Document:

EX-4.8

 Exhibit 4.8 
 MPT OF WYANDOTTE COUNTY, LLC 
 and 

MPT OF LEAVENWORTH, 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 
  

 
 SIXTH
SUPPLEMENTAL INDENTURE 
 Dated as of June 27, 2013 
 To 
 INDENTURE 

Dated as of February 17, 2012 
 6.375% Senior Notes due 2022 
  

 

 SIXTH SUPPLEMENTAL INDENTURE 

SIXTH SUPPLEMENTAL INDENTURE (this “Sixth Supplemental Indenture”), dated
as of June 27, 2013, by and among MPT of Wyandotte County, LLC, a Delaware limited liability company, and MPT of Leavenworth, 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”) and by that certain Fifth Supplemental Indenture dated as of December 28, 2012 (the “Fifth Supplemental Indenture,” together
with the Base Indenture, the First Supplemental Indenture, the Second Supplement Indenture, the Third Supplemental Indenture and the Fourth 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 June 27, 2013, the New Guaranteeing Subsidiaries guaranteed 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 Sixth 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 Sixth 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 Sixth 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 Sixth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Sixth Supplemental Indenture. 

(c) This Sixth Supplemental Indenture shall be deemed to be incorporated in, and made a part of, the Indenture. The Indenture, as amended
and supplemented by this Sixth 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 Sixth Supplemental Indenture. 
 (d) THIS SIXTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY,
AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.  
 (e) This Sixth 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] 

  
 3 

 IN WITNESS WHEREOF, the parties hereto have caused this Sixth 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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
	
	MPT OF DESOTO, LLC
	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 HUNTINGTON BEACH, 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 WEBSTER, 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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
	
	MPT OF BAYONNE, LLC
	MPT OF ALVARADO, LLC
	MPT OF MOUNTAIN VIEW, 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 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 WICHITA, LLC
	MPT OF ROXBOROUGH, LLC
	MPT OF WYANDOTTE COUNTY, LLC
	MPT OF LEAVENWORTH, 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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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

	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	MPT OF HUNTINGTON BEACH, L.P.
	By:	 	MPT OF HUNTINGTON BEACH, 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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

SIXTH 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

  

							
	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

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

		 	Name: Michael H. Wass
		 	Title: Assistant Vice President

  

SIXTH SUPPLEMENTAL INDENTURE SIGNATURE PAGEEX-4.9

 EXHIBIT 4.9 
 MPT OF CORPUS CHRISTI, LLC 
 as Guarantor, 

MPT OPERATING PARTNERSHIP, L.P. 
 and 
 MPT FINANCE CORPORATION, 

as Issuers, 

MEDICAL PROPERTIES TRUST, INC., 
 as Parent and a Guarantor, 
 the other GUARANTORS named herein, 

as Guarantors, 

and 
 WILMINGTON
TRUST, NATIONAL ASSOCIATION, 
 as Trustee 

 
  

SEVENTH SUPPLEMENTAL INDENTURE 
 Dated as of August 8, 2013 
 To 

INDENTURE 
 Dated
as of February 17, 2012 
 6.375% Senior Notes due 2022 

 
  

 SEVENTH SUPPLEMENTAL INDENTURE 

SEVENTH SUPPLEMENTAL INDENTURE (this “Seventh Supplemental Indenture”),
dated as of August 8, 2013, by and among MPT of Corpus Christi, LLC, a Delaware limited liability company (the “New Guaranteeing Subsidiary”), 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”), and by that certain Sixth Supplemental Indenture dated as of June 27, 2013 (the
“Sixth Supplemental Indenture,” together with the Base Indenture, the First Supplemental Indenture, the Second Supplement Indenture, the Third Supplemental Indenture, the Fourth Supplemental Indenture, and the Fifth Supplemental
Indenture, the “Indenture”), providing for the issuance by the Issuers of the 6.375% Senior Notes due 2022 (the “Notes”); 
 WHEREAS, pursuant to Section 9.01(a)(4) of the Indenture, the Issuers, the Guarantors and the Trustee may supplement the Indenture without the consent of any Holders in order to add Guarantees with
respect to the Notes; 
 WHEREAS, as of August    , 2013, the New Guaranteeing Subsidiary guarantees the
Credit Agreement, and pursuant to Section 4.14(a) of the Indenture, the New Guaranteeing Subsidiary is required to become Guarantor 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
Seventh Supplemental Indenture. 

 NOW, THEREFORE, in consideration of the foregoing and for other good and valuable
consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiary mutually covenants and agrees 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 Subsidiary hereby agrees 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 Seventh Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained
herein, all of which recitals and statements are made solely by the Issuers. 
 (b) On the date hereof, the Indenture shall be
supplemented and amended in accordance herewith, and this Seventh Supplemental Indenture shall form part of the Indenture for all purposes, and the Holder of every Note heretofore or hereafter authenticated and delivered under the Indenture shall be
bound thereby. The Trustee accepts the trusts created by the Indenture, as amended and supplemented by this Seventh Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by
this Seventh Supplemental Indenture. 
 (c) This Seventh Supplemental Indenture shall be deemed to be incorporated in, and made
a part of, the Indenture. The Indenture, as amended and supplemented by this Seventh Supplemental Indenture, shall be read, taken and construed as one and the same instrument and all the provisions of the Indenture shall remain in full force and
effect in accordance with the terms thereof and as amended and supplemented by this Seventh Supplemental Indenture. 
 (d)
THIS SEVENTH SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (e) This Seventh Supplemental Indenture may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such counterparts shall together constitute but
one and the same instrument. 
 [Signature Pages Follow] 

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

											
	MPT OPERATING PARTNERSHIP, L.P.,
		 	as Issuer
			
		 	By:	 	MEDICAL PROPERTIES TRUST, LLC,
		 		 	its general partner
				
		 		 	By:	 	MEDICAL PROPERTIES TRUST, INC,
		 		 		 	its sole member
					
		 		 		 	By:	 	 /s/ R. Steven Hamner

		 		 		 		 	Name:	 	R. Steven Hamner
		 		 		 		 	Title:	 	Executive Vice President and Chief Financial Officer
	
	MPT FINANCE CORPORATION,
	as Issuer
		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	President, Secretary and General Manager
	
	MEDICAL PROPERTIES TRUST, INC.,
	as Parent and a Guarantor
		
	By:	 	 /s/ R. Steven Hamner

		 	Name:	 	R. Steven Hamner
		 	Title:	 	Executive Vice President and Chief Financial Officer

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
	
	 MPT OF DESOTO, LLC
 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 HUNTINGTON BEACH, 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 WEBSTER, 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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
	
	 MPT OF BAYONNE, LLC
 MPT OF
ALVARADO, LLC
 MPT OF MOUNTAIN VIEW, 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 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 WICHITA, LLC

MPT OF ROXBOROUGH, 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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	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

 
									
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	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

 
											
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	MPT OF HUNTINGTON BEACH, L.P.
	By:	 	MPT OF HUNTINGTON BEACH, 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

 
											
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

											
	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

 
											
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	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

 
											
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	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

 
											
	
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
											
	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

  

									
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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

  

									
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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

  

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

  

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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

  

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

  

									
	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

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

		 	Name: Michael H. Wass
		 	Title: Assistant Vice President

  

SEVENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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