
agreement by signing and returning this Confirmation.

Very truly yours,

UBS SECURITIES LLC,                          UBS AG, LONDON BRANCH
acting solely in its capacity as Agent       By: UBS Securities LLC,
of UBS AG, London Branch                     acting solely in its capacity
                                             as its Agent

By: /s/ Adam Frieman                         By:  /s/ Adam Frieman
Name:     Adam Frieman                       Name:    Adam Frieman
Title:   Managing Director                   Title:   Managing Director

By: /s/ Dimitry Mandel                       By:  /s/ Dimitry Mandel
Name:    Dimitry Mandel                      Name:    Dimitry Mandel
Title:   Executive Director                  Title:   Executive Director

Accepted and confirmed as
of the date first above written:

MEDICAL PROPERTIES TRUST, INC.

By: /s/ R. Steven Hamner
Name: R. Steven Hamner
Title:   Executive Vice President & CFO

<PAGE>

                                                                      SCHEDULE I

<TABLE>
<CAPTION>
Forward Price                                                Forward Price
Reduction Date                                               Reduction Amount
--------------                                               ----------------
<S>                                                          <C>
March 29, 2007                                               $0.27

June 14, 2007                                                $0.28

September 14, 2007                                           $0.31

December 13, 2007                                            $0.32
</TABLE>

<PAGE>

                                                                         ANNEX A

                          PRIVATE PLACEMENT PROCEDURES

(i)   If Party B delivers the Restricted Shares pursuant to this clause (i) (a
      "Private Placement Settlement"), then delivery of Restricted Shares by
      Party B shall be effected in customary private placement procedures with
      respect to such Restricted Shares reasonably acceptable to Party A;
      provided that if , on or before the date that a Private Placement
      Settlement would occur, Party B has taken, or caused to be taken, any
      action that would make unavailable either the exemption pursuant to
      Section 4(2) of the Securities Act for the sale by Party B to Party A (or
      any affiliate designated by Party A) of the Restricted Shares or the
      exemption pursuant to Section 4(1) or Section 4(3) of the Securities Act
      for resales of the Restricted Shares by Party A (or any such affiliate of
      Party A) or Party B fails to deliver the Restricted Shares when due or
      otherwise fails to perform obligations within its control in respect of a
      Private Placement Settlement, it shall be an Event of Default with respect
      to Party B and Section 6 of the Agreement shall apply. The Private
      Placement Settlement of such Restricted Shares shall include customary
      representations, covenants, blue sky and other governmental filings and/or
      registrations, indemnities to Party A, due diligence rights (for Party A
      or any designated buyer of the Restricted Shares by Party A), opinions and
      certificates, and such other documentation as is customary for private
      placement agreements, all reasonably acceptable to Party A. In the case of
      a Private Placement Settlement, Party A shall, in its good faith
      discretion, adjust the amount of Restricted Shares to be delivered to
      Party A hereunder in a commercially reasonable manner to reflect the fact
      that such Restricted Shares may not be freely returned to securities
      lenders by Party A and may only be saleable by Party A at a discount to
      reflect the lack of liquidity in Restricted Shares. Notwithstanding the
      Agreement or this Confirmation, the date of delivery of such Restricted
      Shares shall be the Clearance System Business Day following notice by
      Party A to Party B of the number of Restricted Shares to be delivered
      pursuant to this clause (i). For the avoidance of doubt, delivery of
      Restricted Shares shall be due as set forth in the previous sentence and
      not be due on the Settlement Date or Termination Settlement Date that
      would otherwise be applicable.

(ii)  If Party B delivers any Restricted Shares in respect of the Transaction,
      Party B agrees that (i) such Shares may be transferred by and among UBS AG
      and its affiliates and (ii) after the minimum "holding period" within the
      meaning of Rule 144(d) under the Securities Act has elapsed after the
      applicable Settlement Date, Party B shall promptly remove, or cause the
      transfer agent for the Shares to remove, any legends referring to any
      transfer restrictions from such Shares upon delivery by Party A (or such
      affiliate of Party A) to Party B or such transfer agent of seller's and
      broker's representation letters customarily delivered by Party A or its
      affiliates in connection with resales of restricted securities pursuant to
      Rule 144 under the Securities Act, each without any further requirement
      for the delivery of any certificate, consent, agreement, opinion of
      counsel, notice or any other document, any transfer tax stamps or payment
      of any other amount or any other action by Party A (or such affiliate of
      Party A).February 22, 2007

To:      MEDICAL PROPERTIES TRUST, INC.
         1000 Urban Center Drive, Suite 501
         Birmingham, Alabama 35242

From:    WACHOVIA BANK, NATIONAL ASSOCIATION
         c/o Wachvoia Capital Markets, LLC
         375 Park Avenue
         New York, NY 10152

From:    WACHOVIA CAPITAL MARKETS, LLC,
         SOLELY AS AGENT
         tel: (212) 214-6100
         fax: (212) 214-5913

Dear Sirs,

The purpose of this letter agreement (this "Confirmation") is to confirm the
terms and conditions of the transaction entered into between us on the Trade
Date specified below (the "Transaction"). This Confirmation constitutes a
"Confirmation" as referred to in the ISDA Master Agreement specified below.

1.    The definitions and provisions contained in the 2000 ISDA Definitions (the
      "2000 Definitions") and the 2002 ISDA Equity Derivatives Definitions (the
      "2002 Definitions" and, together with the 2000 Definitions, the
      "Definitions"), each as published by the International Swaps and
      Derivatives Association, Inc., are incorporated into this Confirmation. In
      the event of any inconsistency between the 2002 Definitions and the 2000
      Definitions, the 2002 Definitions will govern. In the event of any
      inconsistency between the Definitions and this Confirmation, this
      Confirmation will govern.

      This Confirmation evidences a complete and binding agreement between Party
      A and Party B as to the terms of the Transaction to which this
      Confirmation relates. This Confirmation shall supplement, form a part of,
      and be subject to an agreement in the form of the 2002 ISDA Master
      Agreement (the "Agreement") as if Party A and Party B had executed an
      agreement in such form on the Trade Date (but without any Schedule except
      for (i) the election of the laws of the State of New York as the governing
      law and (ii) United States dollars as the Termination Currency). In the
      event of any inconsistency between provisions of that Agreement and this
      Confirmation, this Confirmation will prevail for the purpose of the
      Transaction to which this Confirmation relates. The parties hereby agree
      that no Transaction other than the Transaction to which this Confirmation
      relates shall be governed by the Agreement. For purposes of the 2002
      Definitions, the Transaction is a Share Forward Transaction.

