Document:

Exhibit 4.1

 EXHIBIT 4.1 

 
  
 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 

 
  

EIGHTH SUPPLEMENTAL INDENTURE 
 Dated as of August 20, 2013 
 To 

INDENTURE 
 Dated
as of February 17, 2012 
 6.375% SENIOR NOTES DUE 2022 

 
  

 
  

 EIGHTH SUPPLEMENTAL INDENTURE 

EIGHTH SUPPLEMENTAL INDENTURE (this “Eighth Supplemental Indenture”), dated as of August 20, 2013, by and among 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 a Guarantor, each of the other Guarantors (as defined in the Indenture), as Subsidiary Guarantors, and Wilmington Trust, National Association, existing under the laws of the United
States of America, as Trustee (the “Trustee”). 
 W I T N E S S E T H 

WHEREAS, the Issuers, Parent and certain of Parent’s subsidiaries have heretofore executed and delivered an Indenture, dated as of
February 17, 2012, as supplemented prior to the date hereof (the “Base Indenture,” as amended and supplemented from time to time, the “Indenture”), providing for the initial issuance by the Issuers of $200.0 million
aggregate principal amount of 6.375% senior notes due 2022 (the “Initial Notes”); 
 WHEREAS,
Section 9.01(a)(13) of the Base Indenture provides that the Issuers, the Guarantors and the Trustee may amend or supplement the Base Indenture from time to time without the consent of the Holders (as defined in the Indenture) to provide for the
issuance of Additional Notes (as defined in the Indenture) in accordance with the limitations set forth in the Base Indenture; 

WHEREAS, all things necessary to make the New Notes (as defined below), when executed by the Issuers and authenticated and delivered by
the Trustee and issued upon the terms and subject to the conditions set forth herein and in the Base Indenture against payment therefor, the valid, binding and legal obligations of the Issuers and to make this Eighth Supplemental Indenture a valid,
binding and legal agreement of the Issuers and the Guarantors, have been done; 
 NOW THEREFORE, in consideration of the
foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers and each Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as
follows: 
 SECTION I 
 DEFINITIONS 
 All 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. 
 “New Notes” means the $150 million aggregate principal amount of Additional Notes issued under this Eighth Supplemental Indenture in accordance with Section 2.02 of the Base
Indenture. 
 SECTION II 
 AUTHORIZATION AND ISSUANCE OF ADDITIONAL NOTES 
 The Issuers will be
entitled, upon delivery of an Authentication Order and an Opinion of Counsel, subject to their compliance with Section 4.08 of the Base Indenture, to issue the New Notes under this Eighth Supplemental Indenture which will have identical terms
as the Initial Notes, other than with respect to the date of issuance and issue price. The Initial Notes and the New Notes issued will be treated as a single class for all purposes under the Indenture. 

 SECTION III 
 EXECUTION AND AUTHENTICATION OF NEW NOTES 
 The Trustee will, upon receipt
of an Authentication Order, authenticate New Notes for issue that may be validly issued under this Eighth Supplemental Indenture. The aggregate principal amount of Notes outstanding at any time may not exceed the aggregate principal amount of Notes
authorized for issuance by the Issuers pursuant to one or more Authentication Orders, except as provided in the Base Indenture. 

SECTION IV 

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 Eighth 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 Eighth 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 Eighth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Eighth Supplemental Indenture. 

C. This Eighth Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended
and supplemented by this Eighth 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 Eighth Supplemental Indenture. 
 D. THIS EIGHTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED
BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.  
 E. This Eighth 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. 

  
 2 

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

			
	Very truly yours,
	
	MPT OPERATING PARTNERSHIP, L.P.
	
	 BY: MEDICAL PROPERTIES TRUST, LLC,
 ITS GENERAL PARTNER

	
	 BY: MEDICAL PROPERTIES TRUST, INC.,
 ITS SOLE MEMBER

		
	By:	 	/s/ R. Steven Hamner
		 	Name: R. Steven Hamner
		 	Title: Executive Vice President and Chief           Financial Officer
	
	MPT FINANCE CORPORATION
		
	By:	 	/s/ R. Steven Hamner
		 	Name: R. Steven Hamner
		 	Title: President, Secretary and General Manager
	
	MEDICAL PROPERTIES TRUST, INC.
		
