MPT OF COMMERCE CITY FCER, LLC MPT OF FORT WORTH FCER, LLC, MPT OF SUMMERWOOD FCER, LLC MPT OF FAIRMOUNT – ALECTO, LLC MPT OF HOOVER – MEDICAL WEST, LLC MPT UK HOLDCO MPT BATH MPT RHM HOHENLOHE MPT RHM BUCHBERG and MPT RHM HEINRICH MANN as Guarantors,...

Exhibit 4.19

MPT OF COMMERCE CITY FCER, LLC

MPT OF FORT WORTH FCER, LLC,

MPT OF SUMMERWOOD FCER, LLC

MPT OF FAIRMOUNT – ALECTO, LLC

MPT OF XXXXXX – MEDICAL WEST, LLC

MPT UK HOLDCO

MPT BATH

MPT RHM HOHENLOHE

MPT RHM BUCHBERG

and

MPT RHM XXXXXXXX XXXX

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 COMPANY,

as Trustee

SIXTEENTH SUPPLEMENTAL INDENTURE

Dated as of October 3, 2014

To

INDENTURE

Dated as of April 26, 2011

6.875% Senior Notes due 2021

SIXTEENTH SUPPLEMENTAL INDENTURE

SIXTEENTH SUPPLEMENTAL INDENTURE (this “Sixteenth Supplemental Indenture”), dated as of October 3, 2014, by and among MPT of Commerce City FCER, LLC, a Delaware limited liability company, MPT of Fort Worth FCER, LLC, a Delaware limited liability company, MPT of Summerwood FCER, LLC, a Delaware limited liability company, MPT of Fairmount – Alecto, LLC, a Delaware limited liability company, MPT of Xxxxxx – Medical West, LLC, a Delaware limited liability company (the “Domestic Guarantors”), and MPT UK Holdco, MPT Bath, MPT RHM Hohenlohe, MPT RHM Buchberg and MPT RHM Xxxxxxxx Xxxx, each a société à responsabilité limitée incorporated and existing under the laws of the Grand Duchy of Luxembourg (the ‘Lux Guarantors” and together with the Domestic Guarantors, the “New Guaranteeing Subsidiaries”), MPT Operating Partnership, L.P., a Delaware limited partnership (“Opco”), MPT Finance Corporation, a Delaware corporation (“Xxxxx” 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 Company, a Delaware chartered trust company, as Trustee (the “Trustee”).

WITNESSETH

WHEREAS, the Issuers and the Guarantors have heretofore executed and delivered an Indenture, dated as of April 26, 2011 (the “Base Indenture”), as supplemented by that certain First Supplemental Indenture, dated as of August 10, 2011 (the “First Supplemental Indenture”), by that certain Second Supplemental Indenture, dated as of October 3, 2011 (the “Second Supplemental Indenture”), by that certain Third Supplemental Indenture, dated as of December 2, 2011 (the “Third Supplemental Indenture”), by that certain Fourth Supplemental Indenture, dated as of January 19, 2012 (the “Fourth Supplemental Indenture”), by that certain Fifth Supplemental Indenture dated as of April 9, 2012, (the “Fifth Supplemental Indenture”), by that certain Sixth Supplemental Indenture dated as of June 27, 2012, (the “Sixth Supplemental Indenture”), by that certain Seventh Supplemental Indenture dated as of July 31, 2012 (the “Seventh Supplemental Indenture”), by that certain Eighth Supplemental Indenture dated as of September 28, 2012 (the “Eighth Supplemental Indenture”), by that certain Ninth Supplement Indenture dated as of December 28, 2012 (the “Ninth Supplemental Indenture”), by that certain Tenth Supplement Indenture dated as of June 27, 2013 (the “Tenth Supplemental Indenture”), by that certain Eleventh Supplemental Indenture dated as of August 8, 2013 (the “Eleventh Supplemental Indenture”), by that certain Twelfth Supplemental Indenture dated as of October 30, 2013 (the “Twelfth Supplemental Indenture”), by that certain Thirteenth Supplemental Indenture dated as of December 20, 2013 (the “Thirteenth Supplemental Indenture”), by that certain Fourteenth Supplemental Indenture dated as of March 31, 2014 (the “Fourteenth Supplemental Indenture”) and by that certain Fifteenth Supplemental Indenture dates as of June 30, 2014 (the “Fifteenth Supplemental Indenture”, together with the Base Indenture, the First Supplemental Indenture, the Second Supplemental Indenture, the Third Supplemental Indenture, the Fourth Supplemental Indenture, the Fifth Supplemental Indenture, the Sixth Supplemental Indenture, the Seventh Supplemental Indenture, the Eighth Supplemental Indenture, the Ninth Supplemental Indenture, the Tenth Supplemental Indenture, the Eleventh Supplemental Indenture, the Twelfth Supplemental Indenture, the Thirteenth Supplemental Indenture and the Fourteenth Supplemental Indenture, the “Indenture”), providing for the issuance by the Issuers of the 6.875% Senior Notes due 2021 (the “Notes”);

