Document:

EX-4.33

 Exhibit 4.33 

MPT OF COMMERCE CITY FCER, LLC 

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

MPT OF HOOVER – MEDICAL WEST, LLC 

MPT UK HOLDCO 
 MPT BATH 

MPT RHM HOHENLOHE 
 MPT RHM BUCHBERG

 and 
 MPT RHM HEINRICH MANN

 as Guarantors, 
 MPT OPERATING
PARTNERSHIP, L.P. 
 and 
 MPT
FINANCE CORPORATION, 
 as Issuers, 

MEDICAL PROPERTIES TRUST, INC., 

as Parent and a Guarantor, 
 the
other GUARANTORS named herein, 
 as Guarantors, 

and 
 WILMINGTON TRUST, NATIONAL
ASSOCIATION, 
 as Trustee 

THIRTEENTH SUPPLEMENTAL INDENTURE 

Dated as of October 3, 2014 

To 
 INDENTURE 

Dated as of February 17, 2012 

6.375% Senior Notes due 2022 
  

 

 THIRTEENTH SUPPLEMENTAL INDENTURE 

THIRTEENTH SUPPLEMENTAL INDENTURE (this “Thirteenth Supplemental Indenture”),
dated as of October 3, 2014, by and among MPT of Commerce City FCER, LLC, a Delaware limited liability company, MPT of Fort Worth FCER, LLC, a Delaware limited liability company, MPT of Summerwood FCER, LLC, a Delaware limited liability
company, MPT of Fairmount – Alecto, LLC, a Delaware limited liability company, MPT of Hoover – Medical West, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT UK Holdco, MPT Bath, MPT RHM
Hohenlohe, MPT RHM Buchberg and MPT RHM Heinrich Mann, each a société à responsabilité limitée incorporated and existing under the laws of the Grand Duchy of Luxembourg (the “Lux Guarantors”
and together with the Domestic Guarantors, the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation
(“Finco” and, together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the Indenture), as
Guarantors, and Wilmington Trust, National Association, existing under the laws of the United States of America, as Trustee (the “Trustee”). 

WITNESSETH 
 WHEREAS, the
Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of February 17, 2012, (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture dated as of April 9, 2012
(the “First Supplemental Indenture”), by that certain Second Supplemental Indenture dated as of June 27, 2012 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture dated as of
July 31, 2012 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture dated as of September 28, 2012 (the “Fourth Supplemental Indenture”), by that certain Fifth Supplemental
Indenture dated as of December 28, 2012 (the “Fifth Supplemental Indenture”), by that certain Sixth Supplemental Indenture dated as of June 27, 2013, by that certain Seventh Supplemental Indenture dated as of
August 8, 2013 (the “Seventh Supplemental Indenture”), by that certain Eighth Supplemental Indenture dated as of August 20, 2013 (the “Eighth Supplemental Indenture”), by that certain Ninth Supplemental
Indenture dated as of October 30, 2013 (the “Ninth Supplemental Indenture”), by that certain Tenth Supplemental Indenture dated as of December 20, 2013 (the “Tenth Supplemental Indenture”), by that certain
Eleventh Supplemental Indenture dated as of March 31, 2014 (the “Eleventh Supplemental Indenture”) and by that certain Twelfth Supplemental Indenture dated as of June 30, 2014 (the “Twelfth Supplemental
Indenture”, together with the Base Indenture, the First Supplemental Indenture, the Second Supplement Indenture, the Third Supplemental Indenture, the Fourth Supplemental Indenture, the Fifth Supplemental Indenture, the Sixth Supplemental
Indenture, the Seventh Supplemental Indenture, the Eighth Supplemental Indenture, the Ninth Supplemental Indenture, the Tenth Supplemental Indenture and the Eleventh Supplemental Indenture, the “Indenture”), providing for the
issuance by the Issuers of the 6.375% Senior Notes due 2022 (the “Notes”); 
 WHEREAS, pursuant to Section 9.01(a)(4)
of the Indenture, the Issuers, the Guarantors and the Trustee may supplement the Indenture without the consent of any Holders in order to add Guarantees with respect to the Notes; 

 WHEREAS, as of August 6, 2014 and September 30, 2014, the Domestic Guarantors
guaranteed the Credit Agreement, and pursuant to Section 4.14(a) of the Indenture, the Domestic Guarantors are required to become Guarantors under the Indenture; 

