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                                                                   EXHIBIT 10.49

                                 PROMISSORY NOTE

                                                                    June 9, 2005
                                                             Birmingham, Alabama

FOR VALUE RECEIVED, DENHAM SPRINGS HEALTHCARE PROPERTIES, L.L.C., a Louisiana
limited liability company (the "Maker"), by this Promissory Note (this "Note")
hereby absolutely and unconditionally promises to pay to the order of MPT OF
DENHAM SPRINGS, LLC, a Delaware limited liability company, or any other holder
or holders hereof from time to time (the "Lender") at 1000 Urban Center Drive,
Suite 501, Birmingham, Alabama 35242, or at such other address as the Lender may
designate to the Maker in writing from time to time, a principal sum equal to
Six Million and No/100 Dollars ($6,000,000.00) (the "Loan"), together with
interest from the date hereof on such principal sum at the rate equal to the
Interest Rate (as herein defined). For purposes of this Note, the Interest Rate
shall equal Ten and One Half Percent (10.5%) per annum, adjusted on January 1,
2006 and on each January 1 thereafter during the term of this Note, by the
greater of Two and One Half Percent (2.5%) or the percentage by which CPI (as
herein defined) increases from November to November, it being understood,
however, that the first comparison shall be made by reference to any change in
CPI from March 2005 to November 2005 and thereafter, such comparison shall be
made from November to November. For purposes of this Note, the term "CPI" shall
mean the Consumer Price Index, all urban consumers, all items, U.S. City
Average, published by the United States Department of Labor, Bureau of Labor
Statistics, in which 1982-1984 equals one hundred (100). If the Consumer Price
Index is discontinued or revised during the term of this Note, such other
governmental index or computation with which it is replaced shall be used in
order to obtain substantially the same result as would be obtained if the Index
had not been discontinued or revised.

1. Payments. All payments hereunder shall be made by the Maker to the Lender in
lawful money of the United States and at the address of the Lender as set forth
above or as hereafter designated by the Lender by notice thereof to the Maker.
Such payments shall be determined and made as follows:

      (a) Interest Only. Until the fifteenth (15th) anniversary of the date
hereof, the Maker shall not be required to make payments of principal hereunder,
but shall pay to the Lender all interest accruing on the principal balance that
is from time to time outstanding hereunder. Such interest payments shall be due
and payable on the tenth (10th) day of each calendar month commencing with June
2005.

      (b) Principal. Upon the fifteenth (15th) anniversary of the date hereof,
all amounts then outstanding hereunder, including all accrued but unpaid
interest shall be due and payable (the "Maturity Date").

      (c) Interest Calculations. All interest hereunder will be computed for the
actual number of days elapsed on the basis of a year consisting of Three Hundred
and Sixty (360) days.

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      (d) Prepayment. Notwithstanding the foregoing, the Maker shall have the
right at any time to prepay all or any portion of the principal amount hereunder
without penalty or premium.

      (e) Default. Upon the occurrence of an Event of Default (as hereinafter
defined), all amounts then outstanding hereunder shall be immediately due and
payable in full.

      (f) Priority. All payments received hereunder shall be applied first to
the payment of any expenses or charges payable hereunder, then to accrued
interest, with the balance applied to principal remaining under this Note.