	By:	 	/s/ R. Steven Hamner
		 	Name: R. Steven Hamner
		 	Title: Executive Vice President and Chief           Financial Officer
	
	MEDICAL PROPERTIES TRUST, LLC
	
	By: MEDICAL PROPERTIES TRUST, INC.,
	ITS SOLE MEMBER
		
	By:	 	/s/ R. Steven Hamner
		 	Name: R. Steven Hamner
		 	Title: Executive Vice President and Chief           Financial Officer
	
	 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

 [Signature Page to Eighth Supplemental Indenture] 

 
			
	 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
 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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
  
 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/ R. Steven Hamner                                

  Name: R. Steven Hamner
   Title: Executive Vice President and

            Chief Financial Officer

 [Signature Page to Eighth Supplemental Indenture] 

  

			
		  	 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
  
 MPT OF WARM
SPRINGS, L.P.
  
 By: MPT OF WARM SPRINGS, 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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, LLC,
 ITS GENERAL PARTNER

 

By: MEDICAL PROPERTIES TRUST, INC.,
 ITS SOLE MEMBER

 [Signature Page to Eighth Supplemental Indenture] 

			
		  	 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, 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, LLC,
 ITS GENERAL PARTNER

 

By: MEDICAL PROPERTIES TRUST, INC.,
 ITS SOLE MEMBER
  
 By:
/s/ R. Steven Hamner                                

      Name: R. Steven Hamner

      Title: Executive Vice President and

                Chief Financial
Officer

 [Signature Page to Eighth Supplemental Indenture] 

 TRUSTEE: 
 WILMINGTON TRUST, NATIONAL ASSOCIATION, 
 as Trustee, 

By: /s/ Michael H.
Wass                                        

       Name: Michael H. Wass 
       Title: Assistant Vice President 
 [Signature
Page to Eighth Supplemental Indenture]EX-10.1

 Exhibit 10.1 
 MBIA INC. 2005 NON-EMPLOYEE DIRECTOR DEFERRED 
 COMPENSATION PLAN

 (As amended through August 2012) 
 WHEREAS, the Company had adopted the Pre-2005 Plan which remains in effect for deferrals made on or prior to December 31, 2004; 

WHEREAS, the Company wishes to enable non-employee directors to continue deferring compensation after December 31, 2004 in a manner
consistent with the requirements of Section 409A of the Code so as to avoid the imposition of penalty taxes on non-employee directors deferring compensation; 
 WHEREAS, it is intended that the compensation deferrals under the Pre-2005 Plan shall remain “grandfathered” and therefore not subject to Section 409A of the Code; 

WHEREAS, this Plan is intended to be a successor to the Pre-2005 Plan, and a continuation thereof, but structured as a separate plan for
ease of recordkeeping and administration; 
 NOW THEREFORE, the Company hereby adopts the MBIA Inc. 2005 Non-Employee Director
Deferred Compensation Plan (the “Plan”) governing deferrals made on and after January 1, 2005. 
 1.
Purpose. 
 The purpose of the Plan is to permit eligible directors of MBIA Inc. to defer compensation and to enhance the
long-term mutuality of interest between the directors and shareholders of MBIA Inc. by providing eligible directors the opportunity to purchase the common stock of MBIA Inc. and to otherwise share in the success of MBIA Inc. 

2. Definitions. 
 “Accounts” means the Investment Account and Share Account maintained by the Company on behalf of each Participant in the Plan. 

“Board” means the Board of Directors of the Company. 

“Code” means the Internal Revenue Code of 1986, as amended, or any subsequent income tax law of the United States.
References to Code sections shall be deemed to include all subsequent amendments of those sections or the corresponding provisions of any subsequent income tax law. 

 “Common Stock” means the common stock of the Company, par value $1.00 per
share, any common stock into which such common stock may be changed and any common stock resulting from the reclassification of such common stock. 
 “Company” means MBIA Inc., a Connecticut corporation. 

“Deferred Compensation” means, with respect to a Participant, the aggregate amount of the Retainer and/or Fees deferred
by such Participant in accordance with Section 4(a) hereof. 
 “Eligible Director” means a director of the
Company who is not an employee of the Company or any of its subsidiaries. 
 “Exchange Shares” means a Share
granted to an Eligible Director pursuant to Section 5 hereof in exchange for such Eligible Director’s election to forego receipt of all or a portion of his or her Retainer or Fees. 