WHEREAS, the Indenture requires that an entity that constitutes a Guarantor shall join the Issuers and the existing Guarantors in executing
and delivering to the Trustee a supplemental indenture pursuant to which such entity shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the
Notes on a senior basis and all other obligations under the Indenture; 
 WHEREAS, the Lux Guarantors wish to join the Issuers and the
existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which the Lux Guarantors shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if
any, and interest in respect of the Notes on a senior secured basis and all other obligations under the Indenture; and 
 WHEREAS, pursuant
to Section 9.01 of the Indenture, the Trustee is authorized to execute and deliver this Thirteenth Supplemental Indenture. 
 NOW,
THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for
the equal and ratable benefit of the Holders of the Notes as follows: 
 1. CAPITALIZED TERMS.
Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein. 

2. AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide
unconditional Guarantees effective as of September 30, 2014, on the terms and subject to the conditions set forth in the Indenture including but not limited to Article 10 thereof. 

3. MISCELLANEOUS PROVISIONS. 

(a) The Trustee makes no undertaking or representation in respect of, and shall not be responsible in any manner whatsoever for and in respect
of, the validity or sufficiency of this Thirteenth Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and
statements are made solely by the Issuers. 
 (b) Effective as of September 30, 2014, the Indenture shall be supplemented and amended
in accordance herewith, and this Thirteenth Supplemental Indenture shall form part of the Indenture for all purposes, and the Holder of every Note heretofore or hereafter authenticated and delivered under the Indenture shall be bound thereby. The
Trustee accepts the trusts created by the Indenture, as amended and supplemented by this Thirteenth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Thirteenth
Supplemental Indenture. 

 (c) This Thirteenth Supplemental Indenture shall be deemed to be incorporated in, and made a part
of, the Indenture. The Indenture, as amended and supplemented by this Thirteenth Supplemental Indenture, shall be read, taken and construed as one and the same instrument and all the provisions of the Indenture shall remain in full force and effect
in accordance with the terms thereof and as amended and supplemented by this Thirteenth Supplemental Indenture. 
 (d) THIS THIRTEENTH
SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This Thirteenth
Supplemental Indenture may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but one and the same instrument. 

[Signature Pages Follow] 

 IN WITNESS WHEREOF, the parties hereto have caused this Thirteenth Supplemental Indenture to be
duly executed and attested, all as of the date first above written. 
  

									
	 MPT OPERATING PARTNERSHIP, L.P.,
 as
Issuer

			
			By: 		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

				
					By: 		 MEDICAL PROPERTIES TRUST, INC.,

its sole member

					
							By:		 /s/ Emmett E. McLean

							Name: 		Emmett E. McLean
							Title:		Executive Vice President, Chief
									Operating Officer, Treasurer and
									Secretary

  

			
	 MPT FINANCE CORPORATION,
 as
Issuer

		
	By:		 /s/ Emmett E. McLean

	Name: 		Emmett E. McLean
	Title:		Assistant Secretary
	
	 MEDICAL PROPERTIES TRUST, INC.,
 as
Parent and a Guarantor

		
	By:		 /s/ Emmett E. McLean

	Name:		Emmett E. McLean
	Title:		Executive Vice President, Chief Operating
			Officer, Treasurer and Secretary
	
	MEDICAL PROPERTIES TRUST, LLC
		
	By:		 MEDICAL PROPERTIES TRUST, INC.,
 its sole
member

		
	By:		 /s/ Emmett E. McLean

	Name:		Emmett E. McLean
	Title:		Executive Vice President, Chief Operating
			Officer, Treasurer and Secretary

