EX-4.3


 Exhibit 4.3 

SECOND SUPPLEMENTAL INDENTURE 

dated as of May 12, 2017 

among 
 CHS/COMMUNITY HEALTH
SYSTEMS, INC., 
 the GUARANTORS party hereto, 

REGIONS BANK, 
 as Trustee,
Registrar and Paying Agent 
 and 

CREDIT SUISSE AG, 
 as
Collateral agent 
 to the 

INDENTURE 
 dated as of
March 16, 2017 
 between 

CHS/COMMUNITY HEALTH SYSTEMS, INC. 

and 
 REGIONS BANK, 

as Trustee, Registrar and Paying Agent 
  

 
  

Additional $900,000,000 6.250% Senior Secured Notes due 2023 
  

 
  






 This SECOND SUPPLEMENTAL INDENTURE (this “Second Supplemental Indenture”), dated
as of May 12, 2017, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), the GUARANTORS party hereto (the “Guarantors”), REGIONS BANK, an Alabama banking corporation (the
“Trustee”), and CREDIT SUISSE AG, as collateral agent (the “Collateral Agent”). 
 RECITALS 

WHEREAS, the Issuer and the Trustee have heretofore executed and delivered an Indenture, dated as of March 16, 2017 (the “Base
Indenture”) and a First Supplemental Indenture, dated as of March 16, 2017 (the “First Supplemental Indenture” and, together with the Base Indenture, the “Indenture”), providing for the issuance on
such date by the Issuer of $2,200,000,000 aggregate principal amount of the Issuer’s 6.250% Senior Secured Notes due 2023 (the “Initial Notes”); 

WHEREAS, Section 2.1(a) of the First Supplemental Indenture provides, among other things, that the Issuer may issue, from time to time,
in accordance with the provisions of the First Supplemental Indenture, Additional Notes having identical terms and conditions as the Initial Notes, other than, if applicable, the date from which interest will accrue; 

WHEREAS, the Issuer has entered into that certain Underwriting Agreement, dated as of May 9, 2017, among the Issuer, the Guarantors and
Credit Suisse Securities (USA) LLC, as representative of the underwriters, pursuant to which, among other things, on the date hereof, the Issuer is issuing $900,000,000 of 6.250% Senior Secured Notes due 2023 as Additional Notes (the “May
2017 Additional Notes”) as permitted by Section 2.1 of the First Supplemental Indenture; 
 WHEREAS, the Issuer intends by
this Second Supplemental Indenture to create and provide for the issuance of the May 2017 Additional Notes as Additional Notes under the Indenture; 

WHEREAS, pursuant to Section 9.1(7) of the First Supplemental Indenture, the Issuer, the Guarantors, the Trustee, and the Collateral
Agent are authorized to execute and deliver this Second Supplemental Indenture to provide for the issuance of the Additional Notes under the Indenture without notice to or consent of any Holder; and 

WHEREAS, all things necessary to make the May 2017 Additional Notes, when executed by the Issuer and authenticated and delivered by the
Trustee, issued upon the terms and subject to the conditions set forth hereinafter and in the Indenture and delivered as provided in the Indenture against payment therefor, valid, binding and legal obligations of the Issuer according to their terms,
and all actions required to be taken by the Issuer under the Indenture to make this Second Supplemental Indenture a valid, binding and legal agreement of the Issuer, have been done. 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the sufficiency and adequacy of which are
hereby acknowledged, the parties hereto hereby agree as follows: 
 ARTICLE 1 

DEFINITIONS AND INCORPORATION BY REFERENCE 

Section 1.01 Definitions. 

(a) All capitalized terms used herein and not otherwise defined herein shall have the meanings ascribed thereto in the Indenture. 

(b) For all purposes of this Second Supplemental Indenture, except as otherwise herein expressly provided or unless the context otherwise
requires: (i) the terms and expressions used herein shall have the same meanings as corresponding terms and expressions used in the Indenture; and (ii) the words “herein,” “hereof” and “hereby” and other words
of similar import used in this Second Supplemental Indenture refer to this Second Supplemental Indenture as a whole and not to any particular section hereof. 






 ARTICLE 2 

MAY 2017 ADDITIONAL NOTES 

Section 2.01 Creation of the May 2017 Additional Notes. In accordance with Section 2.1(a) of the First Supplemental
Indenture, the Issuer hereby creates the May 2017 Additional Notes as Additional Notes under the Indenture. The May 2017 Additional Notes shall be issued initially in an aggregate principal amount of $900,000,000 on the date hereof and will be
issued at an issue price of 101.75% of the principal amount thereof plus accrued and unpaid interest from March 16, 2017. Interest on the May 2017 Additional Notes shall accrue from March 16, 2017. 