“Fair Market Value” means, on any date, the closing price of the Common Stock as reported on the consolidated tape of
the New York Stock Exchange (or on such other recognized quotation system on which the trading prices of the Common Stock are quoted at the relevant time) on such date. In the event that there are no Common Stock transactions reported on such tape
(or such other system) on such date, Fair Market Value shall mean the closing price on the immediately preceding date on which Common Stock transactions were so reported. 
 “Fees” means the attendance fees and chairperson fees payable to an Eligible Director for his or her services as a director of the Company. 

“Investment Account” means a book entry account established and maintained by the Company on behalf of a Participant to
record the Deferred Compensation allocated to the Participant’s Investment Account and any additions thereto or subtractions therefrom credited or charged in accordance with Section 4(b) hereof. 

“Participant” means an Eligible Director who has elected in accordance with Section 4(a) of the Plan to defer
receipt of any portion of the Retainer and/or Fees otherwise payable to such Eligible Director. An individual shall cease to be a Participant upon the payment on behalf of such individual of all amounts then standing to the credit of such
individual’s Accounts under the Plan. 
 “Plan” means the MBIA Inc. 2005 Non-Employee Director Deferred
Compensation Plan, as the same may be amended from time to time. 
 “Pre-2005 Plan” means the Amended and
Restated Deferred Compensation and Stock Ownership Plan for Non-Employee Directors of MBIA Inc. 
 “Retainer”
means the annual retainer payable to an Eligible Director for his or her services as a director of the Company. 

  
 2 

 “Share” means a share of Common Stock. 

“Share Account” means a book entry account established and maintained by the Company on behalf of a Participant to
record the Deferred Compensation allocated to the Participant’s Share Account and any additions thereto or subtractions therefrom credited or charged in accordance with Section 4(b) hereof. 

3. Administration. 
 (a) The Plan shall be administered by the Board. The Board may delegate its powers and functions hereunder to a duly appointed committee of the Board consisting of two or more members, each of whom is a
“Non-Employee Director” within the meaning of Rule 16b-3, as promulgated under the Securities Exchange Act of 1934, as amended. 
 (b) The Board shall have full authority to interpret the Plan; to establish, amend and rescind rules for carrying out the Plan; to administer the Plan; and to make all other determinations and to take
such steps in connection with the Plan, the Accounts and any Exchange Shares granted hereunder as the Board, in its discretion, deems necessary or desirable for administering the Plan. 

(c) The Board may designate the Secretary of the Company, other employees of the Company or competent professional advisors to assist the
Board in the administration of the Plan and may grant authority to such person to execute agreements or other documents on its behalf. 
 (d) The Board may employ such legal counsel, consultants and agents as it may deem desirable for the administration of the Plan and may rely upon any opinion received from any such counsel or consultant
and any computation received from any such consultant or agent. No member or former member of the Board or any committee thereof or any person designated pursuant to subsection (c) above shall be liable for any action or determination made in
good faith with respect to the Plan, any Account or any grant hereunder. To the maximum extent permitted by applicable law and the Certificate of Incorporation and By-Laws of the Company, each member or former member of the Board or any committee
thereof or any person designated pursuant to subsection (c) above shall be indemnified and held harmless by the Company against any cost or expense (including counsel fees) or liability (including any sum paid with the approval of the Company
in settlement of a claim) arising out of any act or omission to act in connection with the Plan, unless arising out of such person’s own fraud or bad faith. Such indemnification shall be in addition to any rights of indemnification such person
may have as a director, officer or employee of the Company or under the Certificate of Incorporation or the By-Laws of the Company. Expenses incurred by the Board in the engagement of any such counsel, consultant or agent shall be paid by the
Company. 
 (e) For any period after the Effective Date and until December 31, 2007, this Plan shall have been administered
by the Board in accordance with the terms and conditions of the Pre-2005 Plan, but subject to such modifications or adjustments thereto as shall have been necessary to assure good faith compliance with section 409A of the Code during such period.
For this purpose and for purposes of any transitional rule applicable under Section 409A of the Code, this Plan shall be treated as though a continuation of the Pre-2005 Plan. 

  
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 4. Deferral Program. 