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
			
	MPT OF VICTORVILLE, LLC
	MPT OF BLOOMINGTON, LLC
	MPT OF COVINGTON, LLC
	MPT OF REDDING, LLC
	MPT OF CHINO, LLC
	MPT OF DALLAS LTACH, LLC
	MPT OF PORTLAND, LLC
	MPT OF VICTORIA, LLC
	MPT OF LULING, LLC
	MPT OF WEST ANAHEIM, LLC
	MPT OF LA PALMA, LLC
	MPT OF PARADISE VALLEY, LLC
	MPT OF SOUTHERN CALIFORNIA, LLC
	MPT OF TWELVE OAKS, LLC
	MPT OF SHASTA, LLC
	MPT OF BOSSIER CITY, LLC
	MPT OF WEST VALLEY CITY, LLC
	MPT OF IDAHO FALLS, LLC
	MPT OF POPLAR BLUFF, LLC
	MPT OF BENNETTSVILLE, LLC
	MPT OF DETROIT, LLC
	MPT OF BRISTOL, LLC
	MPT OF NEWINGTON, LLC
	MPT OF ENFIELD, LLC
	MPT OF PETERSBURG, LLC
	MPT OF GARDEN GROVE HOSPITAL, LLC
	MPT OF GARDEN GROVE MOB, LLC
	MPT OF SAN DIMAS HOSPITAL, LLC
	MPT OF SAN DIMAS MOB, LLC
	MPT OF CHERAW, LLC
	MPT OF FT. LAUDERDALE, LLC.
	MPT OF PROVIDENCE, LLC
	MPT OF SPRINGFIELD, LLC
	MPT OF WARWICK, LLC
	MPT OF RICHARDSON, LLC
	MPT OF ROUND ROCK, LLC
	MPT OF SHENANDOAH, LLC
	MPT OF HILLSBORO, LLC
	MPT OF FLORENCE, LLC
	MPT OF CLEAR LAKE, LLC
	MPT OF TOMBALL, LLC
	MPT OF GILBERT, LLC
	MPT OF CORINTH, LLC
	MPT OF BAYONNE, LLC
	MPT OF ALVARADO, LLC
	MPT OF DESOTO, LLC
	MPT OF HAUSMAN, LLC
	MPT OF HOBOKEN HOSPITAL, LLC

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
			
	MPT OF HOBOKEN REAL ESTATE, LLC
	MPT OF OVERLOOK PARKWAY, LLC
	MPT OF NEW BRAUNFELS, LLC
	MPT OF WESTOVER HILLS, LLC
	MPT OF WICHITA, LLC
	MPT OF BILLINGS, LLC
	MPT OF BOISE, LLC
	MPT OF BROWNSVILLE, LLC
	MPT OF CASPER, LLC
	MPT OF COMAL COUNTY, LLC
	MPT OF GREENWOOD, LLC
	MPT OF JOHNSTOWN, LLC
	MPT OF LAREDO, LLC
	MPT OF LAS CRUCES, LLC
	MPT OF MESQUITE, LLC
	MPT OF POST FALLS, LLC
	MPT OF PRESCOTT VALLEY, LLC
	MPT OF PROVO, LLC
	MPT OF NORTH CYPRESS, LLC
	MPT OF LAFAYETTE, LLC
	MPT OF INGLEWOOD LLC
	MPT OF RENO, LLC
	MPT OF ROXBOROUGH, LLC
	MPT OF ALTOONA, LLC
	MPT OF HAMMOND, LLC
	MPT OF SPARTANBURG, LLC
	MPT OF WYANDOTTE COUNTY, LLC
	MPT OF LEAVENWORTH, LLC
	MPT OF CORPUS CHRISTI, LLC
	MPT OF BRODIE FCER, LLC
	MPT OF LITTLE ELM FCER, LLC
	MPT OF OGDEN, LLC
	MPT OF NACOGDOCHES FCER, LLC
	MPT OF MESA, LLC
	MPT OF PORT ARTHUR, LLC
	MPT OF WEST MONROE, LLC
	MPT OF DALLAS, LLC
	MPT OF LEGACY MONTCLAIR, LLC
	MPT OF ALVIN FCER, LLC
	MPT OF FIRESTONE FCER, LLC
	MPT OF HOUSTON-ELDRIDGE FCER, LLC
	MPT OF CEDAR HILL FCER, LLC
	MPT OF ALLEN FCER, LLC
	MPT OF FRISCO FCER, LLC
	MPT OF BROOMFIELD FCER, LLC
	MPT OF CHAMPION FOREST FCER, LLC
	MPT OF NORTH GATE FCER, LLC
	MPT OF THORNTON FCER, LLC

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF FOUNTAIN FCER, LLC
	MPT OF MISSOURI CITY FCER, LLC
	MPT OF PEARLAND FCER, LLC
	MPT OF MISSOURI CITY – DULLES FCER, LLC
	MPT OF COMMERCE CITY FCER, LLC
	MPT OF FORT WORTH FCER, LLC
	MPT OF SUMMERWOOD FCER, LLC
	MPT OF FAIRMONT – ALECTO, LLC
	MPT OF HOOVER – MEDICAL WEST, LLC
		
	By: 		 MPT OPERATING PARTNERSHIP, L.P.,

sole member of each of the above entities

			
			By: 		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

				
					By: 		 MEDICAL PROPERTIES TRUST, INC.,

its sole member

					
							By:		 /s/ Emmett E. McLean

							Name: 		Emmett E. McLean
							Title:		Executive Vice President,
									Chief Operating Officer, Treasurer
									and Secretary
	
	MPT OF DALLAS LTACH, L.P.
		
