Document:

EX-4.13

 EXHIBIT 4.13 
  

 
 MPT OF LOS ANGELES, L.P. 

MPT OF MONTCLAIR, LLC, 
 MPT OF
ALVIN FCER, LLC, 
 MPT OF FIRESTONE FCER, LLC, 

MPT OF HOUSTON-ELDRIDGE FCER, LLC, 

MPT OF CEDAR HILL FCER, LLC, 
 MPT
OF ALLEN FCER, LLC, 
 MPT OF FRISCO FCER, LLC, 

MPT OF BROOMFIELD FCER, LLC, 
 MPT
OF CHAMPION FOREST FCER, LLC, 
 MPT OF NORTHGATE FCER, LLC, 

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

and 
 MPT OF PEARLAND FCER, LLC,

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

MEDICAL PROPERTIES TRUST, INC., 

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

and 
 WILMINGTON TRUST, NATIONAL
ASSOCIATION, 
 as Trustee 

ELEVENTH SUPPLEMENTAL INDENTURE 

Dated as of March 31, 2014 

To 
 INDENTURE 

Dated as of February 17, 2012 

6.375% Senior Notes due 2022 
  

 

 ELEVENTH SUPPLEMENTAL INDENTURE 

ELEVENTH SUPPLEMENTAL INDENTURE (this “Eleventh Supplemental Indenture”), dated
as of March 31, 2014, by and among MPT of Los Angeles, L.P., a Delaware limited partnership, MPT of Montclair, LLC, a Delaware limited liability company, MPT of Alvin FCER, LLC, a Delaware limited liability company, MPT of Firestone FCER, LLC,
a Delaware limited liability company, MPT of Houston-Eldridge FCER, LLC, a Delaware limited liability company, MPT of Cedar Hill FCER, LLC, a Delaware limited liability company, MPT of Allen FCER, LLC, a Delaware limited liability company, MPT of
Frisco FCER, LLC, a Delaware limited liability company, MPT of Broomfield FCER, LLC, a Delaware limited liability company, MPT of Champion Forest FCER, LLC, a Delaware limited liability company, MPT of Northgate FCER, LLC, a Delaware limited
liability company, MPT of Thornton FCER, LLC, a Delaware limited liability company, MPT of Fountain FCER, LLC, a Delaware limited liability company, MPT of Missouri City FCER, LLC, a Delaware limited liability company and MPT of Pearland FCER, LLC,
a Delaware limited liability company (the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation
(“Finco” and, together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the Indenture), as
Guarantors, and Wilmington Trust, National Association, existing under the laws of the United States of America, as Trustee (the “Trustee”). 

WITNESSETH 
 WHEREAS, the
Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of 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”) and by that certain Tenth Supplemental Indenture dated as of December 20, 2013 (the “Tenth 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 and the Ninth 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 March 31, 2014, the New Guaranteeing Subsidiaries guarantee the Credit
Agreement, and pursuant to Section 4.14(a) of the Indenture, the New Guaranteeing Subsidiaries are required to become Guarantors under the Indenture; 

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

2. AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide
unconditional Guarantees on the terms and subject to the conditions set forth in the Indenture including but not limited to Article 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 Eleventh Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and statements
are made solely by the Issuers. 
 (b) On the date hereof, the Indenture shall be supplemented and amended in accordance herewith, and this
Eleventh 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 Eleventh Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Eleventh Supplemental Indenture. 

(c) This Eleventh Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended
and supplemented by this Eleventh 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 Eleventh Supplemental Indenture. 

 (d) THIS ELEVENTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE
WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This Eleventh 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 Eleventh 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

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

			
	 MPT OF VICTORVILLE, LLC
 MPT OF
BUCKS COUNTY, LLC
 MPT OF BLOOMINGTON, LLC
 MPT OF COVINGTON,
LLC
 MPT OF DENHAM SPRINGS, LLC
 MPT OF REDDING, LLC

MPT OF CHINO, LLC
 MPT OF DALLAS LTACH, LLC

MPT OF PORTLAND, LLC
 MPT OF WARM SPRINGS, LLC

MPT OF VICTORIA, LLC
 MPT OF LULING, LLC

MPT OF WEST ANAHEIM, LLC
 MPT OF LA PALMA, LLC

MPT OF PARADISE VALLEY, LLC
 MPT OF SOUTHERN CALIFORNIA, LLC

MPT OF TWELVE OAKS, LLC
 MPT OF SHASTA, LLC

MPT OF BOSSIER CITY, LLC
 MPT OF WEST VALLEY CITY, LLC

MPT OF IDAHO FALLS, LLC
 MPT OF POPLAR BLUFF, LLC

MPT OF BENNETTSVILLE, LLC
 MPT OF DETROIT, LLC

MPT OF BRISTOL, LLC
 MPT OF NEWINGTON, LLC

MPT OF ENFIELD, LLC
 MPT OF PETERSBURG, LLC

MPT OF GARDEN GROVE HOSPITAL, LLC
 MPT OF GARDEN GROVE MOB,
LLC
 MPT OF SAN DIMAS HOSPITAL, LLC
 MPT OF SAN DIMAS MOB,
LLC
 MPT OF CHERAW, LLC
 MPT OF FT. LAUDERDALE, LLC.