(a) Deferral Election. 
 (i) Participation. Prior to December 15 of any calendar year, an Eligible Director may elect to defer all or any portion, in 25% increments, of (i) the Retainer payable for
services rendered in the calendar year following the calendar year in which such election is made and (ii) the Fees payable in respect of services rendered in the calendar year following the calendar year in which such election is made.
Any person who shall become an Eligible Director during any calendar year and does not otherwise participate in or is eligible to participate in any “Account Balance Plan” of the Company within the meaning of Section 409A of the Code
may elect, not later than the 30th day following the commencement of his term as an Eligible Director, to defer payment of all or a portion, in 25% increments, of the Retainer and/or Fees payable for the portion of the calendar year following such
election. 
 (ii) Form and Duration of Deferral Election. A deferral election shall be made by written
notice filed with the Secretary of the Company. Such election shall continue in effect (including with respect to the Retainer and/or Fees payable for and/or in, respectively, subsequent calendar years) unless and until the Participant revokes or
modifies such election by written notice filed with the Secretary of the Company. Any such revocation or modification of a deferral election with respect to the Retainer and/or Fees shall become effective as of the end of the calendar year in which
such notice is given and only with respect to the Retainer and/or Fees payable for services as a director in the calendar year following such election. Amounts credited to the Participant’s Accounts prior to the effective date of any such
revocation or modification of a deferral election shall not be affected by such revocation or modification and shall be distributed only in accordance with the otherwise applicable terms of the Plan. 

(iii) Renewal. An Eligible Director who has revoked an election to participate in the Plan may file a new election
in accordance with Section 4(a)(i) above to defer (A) the Retainer payable for services to be rendered in the calendar year following the calendar year in which such new election is filed and/or (B) the Fees payable in
the calendar year following the calendar year in which such new election is filed for services to be rendered in the calendar year following the calendar year in which such new election is filed. 

(b) Participants’ Accounts. 

  
 4 

 (i) Establishment of Accounts. The Company shall maintain an
Investment Account and a Share Account on behalf of each Participant and shall make additions to and subtractions from such Accounts as provided herein. 
 (ii) Investment Account. Deferred Compensation allocated to a Participant’s Investment Account pursuant to Section 4(b)(iv) shall be credited to the Investment Account as of the date such
Deferred Compensation would have been paid to the Participant. As of the end of each calendar quarter, each Participant’s Investment Account shall be credited with (or reduced by) an amount representing the hypothetical return (or loss) that
would have been earned had the amount credited to such Account been invested among the notional investment or investments approved by the Board for purposes of this Plan and specified in the Participant’s election form during the portion of
such calendar quarter that such amounts were credited to the Participant’s Investment Account. 
 (iii)
Share Account. Deferred Compensation allocated to a Participant’s Share Account pursuant to Section 4(b)(iv) shall be deemed to be invested in that number of notional Shares (the “Units”) which is equal to the quotient
obtained by dividing (i) the dollar amount of such Deferred Compensation by (ii) the Fair Market Value of a Share on the date the Deferred Compensation then being allocated to the Share Account would otherwise have been paid
to the Participant. Whenever a dividend (other than a dividend payable in the form of Common Stock) is declared with respect to the Common Stock, the number of Units credited to a Participant’s Share Account shall be increased by that number of
Units which is equal to the quotient obtained by dividing 
 (A) an amount equal to the product of (x) the
number of Units credited to the Participant’s Share Account on the related dividend record date multiplied by (y) the amount of any cash dividend declared by the Company with respect to a Share (or, in the case of any dividend
distributable in property other than Common Stock, the per share value of such dividend, as determined by the Company for purposes of income tax reporting) by 
 (B) the Fair Market Value of a Share on the related dividend payment date. 
 In the case of any dividend declared on the Common Stock which is payable in Common Stock, a Participant’s Share Account shall be increased by that number of Units which is equal to the product of

 (x) the number of Units credited to the Participant’s Share Account on the related dividend record date multiplied
by 
 (y) the number of Shares (including any fraction thereof) declared as a dividend with respect to a Share.

  
 5 

 (iv) Investment Elections with Respect to Deferred Compensation.

  

	 	(A)	General Rules. Each election with respect to the initial allocation of Deferred Compensation to a Participant’s Share Account pursuant to subsection
(B) below or a change in the manner in which Deferred Compensation is allocated between a Participant’s Accounts pursuant to subsection (C) below shall be irrevocable once made; provided, however, that nothing herein
shall preclude a Participant from making a subsequent election in accordance with subsection (C) below to change the manner in which Deferred Compensation is allocated between such Participant’s Accounts under the Plan.