	By: 		MPT OF DALLAS LTACH, LLC, its general partner
			
			By: 		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By: 		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By: 		 MEDICAL PROPERTIES TRUST, INC.,

its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
											
	MPT OF VICTORIA, L.P.
		
	By: 		MPT OF VICTORIA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By: 		MEDICAL PROPERTIES TRUST,
							 LLC,
 its general
partner

					
							By: 		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF LULING, L.P.
		
	By: 		MPT OF LULING, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By: 		MEDICAL PROPERTIES TRUST,
							 LLC,
 its general
partner

					
							By: 		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF WEST ANAHEIM, L.P.
		
	By: 		MPT OF WEST ANAHEIM, LLC, its general
			partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By: 		MEDICAL PROPERTIES TRUST,
							 LLC,
 its general
partner

					
							By: 		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
											
	MPT OF LA PALMA, L.P.
		
	By: 		MPT OF LA PALMA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		 MEDICAL PROPERTIES TRUST,

LLC,
 its general partner

					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF PARADISE VALLEY, L.P.
		
	By: 		MPT OF PARADISE VALLEY, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST,
							 LLC,
 its general
partner

					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF SOUTHERN CALIFORNIA, L.P.
		
	By: 		MPT OF SOUTHERN CALIFORNIA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
											
	MPT OF TWELVE OAKS, L.P.
		
	By: 		 MPT OF TWELVE OAKS, LLC, its general

partner

			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		 MEDICAL PROPERTIES TRUST,

LLC,
 its general partner

					
							By:		 MEDICAL PROPERTIES TRUST, INC.,

									its sole member
	
	MPT OF SHASTA, L.P.
		
	By: 		MPT OF SHASTA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		 MEDICAL PROPERTIES TRUST,

LLC,
 its general partner

							
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF GARDEN GROVE HOSPITAL, L.P.
		
	By: 		MPT OF GARDEN GROVE HOSPITAL, LLC, its general partner
			
			By:		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By:		MEDICAL PROPERTIES TRUST,
							 LLC,
 its general
partner

					
							By:		MEDICAL PROPERTIES TRUST,
									INC., its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF GARDEN GROVE MOB, L.P.
		
	By: 		MPT OF GARDEN GROVE MOB, LLC, its general partner
			
			By: 		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By: 		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By: 		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SAN DIMAS HOSPITAL, L.P.
		
	By:		MPT OF SAN DIMAS HOSPITAL, LLC, its general partner
			
			By:		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By:		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SAN DIMAS MOB, L.P.
		
	By:		MPT OF SAN DIMAS MOB, LLC, its general partner
			
			By:		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By:		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF RICHARDSON, L.P.
		
	By: 		MPT OF RICHARDSON, LLC, its general partner
			
			By: 		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By: 		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By: 		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	 MPT OF ROUND ROCK, L.P.

		
	By:		MPT OF ROUND ROCK, LLC, its general partner
			
			By:		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By:		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SHENANDOAH, L.P.
		
	By:		MPT OF SHENANDOAH, LLC, its general partner
			
			By:		 MPT OPERATING PARTNERSHIP, L.P.,

its sole member

				
					By:		 MEDICAL PROPERTIES TRUST, LLC,

its general partner

					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF HILLSBORO, L.P.
		
	By:		MPT OF HILLSBORO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF CLEAR LAKE, L.P.
		
	By:		MPT OF CLEAR LAKE, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF TOMBALL, L.P.
		
	By:		MPT OF TOMBALL, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF CORINTH, L.P.
		
	By:		MPT OF CORINTH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF ALVARADO, L.P.
		
	By:		MPT OF ALVARADO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF DESOTO, L.P.
		