      Party A and Party B each represents to the other that it has entered into
      this Transaction in reliance upon such tax, accounting, regulatory, legal,
      and financial advice as it deems necessary and not upon any view expressed
      by the other.

                                       1
<PAGE>

2.    The terms of the particular Transaction to which this Confirmation relates
      are as follows:

<TABLE>
<S>                                                  <C>
         General Terms:
         --------------

              Party A:                               Wachovia Bank, National Association

              Party B:                               Medical Properties Trust, Inc.

              Trade Date:                            February 22, 2007

              Effective Date:                        February 28, 2007

              Base Amount:                           Initially, 1,500,000 Shares.  On each Settlement Date, the Base Amount shall
                                                     be reduced by the number of Settlement Shares for such Settlement Date.

              Maturity Date:                         February 28, 2008 (or, if such date is not a Scheduled Trading Day, the next
                                                     following Scheduled Trading Day).

              Forward Price:                         On the Effective Date, the Initial Forward Price, and on any other day,
                                                     the Forward Price as of the immediately preceding calendar day multiplied
                                                     by the sum of (i) 1 and (ii) the Daily Rate for such day; provided that on
                                                     each Forward Price Reduction Date, the Forward Price in effect on such
                                                     date shall be the Forward Price otherwise in effect on such date minus the
                                                     Forward Price Reduction Amount for such Forward Price Reduction Date.

              Initial Forward Price:                 USD $14.82 per Share.

              Daily Rate:                            For any day, (i)(A) USD-Federal Funds Rate for such day MINUS (B) the Spread
                                                     DIVIDED by (ii) 365.

              USD-Federal                            Funds Rate For any day, the rate set forth for such day opposite the
                                                     caption "Federal funds", as such rate is displayed on the page
                                                     "FedsOpen [Index] [GO]" on the BLOOMBERG Professional Service, or
                                                     any successor page; provided that if no rate appears for any day on
                                                     such page, the rate for the immediately preceding day for which a
                                                     rate appears shall be used for such day.

              Spread:                                1.00%

              Forward Price Reduction Date:          March 29, 2007, June 14, 2007, September 14, 2007, and December 13, 2007.

              Forward Price Reduction
              Amount:                                As set forth in Schedule I hereto
</TABLE>

                                       2
<PAGE>

<TABLE>
<S>                                                  <C>
              Shares:                                Common Stock, $0.001 par value per share, of Party B (also referred to herein
                                                     as the "Issuer") (Exchange identifier: "MPW").

              Exchange:                              The New York Stock Exchange.

              Related Exchange(s):                   All Exchanges.

              Clearance System:                      DTC.

              Calculation Agent:                     Wachovia Bank, National Association

         Settlement Terms:
         -----------------

              Settlement Date:                       Any Scheduled Trading Day following the Effective Date and up to and
                                                     including the Maturity Date, as designated (a) by Party B in a
                                                     written notice (a "Settlement Notice") that satisfies the Settlement
                                                     Notice Requirements and is delivered to Party A (i) at least three
                                                     Scheduled Trading Days prior to such Settlement Date, which may be
                                                     the Maturity Date, if Physical Settlement applies, and (ii) a number
                                                     of Scheduled Trading Days prior to such Settlement Date, which may
                                                     be the Maturity Date, equal to the greater of (A) 10 and (B) the
                                                     product, rounded up to the nearest whole number, of (1) the number
                                                     of Shares to be settled on such date, divided by the initial Base
                                                     Amount, and (2) 40, if Cash Settlement applies; provided that (i)
                                                     the Maturity Date shall be a Settlement Date if on such date the
                                                     Base Amount is greater than zero, (ii) if Cash Settlement applies
                                                     and Party A shall have fully unwound its hedge during an Unwind
                                                     Period by a date that is more than three Scheduled Trading Days
                                                     prior to a Settlement Date specified above, Party A may, by written
                                                     notice to Party B, specify any Scheduled Trading Day prior to such
                                                     originally specified Settlement Date as the Settlement Date, (iii)
                                                     if the Unwind Period for two Settlement Dates would overlap, the
                                                     Unwind Period for the later Settlement Date shall not begin until
                                                     the earlier settlement date has occurred and (iv) the Settlement
                                                     Date may be modified as provided under "Unwind Period" below; or (b)
                                                     by Party A pursuant to "Termination Settlement" below.

              Settlement                             Shares: With respect to any Settlement Date, a number of Shares, not
                                                     to exceed the Base Amount, designated as such by Party B in the
                                                     related Settlement Notice or by Party A pursuant to "Termination
                                                     Settlement" below; provided that Party B may not deliver more than
                                                     two such notices during the Term of this Transaction and no such
                                                     notice shall be delivered with respect to less than 500,000 Shares;
                                                     and provided further that on the Maturity Date the number of
                                                     Settlement Shares shall be equal to the Base Amount on such date.
</TABLE>

                                       3
<PAGE>

<TABLE>
<S>                                                  <C>
              Settlement:                            Physical Settlement or Cash Settlement, at the election of Party B
                                                     as set forth in a Settlement Notice that satisfies the Settlement
                                                     Notice Requirements; provided that Physical Settlement shall apply
                                                     (i) if no Settlement Method is validly selected, (ii) with respect
                                                     to any Settlement Shares in respect of which Party A is unable, in
                                                     its judgment, to unwind its hedge by the end of the Unwind Period in
                                                     a manner that, in the judgment of Party A, is consistent with the
                                                     requirements for qualifying for the safe harbor provided by Rule
                                                     10b-18 under the Exchange Act or due to the lack of sufficient
                                                     liquidity in the Shares on any Scheduled Trading Day during the
                                                     Unwind Period, (iii) if, at the time of electing Cash Settlement or
                                                     as a result of such election, Party B would be in default under the
                                                     Credit Agreement, dated as of October 27, 2005, as amended, by and
                                                     among MPT Operating Partnership L.P., as borrower, Merrill Lynch
                                                     Capital, a division of Merrill Lynch Business Financial Services,
                                                     Inc., as administrative agent and lender, and the additional lenders
                                                     from time to time party thereto (the "Credit Agreement"), and (iv)
                                                     to any Termination Settlement Date (as defined below under
                                                     "Termination Settlement").

              Settlement Notice
              Requirements:                          Notwithstanding any other provision hereof, a Settlement Notice
                                                     delivered by Party B that specifies Cash Settlement will not be
                                                     effective to establish a Settlement Date or require Cash Settlement
                                                     unless Party B delivers to Party A with such Settlement Notice a
                                                     representation signed by Party B substantially in the following
                                                     form: "As of the date of this Settlement Notice, Party B is not
                                                     aware of any material nonpublic information concerning itself or the
                                                     Shares, and is designating the date contained herein as a Settlement
                                                     Date in good faith and not as part of a plan or scheme to evade
                                                     compliance with the federal securities laws."