Section 2.02 The Notes. The May 2017 Additional Notes initially will be issued in the form of Global Notes as follows: 

(a) certificate number 006 (CUSIP No. 12543D AY6 / ISIN US12543DA Y67) in the aggregate principal amount of $500,000,000; 

(b) certificate number 007 (CUSIP No. 12543D AY6 / ISIN US12543DA Y67) in the aggregate principal amount of $400,000,000. 

ARTICLE 3 
 MISCELLANEOUS 

Section 3.01 Ratification of the Base Indenture and the First Supplemental Indenture. 

This Second Supplemental Indenture is executed and shall be constructed as an indenture supplement to the Indenture, and as supplemented and
modified hereby, the Base Indenture and the First Supplemental Indenture are in all respects ratified and confirmed, and the Base Indenture, the First Supplemental Indenture and this Second Supplemental Indenture shall be read, taken and constructed
as one and the same instrument. 
 Section 3.02 Trust Indenture Act Controls. 

If and to the extent that any provision of this Second Supplemental Indenture limits, qualifies or conflicts with another provision which is
required to be included in this Second Supplemental Indenture by the Trust Indenture Act, the provision required by the Trust Indenture Act shall control. Each Guarantor in addition to performing its obligations under its Note Guarantee shall
perform such other obligations as may be imposed upon it with respect to this Second Supplemental Indenture under the Trust Indenture Act. 

Section 3.03 Notices. 

All notices and other communications shall be given as provided in the First Supplemental Indenture. 

Section 3.04 Governing Law. 

THIS SECOND SUPPLEMENTAL INDENTURE AND THE MAY 2017 ADDITIONAL NOTES SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF
THE STATE OF NEW YORK. 
 Section 3.05 Successors. 

All agreements of the Issuer and each Guarantor in this Second Supplemental Indenture and the May 2017 Additional Notes shall bind their
respective successors. All agreements of the Trustee and the Collateral Agent in this Second Supplemental Indenture shall bind their respective successors. 

  
 2 







 Section 3.06 Multiple Originals. 

The parties may sign any number of copies of this Second Supplemental Indenture. Each signed copy shall be an original, but all of them
together represent the same agreement. One signed copy is enough to prove this Second Supplemental Indenture. The exchange of copies of this Second Supplemental Indenture and of signature pages by facsimile or PDF transmission shall constitute
effective execution and delivery of this Second Supplemental Indenture as to the parties hereto and may be used in lieu of the original Second Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or PDF
shall be deemed to be their original signatures for all purposes. 
 Section 3.07 Headings. 

The headings of the Articles and Sections of this Second Supplemental Indenture have been inserted for convenience of reference only, are not
intended to be considered a part hereof and shall not modify or restrict any of the terms or provisions hereof. 
 Section 3.08
Trustee Not Responsible for Recitals. 
 Neither the Trustee nor the Collateral Agent make any representation or warranty as to the
validity or sufficiency of this Second Supplemental Indenture or with respect to the recitals contained herein, all of which recitals are made solely by the other parties hereto. 

[Signature page follows] 

  
 3 







 IN WITNESS WHEREOF, the parties have caused this Second Supplemental Indenture to be duly
executed as of the date first written above. 
  

			
	 ISSUER:
  

CHS/COMMUNITY HEALTH SYSTEMS, INC.

		
	By:    	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer



  
 [Signature Page to
Second Supplemental Indenture] 








			
	COMMUNITY HEALTH SYSTEMS, INC.	  	CAROLINAS JV HOLDINGS GENERAL, LLC
		
	ABILENE HOSPITAL, LLC	  	CAROLINAS JV HOLDINGS, L.P.
		