2. Default. For purposes of this Note, an "Event of Default" shall be deemed to
have occurred upon: (i) any failure by the Maker to pay (by delivery of cash or
other immediately available funds) all or any portion of interest and/or
principal under this Note when the same shall be due and payable in accordance
with the terms hereof, whether on the Maturity Date, by acceleration or
otherwise which failure continues unremedied within five (5) days after written
notice from Lender (provided that after two (2) notices during any calendar
year, any further nonpayment by Maker in such calendar year shall not require
notice for such nonpayment to constitute an Event of Default); (ii) (A) the
filing by the Maker of a voluntary petition seeking liquidation, reorganization,
arrangement, dissolution or readjustment, in any form, of its debts under Title
11 of the United States Code (or corresponding provisions of future laws) or any
other applicable state, federal or foreign bankruptcy, insolvency or similar
law, or the filing by the Maker of an answer consenting to or acquiescing in any
such petition, (B) the making by the Maker of any assignment for the benefit of
its creditors, or any failure, inability or admission by the Maker in writing of
its inability to pay its debts as they become due, (C) the filing of (x) an
involuntary petition against the Maker under Title 11 of the United States Code,
or any other applicable bankruptcy, insolvency or similar law (or corresponding
provisions of future laws), (y) an application for the appointment of a
custodian, receiver, trustee or other similar official for the Maker for all or
a substantial part of the assets of the Maker or (z) an involuntary petition
against the Maker seeking liquidation, winding up, reorganization, arrangement,
adjustment, protection, dissolution, relief or composition of the Maker or any
of the Maker's debts under any other federal or state or foreign insolvency or
similar law, provided that any such filing referred to in this clause (C) shall
not have been vacated, set aside or stayed within a 45 day period from the date
thereof, (D) the entry against the Maker of a final and nonappealable order for
relief under any bankruptcy, insolvency or similar law now or hereafter in
effect or (E) any limited liability company action by the Maker to effect or in
furtherance of any of the foregoing; (iii) any default by the Maker or Gulf
States Long Term Acute Care of Denham Springs, L.L.C. (the "Tenant") (after
applicable notice and cure periods) under that certain Lease Agreement of even
date herewith; (iv) any default (after applicable notice and cure periods) by
Maker or Tenant under any agreement between the Maker or any of its affiliates
and the Lender or any of its affiliates including, without limitation that
certain Purchase, Sale and Loan Agreement of even date herewith among Maker,
Lender, Tenant, MPT Operating Partnership, L.P., MPT of Covington, LLC,
Covington

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Healthcare Properties, L.L.C. and Gulf States Long Term Acute Care of Covington,
L.L.C., that certain Loan Agreement of even date herewith among Maker, Lender
and Tenant and that certain Mortgage, Security Agreement, Assignment of Leases
and Rents and Fixture Filing (the "Mortgage"); (v) the Maker shall voluntarily
terminate its business operations or shall be dissolved, voluntarily or
involuntarily, by operation of law or otherwise; (vi) the Maker shall, or shall
agree to, sell, pledge, encumber or otherwise dispose of any interest in the
Collateral (as herein defined); or (vii) the aggregate ownership of the current
members of Tenant, Maker or Guarantors (as herein defined) shall be reduced
below fifty one percent (51%) and the same is not cured within thirty (30) days
following receipt of written notice from Lender, provided that after two (2)
notices during any calendar year, no further notices shall be required in such
calendar year for such event to constitute an Event of Default.

3. Default Rate. In the event that any amount of the principal hereof or accrued
interest on this Note is not paid in full when due (whether at stated maturity,
by acceleration or otherwise), the Maker shall pay to the Lender on demand
interest on such unpaid amount (to the extent permissible under applicable law)
for the period from the date such amount became due until such amount shall have
been paid in full at an interest rate per annum equal to the lesser of the
maximum rate permitted by law and a rate equal to four percent (4%) per annum
above the Interest Rate (the "Default Rate"). If any amount remains unpaid past
the Maturity Date, interest shall continue to accrue on such unpaid amount at
the Default Rate until paid in full.

4. Indemnity. The Maker shall pay (i) all reasonable out-of-pocket expenses of
the Lender in connection with the preparation of this Note, any waiver or
consent hereunder or any amendment hereof or any Event of Default hereunder and
(ii) if an Event of Default occurs, all reasonable out-of-pocket expenses
incurred by the Lender, including (without duplication) the reasonable fees and
disbursements of outside counsel in connection with such Event of Default and
collection, bankruptcy, insolvency and other enforcement proceedings resulting
therefrom. Without limitation of the foregoing, the Maker agrees to indemnify
the Lender, its affiliates and the respective directors, officers, agents and
employees of the foregoing (each, an "Indemnitee") and hold each Indemnitee
harmless from and against any and all liabilities, losses, damages, costs and
reasonable expenses of any kind, including, without limitation, the reasonable
fees and disbursements of counsel and settlement costs, which may be incurred by
such Indemnitee in connection with any investigative, administrative or judicial
proceeding (whether or not such Indemnitee shall be designated a party thereto)
brought or threatened relating to or arising out of this Note.