              Unwind                                 Period: Each Scheduled Trading Day that is not a Disrupted Day
                                                     during the period from and including the first Scheduled Trading Day
                                                     following the date Party B validly elects Cash Settlement in respect
                                                     of a Settlement Date through the third Scheduled Trading Day
                                                     preceding such Settlement Date; subject to "Termination Settlement"
                                                     below.

              Exchange Act:                          The Securities Exchange Act of 1934, as amended from time to time.

              Physical Settlement:                   On any Settlement Date in respect of which Physical Settlement
                                                     applies, Party B shall deliver to Party A through the Clearance
                                                     System the Settlement Shares for such Settlement Date, and Party A
                                                     shall deliver to Party B, by wire transfer of immediately available
                                                     funds to an account designated by Party B, an amount in cash equal
                                                     to the Physical Settlement Amount for such Settlement Date, on a
                                                     delivery versus payment basis.
</TABLE>

                                       4
<PAGE>

<TABLE>
<S>                                                  <C>
              Physical Settlement Amount:            For any Settlement Date in respect of which Physical Settlement
                                                     applies, an amount in cash equal to the product of (i) the Forward
                                                     Price on such Settlement Date and (ii) the number of Settlement
                                                     Shares for such Settlement Date.

              Cash Settlement:                       On any Settlement Date in respect of which Cash Settlement applies,
                                                     if the Cash Settlement Amount for such Settlement Date is a positive
                                                     number, Party A will pay such Cash Settlement Amount to Party B. If
                                                     the Cash Settlement Amount is a negative number, Party B will pay
                                                     the absolute value of such Cash Settlement Amount to Party A. Such
                                                     amounts shall be paid on the Settlement Date.

              Cash Settlement Amount:                For any Settlement Date in respect of which Cash Settlement applies,
                                                     an amount determined by the Calculation Agent equal to the
                                                     difference between (1) the product of (i) (A) the Forward Price on
                                                     the first day of the applicable Unwind Period minus (B) the weighted
                                                     average of the 10b-18 VWAPs per Share for each Scheduled Trading Day
                                                     at which Party A actually purchases Shares during such Unwind Period
                                                     to unwind its hedge, multiplied by (ii) the number of Settlement
                                                     Shares for such Settlement Date, minus (2) the product of (i) the
                                                     Forward Price Reduction Amount for any Forward Price Reduction Date
                                                     that occurs during such Unwind Period multiplied by (ii) the number
                                                     of Shares with respect to which Party A has not unwound its hedge as
                                                     of such Forward Price Reduction Date.

              10b-18 VWAP:                           For any Scheduled Trading Day during the Unwind Period which is not
                                                     a Disrupted Day, the volume-weighted average price at which the
                                                     Shares trade as reported in the composite transactions for the
                                                     Exchange on such Scheduled Trading Day, excluding (i) trades that do
                                                     not settle regular way, (ii) opening (regular way) reported trades
                                                     on the Exchange on such Scheduled Trading Day, (iii) trades that
                                                     occur in the last ten minutes before the scheduled close of trading
                                                     on the Exchange on such Scheduled Trading Day and ten minutes before
                                                     the scheduled close of the primary trading session in the market
                                                     where the trade is effected, and (iv) trades on such Scheduled
                                                     Trading Day that do not satisfy the requirements of Rule
                                                     10b-18(b)(3), as determined in good faith by the Calculation Agent.
                                                     Party B acknowledges that Party A may refer to the Bloomberg Page
                                                     "MPW [Equity] AQR SEC" (or any successor thereto), in its
                                                     discretion, for such Scheduled Trading Day to determine the 10b-18
                                                     VWAP.

              Settlement Currency:                   USD.

              Failure to Deliver:                    Inapplicable.

         Adjustments:
         -----------
</TABLE>

                                       5
<PAGE>

<TABLE>
<S>                                                  <C>
              Method of Adjustment:                  Calculation Agent Adjustment; notwithstanding anything to the
                                                     contrary in the 2002 Definitions, but without affecting Calculation
                                                     Agent's obligations contained in Section 1.40 of the 2002
                                                     Definitions, in effecting any adjustments contemplated by Section
                                                     11.2(c) of the 2002 Definitions, the Calculation Agent may make an
                                                     adjustment pursuant to Calculation Agent Adjustment to any one or
                                                     more of the Base Amount, the Forward Price and any other variable
                                                     relevant to the settlement or payment terms of the Transaction.

              Additional Adjustment:                 If, in Party A's sole judgment, the actual cost to Party A, over any
                                                     one month period, of borrowing a number of Shares equal to the Base
                                                     Amount to hedge its exposure to the Transaction exceeds a weighted
                                                     average rate equal to 100 basis points per annum, the Calculation
                                                     Agent shall reduce the Forward Price in order to compensate Party A
                                                     for the amount by which such cost exceeded a weighted average rate
                                                     equal to 100 basis points per annum during such period. The
                                                     Calculation Agent shall notify Party B prior to making any such
                                                     adjustment to the Forward Price and, upon the request of Party B,
                                                     Party A shall provide an itemized list of its stock loan costs for
                                                     the applicable one month period.

         Account Details:
         ---------------

                Payments to Party A:                 ABA: 053-000-219
                                                     Wachovia Bank, National Association
                                                     Charlotte, NC
                                                     A/C: 04659360009768
                                                     Attn: Equity Derivatives

              Payments to Party B:                   To be advised under separate cover or telephone confirmed prior to each
                                                     Settlement Date.