MPT OF PROVIDENCE, LLC
 MPT OF SPRINGFIELD, LLC

MPT OF WARWICK, LLC
 MPT OF RICHARDSON, LLC

MPT OF ROUND ROCK, LLC
 MPT OF SHENANDOAH, LLC

MPT OF HILLSBORO, LLC
 MPT OF FLORENCE, LLC

MPT OF CLEAR LAKE, LLC
 MPT OF TOMBALL, LLC

MPT OF GILBERT, LLC
 MPT OF CORINTH, LLC

MPT OF BAYONNE, LLC
 MPT OF ALVARADO, LLC

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

			
	 MPT OF DESOTO, LLC
 MPT OF HAUSMAN,
LLC
 MPT OF HOBOKEN HOSPITAL, LLC
 MPT OF HOBOKEN REAL ESTATE,
LLC
 MPT OF OVERLOOK PARKWAY, LLC
 MPT OF NEW BRAUNFELS,
LLC
 MPT OF WESTOVER HILLS, LLC
 MPT OF WICHITA, LLC

MPT OF BILLINGS, LLC
 MPT OF BOISE, LLC

MPT OF BROWNSVILLE, LLC
 MPT OF CASPER, LLC

MPT OF COMAL COUNTY, LLC
 MPT OF GREENWOOD, LLC

MPT OF JOHNSTOWN, LLC
 MPT OF LAREDO, LLC

MPT OF LAS CRUCES, LLC
 MPT OF MESQUITE, LLC

MPT OF POST FALLS, LLC
 MPT OF PRESCOTT VALLEY, LLC

MPT OF PROVO, LLC
 MPT OF NORTH CYPRESS, LLC

MPT OF LAFAYETTE, LLC
 MPT OF INGLEWOOD LLC

MPT OF RENO, LLC
 MPT OF ROXBOROUGH, LLC

MPT OF ALTOONA, LLC
 MPT OF HAMMOND, LLC

MPT OF SPARTANBURG, LLC
 MPT OF WYANDOTTE COUNTY, LLC

MPT OF LEAVENWORTH, LLC
 MPT OF CORPUS CHRISTI, LLC

MPT OF BRODIE FCER, LLC
 MPT OF LITTLE ELM FCER, LLC

MPT OF OGDEN, LLC
 MPT OF NACOGDOCHES FCER, LLC

MPT OF MESA, LLC
 MPT OF PORT ARTHUR, LLC

MPT OF WEST MONROE, LLC
 MPT OF DALLAS, LLC

MPT OF MONTCLAIR, LLC
 MPT OF ALVIN FCER, LLC

MPT OF FIRESTONE FCER, LLC
 MPT OF HOUSTON-ELDRIDGE FCER, LLC

MPT OF CEDAR HILL FCER, LLC
 MPT OF ALLEN FCER, LLC

MPT OF FRISCO FCER, LLC

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

		
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	sole member of each of the above entities
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC.,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ Emmett E. McLean

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

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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH 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

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

			
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Holdco	 	MPT RHM Holdco
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Sonnenwende	 	MPT RHM Sonnenwende
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Klaus	 	MPT RHM Klaus
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Vesalius	 	MPT RHM Vesalius
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Park	 	MPT RHM Park
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Fontana	 	MPT RHM Fontana
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Hillersbach	 	MPT RHM Hillersbach
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Christiaan	 	MPT RHM Christiaan
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

	Name:	 	Michael H. Waas
	Title:	 	Assistant Vice President

  

ELEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGEEX-4.19

 EXHIBIT 4.19 
  

 
 MPT OF LOS ANGELES, L.P. 