	ABILENE MERGER, LLC	  	CENTRAL FLORIDA HMA HOLDINGS, LLC
		
	AFFINITY HEALTH SYSTEMS, LLC	  	CENTRAL STATES HMA HOLDINGS, LLC
		
	AFFINITY HOSPITAL, LLC	  	CHESTER HMA, LLC
		
	AMORY HMA, LLC	  	CHESTNUT HILL HEALTH SYSTEM, LLC
		
		  	CHHS HOLDINGS, LLC
		
	BERWICK HOSPITAL COMPANY, LLC	  	CHHS HOSPITAL COMPANY, LLC
		
	BILOXI H.M.A., LLC	  	CHS PENNSYLVANIA HOLDINGS, LLC
		
	BIRMINGHAM HOLDINGS II, LLC	  	CHS TENNESSEE HOLDINGS, LLC
		
	BIRMINGHAM HOLDINGS, LLC	  	CHS VIRGINIA HOLDINGS, LLC
		
	BLUEFIELD HOLDINGS, LLC	  	CHS WASHINGTON HOLDINGS, LLC
		
	BLUEFIELD HOSPITAL COMPANY, LLC	  	CITRUS HMA, LLC
		
	BLUFFTON HEALTH SYSTEM LLC	  	CLARKSDALE HMA, LLC
		
	BRANDON HMA, LLC	  	CLARKSVILLE HOLDINGS II, LLC
		
	BREVARD HMA HOLDINGS, LLC	  	CLARKSVILLE HOLDINGS, LLC
		
	BREVARD HMA HOSPITALS, LLC	  	CLEVELAND HOSPITAL COMPANY, LLC
		
	BROWNWOOD HOSPITAL, L.P.	  	CLEVELAND TENNESSEE HOSPITAL COMPANY, LLC
		
	BROWNWOOD MEDICAL CENTER, LLC	  	CLINTON HMA, LLC
		
	BULLHEAD CITY HOSPITAL CORPORATION	  	COATESVILLE HOSPITAL CORPORATION
		
	BULLHEAD CITY HOSPITAL INVESTMENT CORPORATION	  	COCKE COUNTY HMA, LLC
		
	CAMPBELL COUNTY HMA, LLC	  	COLLEGE STATION HOSPITAL, L.P.
		
	CARLISLE HMA, LLC	  	COLLEGE STATION MEDICAL CENTER, LLC
		
	CARLSBAD MEDICAL CENTER, LLC	  	COLLEGE STATION MERGER, LLC
		
	CAROLINAS HOLDINGS, LLC	  	COMMUNITY HEALTH INVESTMENT COMPANY, LLC

  

			
	                        By:	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer

 Acting on behalf of each of the Guarantors set forth above 

  
 [Signature Page to
Second Supplemental Indenture] 








			
		
	CP HOSPITAL GP, LLC	  	HEALTH MANAGEMENT ASSOCIATES, LP
		
	CPLP, LLC	  	HEALTH MANAGEMENT GENERAL PARTNER I, LLC
		
	CRESTWOOD HEALTHCARE, L.P.	  	HEALTH MANAGEMENT GENERAL PARTNER, LLC
		
	CRESTWOOD HOSPITAL LP, LLC	  	HMA FENTRESS COUNTY GENERAL HOSPITAL, LLC
		
	CRESTWOOD HOSPITAL, LLC	  	HMA HOSPITALS HOLDINGS, LP
		
	CSMC, LLC	  	HMA SANTA ROSA MEDICAL CENTER, LLC
		
	DEACONESS HOLDINGS, LLC	  	HMA SERVICES GP, LLC
		
	DEACONESS HOSPITAL HOLDINGS, LLC	  	HMA-TRI HOLDINGS, LLC
		
	DESERT HOSPITAL HOLDINGS, LLC	  	HOBBS MEDCO, LLC
		
	DETAR HOSPITAL, LLC	  	HOSPITAL MANAGEMENT ASSOCIATES, LLC
		
	DHFW HOLDINGS, LLC	  	HOSPITAL MANAGEMENT SERVICES OF FLORIDA, LP
		
	DUKES HEALTH SYSTEM, LLC	  	HOSPITAL OF MORRISTOWN, LLC
		
	DYERSBURG HOSPITAL COMPANY, LLC	  	JACKSON HMA, LLC
		
	EMPORIA HOSPITAL CORPORATION	  	JACKSON HOSPITAL CORPORATION
		
	FLORIDA HMA HOLDINGS, LLC	  	JEFFERSON COUNTY HMA, LLC
		
	FOLEY HOSPITAL CORPORATION	  	JOURDANTON HOSPITAL CORPORATION
		
	FORT SMITH HMA, LLC	  	KAY COUNTY HOSPITAL CORPORATION
		
	FRANKFORT HEALTH PARTNER, INC.	  	KAY COUNTY OKLAHOMA HOSPITAL COMPANY, LLC
		
	FRANKLIN HOSPITAL CORPORATION	  	KENNETT HMA, LLC
		
	GADSDEN REGIONAL MEDICAL CENTER, LLC	  	KEY WEST HMA, LLC
		
	GAFFNEY H.M.A., LLC	  	KIRKSVILLE HOSPITAL COMPANY, LLC
		
	GRANBURY HOSPITAL CORPORATION	  	KNOXVILLE HMA HOLDINGS, LLC
		
	GRMC HOLDINGS, LLC	  	LAKEWAY HOSPITAL COMPANY, LLC
		
	HALLMARK HEALTHCARE COMPANY, LLC	  	LANCASTER HOSPITAL CORPORATION
		
	HEALTH MANAGEMENT ASSOCIATES, LLC	  	LAREDO TEXAS HOSPITAL COMPANY, L.P.