              Delivery of Shares to Party A:         DTC Settlement Instructions:
                                                     DTC Number:       2072
                                                     Agent ID:         52196
                                                     Institution ID:   52196

              Delivery of Shares to Party B:         To be advised.
</TABLE>

3.    Other Provisions:

         Conditions to Effectiveness:

            The effectiveness of this Confirmation on the Effective Date shall
            be subject to (i) the condition that the respective representations
            and warranties of Wachovia Capital Markets, LLC (the "Agent") and
            Party B contained in the Underwriting Agreement dated the date
            hereof among Party B, Party A and UBS Securities LLC and the Agent
            as Representatives of the Several Underwriters (the "Underwriting
            Agreement") and any certificate delivered pursuant thereto by the
            Agent or Party B are true and correct on the Effective Date as if
            made as of the Effective Date, (ii) the condition that the Agent and
            Party B have performed all of their respective obligations required
            to

                                       6
<PAGE>

            be performed by them under the Underwriting Agreement on or prior to
            the Effective Date, (iii) the condition that Party B has delivered
            to Party A resolutions of the Board of Directors of Party B
            authorizing the Transaction, in form and substance satisfactory to
            Party A, (iv) the satisfaction of all of the conditions set forth in
            Section 7 of the Underwriting Agreement and (v) the condition that
            neither of the following has occurred (A) Party A is unable to
            borrow and deliver for sale a number of Shares equal to the Base
            Amount, or (B) in Party A's sole judgment either it is impracticable
            to do so or Party A would incur a weighted average stock loan cost
            of more than a rate equal to 150 basis points per annum to do so (in
            either of which events this Confirmation shall be effective but the
            Base Amount for this Transaction shall be the number of Shares Party
            A is required to deliver in accordance with Section 1 of the
            Underwriting Agreement).

         Representations and Agreements of Party B:

            Party B (i) has such knowledge and experience in financial and
            business affairs as to be capable of evaluating the merits and risks
            of entering into this Transaction; (ii) has consulted with its own
            legal, financial, accounting and tax advisors in connection with
            this Transaction; and (iii) is entering into this Transaction for a
            bona fide business purpose.

            Party B is not and has not been the subject of any civil proceeding
            of a judicial or administrative body of competent jurisdiction that
            could reasonably be expected to impair materially Party B's ability
            to perform its obligations hereunder.

            Party B will by the next succeeding New York Business Day notify
            Party A upon obtaining knowledge of the occurrence of any event that
            would constitute an Event of Default, a Potential Event of Default
            or a Potential Adjustment Event.

         Additional Representations, Warranties and Agreements of Party B:
         Party B hereby represents and warrants to, and agrees with, Party A
         as of the date hereof that:

            (a)   Any Shares, when issued and delivered in accordance with the
                  terms of the Transaction, will be duly authorized and validly
                  issued, fully paid and nonassessable, and the issuance thereof
                  will not be subject to any preemptive or similar rights.

            (b)   Party B has reserved and will keep available at all times,
                  free from preemptive rights, out of its authorized but
                  unissued Shares, solely for the purpose of issuance upon
                  settlement of the Transaction as herein provided, the full
                  number of Shares as shall be issuable at such time upon
                  settlement of the Transaction. All Shares so issuable shall,
                  upon such issuance, be accepted for listing or quotation on
                  the Exchange.

            (c)   Subject to the last sentence of this paragraph, Party B agrees
                  to provide Party A at least 30 days' written notice (an
                  "Issuer Repurchase Notice") prior to executing any repurchase
                  of Shares by Party B or any of its subsidiaries (or entering
                  into any contract that would require, or give the option to,
                  Party B or any of its subsidiaries, to purchase or repurchase
                  Shares), whether out of profits or capital or whether the
                  consideration for such repurchase is cash, securities or
                  otherwise (an "Issuer Repurchase"), that alone or in the
                  aggregate would result in the Base Amount Percentage (as
                  defined below) being (i) equal to or greater than 4.5% of the
                  outstanding Shares and (ii) greater by 0.5% or more than the
                  Base Amount Percentage at the time of the immediately
                  preceding Issuer Repurchase Notice (or in the case of the
                  first such Issuer Repurchase Notice, greater than the Base
                  Amount Percentage as of the later of the date hereof or the
                  immediately preceding Settlement Date, if any). The "Base
                  Amount Percentage" as of any day is the fraction (1) the
                  numerator of which is the Base Amount and (2) the denominator
                  of which is the number of Shares outstanding on such day. If
                  Party B

                                       7
<PAGE>

                  reasonably determines that compliance with any notice
                  obligations of Party B contained in this paragraph any delay
                  of related repurchase of Shares could jeopardize Party B's
                  status as a "real estate investment trust" within the meaning
                  of the Internal Revenue Code of 1986, as amended, and the
                  Treasury Regulations promulgated thereunder, then,
                  notwithstanding any such notice obligations, Party B shall be
                  entitled to immediately effect any repurchases of Shares
                  contemplated by Party B's charter ("Charter Repurchases")
                  reasonable necessary to maintain such status and shall use its
                  best efforts to simultaneously notify Party A of such
                  repurchases.

            (d)   Neither the execution and delivery of this Confirmation nor
                  the incurrence or performance of obligations of Party B
                  hereunder will conflict with or result in a breach of the
                  Amended and Restated Articles of Incorporation of Party B, as
                  amended and restated as of the date hereof (the "Articles of
                  Incorporation") or by-laws (or any equivalent documents) of
                  Party B, or any applicable law or regulation, including any
                  provisions of the Maryland General Corporation Law, or any
                  order, writ, injunction or decree of any court or governmental
                  authority or agency, or any agreement or instrument to which
                  the Party B or any of its subsidiaries is a party or by which
                  the Party B or any of its subsidiaries is bound or to which
                  the Party B or any of its subsidiaries is subject, including
                  the Credit Agreement, or constitute a default under, or result
                  in the creation of any lien under, any such agreement or
                  instrument, or breach or constitute a default under any
                  agreements and contracts of the Counterparty and the
                  significant subsidiaries filed as exhibits to the
                  Counterparty's Annual Report on Form 10-K.

            (e)   No filing with, or approval, authorization, consent, license
                  registration, qualification, order or decree of, any court or
                  governmental authority or agency, domestic or foreign, is
                  necessary or required for the execution, delivery and
                  performance by Party B of this Confirmation and the
                  consummation of the Transaction (including, without
                  limitation, the issuance and delivery of Shares on any
                  Settlement Date) except (i) such as have been obtained under
                  the Securities Act, and (ii) as may be required to be obtained
                  under state securities laws.

            (f)   Party B is not insolvent, nor will Party B be rendered
                  insolvent as a result of this Transaction.

            (g)   Neither Party B nor any of its affiliates shall take or
                  refrain from taking any action (including, without limitation,
                  any direct purchases by Party B or any of its affiliates or
                  any purchases by a party to a derivative transaction with
                  Party B or any of its affiliates), either under this
                  Confirmation, under an agreement with another party or
                  otherwise, that might cause any purchases of Shares by Party A
                  or any of its affiliates in connection with any Cash
                  Settlement of this Transaction not to meet the requirements of
                  the safe harbor provided by Rule 10b-18 under the Exchange Act
                  if such purchases were made by Party B.