MPT OF MONTCLAIR, LLC, 
 MPT OF
ALVIN FCER, LLC, 
 MPT OF FIRESTONE FCER, LLC, 

MPT OF HOUSTON-ELDRIDGE FCER, LLC, 

MPT OF CEDAR HILL FCER, LLC, 
 MPT
OF ALLEN FCER, LLC, 
 MPT OF FRISCO FCER, LLC, 

MPT OF BROOMFIELD FCER, LLC, 
 MPT
OF CHAMPION FOREST FCER, LLC, 
 MPT OF NORTHGATE FCER, LLC, 

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

and 
 MPT OF PEARLAND FCER, LLC,

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

MEDICAL PROPERTIES TRUST, INC., 

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

and 
 WILMINGTON TRUST, NATIONAL
ASSOCIATION, 
 as Trustee 
  

 
 FOURTH
SUPPLEMENTAL INDENTURE 
 Dated as of March 31, 2014 

To 
 INDENTURE 

Dated as of October 10, 2013 

5.70% Senior Notes due 2020 
  

 

 FOURTH SUPPLEMENTAL INDENTURE 

FOURTH SUPPLEMENTAL INDENTURE (this “Fourth Supplemental Indenture”), dated as
of March 31, 2014, by and among MPT of Los Angeles, L.P., a Delaware limited partnership, MPT of Montclair, LLC, a Delaware limited liability company, MPT of Alvin FCER, LLC, a Delaware limited liability company, MPT of Firestone FCER, LLC, a
Delaware limited liability company, MPT of Houston-Eldridge FCER, LLC, a Delaware limited liability company, MPT of Cedar Hill FCER, LLC, a Delaware limited liability company, MPT of Allen FCER, LLC, a Delaware limited liability company, MPT of
Frisco FCER, LLC, a Delaware limited liability company, MPT of Broomfield FCER, LLC, a Delaware limited liability company, MPT of Champion Forest FCER, LLC, a Delaware limited liability company, MPT of Northgate FCER, LLC, a Delaware limited
liability company, MPT of Thornton FCER, LLC, a Delaware limited liability company, MPT of Fountain FCER, LLC, a Delaware limited liability company, MPT of Missouri City FCER, LLC, a Delaware limited liability company and MPT of Pearland FCER, LLC,
a Delaware limited liability company (the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation
(“Finco” and, together with Opco, the “Issuers”), Medical Properties Trust, Inc., a Maryland corporation (the “Parent”), as Guarantor, each of the other Guarantors (as defined in the Indenture), as
Guarantors, and Wilmington Trust, National Association, existing under the laws of the United States of America, as Trustee (the “Trustee”). 

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

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

 WHEREAS, pursuant to Section 10.06 of the Indenture, the Trustee is authorized to execute
and deliver this Fourth Supplemental Indenture. 
 NOW, THEREFORE, in consideration of the foregoing and for other good and valuable
consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to
them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein. 
 2.
AGREEMENT TO GUARANTEE. The New Guaranteeing Subsidiaries hereby agree to provide unconditional Guarantees on the terms and subject to the conditions set forth in the Indenture including, but not limited
to, Article 11 thereof. 
 3. MISCELLANEOUS PROVISIONS. 

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

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

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

									
	MPT OPERATING PARTNERSHIP, L.P.,
	as Issuer
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC.,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ Emmett E. McLean

		 		 		 	Name:	 	Emmett E. McLean
		 		 		 	Title:	 	Executive Vice President,
		 		 		 		 	Chief Operating Officer,
		 		 		 		 	Treasurer and Secretary
	
	 MPT FINANCE CORPORATION,
 as
Issuer

		
	By:	 	 /s/ Emmett E. McLean

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

		
	By:	 	 /s/ Emmett E. McLean

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 MPT OF VICTORVILLE, LLC 

MPT OF BUCKS COUNTY, LLC 

MPT OF BLOOMINGTON, LLC 

MPT OF COVINGTON, LLC 

MPT OF DENHAM SPRINGS, LLC 

MPT OF REDDING, LLC 

MPT OF CHINO, LLC 

MPT OF DALLAS LTACH, LLC 

MPT OF PORTLAND, LLC 

MPT OF WARM SPRINGS, LLC 

MPT OF VICTORIA, LLC 

MPT OF LULING, LLC 

MPT OF WEST ANAHEIM, LLC 

MPT OF LA PALMA, LLC 

MPT OF PARADISE VALLEY, LLC 

MPT OF SOUTHERN CALIFORNIA, LLC 

MPT OF TWELVE OAKS, LLC 

MPT OF SHASTA, LLC 

MPT OF BOSSIER CITY, LLC 

MPT OF WEST VALLEY CITY, LLC 

MPT OF IDAHO FALLS, LLC 

MPT OF POPLAR BLUFF, LLC 

MPT OF BENNETTSVILLE, LLC 

MPT OF DETROIT, LLC 

MPT OF BRISTOL, LLC 

MPT OF NEWINGTON, LLC 

MPT OF ENFIELD, LLC 

MPT OF PETERSBURG, LLC 

MPT OF GARDEN GROVE HOSPITAL, LLC 

MPT OF GARDEN GROVE MOB, LLC 

MPT OF SAN DIMAS HOSPITAL, LLC 

MPT OF SAN DIMAS MOB, LLC 

MPT OF CHERAW, LLC 

MPT OF FT. LAUDERDALE, LLC. 