  

			
	                        By:	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer

 Acting on behalf of each of the Guarantors set forth above 

  
 [Signature Page to
Second Supplemental Indenture] 








			
		
	LAS CRUCES MEDICAL CENTER, LLC	  	NAVARRO REGIONAL, LLC
		
	LEA REGIONAL HOSPITAL, LLC	  	NC-DSH, LLC
		
	LEBANON HMA, LLC	  	NORTHAMPTON HOSPITAL COMPANY, LLC
		
	LONGVIEW CLINIC OPERATIONS COMPANY, LLC	  	NORTHWEST ARKANSAS HOSPITALS, LLC
		
	LONGVIEW MEDICAL CENTER, L.P.	  	NORTHWEST HOSPITAL, LLC
		
	LONGVIEW MERGER, LLC	  	NOV HOLDINGS, LLC
		
	LRH, LLC	  	NRH, LLC
		
	LUTHERAN HEALTH NETWORK OF INDIANA, LLC	  	OAK HILL HOSPITAL CORPORATION
		
	MADISON HMA, LLC	  	ORO VALLEY HOSPITAL, LLC
		
	MARSHALL COUNTY HMA, LLC	  	PALMER-WASILLA HEALTH SYSTEM, LLC
		
	MARTIN HOSPITAL COMPANY, LLC	  	PASCO REGIONAL MEDICAL CENTER, LLC
		
	MARY BLACK HEALTH SYSTEM LLC	  	PENNSYLVANIA HOSPITAL COMPANY, LLC
		
		  	PHOENIXVILLE HOSPITAL COMPANY, LLC
		
	MCSA, L.L.C.	  	POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
		
	MEDICAL CENTER OF BROWNWOOD, LLC	  	PORT CHARLOTTE HMA, LLC
		
		  	POTTSTOWN HOSPITAL COMPANY, LLC
		
	MERGER LEGACY HOLDINGS, LLC	  	PUNTA GORDA HMA, LLC
		
	METRO KNOXVILLE HMA, LLC	  	QHG GEORGIA HOLDINGS II, LLC
		
	MISSISSIPPI HMA HOLDINGS I, LLC	  	QHG GEORGIA HOLDINGS, INC.
		
	MISSISSIPPI HMA HOLDINGS II, LLC	  	QHG GEORGIA, LP
		
	MOBERLY HOSPITAL COMPANY, LLC	  	QHG OF BLUFFTON COMPANY, LLC
		
	NAPLES HMA, LLC	  	QHG OF CLINTON COUNTY, INC.
		
	NATCHEZ HOSPITAL COMPANY, LLC	  	QHG OF ENTERPRISE, INC.
		
	NATIONAL HEALTHCARE OF LEESVILLE, INC.	  	QHG OF FORREST COUNTY, INC.
		
	NAVARRO HOSPITAL, L.P.	  	QHG OF FORT WAYNE COMPANY, LLC

  

			
	                        By:	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer

 Acting on behalf of each of the Guarantors set forth above 

  
 [Signature Page to
Second Supplemental Indenture] 








			
		