	By:		MPT OF DESOTO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF MOUNTAIN VIEW LLC
		
	By:		MPT OF IDAHO FALLS, LLC, its sole member
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	WICHITA HEALTH ASSOCIATES LIMITED PARTNERSHIP
		
	By:		MPT OF WICHITA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF NORTH CYPRESS, L.P.
		
	By:		MPT OF NORTH CYPRESS, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

 
									
	MPT OF INGLEWOOD, L.P.
		
	By:		MPT OF INGLEWOOD, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF ROXBOROUGH, L.P.
		
	By:		MPT OF ROXBOROUGH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MPT OF LOS ANGELES, L.P.
		
	By:		MPT OF LOS ANGELES, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  

									
	MEDICAL PROPERTIES TRUST, LLC
		
	By:		MEDICAL PROPERTIES TRUST, INC., its sole member
			
			By:		 /s/ Emmett E. McLean

			Name:		Emmett E. McLean
			Title:		Executive Vice President, Chief Operating Officer, Treasurer and Secretary

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGE 

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

	 Name:
		 Michael H. Wass

	 Title:
		 Assistant Vice President

  

THIRTEENTH SUPPLEMENTAL INDENTURE SIGNATURE
PAGEEX-4.41

 Exhibit 4.41 
  

 
 MPT OF COMMERCE CITY FCER, LLC 

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

MPT OF HOOVER – MEDICAL WEST, LLC 

MPT UK HOLDCO 
 MPT BATH 

MPT RHM HOHENLOHE 
 MPT RHM BUCHBERG

 and 
 MPT RHM HEINRICH MANN

 as Guarantors, 
 MPT OPERATING
PARTNERSHIP, L.P. 
 and 
 MPT
FINANCE CORPORATION, 
 as Issuers, 

MEDICAL PROPERTIES TRUST, INC., 

as Parent and a Guarantor, 
 the
other GUARANTORS named herein, 
 as Guarantors, 

and 
 WILMINGTON TRUST, NATIONAL
ASSOCIATION, 
 as Trustee 
  

 
 SEVENTH
SUPPLEMENTAL INDENTURE 
 Dated as of October 3, 2014 

To 
 INDENTURE 

Dated as of October 10, 2013 

5.70% Senior Notes due 2020 
  

 

 SEVENTH SUPPLEMENTAL INDENTURE 

SEVENTH SUPPLEMENTAL INDENTURE (this “Seventh Supplemental Indenture”), dated as
of October 3, 2014, by and among MPT of Commerce City FCER, LLC, a Delaware limited liability company, MPT of Fort Worth FCER, LLC, a Delaware limited liability company, MPT of Summerwood FCER, LLC, a Delaware limited liability company, MPT of
Fairmount – Alecto, LLC, a Delaware limited liability company, MPT of Hoover – Medical West, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT UK Holdco, MPT Bath, MPT RHM Hohenlohe, MPT RHM
Buchberg and MPT RHM Heinrich Mann, each a société à responsabilité limitée incorporated and existing under the laws of the Grand Duchy of Luxembourg (the “Lux Guarantors” and together with
the Domestic Guarantors, the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation (“Finco” and,
together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the Indenture), as Guarantors, and Wilmington
Trust, National Association, existing under the laws of the United States of America, as Trustee (the “Trustee”). 

WITNESSETH 
 WHEREAS, the
Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of October 10, 2013 (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture, dated as of October 10,
2013 (the “First Supplemental Indenture”), by that certain Second Supplemental Indenture, dated as of October 30, 2013 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture, dated
as of December 20, 2013 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture, dated as of March 31, 2014 (the “Fourth Supplemental Indenture”), by that certain Fifth
Supplemental Indenture, dated as of April 17, 2014 (the “Fifth Supplemental Indenture”), and by that certain Sixth Supplemental Indenture, dated as of June 30, 2014 (the “Sixth Supplemental Indenture” and
together with the Base Indenture, the First Supplemental Indenture, the Second Supplemental Indenture, the Third Supplemental Indenture, the Fourth Supplemental Indenture and the Fifth Supplemental Indenture, the “Indenture”),
providing for the issuance by the Issuers of the 5.750% Senior Notes due 2020 (the “Notes”); 
 WHEREAS, pursuant to
Section 10.01(a)(4) of the Indenture, the Parent, the Issuers, the Guarantors and the Trustee, together, may supplement the Indenture without notice to or the consent of any Holders or any other party to the Indenture in order to add Guarantees
with respect to the Notes; 
 WHEREAS, as of August 6, 2014 and September 30, 2014, the Domestic Guarantors guaranteed the Credit
Agreement, and pursuant to Section 5.14(a) of the Indenture, the Domestic Guarantors are required to become Guarantors under the Indenture; 