5. Usury. It is the intention of the Lender and the Maker to comply strictly
with applicable usury laws and, accordingly, in no event and upon no contingency
shall the Lender ever be entitled to receive, collect, or apply as interest any
interest, fees, charges or other payments equivalent to interest, in excess of
the maximum rate which the Lender may lawfully charge under applicable statutes
and laws from time to time in effect; and in the event that the Lender ever
receives, collects, or applies as interest any such excess, such amount which,
but for this provision, would be excessive interest, shall be applied to the
reduction of the principal amount of the Loan; and if the principal amount of
the

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Loan, all lawful interest thereon, and all lawful fees and charges in
connection therewith, are paid in full, any remaining excess shall forthwith be
paid to the Maker, or other party lawfully entitled thereto.

6. Waivers. The Maker and any endorsers or guarantors hereof hereby waive
demand, diligence, presentment, protest, notice of dishonor, notice of protest
and, to the extent permissible under applicable law, notices and rights of every
kind, and warrants to the Lender that all action and approvals required for the
execution and delivery hereof as a legal, valid and binding obligation of the
Maker, enforceable in accordance with the terms hereof, have been duly taken and
obtained. The failure of the Lender to exercise any of its rights hereunder in
any instance shall not constitute a waiver thereof in that or any other
instance. The obligations of the Maker under this Note are absolute and
unconditional under all circumstances and irrespective of any setoff,
counterclaim or defense to payment (of any type or description, whether as a
result of non-compliance with any of the provisions of this Note, any of the
other agreements referred to herein, or otherwise) which the Maker may have or
have had against the Lender or any other person or entity.

7. Notice. All notices and other communications hereunder shall be in writing
and shall be effective when deposited in the United States mail, by certified or
registered mail, return receipt requested, postage prepaid and properly
addressed to the respective party to whom such notice relates to the following
addresses:

       If to any Seller Party:      c/o
                                    Covington Healthcare Properties, L.L.C.
                                    18153 East Petroleum Drive
                                    Post Office Box 83180
                                    Baton Rouge, Louisiana 70809-6125
                                    Attention: S. Chris Herndon

       With a copy to:              Roedel Parsons
                                    8440 Jefferson Highway, Suite 301
                                    Baton Rouge, Louisiana  70809
                                    Attention:  David A. Woolridge, Jr.

       If to any Purchaser Party    c/o Medical Properties Trust, Inc.
                                    1000 Urban Center Drive, Suite 501
                                    Birmingham, AL  35242
                                    Attention: Edward K. Aldag, Jr.

       With a copy to:              Baker, Donelson, Bearman, Caldwell
                                    & Berkowitz, PC
                                    420 20th Street North, Suite 1600
                                    Birmingham, Alabama 35203
                                    Attention: Thomas O. Kolb, Esq.

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8. Security, Guaranty. This Note is secured by a mortgage on certain real
property of the Maker (the "Collateral") pursuant to the Mortgage and is
guaranteed by Tenant, Team Rehab, L.L.C. and Gulf States Health Services, Inc.
(the "Guarantors") pursuant to a Loan Guaranty of even date herewith.

      IN WITNESS WHEREOF, the undersigned has executed this Note on the date and
year first above written.

                                MAKER:

                                DENHAM SPRINGS HEALTHCARE
                                PROPERTIES, L.L.C.

                                By:/s/ S. Chris Herndon
                                   --------------------
                                Its: Chief Financial Officer

                                        5<PAGE>
                                                                     EXHIBIT 4.1

PREFERRED SHARES                                                PREFERRED SHARES
                                    WINDROSE
                            MEDICAL PROPERTIES TRUST

                       WINDROSE MEDICAL PROPERTIES TRUST
                         A REAL ESTATE INVESTMENT TRUST

                 FORMED UNDER THE LAWS OF THE STATE OF MARYLAND

                                                             SEE REVERSE FOR
                                                            IMPORTANT NOTICE ON
                                                           TRANSFER RESTRICTIONS
                                                           AND OTHER INFORMATION
                                                              CUSIP 973491 20 2

THIS CERTIFIES THAT

is the owner of

       FULLY PAID AND NONASSESSABLE 7.5% SERIES A CUMULATIVE CONVERTIBLE
     PREFERRED SHARES OF BENEFICIAL INTEREST, $.01 PAR VALUE PER SHARE, OF

                       WINDROSE MEDICAL PROPERTIES TRUST

(the "Trust"), transferable on the books of the Trust by the holder hereof
in person or by its duly authorized attorney upon surrender of this Certificate
properly endorsed. This Certificate and the shares represented hereby are
issued and shall be held subject to all of the provisions of the Declaration of
Trust and Bylaws of the Trust and any amendments thereto. This Certificate is
not valid unless countersigned and registered by the Transfer Agent and
Registrar.