	QHG OF HATTIESBURG, INC.	  	SILOAM SPRINGS ARKANSAS HOSPITAL COMPANY, LLC
		
	QHG OF SOUTH CAROLINA, INC.	  	SILOAM SPRINGS HOLDINGS, LLC
		
	QHG OF SPARTANBURG, INC.	  	SOUTHEAST HMA HOLDINGS, LLC
		
	QHG OF SPRINGDALE, INC.	  	SOUTHERN TEXAS MEDICAL CENTER, LLC
		
	REGIONAL HOSPITAL OF LONGVIEW, LLC	  	SOUTHWEST FLORIDA HMA HOLDINGS, LLC
		
	RIVER OAKS HOSPITAL, LLC	  	SPOKANE VALLEY WASHINGTON HOSPITAL COMPANY, LLC
		
	RIVER REGION MEDICAL CORPORATION	  	SPOKANE WASHINGTON HOSPITAL COMPANY, LLC
		
	ROCKLEDGE HMA, LLC	  	STATESVILLE HMA, LLC
		
	ROH, LLC	  	TENNESSEE HMA HOLDINGS, LP
		
	ROSWELL HOSPITAL CORPORATION	  	TENNYSON HOLDINGS, LLC
		
	RUSTON HOSPITAL CORPORATION	  	TOMBALL TEXAS HOLDINGS, LLC
		
	RUSTON LOUISIANA HOSPITAL COMPANY, LLC	  	TOMBALL TEXAS HOSPITAL COMPANY, LLC
		
	SACMC, LLC	  	TRIAD HEALTHCARE, LLC
		
	SALEM HOSPITAL CORPORATION	  	TRIAD HOLDINGS III, LLC
		
	SAN ANGELO COMMUNITY MEDICAL CENTER, LLC	  	TRIAD HOLDINGS IV, LLC
		
	SAN ANGELO MEDICAL, LLC	  	TRIAD HOLDINGS V, LLC
		
	SCRANTON HOLDINGS, LLC	  	TRIAD NEVADA HOLDINGS, LLC
		
	SCRANTON HOSPITAL COMPANY, LLC	  	TRIAD OF ALABAMA, LLC
		
	SCRANTON QUINCY HOLDINGS, LLC	  	TRIAD-ARMC, LLC
		
	SCRANTON QUINCY HOSPITAL COMPANY, LLC	  	TRIAD-EL DORADO, INC.
		
		  	TRIAD-NAVARRO REGIONAL HOSPITAL SUBSIDIARY, LLC
		
	SEBRING HOSPITAL MANAGEMENT ASSOCIATES, LLC	  	TULLAHOMA HMA, LLC
		
	SEMINOLE HMA, LLC	  	TUNKHANNOCK HOSPITAL COMPANY, LLC
		
	SHARON PENNSYLVANIA HOLDINGS, LLC	  	VAN BUREN H.M.A., LLC
		
	SHARON PENNSYLVANIA HOSPITAL COMPANY, LLC	  	VENICE HMA, LLC
		
	SHELBYVILLE HOSPITAL COMPANY, LLC	  	VHC MEDICAL, LLC

  

			
	                        By:	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer

 Acting on behalf of each of the Guarantors set forth above 

  
 [Signature Page to
Second Supplemental Indenture] 








			
		
	VICKSBURG HEALTHCARE, LLC	  	WEST GROVE HOSPITAL COMPANY, LLC
		
	VICTORIA HOSPITAL, LLC	  	WHMC, LLC
		
	VICTORIA OF TEXAS, L.P.	  	WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY, LLC
		
	VIRGINIA HOSPITAL COMPANY, LLC	  	WILKES-BARRE HOLDINGS, LLC
		
	WARREN OHIO HOSPITAL COMPANY, LLC	  	WILKES-BARRE HOSPITAL COMPANY, LLC
		
		  	WOMEN & CHILDREN’S HOSPITAL, LLC
		
	WEATHERFORD HOSPITAL CORPORATION	  	WOODLAND HEIGHTS MEDICAL CENTER, LLC
		
	WEATHERFORD TEXAS HOSPITAL COMPANY, LLC	  	WOODWARD HEALTH SYSTEM, LLC
		
	WEBB HOSPITAL CORPORATION	  	YAKIMA HMA, LLC
		
	WEBB HOSPITAL HOLDINGS, LLC	  	YORK PENNSYLVANIA HOLDINGS, LLC
		
	WESLEY HEALTH SYSTEM LLC	  	YORK PENNSYLVANIA HOSPITAL COMPANY, LLC

  

			
	                        By:	 	/s/ Edward W. Lomicka
		 	Name: Edward W. Lomicka
		 	Title: Vice President and Treasurer

 Acting on behalf of each of the Guarantors set forth above 

  
 [Signature Page to
Second Supplemental Indenture] 







 
			
	 TRUSTEE, REGISTRAR AND PAYING AGENT:
  

REGIONS BANK

		
	By:    	 	/s/ Wallace Duke
		 	Name: Wallace Duke
		 	Title: Vice President & Trust Officer


  

			
	 COLLATERAL AGENT:
  

CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH



  

			
	By:	 	/s/ Robert Hetu


 
			
	Name:	 	Robert Hetu


 
			
	Title:	 	Authorized Signatory


  

			
	By:	 	/s/ Warren Van Heyst


 
			
	Name:	 	Warren Van Heyst


 
			
	Title:	 	Authorized Signatory


  

  
 [Signature Page to
Second Supplemental Indenture]