EX-4.9







	 	 	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 



Exhibit 4.9



THIRD SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of October 10, 2008, among
CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), each of the parties
identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New Subsidiary
Guarantor” and collectively, the “New Subsidiary Guarantors”) and U.S. BANK NATIONAL ASSOCIATION,
as Trustee under the Indenture (the “Trustee”).




W I T N E S S E T H:





     WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture (the
"Indenture”), dated as of July 25, 2007, providing for the issuance of the
87/8% Senior Notes due 2015 (the “Securities”);



     WHEREAS, each of the undersigned New Subsidiary Guarantors has deemed it advisable and in its
best interest to execute and deliver this Supplemental Indenture, and to become a New Subsidiary
Guarantor under the Indenture; and



     WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the New
Subsidiary Guarantors are authorized to execute and deliver this Supplemental Indenture.



     NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the
receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantors and the Trustee
mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as
follows:



     SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have
the meanings assigned to them in the Indenture.



     SECTION 2. Guaranties. Each New Subsidiary Guarantor hereby agrees to guarantee the
Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in
Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as
a Subsidiary Guarantor.



     SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture.
Except as expressly amended hereby, the Indenture is in all respects ratified and confirmed and all
the terms, conditions and provisions thereof shall remain in full force and effect. This
Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the
benefit of the Trustee and every Holder of Securities heretofore or hereafter authenticated and the
Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and
delivered shall be bound hereby.



     SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND
CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.



     SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to
the validity or sufficiency of this Supplemental Indenture.



     SECTION 6. Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent
the same agreement.



     SECTION 7. Effect of Headings. The Section headings herein are for convenience only
and shall not effect the construction of this Supplemental Indenture.



 









 






IN WITNESS WHEREOF, the parties have caused this Supplemental
Indenture to be duly executed as of this 10th day of October,
2008.



	 	 	 	 	 
	 	CHS/Community Health Systems, Inc.

a Delaware corporation

 	 
	 	By:  	/s/ Rachel A. Seifert
 	 
	 	 	Rachel A. Seifert 	 
	 	 	Senior Vice President, Secretary & General Counsel 	 



	 	 	 	 	 
	 	Affinity Health Systems, LLC,

a Delaware limited liability company



Affinity Hospital, LLC,

a Delaware limited liability company



Birmingham Holdings II, LLC,

a Delaware limited liability company



CHS Washington Holdings, LLC,

a Delaware limited liability company

Spokane Valley Washington Hospital Company, LLC,

a Delaware limited liability company	 



	 	 	 	 	 
	 	Spokane Washington Hospital Company, LLC,

a Delaware limited liability company

 	 
	 	By:  	/s/ Rachel A. Seifert
 	 
	 	 	Rachel A. Seifert 	 
	 	 	Senior Vice President and Secretary 	 



	 	 	 	 	 
	 	U.S. Bank National Association,

as Trustee

 	 
	 	By:  	/s/ Wally Jones
 	 
	 	 	Wally Jones 	 
	 	 	Vice President