            (h)   Party B will not engage in any "distribution" (as defined in
                  Regulation M under the Exchange Act) that would cause a
                  "restricted period" (as defined in Regulation M) to occur
                  during any Unwind Period.

            (i)   Party B is an "eligible contract participant" (as such term is
                  defined in Section 1(a)(12) of the Commodity Exchange Act, as
                  amended).

            (j)   In addition to any other requirements set forth herein, Party
                  B agrees not to elect Physical Settlement or Cash Settlement
                  if, in the reasonable judgment of either Party A or Party B,
                  such settlement or Party A's related market activity would
                  result in a violation of the U.S. federal securities laws or
                  any other federal or state law or regulation applicable to
                  Party B.

         Covenant of Party B:

                                       8
<PAGE>

            The parties acknowledge and agree that any Shares delivered by Party
            B to Party A on any Settlement Date will be newly issued Shares and
            when delivered by Party A (or an affiliate of Party A) to securities
            lenders from whom Party A (or an affiliate of Party A) borrowed
            Shares in connection with hedging its exposure to the Transaction
            will be freely saleable without further registration or other
            restrictions under the Securities Act of 1933, as amended (the
            "Securities Act"), in the hands of those securities lenders,
            irrespective of whether such stock loan is effected by Party A or an
            affiliate of Party A. Accordingly, Party B agrees that the
            Settlement Shares that it delivers to Party A on each Settlement
            Date will not bear a restrictive legend and that such Settlement
            Shares will be deposited in, and the delivery thereof shall be
            effected through the facilities of, the Clearance System.

         Covenants of Party A:

            (a)   Unless the provisions set forth below under "Private Placement
                  Procedures" shall be applicable, Party A shall use any Shares
                  delivered by Party B to Party A on any Settlement Date to
                  return to securities lenders to close out open stock loans, if
                  any, with respect to Shares.

            (b)   In connection with bids and purchases of Shares in connection
                  with any Cash Settlement of this Transaction, Party A shall
                  use its reasonable best efforts to conduct its activities, or
                  cause its affiliates to conduct their activities, in a manner
                  consistent with the requirements of the safe harbor provided
                  by Rule 10b-18 under the Exchange Act, as if such provisions
                  were applicable to such purchases.

            Insolvency Filing:

            Notwithstanding anything to the contrary herein, in the Agreement or
            in the Definitions, upon any Insolvency Filing in respect of the
            Issuer, the Transaction shall automatically terminate on the date
            thereof without further liability of either party to this
            Confirmation to the other party (except for any liability in respect
            of any breach of representation or covenant by a party under this
            Confirmation prior to the date of such Insolvency Filing).

            Extraordinary Dividends:

            If an ex-dividend date for an Extraordinary Dividend occurs on or
            after the Trade Date and on or prior to the Maturity Date, Party B
            shall pay an amount, as determined by the Calculation Agent, in cash
            equal to the product of such Extraordinary Dividend and the Base
            Amount on the record date for such dividend to Party A on the
            earlier of (i) the date on which such Extraordinary Dividend is paid
            by the Issuer to holders of record of the Shares or (ii) the
            Maturity Date. "Extraordinary Dividend" means the per Share amount
            of any cash dividend or distribution declared by the Issuer with
            respect to the Shares that is specified by the board of directors of
            the Issuer as an "extraordinary" dividend.

            Acceleration Events:

            The following events shall each constitute an "Acceleration Event":

            (a)   Stock Borrow Events. In the reasonable judgment of Party A (i)
                  Party A is unable to hedge Party A's exposure to the
                  Transaction because (A) of the lack of sufficient Shares being
                  made available for Share borrowing by lenders, or (B) it is
                  otherwise commercially impracticable or (ii) Party A would
                  incur a cost to borrow Shares to hedge its exposure to the
                  Transaction that is greater than a rate equal to 150 basis
                  points per annum (each of (i) and (ii) a "Stock Borrow
                  Event");

                                       9
<PAGE>

            (b)   Dividends and Other Distributions. On any day occurring after
                  the Trade Date Party B declares a distribution, issue or
                  dividend to existing holders of the Shares of (i) any cash
                  dividend (other than an Extraordinary Dividend) to the extent
                  all cash dividends having an ex-dividend date during the
                  period from and including any Forward Price Reduction Date
                  (with each of the Trade Date and the Maturity Date being a
                  Forward Price Reduction Date having a Forward Price Reduction
                  Amount equal to $0.00 for purposes of this clause (b) only) to
                  but excluding the next subsequent Forward Price Reduction Date
                  exceeds, on a per Share basis, the sum of the Forward Price
                  Reduction Amount and $0.01, or (ii) share capital or
                  securities of another issuer acquired or owned (directly or
                  indirectly) by Party B as a result of a spin-off or other
                  similar transaction or (iii) any other type of securities
                  (other than Shares), rights or warrants or other assets, for
                  payment (cash or other consideration) at less than the
                  prevailing market price as determined by Party A;

            (d)   ISDA Early Termination Date. Either Party A or Party B has the
                  right to designate an Early Termination Date pursuant to
                  Section 6 of the Agreement;

            (e)   Other ISDA Events. The occurrence of an Announcement Date in
                  respect of an Extraordinary Event; the occurrence of any
                  Change in Law or Delisting; provided that in case of a
                  Delisting, in addition to the provisions of Section
                  12.6(a)(iii) of the 2002 Definitions, it will also constitute
                  a Delisting if the Exchange is located in the United States
                  and the Shares are not immediately re-listed, re-traded or
                  re-quoted on any of the New York Stock Exchange, the American
                  Stock Exchange or the NASDAQ National Market (or their
                  respective successors); or

            (f)   Issuer Repurchases. Party B publicly announces or discloses
                  any Issuer Repurchase (whether or not subsequently amended)
                  that alone, or in the aggregate, results in, or could result
                  in, the Base Amount representing more than 4.5% of the total
                  outstanding Shares (assuming the consummation of such proposed
                  Issuer Repurchase).