WHEREAS, the Indenture requires that an entity that constitutes a Guarantor shall join the Issuers and the existing Guarantors in executing
and delivering to the Trustee a supplemental indenture pursuant to which such entity shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the
Notes on a senior basis and all other obligations under the Indenture; 

 WHEREAS, the Lux Guarantors wish to join the Issuers and the existing Guarantors in executing and
delivering to the Trustee a supplemental indenture pursuant to which the Lux Guarantors shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the
Notes on a senior basis and all other obligations under the Indenture; and 
 WHEREAS, pursuant to Section 10.06 of the Indenture, the
Trustee is authorized to execute and deliver this Seventh Supplemental Indenture. 
 NOW, THEREFORE, in consideration of the foregoing and
for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for the equal and ratable benefit of the Holders of
the Notes as follows: 
 1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall
have the meanings assigned to them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein. 

2. AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide
unconditional Guarantees effective as of September 30, 2014, on the terms and subject to the conditions set forth in the Indenture including, but not limited to, Article 11 thereof. 

3. MISCELLANEOUS PROVISIONS. 

(a) The Trustee makes no undertaking or representation in respect of, and shall not be responsible in any manner whatsoever for and in respect
of, the validity or sufficiency of this Seventh Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and statements
are made solely by the Issuers. 
 (b) Effective as of September 30, 2014, the Indenture shall be supplemented and amended in
accordance herewith, and this Seventh Supplemental Indenture shall form part of the Indenture for all purposes, and the Holder of every Note heretofore or hereafter authenticated and delivered under the Indenture shall be bound thereby. The Trustee
accepts the trusts created by the Indenture, as amended and supplemented by this Seventh Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Seventh Supplemental
Indenture. 
 (c) This Seventh Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The
Indenture, as amended and supplemented by this Seventh Supplemental Indenture, shall be read, taken and construed as one and the same instrument and all the provisions of the Indenture shall remain in full force and effect in accordance with the
terms thereof and as amended and supplemented by this Seventh Supplemental Indenture. 

 (d) THIS SEVENTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE
WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This Seventh Supplemental Indenture may be executed in any number of counterparts, each
of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but one and the same instrument. 

 IN WITNESS WHEREOF, the parties hereto have caused this Seventh Supplemental Indenture to be duly
executed and attested, all as of the date first above written. 
  

											
	 MPT OPERATING PARTNERSHIP, L.P.,

as Issuer

			
			By: 		MEDICAL PROPERTIES TRUST, LLC, its general partner
				
					By: 		MEDICAL PROPERTIES TRUST, INC., its sole member
					
							By:		 /s/ Emmett E. McLean

							Name: 		Emmett E. McLean
							Title:		Executive Vice President, Chief
									Operating Officer, Treasurer and
									Secretary

  

			
	 MPT FINANCE CORPORATION,
 as
Issuer

		
	By:		 /s/ Emmett E. McLean

	Name:		Emmett E. McLean
	Title:		Assistant Secretary
	
	MEDICAL PROPERTIES TRUST, INC., as Parent and a Guarantor
		
	By:		 /s/ Emmett E. McLean

	Name:		Emmett E. McLean
	Title:		Executive Vice President, Chief Operating
			Officer, Treasurer and Secretary
	
	MEDICAL PROPERTIES TRUST, LLC
		
	By:		MEDICAL PROPERTIES TRUST, INC.,
			its sole member
		
	By:		 /s/ Emmett E. McLean

	Name:		Emmett E. McLean
	Title:		Executive Vice President, Chief Operating
			Officer, Treasurer and Secretary

