Document:

EX-4.6

 Exhibit 4.6 
 MPT OF RENO, LLC 
 MPT OF ROXBOROUGH, LLC 

and 
 MPT OF
ROXBOROUGH, L.P. 
 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 September 28, 2012 
 To 

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

 
  

 FOURTH SUPPLEMENTAL INDENTURE 

FOURTH SUPPLEMENTAL INDENTURE (this “Fourth Supplemental Indenture”), dated
as of September 28, 2012, by and among MPT of Roxborough L.P., a Delaware limited partnership, MPT of Roxborough, LLC, a Delaware limited liability company and MPT of Reno, 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”), and by that certain Third Supplemental Indenture dated as of July 31, 2012 (the “Third Supplemental Indenture,” together with the
Base Indenture, the First Supplemental Indenture and the Second Supplement 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 September 28,
2012, 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 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 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 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. 

[Signature Pages Follow] 

  
 3 

 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/ 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

 FOURTH 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 TUCSON, 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 FAYETTEVILLE, LLC
	4499 ACUSHNET AVENUE, LLC
	8451 PEARL STREET, 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

 FOURTH SUPPLEMENTAL INDENTURE
SIGNATURE PAGE 

 
	
	MPT OF HILLSBORO, LLC
	MPT OF FLORENCE, LLC
	MPT OF CLEAR LAKE, LLC
	MPT OF TOMBALL, LLC
	MPT OF GILBER, LLC
	MPT OF CORINTH, LLC
	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 ROXBOROUGH, 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

 FOURTH 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

 FOURTH 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

 FOURTH 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

 FOURTH 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

 FOURTH 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 WEBSTER, L.P.
	By:	 	MPT OF WEBSTER, 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
	
	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

 FOURTH SUPPLEMENTAL INDENTURE
SIGNATURE PAGE 

 
													
	 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
	
	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, L.L.C,
		 		 		 	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

 FOURTH SUPPLEMENTAL INDENTURE
SIGNATURE PAGE 

 
											
	MPT OF WICHITA, LLC
	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
					
		 		 		 	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

 FOURTH SUPPLEMENTAL INDENTURE
SIGNATURE PAGE 

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

		 	 Name: Michael H. Wass

		 	 Title: Banking Officer

 FOURTH SUPPLEMENTAL INDENTURE
SIGNATURE PAGEEX-4.7

 Exhibit 4.7 
 MPT OF ALTOONA, LLC 
 MPT OF HAMMOND, LLC 

and 
 MPT OF
SPARTANBURG, 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 

 
  

FIFTH SUPPLEMENTAL INDENTURE 
 Dated as of December 26, 2012 
 To 

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

 
  

 FIFTH SUPPLEMENTAL INDENTURE 

FIFTH SUPPLEMENTAL INDENTURE (this “Fifth Supplemental Indenture”), dated
as of December 26, 2012, by and among MPT of Altoona, LLC, a Delaware limited liability company, MPT of Hammond, LLC, a Delaware limited liability company and MPT of Spartanburg, 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), and by that certain Fourth
Supplemental Indenture dated as of September 28, 2012 (the “Fourth Supplemental Indenture.” together with the Base Indenture, the First Supplemental Indenture, the Second Supplement Indenture and the Third 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 December 26, 2012, 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
Fifth 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 Fifth 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 Fifth 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 Fifth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Fifth Supplemental Indenture. 

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

  

FIFTH 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 TUCSON, 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

  

FIFTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
	
	MPT OF CORINTH, LLC
	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 WICHITA, LLC
	MPT OF RENO, LLC
	MPT OF ROXBOROUGH, LLC
	MPT OF ALTOONA, LLC
	MPT OF HAMMOND, LLC
	MPT OF SPARTANBURG, 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

  

FIFTH 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

  

FIFTH 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

  

FIFTH 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

  

FIFTH 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

  

FIFTH 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 WEBSTER, L.P.
	By:	 	MPT OF WEBSTER, 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

  

FIFTH 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

  

FIFTH 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

  

FIFTH 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

  

FIFTH 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
	
	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

  

FIFTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

 
									
	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
	
	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

  

FIFTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE 

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

		 	Name: Michael H. Wass
		 	Title: Banking Officer

  

FIFTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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