         Termination Settlement:

            Upon the occurrence of any Acceleration Event, Party A shall have
            the right to designate, upon at least one Scheduled Trading Day's
            notice, any Scheduled Trading Day following such occurrence to be a
            Settlement Date hereunder (a "Termination Settlement Date") to which
            Physical Settlement shall apply, and to select the number of
            Settlement Shares relating to such Termination Settlement Date;
            provided that (i) in the case of an Acceleration Event arising out
            of a Stock Borrow Event, the number of Settlement Shares so
            designated by Party A shall not exceed the number of Shares as to
            which such Stock Borrow Event exists and (ii) in the case of an
            Acceleration Event arising out of an Issuer Repurchase, the number
            of Settlement Shares so designated by Party A shall not exceed the
            number of Shares necessary to cause the Base Amount to be less than
            4.5% of the total outstanding Shares (assuming consummation of such
            proposed Issuer Repurchase). If, upon designation of a Termination
            Settlement Date by Party A pursuant to the preceding sentence, Party
            B fails to deliver the Settlement Shares relating to such
            Termination Settlement Date when due, such failure shall constitute
            an Event of Default with respect to Party B and Section 6 of the
            Agreement shall apply. If an Acceleration Event occurs during an
            Unwind Period relating to a number of Settlement Shares to which
            Cash Settlement applies, then on the Termination Settlement Date
            relating to such Acceleration Event, notwithstanding any election to
            the contrary by Party B, Cash Settlement shall apply to the portion
            of the Settlement Shares relating to such Unwind Period as to which
            Party A has unwound its hedge and Physical Settlement shall apply in
            respect of the remainder (if any) of such Settlement Shares, in
            addition to the Settlement Shares designated by Party A in respect
            of such Termination Settlement Date.

         Private Placement Procedures

                                       10
<PAGE>

            If Party B is unable to comply with the provisions of "Covenant of
            Party B" above because of a change in law or a change in the policy
            of the Securities and Exchange Commission or its staff, or Party A
            otherwise determines that in its reasonable opinion any Settlement
            Shares to be delivered to Party A by Party B may not be freely
            returned by Party A or its affiliates to securities lenders as
            described under "Covenant of Party B" above, then delivery of any
            such Settlement Shares (the "Restricted Shares") shall be effected
            pursuant to Annex A hereto, unless waived by Party A.

         Rule 10b5-1:

            It is the intent of Party A and Party B that following any election
            of Cash Settlement by Party B, the purchase of Shares by Party A
            during any Unwind Period comply with the requirements of Rule
            10b5-1(c)(1)(i)(B) of the Exchange Act and that this Confirmation
            shall be interpreted to comply with the requirements of Rule
            10b5-1(c).

            Party B acknowledges that (i) during any Unwind Period Party B does
            not have, and shall not attempt to exercise, any influence over how,
            when or whether to effect purchases of Shares by Party A (or its
            agent or affiliate) in connection with this Confirmation and (ii)
            Party B is entering into the Agreement and this Confirmation in good
            faith and not as part of a plan or scheme to evade compliance with
            federal securities laws including, without limitation, Rule 10b-5
            promulgated under the Exchange Act.

            Party B hereby agrees with Party A that during any Unwind Period
            Party B shall not communicate, directly or indirectly, any Material
            Non-Public Information (as defined herein) to any EDG Personnel (as
            defined below). For purposes of this Transaction, "Material
            Non-Public Information" means information relating to Party B or the
            Shares that (a) has not been widely disseminated by wire service, in
            one or more newspapers of general circulation, by communication from
            Party B to its shareholders or in a press release, or contained in a
            public filing made by Party B with the Securities and Exchange
            Commission and (b) a reasonable investor might consider to be of
            importance in making an investment decision to buy, sell or hold
            Shares. For the avoidance of doubt and solely by way of
            illustration, information should be presumed "material" if it
            relates to such matters as dividend increases or decreases, earnings
            estimates, changes in previously released earnings estimates,
            significant expansion or curtailment of operations, a significant
            increase or decline of orders, significant merger or acquisition
            proposals or agreements, significant new products or discoveries,
            extraordinary borrowing, major litigation, liquidity problems,
            extraordinary management developments, purchase or sale of
            substantial assets, or other similar information. For purposes of
            this Transaction, "EDG Personnel" means any employee on the trading
            side of the Equity Derivatives Group of the Agent (or any other
            person or persons designated from time to time by the respective
            Compliance Groups of Party A).

         Maximum Share Delivery:

            Notwithstanding any other provision of this Confirmation, in no
            event will Party B be required to deliver on any Settlement Date,
            whether pursuant to Physical Settlement, Termination Settlement or
            any Private Placement Settlement, more than 6,000,000 Shares to
            Party A, subject to reduction by the amount of any Shares delivered
            by Party B on any prior Settlement Date.

         Market Disruption Event:

            Section 6.3(a) of the 2002 Definitions is amended by deleting the
            words "at any time during the one hour period that ends at the
            relevant Valuation Time, Latest Exercise Time, Knock-in Valuation
            Time or Knock-out Valuation Time, as the case may be,".

                                       11
<PAGE>

         Assignment:

            Party A may assign or transfer any of its rights or delegate any of
            its duties hereunder to any affiliate of Party A or any entity
            organized or sponsored by Party A without the prior written consent
            of Party B. Notwithstanding any other provision of this Confirmation
            to the contrary requiring or allowing Party A to purchase or receive
            any Shares from Party B, Party A may designate any of its affiliates
            to purchase or receive such Shares or otherwise to perform Party A's
            obligations in respect of this Transaction and any such designee may
            assume such obligations, and Party A shall be discharged of its
            obligations to Party B solely to the extent of any such performance.

         Matters Relating to Agent:

            (a) The Agent is registered as a broker-dealer with the U.S.
            Securities and Exchange Commission and the National Association of
            Securities Dealers, is acting hereunder for and on behalf of Party A
            solely in its capacity as agent for Party A pursuant to instructions
            from Party A, and is not and will not be acting as the
            Counterparty's agent, broker, advisor or fiduciary in any respect
            under or in connection with this Transaction.

            (b) In addition to acting as Party A's agent in executing this
            Transaction, the Agent is authorized from time to time to give
            written payment and/or delivery instructions to the Counterparty
            directing it to make its payments and/or deliveries under this
            Transaction to an account of the Agent for remittance to Party A (or
            its designee), and for that purpose any such payment or delivery by
            the Counterparty to the Agent shall be treated as a payment or
            delivery to Party A.

            (c) Except as otherwise provided herein, any and all notices,
            demands, or communications of any kind transmitted in writing by
            either Party A or the Counterparty under or in connection with this
            Transaction will be transmitted exclusively by such party to the
            other party through the Agent at the following address:

                      Wachovia Capital Markets, LLC
                      201 South College Street, 6th Floor
                      Charlotte, NC  28288-0601
                      Facsimile No.: (704) 383-8425
                      Telephone No.: (704) 715-8086
                      Attention:  Equity Derivatives

            (d) The Agent shall have no responsibility or liability to Party A
            or the Counterparty for or arising from (i) any failure by either
            Party A or the Counterparty to perform any of their respective
            obligations under or in connection with this Transaction, (ii) the
            collection or enforcement of any such obligations, or (iii) the
            exercise of any of the rights and remedies of either Party A or the
            Counterparty under or in connection with this Transaction. Each of
            Party A and the Counterparty agrees to proceed solely against the
            other to collect or enforce any such obligations, and the Agent
            shall have no liability in respect of this Transaction except for
            its gross negligence or willful misconduct in performing its duties
            as the agent of Party A.