WHEREAS, pursuant to Section 9.01(a)(4) of the Indenture, the Issuers, the Guarantors and the Trustee may supplement the Indenture without the consent of any Holders in order to add Guarantees with respect to the Notes;

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

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

WHEREAS, the Lux Guarantors wish to join the Issuers and the existing Guarantors in executing and delivering to the Trustee a supplemental indenture pursuant to which the Lux Guarantors shall unconditionally Guarantee, on a joint and several basis, the full and prompt payment of the principal of, premium, if any, and interest in respect of the Notes on a senior 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 Sixteenth Supplemental Indenture.

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers, the Guarantors, the Trustee and the New Guaranteeing Subsidiaries mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows:

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. The rules of interpretation set forth in the Indenture shall be applied here as if set forth in full herein.

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

3. MISCELLANEOUS PROVISIONS.

(a) The Trustee makes no undertaking or representation in respect of, and shall not be responsible in any manner whatsoever for and in respect of, the validity or sufficiency of this Sixteenth Supplemental Indenture or the proper authorization or the due execution hereof by the Issuers or for or in respect of the recitals and statements contained herein, all of which recitals and statements are made solely by the Issuers.

(b) Effective as of September 30, 2014, the Indenture shall be supplemented and amended in accordance herewith, and this Sixteenth 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 Sixteenth Supplemental Indenture, and agrees to perform the same upon the terms and conditions of the Indenture, as amended and supplemented by this Sixteenth Supplemental Indenture.

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

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

(e) This Sixteenth 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 Sixteenth 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/ Xxxxxx X. XxXxxx
						Name:		Xxxxxx X. XxXxxx
						Title:		Executive Vice President, Chief
								Operating Officer, Treasurer and
								Secretary

MPT FINANCE CORPORATION,
as Issuer
By:		/s/ Xxxxxx X. XxXxxx
Name:		Xxxxxx X. XxXxxx
Title:		Assistant Secretary
MEDICAL PROPERTIES TRUST, INC., as Parent and a Guarantor
By:		/s/ Xxxxxx X. XxXxxx
Name:		Xxxxxx X. XxXxxx
Title:		Executive Vice President, Chief Operating
		Officer, Treasurer and Secretary
MEDICAL PROPERTIES TRUST, LLC
By:		MEDICAL PROPERTIES TRUST, INC.,
		its sole member
By:		/s/ Xxxxxx X. XxXxxx
Name:		Xxxxxx X. XxXxxx
Title:		Executive Vice President, Chief Operating
		Officer, Treasurer and Secretary