MPT OF PROVIDENCE, LLC 

MPT OF SPRINGFIELD, LLC 

MPT OF WARWICK, LLC 

MPT OF RICHARDSON, LLC 

MPT OF ROUND ROCK, LLC 

MPT OF SHENANDOAH, LLC 

MPT OF HILLSBORO, LLC 

MPT OF FLORENCE, LLC 

MPT OF CLEAR LAKE, LLC 

MPT OF TOMBALL, LLC 

MPT OF GILBERT, LLC 

MPT OF CORINTH, LLC 

MPT OF BAYONNE, LLC 

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 MPT OF ALVARADO, LLC 

MPT OF DESOTO, LLC 

MPT OF HAUSMAN, LLC 

MPT OF HOBOKEN HOSPITAL, LLC 

MPT OF HOBOKEN REAL ESTATE, LLC 

MPT OF OVERLOOK PARKWAY, LLC 

MPT OF NEW BRAUNFELS, LLC 

MPT OF WESTOVER HILLS, LLC 

MPT OF WICHITA, LLC 

MPT OF BILLINGS, LLC 

MPT OF BOISE, LLC 

MPT OF BROWNSVILLE, LLC 

MPT OF CASPER, LLC 

MPT OF COMAL COUNTY, LLC 

MPT OF GREENWOOD, LLC 

MPT OF JOHNSTOWN, LLC 

MPT OF LAREDO, LLC 

MPT OF LAS CRUCES, LLC 

MPT OF MESQUITE, LLC 

MPT OF POST FALLS, LLC 

MPT OF PRESCOTT VALLEY, LLC 

MPT OF PROVO, LLC 

MPT OF NORTH CYPRESS, LLC 

MPT OF LAFAYETTE, LLC 

MPT OF INGLEWOOD LLC 

MPT OF RENO, LLC 

MPT OF ROXBOROUGH, LLC 

MPT OF ALTOONA, LLC 

MPT OF HAMMOND, LLC 

MPT OF SPARTANBURG, LLC 

MPT OF WYANDOTTE COUNTY, LLC 

MPT OF LEAVENWORTH, LLC 

MPT OF CORPUS CHRISTI, LLC 

MPT OF BRODIE FCER, LLC 

MPT OF LITTLE ELM FCER, LLC 

MPT OF OGDEN, LLC 

MPT OF NACOGDOCHES FCER, LLC 

MPT OF MESA, LLC 

MPT OF PORT ARTHUR, LLC 

MPT OF WEST MONROE, LLC 

MPT OF DALLAS, LLC 

MPT OF MONTCLAIR, LLC 

MPT OF ALVIN FCER, LLC 

MPT OF FIRESTONE FCER, LLC 

MPT OF HOUSTON-ELDRIDGE FCER, LLC 

MPT OF CEDAR HILL FCER, LLC 

MPT OF ALLEN FCER, LLC 

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

		
	By:	 	MPT OPERATING PARTNERSHIP, L.P.,
		 	sole member of each of the above entities
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC.,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ Emmett E. McLean

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

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

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

its sole member

				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 		 	its general partner
					
		 		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC., its sole member

  
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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

  
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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

  
 FOURTH
SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

					
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Holdco	 	MPT RHM Holdco
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Sonnenwende	 	MPT RHM Sonnenwende
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Klaus	 	MPT RHM Klaus
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Vesalius	 	MPT RHM Vesalius
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Park	 	MPT RHM Park
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Fontana	 	MPT RHM Fontana
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Hillersbach	 	MPT RHM Hillersbach
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager
		
	 /s/ Leanne McWilliams
	 	 /s/ James Kevin Hanna

	MPT RHM Christiaan	 	MPT RHM Christiaan
	By: Leanne McWilliams	 	By: James Kevin Hanna
	Title: Manager	 	Title: Manager

  
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SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

	Name:	 	Michael H. Waas
	Title:	 	Assistant Vice President

  
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SUPPLEMENTAL INDENTURE SIGNATURE PAGE

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00229-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00229-of-00352.parquet"}]]