  

	 	(B)	Initial Investment Elections. At the time an Eligible Director elects to defer any portion of his or her Retainer or Fees pursuant to Section 4(a), such
Eligible Director shall elect, by written notice delivered to the Secretary of the Company, the manner in which such Deferred Compensation shall be allocated between such Director’s Investment Account and Share Account. Any Deferred
Compensation to be credited to either Account shall be rounded to the nearest whole cent, with amounts equal to or greater than $.005 rounded up and amounts below $.005 rounded down. If an Eligible Director fails to notify the Secretary as to how to
allocate the Deferred Compensation between the two Accounts, 100% of such Deferred Compensation shall be credited to such Director’s Share Account. 

  

	 	(C)	Change of Investment Elections. By written notice to the Secretary of the Company delivered not later than the last day of any calendar quarter, a Participant
may elect to change the manner in which Deferred Compensation is to be allocated between such Participant’s Investment Account and Share Account. 

 (c) Distributions from Accounts. 
 (i) Form of
Distribution Election. At the time an Eligible Director makes his or her first deferral election pursuant to Section 4(a) hereof, such Eligible Director shall also file with the Secretary of the Company a written election (a
“Distribution Election”) with respect to the timing, form of payment and manner of distribution of (A) the aggregate amount, if any, credited to the Director’s Investment Account and (B) the value of any
Units credited to the Director’s Share Account. A Distribution Election shall specify that a distribution from the Investment Account and/or the Share Account shall be paid in one lump sum payment or in such number of installments as such
Eligible Director may designate in accordance with Section 4(c)(ii) below. 

  
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 Distributions under the Plan (including distributions made in installments
pursuant to Section 4(c)(ii)) shall be made or commence to be made during the 90 day period commencing immediately following the date the Eligible Director experiences a separation from service within the meaning of Section 409A of the Code.
All amounts credited to the Eligible Director’s Investment Account shall be payable in cash and amounts credited to the Eligible Director’s Share Account shall be payable in Shares. 

(ii) Installment Payments. In lieu of receiving payment in respect of a Participant’s Accounts in one lump sum
payment, in his or her initial Distribution Election, a Participant may elect in accordance with this Section 4(c) to receive payment of his Accounts in substantially equal annual or monthly installments over a period not exceeding twenty
years. In no event may the value of any annual or monthly payment be less than $10,000 or $1,000, respectively. 

(iii) Amendment of Distribution Election. 

 

	 	(A)	A Participant may at any time, and from time to time, elect by written notice delivered to the Secretary of the Company to change any Distribution Election;
provided, however, that no such election shall be effective unless (x) it is received by the Secretary of the Company not later than one year prior to the date on which the distribution otherwise would have commenced under
Section 4(c)(i) and (y) installment payments and any lump sum payment made pursuant to the amended Distribution Election shall not begin until at least five years after the distribution otherwise would have been paid.

  

	 	(B)	In Plan Year 2006, a Participant may elect to change the method in which distributions from his or her Account shall be made from that determined under Section 4(a) to
any other method of distribution that would have been permitted under Section 4(a), above, provided that no such amendment shall (x) change a Deferral Election with respect to distributions that the Participant otherwise would
receive in Plan Year 2006 or (y) cause a distribution to occur in 2006. 

  

	 	(C)	In Plan Year 2007, a Participant may elect to change the method in which distributions from his or her Account shall be made from that determined under Section 4(a) to
any other method of distribution that would have been permitted under Section 4(a), above, provided that no such amendment shall (x) change a Deferral Election with respect to distributions that the Participant otherwise would
receive in Plan Year 2007 or (y) cause a distribution to occur in 2007. 

  
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 (iv) Payment of Plan Distributions. Any distribution hereunder,
whether in the form of a lump sum payment or installments, shall commence in accordance with the Distribution Election made by the Participant in accordance with Section 4(c)(i) or 4(c)(iii), whichever such Election is effective as of the date
distributions hereunder commence. If a Participant fails to specify in accordance with Section 4(c)(i) or 4(c)(iii) that a distribution shall be made in a lump sum payment or a number of installments, such distribution shall be made in a lump
sum payment. In the case of any distribution being made in annual or monthly installments, each installment after the first installment shall be paid on the first business day of each calendar year or calendar month, as applicable, following the
year or month, as applicable, in which such first installment is paid until the entire amount subject to such installment Distribution Election shall have been paid. 