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
			
	MPT OF VICTORVILLE, LLC
	MPT OF BLOOMINGTON, LLC
	MPT OF COVINGTON, LLC
	MPT OF REDDING, LLC
	MPT OF CHINO, LLC
	MPT OF DALLAS LTACH, LLC
	MPT OF PORTLAND, LLC
	MPT OF VICTORIA, LLC
	MPT OF LULING, LLC
	MPT OF WEST ANAHEIM, LLC
	MPT OF LA PALMA, LLC
	MPT OF PARADISE VALLEY, LLC
	MPT OF SOUTHERN CALIFORNIA, LLC
	MPT OF TWELVE OAKS, LLC
	MPT OF SHASTA, LLC
	MPT OF BOSSIER CITY, LLC
	MPT OF WEST VALLEY CITY, LLC
	MPT OF IDAHO FALLS, LLC
	MPT OF POPLAR BLUFF, LLC
	MPT OF BENNETTSVILLE, LLC
	MPT OF DETROIT, LLC
	MPT OF BRISTOL, LLC
	MPT OF NEWINGTON, LLC
	MPT OF ENFIELD, LLC
	MPT OF PETERSBURG, LLC
	MPT OF GARDEN GROVE HOSPITAL, LLC
	MPT OF GARDEN GROVE MOB, LLC
	MPT OF SAN DIMAS HOSPITAL, LLC
	MPT OF SAN DIMAS MOB, LLC
	MPT OF CHERAW, LLC
	MPT OF FT. LAUDERDALE, LLC
	MPT OF PROVIDENCE, LLC
	MPT OF SPRINGFIELD, LLC
	MPT OF WARWICK, LLC
	MPT OF RICHARDSON, LLC
	MPT OF ROUND ROCK, LLC
	MPT OF SHENANDOAH, LLC
	MPT OF HILLSBORO, LLC
	MPT OF FLORENCE, LLC
	MPT OF CLEAR LAKE, LLC
	MPT OF TOMBALL, LLC
	MPT OF GILBERT, LLC
	MPT OF CORINTH, LLC
	MPT OF BAYONNE, LLC
	MPT OF ALVARADO, LLC
	MPT OF DESOTO, LLC
	MPT OF HAUSMAN, LLC
	MPT OF HOBOKEN HOSPITAL, LLC

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
			
	MPT OF HOBOKEN REAL ESTATE, LLC
	MPT OF OVERLOOK PARKWAY, LLC
	MPT OF NEW BRAUNFELS, LLC
	MPT OF WESTOVER HILLS, LLC
	MPT OF WICHITA, LLC
	MPT OF BILLINGS, LLC
	MPT OF BOISE, LLC
	MPT OF BROWNSVILLE, LLC
	MPT OF CASPER, LLC
	MPT OF COMAL COUNTY, LLC
	MPT OF GREENWOOD, LLC
	MPT OF JOHNSTOWN, LLC
	MPT OF LAREDO, LLC
	MPT OF LAS CRUCES, LLC
	MPT OF MESQUITE, LLC
	MPT OF POST FALLS, LLC
	MPT OF PRESCOTT VALLEY, LLC
	MPT OF PROVO, LLC
	MPT OF NORTH CYPRESS, LLC
	MPT OF LAFAYETTE, LLC
	MPT OF INGLEWOOD LLC
	MPT OF RENO, LLC
	MPT OF ROXBOROUGH, LLC
	MPT OF ALTOONA, LLC
	MPT OF HAMMOND, LLC
	MPT OF SPARTANBURG, LLC
	MPT OF WYANDOTTE COUNTY, LLC
	MPT OF LEAVENWORTH, LLC
	MPT OF CORPUS CHRISTI, LLC
	MPT OF BRODIE FCER, LLC
	MPT OF LITTLE ELM FCER, LLC
	MPT OF OGDEN, LLC
	MPT OF NACOGDOCHES FCER, LLC
	MPT OF MESA, LLC
	MPT OF PORT ARTHUR, LLC
	MPT OF WEST MONROE, LLC
	MPT OF DALLAS, LLC
	MPT OF LEGACY MONTCLAIR, LLC
	MPT OF ALVIN FCER, LLC
	MPT OF FIRESTONE FCER, LLC
	MPT OF HOUSTON-ELDRIDGE FCER, LLC
	MPT OF CEDAR HILL FCER, LLC
	MPT OF ALLEN FCER, LLC
	MPT OF FRISCO FCER, LLC
	MPT OF BROOMFIELD FCER, LLC
	MPT OF CHAMPION FOREST FCER, LLC
	MPT OF NORTH GATE FCER, LLC
	MPT OF THORNTON FCER, LLC