            (e) Upon written request, the Agent will furnish to Party A and the
            Counterparty the date and time of the execution of this Transaction
            and a statement as to the source and amount of any remuneration
            received or to be received by the Agent in connection with this
            Transaction.

                                       12
<PAGE>

         Indemnity

            Party B agrees to indemnify Party A and its affiliates and their
            respective directors, officers, agents and controlling parties
            (Party A and each such affiliate or person being an "Indemnified
            Party") from and against any and all losses, claims, damages and
            liabilities incurred by or asserted against such Indemnified Party
            arising out of, in connection with, or relating to, any breach of
            any covenant or representation made by Party B in this Confirmation
            or the Agreement, the consummation of the transactions contemplated
            hereby or any breach of the Articles of Incorporation, and will
            reimburse any Indemnified Party for all reasonable expenses
            (including reasonable legal fees and expenses) as they are incurred
            in connection with the investigation of, preparation for, or defense
            of any pending or threatened claim or any action or proceeding
            arising therefrom, whether or not such Indemnified Party is a party
            thereto. Party B will not be liable under this Indemnity paragraph
            to the extent that any loss, claim, damage, liability or expense is
            found in a judgment by a court to have resulted from Party A's gross
            negligence, willful misconduct or breach of any representation or
            covenant of Party A contained in this Confirmation of the Agreement.

         Notice

            Non-Reliance:                               Applicable

            Additional Acknowledgments:                 Applicable

            Agreements and Acknowledgments
            Regarding Hedging Activities:               Applicable

4.    The Agreement is further supplemented by the following provisions:

         No Collateral or Setoff.:

            Notwithstanding Section 6(f) or any other provision of the Agreement
            or any other agreement between the parties to the contrary, the
            obligations of Party B hereunder are not secured by any collateral.
            Obligations under this Transaction shall not be set off against any
            other obligations of the parties, whether arising under the
            Agreement, this Confirmation, under any other agreement between the
            parties hereto, by operation of law or otherwise, and no other
            obligations of the parties shall be set off against obligations
            under this Transaction, whether arising under the Agreement, this
            Confirmation, under any other agreement between the parties hereto,
            by operation of law or otherwise, and each party hereby waives any
            such right of setoff. In calculating any amounts under Section 6(e)
            of the Agreement, notwithstanding anything to the contrary in the
            Agreement, (a) separate amounts shall be calculated as set forth in
            such Section 6(e) with respect to (i) this Transaction and (ii) all
            other Transactions, and (b) such separate amounts shall be payable
            pursuant to Section 6(d)(ii) of the Agreement.

         Status of Claims in Bankruptcy:

            Party A acknowledges and agrees that this confirmation is not
            intended to convey to Party A rights with respect to the
            transactions contemplated hereby that are senior to the claims of
            common stockholders in any U.S. bankruptcy proceedings of Party B;
            provided, however, that nothing herein shall limit or shall be
            deemed to limit Party A's right to pursue remedies in the event of a
            breach by Party B of its obligations and agreements with respect to
            this Confirmation and the Agreement; and provided further, that
            nothing herein shall limit or shall be deemed to limit Party A's
            rights in respect of any transaction other than the Transaction.

                                       13
<PAGE>

         Limit on Beneficial Ownership:

            Notwithstanding any other provisions hereof, Party A shall not be
            entitled to receive Shares or any other class of voting securities
            of the Issuer hereunder (whether in connection with the purchase of
            Shares on any Settlement Date or any Termination Settlement Date,
            any Private Placement Settlement or otherwise) to the extent (but
            only to the extent) that such receipt would result in Party A or any
            of its affiliates or associates directly or indirectly beneficially
            owning (as such term is defined for purposes of Section 13(d) of the
            Exchange Act) at any time in excess of 4.5% of the outstanding
            Shares or any other class of voting securities of the Issuer. Any
            purported delivery hereunder shall be void and have no effect to the
            extent (but only to the extent) that such delivery would result in
            Party A or any of its affiliates or associates directly or
            indirectly so beneficially owning in excess of 4.5% of the
            outstanding Shares or any other class of voting securities of the
            Issuer. If any delivery owed to Party A hereunder is not made, in
            whole or in part, as a result of this provision, Party B's
            obligation to make such delivery shall not be extinguished and Party
            B shall make such delivery as promptly as practicable after, but in
            no event later than one Clearance System Business Day after, Party A
            gives notice to Party B that such delivery would not result in Party
            A or any of its affiliates or associates directly or indirectly so
            beneficially owning in excess of 4.5% of the outstanding Shares or
            any other class of voting securities of the Issuer.

         Miscellaneous:

            (a)   Addresses for Notices. For the purpose of Section 12(a) of the
                  Agreement:

                  Address for notices or communications to Party A:

                       Address:              Wachovia Bank, National Association
                                             375 Park Avenue
                                             New York, NY 10152

                       Attention:                     Head of Documentation
                       Telephone No.:        (212) 214-6100
                       Facsimile No.:        (212) 214-5913

                       With a copy to:

                       Address:              Wachovia Capital Markets, LLC
                                             201 South College Street, 6th Floor
                                             Charlotte, NC 28288-0601
                       Attention:            Equity Derivatives
                       Telephone No.:        (704) 715-8086
                       Facsimile No.:        (704) 383-8425

                  Address for notices or communications to Party B:

                       Address:              Medical Properties Trust, Inc.
                                             1000 Urban Center Drive, Suite 501
                                             Birmingham, Alabama 35242
                       Attention:            Charles Lambert
                       Telephone No.:        (205) 969-3755
                       Facsimile No.:        (205) 969-3756

                                       14
<PAGE>

            (b)   WAIVER OF RIGHT TO TRIAL BY JURY. EACH PARTY WAIVES, TO THE
                  FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY RIGHT IT MAY
                  HAVE TO A TRIAL BY JURY IN RESPECT OF ANY SUIT, ACTION OR
                  PROCEEDING RELATING TO THIS CONFIRMATION. Each party (i)
                  certifies that no representative, agent or attorney of the
                  other party has represented, expressly or otherwise, that such
                  other party would not, in the event of such a suit action or
                  proceeding, seek to enforce the foregoing waiver and (ii)
                  acknowledges that it and the other party have been induced to
                  enter into this Confirmation by, among other things, the
                  mutual waivers and certifications herein.