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

MPT OF VICTORVILLE, LLC

MPT OF BLOOMINGTON, LLC

MPT OF XXXXXXXXX, LLC

MPT OF XXXXXXX, LLC

MPT OF CHINO, LLC

MPT OF DALLAS LTACH, LLC

MPT OF PORTLAND, LLC

MPT OF VICTORIA, LLC

MPT OF LULING, LLC

MPT OF WEST ANAHEIM, LLC

MPT OF LA PALMA, LLC

MPT OF PARADISE VALLEY, LLC

MPT OF SOUTHERN CALIFORNIA, LLC

MPT OF TWELVE OAKS, LLC

MPT OF SHASTA, LLC

MPT OF BOSSIER CITY, LLC

MPT OF WEST VALLEY CITY, LLC

MPT OF IDAHO FALLS, LLC

MPT OF POPLAR BLUFF, LLC

MPT OF BENNETTSVILLE, LLC

MPT OF DETROIT, LLC

MPT OF BRISTOL, LLC

MPT OF NEWINGTON, LLC

MPT OF ENFIELD, LLC

MPT OF PETERSBURG, LLC

MPT OF GARDEN GROVE HOSPITAL, LLC

MPT OF GARDEN GROVE MOB, LLC

MPT OF SAN DIMAS HOSPITAL, LLC

MPT OF SAN DIMAS MOB, LLC

MPT OF CHERAW, LLC

MPT OF FT. LAUDERDALE, LLC

MPT OF PROVIDENCE, LLC

MPT OF SPRINGFIELD, LLC

MPT OF WARWICK, LLC

MPT OF XXXXXXXXXX, LLC

MPT OF ROUND ROCK, LLC

MPT OF SHENANDOAH, LLC

MPT OF HILLSBORO, LLC

MPT OF XXXXXXXX, LLC

MPT OF CLEAR LAKE, LLC

MPT OF TOMBALL, LLC

MPT OF XXXXXXX, LLC

MPT OF CORINTH, LLC

MPT OF BAYONNE, LLC

MPT OF XXXXXXXX, LLC

MPT OF DESOTO, LLC

MPT OF XXXXXXX, LLC

MPT OF HOBOKEN HOSPITAL, LLC

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

MPT OF HOBOKEN REAL ESTATE, LLC

MPT OF OVERLOOK PARKWAY, LLC

MPT OF NEW BRAUNFELS, LLC

MPT OF XXXXXXXX HILLS, LLC

MPT OF WICHITA, LLC

MPT OF XXXXXXXX, 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 XXXXXXX, LLC

MPT OF SPARTANBURG, LLC

MPT OF WYANDOTTE COUNTY, LLC

MPT OF LEAVENWORTH, LLC

MPT OF CORPUS CHRISTI, LLC

MPT OF XXXXXX FCER, LLC

MPT OF LITTLE ELM FCER, LLC

MPT OF XXXXX, LLC

MPT OF NACOGDOCHES FCER, LLC

MPT OF MESA, LLC

MPT OF PORT XXXXXX, LLC

MPT OF WEST MONROE, LLC

MPT OF DALLAS, LLC

MPT OF LEGACY MONTCLAIR, LLC

MPT OF XXXXX FCER, LLC

MPT OF FIRESTONE FCER, LLC

MPT OF XXXXXXX-XXXXXXXX FCER, LLC

MPT OF CEDAR HILL FCER, LLC

MPT OF XXXXX FCER, LLC

MPT OF FRISCO FCER, LLC

MPT OF BROOMFIELD FCER, LLC

MPT OF CHAMPION FOREST FCER, LLC

MPT OF NORTH GATE FCER, LLC

MPT OF XXXXXXXX FCER, LLC

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

MPT OF FOUNTAIN FCER, LLC

MPT OF MISSOURI CITY FCER, LLC

MPT OF PEARLAND FCER, LLC

MPT OF MISSOURI CITY – DULLES FCER, LLC

MPT OF COMMERCE CITY FCER, LLC

MPT OF FORT WORTH FCER, LLC

MPT OF SUMMERWOOD FCER, LLC

MPT OF FAIRMONT – ALECTO, LLC

MPT OF XXXXXX – MEDICAL WEST, LLC

By:		MPT OPERATING PARTNERSHIP, L.P.,
		sole member of each of the above entities
		By:		MEDICAL PROPERTIES TRUST, LLC,
				its general partner
				By:		MEDICAL PROPERTIES TRUST, INC.,
						its sole member
						By:		/s/ Xxxxxx X. XxXxxx
						Name:		Xxxxxx X. XxXxxx
						Title:		Executive Vice President,
								Chief Operating Officer, Treasurer
								and Secretary

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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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

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

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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

MPT OF XX XXXXX, X.X.
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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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

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

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

SIXTEENTH 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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

MPT OF XXXXXXXXXX, X.X.
By:		MPT OF XXXXXXXXXX, 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

SIXTEENTH 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

SIXTEENTH 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 XXXXXXXX, X.X.
By:		MPT OF XXXXXXXX, 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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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

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

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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

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

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

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

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

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE

WILMINGTON TRUST, NATIONAL ASSOCIATION, as Trustee,
By:		/s/ Xxxxxxx X. Xxxx
Name:		Xxxxxxx X. Xxxx
Title:		Assistant Vice President

SIXTEENTH SUPPLEMENTAL INDENTURE SIGNATURE PAGE