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF FOUNTAIN FCER, LLC
	MPT OF MISSOURI CITY FCER, LLC
	MPT OF PEARLAND FCER, LLC
	MPT OF COMMERCE CITY FCER, LLC
	MPT OF MISSOURI CITY-DULLES FCER, LLC
	MPT OF FORT WORTH FCER, LLC
	MPT OF SUMMERWOOD FCER, LLC
	MPT OF FAIRMONT – ALECTO, LLC
	MPT OF HOOVER – MEDICAL WEST, LLC
		
	By:		MPT OPERATING PARTNERSHIP, L.P.,
			sole member of each of the above entities
			
			By:		MEDICAL PROPERTIES TRUST, LLC,
					its general partner
				
					By:		MEDICAL PROPERTIES TRUST, INC.,
							its sole member
					
							By:		 /s/ Emmett E. McLean

							Name:		Emmett E. McLean
							Title:		Executive Vice President,
									Chief Operating Officer, Treasurer and Secretary
	
	MPT OF DALLAS LTACH, L.P.
		
	By:		MPT OF DALLAS LTACH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF VICTORIA, L.P.
		
	By:		MPT OF VICTORIA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF LULING, L.P.
		
	By:		MPT OF LULING, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF WEST ANAHEIM, L.P.
		
	By:		MPT OF WEST ANAHEIM, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF LA PALMA, L.P.
		
	By:		MPT OF LA PALMA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF PARADISE VALLEY, L.P.
		
	By:		MPT OF PARADISE VALLEY, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF SOUTHERN CALIFORNIA, L.P.
		
	By:		MPT OF SOUTHERN CALIFORNIA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF TWELVE OAKS, L.P.
		
	By:		MPT OF TWELVE OAKS, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF SHASTA, L.P.
		
	By:		MPT OF SHASTA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC.,
									its sole member
	
	MPT OF GARDEN GROVE HOSPITAL, L.P.
		
	By:		MPT OF GARDEN GROVE HOSPITAL, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF GARDEN GROVE MOB, L.P.
		
	By:		MPT OF GARDEN GROVE MOB, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SAN DIMAS HOSPITAL, L.P.
		
	By:		MPT OF SAN DIMAS HOSPITAL, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SAN DIMAS MOB, L.P.
		
	By:		MPT OF SAN DIMAS MOB, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF RICHARDSON, L.P.
		
	By:		MPT OF RICHARDSON, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF ROUND ROCK, L.P.
		
	By:		MPT OF ROUND ROCK, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF SHENANDOAH, L.P.
		
	By:		MPT OF SHENANDOAH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF HILLSBORO, L.P.
		
	By:		MPT OF HILLSBORO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF CLEAR LAKE, L.P.
		
	By:		MPT OF CLEAR LAKE, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF TOMBALL, L.P.
		
	By:		MPT OF TOMBALL, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF CORINTH, L.P.
		
	By:		MPT OF CORINTH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF ALVARADO, L.P.
		
	By:		MPT OF ALVARADO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF DESOTO, L.P.
		
	By:		MPT OF DESOTO, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
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SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

									
	MPT OF MOUNTAIN VIEW LLC
		
	By:		MPT OF IDAHO FALLS, LLC, its sole member
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	WICHITA HEALTH ASSOCIATES LIMITED PARTNERSHIP
		
	By:		MPT OF WICHITA, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF NORTH CYPRESS, L.P.
		
	By:		MPT OF NORTH CYPRESS, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF INGLEWOOD, L.P.
		
	By:		MPT OF INGLEWOOD, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF ROXBOROUGH, L.P.
		
	By:		MPT OF ROXBOROUGH, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MPT OF LOS ANGELES, L.P.
		
	By:		MPT OF LOS ANGELES, LLC, its general partner
			
			By:		MPT OPERATING PARTNERSHIP, L.P.,
					its sole member
				
					By:		MEDICAL PROPERTIES TRUST, LLC,
							its general partner
					
							By:		MEDICAL PROPERTIES TRUST, INC., its sole member
	
	MEDICAL PROPERTIES TRUST, LLC
		
	By:		MEDICAL PROPERTIES TRUST, INC., its sole member
			
			By:		 /s/ Emmett E. McLean

			Name:		Emmett E. McLean
			Title:		Executive Vice President, Chief
					Operating Officer, Treasurer and Secretary

  
 SEVENTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

	Name:		Michael H. Wass
	Title:		Assistant Vice President

  
 SEVENTH
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