         Acknowledgments.

            The parties hereto intend for:

            (a)   this Transaction to be a "securities contract" as defined in
                  Section 741(7) of Title 11 of the United States Code (the
                  "Bankruptcy Code"), qualifying for the protections under
                  Section 555 of the Bankruptcy Code;

            (b)   a party's right to liquidate this Transaction and to exercise
                  any other remedies upon the occurrence of any Event of Default
                  under the Agreement with respect to the other party to
                  constitute a "contractual right" as defined in the Bankruptcy
                  Code;

            (c)   Party A to be a "financial institution" within the meaning of
                  Section 101(22) of the Bankruptcy Code; and

            (d)   all payments for, under or in connection with this
                  Transaction, all payments for the Shares and the transfer of
                  such Shares to constitute "settlement payments" as defined in
                  the Bankruptcy Code.

         Severability.

            If any term, provision, covenant or condition of this Confirmation,
            or the application thereof to any party or circumstance, shall be
            held to be invalid or unenforceable in whole or in part for any
            reason, the remaining terms, provisions, covenants, and conditions
            hereof shall continue in full force and effect as if this
            Confirmation had been executed with the invalid or unenforceable
            provision eliminated, so long as this Confirmation as so modified
            continues to express, without material change, the original
            intentions of the parties as to the subject matter of this
            Confirmation and the deletion of such portion of this Confirmation
            will not substantially impair the respective benefits or
            expectations of parties to this Agreement; provided, however, that
            this severability provision shall not be applicable if any provision
            of Section 2, 5, 6 or 13 of the Agreement (or any definition or
            provision in Section 14 to the extent that it relates to, or is used
            in or in connection with any such Section) shall be so held to be
            invalid or unenforceable.

                  [Remainder of page intentionally left blank]

                                       15
<PAGE>

Please confirm that the foregoing correctly sets forth the terms of our
agreement by executing a copy of this Confirmation and returning it to us by
facsimile at 212-214-5913 (Attention: Equity Division Documentation Unit, by
telephone contact 212-214-6100).

Very truly yours,

<TABLE>
<S>                                                  <C>
WACHOVIA CAPITAL MARKETS, LLC,                       WACHOVIA BANK, NATIONAL ASSOCIATION
acting solely in its capacity as Agent               By: Wachovia Capital Markets, LLC,
of Wachovia Bank, National Association                     acting solely in its capacity as its Agent

By: /s/ Cathleen Burke                               By:  /s/ Cathleen Burke
   ----------------------------                          ----------------------------
Name:    Cathleen Burke                              Name:    Cathleen Burke
Title:   Managing Director                           Title:   Managing Director

Accepted and confirmed as of the date first above written:

MEDICAL PROPERTIES TRUST, INC.

By:  /s/ R. Steven Hamner
    --------------------------
Name: R. Steven Hamner
Title: Executive Vice President & CFO
</TABLE>

<PAGE>

                                                                      SCHEDULE I

<TABLE>
<CAPTION>
Forward Price                                                   Forward Price
Reduction Date                                                  Reduction Amount
--------------                                                  ----------------
<S>                                                             <C>
March 29, 2007                                                  $0.27

June 14, 2007                                                   $0.28

September 14, 2007                                              $0.31

December 13, 2007                                               $0.32
</TABLE>

<PAGE>

                                                                         ANNEX A

                          PRIVATE PLACEMENT PROCEDURES

(i)   If Party B delivers the Restricted Shares pursuant to this clause (i) (a
      "Private Placement Settlement"), then delivery of Restricted Shares by
      Party B shall be effected in customary private placement procedures with
      respect to such Restricted Shares reasonably acceptable to Party A;
      provided that if , on or before the date that a Private Placement
      Settlement would occur, Party B has taken, or caused to be taken, any
      action that would make unavailable either the exemption pursuant to
      Section 4(2) of the Securities Act for the sale by Party B to Party A (or
      any affiliate designated by Party A) of the Restricted Shares or the
      exemption pursuant to Section 4(1) or Section 4(3) of the Securities Act
      for resales of the Restricted Shares by Party A (or any such affiliate of
      Party A) or Party B fails to deliver the Restricted Shares when due or
      otherwise fails to perform obligations within its control in respect of a
      Private Placement Settlement, it shall be an Event of Default with respect
      to Party B and Section 6 of the Agreement shall apply. The Private
      Placement Settlement of such Restricted Shares shall include customary
      representations, covenants, blue sky and other governmental filings and/or
      registrations, indemnities to Party A, due diligence rights (for Party A
      or any designated buyer of the Restricted Shares by Party A), opinions and
      certificates, and such other documentation as is customary for private
      placement agreements, all reasonably acceptable to Party A. In the case of
      a Private Placement Settlement, Party A shall, in its good faith
      discretion, adjust the amount of Restricted Shares to be delivered to
      Party A hereunder in a commercially reasonable manner to reflect the fact
      that such Restricted Shares may not be freely returned to securities
      lenders by Party A and may only be saleable by Party A at a discount to
      reflect the lack of liquidity in Restricted Shares. Notwithstanding the
      Agreement or this Confirmation, the date of delivery of such Restricted
      Shares shall be the Clearance System Business Day following notice by
      Party A to Party B of the number of Restricted Shares to be delivered
      pursuant to this clause (i). For the avoidance of doubt, delivery of
      Restricted Shares shall be due as set forth in the previous sentence and
      not be due on the Settlement Date or Termination Settlement Date that
      would otherwise be applicable.

(ii)  If Party B delivers any Restricted Shares in respect of the Transaction,
      Party B agrees that (i) such Shares may be transferred by and among the
      Agent and its affiliates and (ii) after the minimum "holding period"
      within the meaning of Rule 144(d) under the Securities Act has elapsed
      after the applicable Settlement Date, Party B shall promptly remove, or
      cause the transfer agent for the Shares to remove, any legends referring
      to any transfer restrictions from such Shares upon delivery by Party A (or
      such affiliate of Party A) to Party B or such transfer agent of seller's
      and broker's representation letters customarily delivered by Party A or
      its affiliates in connection with resales of restricted securities
      pursuant to Rule 144 under the Securities Act, each without any further
      requirement for the delivery of any certificate, consent, agreement,
      opinion of counsel, notice or any other document, any transfer tax stamps
      or payment of any other amount or any other action by Party A (or such
      affiliate of Party A).

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