(v) Investment Account Installment Payments. Where a Participant receives the balance of his Investment Account in
annual or monthly installments, the amount of each installment distribution shall be equal to the product of (i) the balance credited to such Participant’s Investment Account on the date of such distribution and (ii) a
fraction, the numerator of which is one (1) and the denominator of which is the total number of installments remaining to be paid at that time. 
 (vi) Share Account Installment Payments. Where a Participant receives any portion of the balance of his Share Account in annual or monthly installments, the number of Units subject to each
installment distribution shall be equal to the product of (i) the number of Units in such Participant’s Share Account on the date of such distribution and (ii) a fraction, the numerator of which is one (1) and the
denominator of which is the total number of installments remaining to be paid at that time. 
 (vii)
Distribution on Death. If a Participant shall die before payment of all amounts credited to the Participant’s Accounts has been completed, the unpaid balance then credited to such Participant’s Accounts shall be paid to the
Participant’s designated beneficiaries or estate in accordance with the Distribution Election then in effect, with payment to begin on the first business day of the first calendar month commencing after the date of the Participant’s death.
A Participant may designate a beneficiary or beneficiaries (which may be an entity other than a natural person) to receive any payments to be made upon the Participant’s death pursuant to this Section 4. At any time, and from time to time,
any such designation may be changed or cancelled by the Participant without the consent of any beneficiary. Any such designation, change or cancellation must be made by written notice filed with the Secretary of the Company. If a Participant
designates more than one beneficiary, any payments to such beneficiaries made pursuant to this Section 4 shall be made in equal shares unless the Participant has designated otherwise, in which case the payments shall be made in the shares
designated by the Participant. If no beneficiary has been named by a Participant, payment shall be made to the Participant’s estate. 

  
 8 

 5. Exchange Share Program. 

(a) Grant. Subject to the provisions of subsection (c) below, each Eligible Director may elect, by written notice to the
Secretary of the Company, to receive Exchange Shares pursuant to the formula set forth in subsection (d) below by agreeing to forgo all or any portion of such Eligible Director’s Retainer and/or Fees not subject to the Deferral Election
that are payable in the calendar year following the calendar year in which such election is made. 
 (b) Date of Issuance.
Exchange Shares shall be issued as of the first day of each calendar quarter with respect to which an Eligible Director has elected to forgo a portion of his or her Retainer or Fees, (i) with respect to the Retainer payable to such
Eligible Director, payable for services to be performed during such calendar quarter and (ii) with respect to the Fees payable to such Eligible Director, payable for services rendered in the immediately preceding calendar quarter (the
“Date of Issuance”), but based on the amount of such Retainer or Fees, as applicable, in effect at the time of the election described in subsection (c) below. Notwithstanding the foregoing, if the Date of Issuance in any calendar
quarter is a date on which the New York Stock Exchange (or such other exchange on which the Common Stock is then traded) is not open for trading, the grant shall be made on the first day thereafter on which the New York Stock Exchange (or such other
exchange) is open for trading. 
 (c) Method of Election. An Eligible Director who wishes to elect to receive one or more
Exchange Shares in accordance with Section 5(a) shall deliver to the Secretary of the Company a written irrevocable election, not later than December 15 of each calendar year with respect to the Retainer and/or Fees payable to such
Eligible Director in the next following calendar year, specifying the amount of such Director’s Retainer and/or Fees which he or she wishes to forgo. (If the date an election is due is not a business day, such election shall be due on the last
business day immediately preceding such otherwise applicable date.) In the event that an Eligible Director elects to forgo less than 100% of his or her Retainer and/or Fees for a relevant year, such Director may provide in his or her election that
such foregone amount be applied to the issuance of Exchange Shares pro rata in each calendar quarter or from the full amount of the Retainer and Fees otherwise payable for each quarter until the full amount elected has been so applied. If an
Eligible Director fails to specify the timing of the deductions, the amount of such Director’s forgone Retainer and/or Fees will be applied to the issuance of Exchange Shares pro rata in each calendar quarter. 