  IN WITNESS WHEREOF, the Trust has caused this Certificate to be executed on
its behalf by its duly authorized officers.

DATED:

COUNTERSIGNED AND REGISTERED:
CONTINENTIAL STOCK TRANSFER & TRUST COMPANY
BY                   TRANSFER AGENT AND REGISTRAR

                            AUTHORIZED OFFICER

/s/ Daniel R. Leftus                                 /s/
     SECRETARY                                         PRESIDENT

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                                IMPORTANT NOTICE

     The Trust will furnish to any shareholder, on request and without charge,
a full statement of the information required by Section 8-203(d) of the
Corporations and Associations Article of the Annotated Code of Maryland with
respect to the designations and any preferences, conversion and other rights,
voting powers, restrictions, limitations as to dividends and other
distributions, qualifications, and terms and conditions of redemption of the
shares of each class of beneficial interest which the Trust has authority to
issue and, if the Trust is authorized to issue any preferred or special class
in series, (i) the differences in the relative rights and preferences between
the shares of each series to the extent set, and (ii) the authority of the
Board of Trustees to set such rights and preferences of subsequent series. The
foregoing summary does not purport to be complete and is subject to and
qualified in its entirety by reference to the Declaration of Trust of the
Trust, a copy of which will be sent without charge to each shareholder who so
requests. Such request must be made to the Secretary of the Trust at its
principal office or to the Transfer Agent.

     The Trust will furnish a full statement about certain restrictions on
transferability to a shareholder on request and without charge. Such request
must be made to the Secretary of the Trust as its principal office or to the
Transfer Agent.

          KEEP THIS CERTIFICATE IN A SAFE PLACE, IF IT IS LOST, STOLEN
         OR DESTROYED, THE TRUST WILL REQUIRE A BOND OF INDEMNITY AS A
            CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE.

     The following abbreviations, when used in the inscription on the face of
this Certificate, shall be construed as though they were written out in full
according to applicable laws or regulations:

<Table>
<S>         <C>                                        <C>
TEN COM   - as tenants in common                        UNIF GIFT MIN ACT-_________ Custodian _________
TEN ENT   - as tenants by the entireties                                   (Cust)              (Minor)
JT TEN    - as joint tenants with right of                        under Uniform Gifts to Minors
            survivorship and not as                               Act ______________________
            tenants in common                                              (State)
</Table>

    Additional abbreviations may also be used though not in the above list.

For value received, ___________________ hereby sell, assigns and transfers unto

PLEASE INSERT SOCIAL SECURITY OR OTHER
    IDENTIFYING NUMBER OF ASSIGNEE

--------------------------------------

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(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS INCLUDING ZIP CODE, OF ASSIGNEE)

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________________________________________________________________________ shares
of beneficial interest of the Trust represented by this Certificate and do
hereby irrevocably constitute and appoint ______________________________________
attorney to transfer the said shares on the books of the Trust, with full power
of substitution in the premises.

Dated,
       ---------------------

                                        -------------------------------------
                                NOTICE: THE SIGNATURE TO THIS ASSIGNMENT MUST
                                        CORRESPOND WITH THE NAME AS WRITTEN
                                        UPON THE FACE OF THIS CERTIFICATE IN
                                        EVERY PARTICULAR, WITHOUT ALTERATION OR
                                        ENLARGEMENT OR ANY CHANGE WHATEVER.

                                   BY   --------------------------------------
               SIGNATURE(S) GUARANTEED THE SIGNATURE(S) SHOULD BE GUARANTEED
                                        BY AN ELIGIBLE GUARANTOR INSTITUTION
                                        (BANKS, STOCKBROKERS, SAVINGS AND
                                        LOAN ASSOCIATIONS AND CREDIT UNIONS
                                        WITH MEMBERSHIP IN AN APPROVED
                                        SIGNATURE GUARANTEE MEDALLION PROGRAM),
                                        PURSUANT TO S.E.C. RULE 17Ad-16.

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