(d) Number of Shares. The number of Exchange Shares to be issued as of each Date of Issuance shall be equal to the number of whole
Shares determined by the quotient of (x) and (y) below, where (x) and (y) are: 
 (x) the dollar
amount of the Retainer and/or Fees being foregone with respect to services to be performed during the applicable quarter in accordance with an election under this Section 5 to receive Exchange Shares; and 

  
 9 

 (y) the Fair Market Value of the Exchange Shares on the Date of Issuance. 

If the above quotient produces a fractional Share, the Participant shall receive the cash value of such fractional Share, based on the then Fair Market
Value, instead of receiving such fractional Share. 
 6. Shares; Adjustments in Event of Changes in Capitalization.

 (a) Shares Authorized for Issuance. The total number of Shares subject to award under the Plan and the Pre-2005 Plan
may not exceed 500,000 Shares, subject to adjustment pursuant to subsection (b) below. The Shares as to which awards are granted hereunder may be either authorized but unissued Shares or issued Shares that have been or may be reacquired by the
Company, as determined from time to time by the Board. Any Shares subject to award hereunder which for any reason are cancelled or terminated without the issuance of any Common Stock shall again be available for award under the Plan. 

(b) Adjustments in Certain Events. In the event of any stock dividend or stock split, recapitalization, merger, consolidation,
combination, spin-off, distribution of assets to stockholders (other than ordinary cash dividends), exchange of shares, rights offering to purchase Common Stock at a price substantially below fair market value or other similar corporate change, the
Board shall make such equitable adjustments in the number of Shares or Units authorized to be granted hereunder, to the class of any award hereunder, or to any outstanding award, as it deems appropriate in order to prevent dilution or enlargement of
rights. 
 7. Amendment and Termination. 
 The Board may at any time terminate the Plan and may from time to time alter or amend the Plan or any part thereof (including any amendment deemed necessary to ensure that the Company may comply with any
regulatory requirement referred to in Section 8(d)); provided, that, unless otherwise required by law, the rights of an Eligible Director with respect to amounts, if any, standing to the credit of such Director’s Investment or Share
Account or with respect to Exchanges Shares granted to such Director prior to such termination, alteration or amendment may not be impaired without the consent of such Director. 

8. Miscellaneous. 
 (a) Unfunded Plan. The Company shall not be obligated to fund its liabilities under the Plan, the separate memorandum Accounts established for each Participant shall not constitute trusts and no
person shall have any claim against the Company or its assets in connection with the Plan other than as an unsecured general creditor. 
 (b) No Stock Ownership. The crediting of Units to the Share Accounts pursuant to Section 4(b) hereof shall not be deemed to create any interest in any class of equity securities of the Company
and no Participant (or beneficiary) shall have any rights of a shareholder with respect to Units credited hereunder unless and until certificates representing the Shares subject to such Units are issued to such Participant (or his or her designated
beneficiaries). 

  
 10 

 (c) Nonalienation. The right of a Participant to receive a distribution of the value
of such Participant’s Accounts payable pursuant to the Plan shall not be subject to assignment or alienation and shall not be transferable by the Participant other than by will or under the applicable laws of descent and distribution.

 (d) Regulatory Compliance and Listing. The issuance or delivery of any Shares or other stock may be postponed by the
Company for such period as may be required to comply with any applicable requirements under the Federal securities laws, any applicable listing requirements of any national securities exchange and requirements under any other law or regulation
applicable to the issuance or delivery of such Shares, and the Company shall not be obligated to issue or deliver any Shares or other stock if the issuance or delivery of such Shares shall constitute a violation of any provision of any law or of any
regulation of any governmental authority or any national securities exchange. The Company shall use reasonable efforts to comply with any such requirements. 
 (e) Acceleration of Payment. Notwithstanding anything in the Plan to the contrary, neither the Participant nor the Company may change the Participant’s Distribution Election so as to
accelerate the date of distribution or otherwise permit a deferral or distribution in violation of Section 409A of the Code. 
 (f) Status as a Director. Nothing in the Plan shall be deemed to create any obligation on the part of the Board to nominate any director for reelection by the Company’s shareholders.

 (g) Tax Withholding. The Company shall have the right to require, prior to the issuance or delivery of any Shares or
other shares of stock or property or the making of any payment hereunder, payment by the Eligible Director of any taxes required by law with respect to the issuance or delivery of such shares or other property or the making of any such payment.

  
 11

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