<PAGE>

                                                                  EXHIBIT 4.4(A)


                     Healthtrust, Inc.--The Hospital Company

                     11% Senior Subordinated Notes due 2009

        to be unconditionally guaranteed as to the payment of principal,
            premium, if any, and interest by certain subsidiaries of
             Triad Hospitals Holdings, Inc. following the assumption
            of the Securities by Holdings and the asset contributions
                                described herein

                                 --------------

Exchange and Registration Rights Agreement

                                                                    May 11, 1999

Goldman, Sachs & Co.
NationsBanc Montgomery Securities LLC
Chase Securities Inc.
Salomon Smith Barney Inc.
SG Cowen Securities Corporation
 As representatives of the several Purchasers
 named in Schedule I to the Purchase Agreement
c/o Goldman, Sachs & Co.
85 Broad Street
New York, New York 10004

Ladies and Gentlemen:

     Healthtrust, Inc.--The Hospital Company, a Delaware corporation
("Healthtrust"), proposes to issue and sell to the Purchasers (as defined
herein) upon the terms set forth in the Purchase Agreement (as defined herein)
$325,000,000 aggregate principal amount of its 11% Senior Subordinated Notes due
2009, which are to be unconditionally guaranteed by certain subsidiaries of
Triad Hospitals Holdings, Inc., a Delaware corporation ("Holdings"), following
the assumption of the Securities by Holdings and the asset contributions
described below. Upon Healthtrust transferring the Business (as defined herein)
to Triad Hospitals, Inc., a Delaware corporation ("Triad"), and the assumption
by Triad of the indebtedness evidenced by the Securities, Healthtrust will cause
Triad to assume all the rights, obligations and liabilities of Healthtrust under
this agreement pursuant to the Triad Assumption Agreement, the form of which is
attached as Exhibit C hereto. Upon Triad transferring the Business to Holdings
and the assumption by Holdings of the indebtedness evidenced by the Securities,
Triad will cause Holdings to assume all rights, obligations and liabilities of
Triad under this Agreement pursuant to the Holdings Assumption Agreement, the
form of which is attached as Exhibit D hereto. Following the assumption by
Holdings of the indebtedness evidenced by the Securities, Holdings will
contribute certain assets to its subsidiary, Triad Holdings II, LLC and Triad
Holdings II, LLC will then contribute certain assets to its subsidiary, Triad
Holdings III, Inc. Following these contributions and immediately prior to the
completion of the Distribution, Holdings will cause the Guarantors (as defined
in the Guarantor Assumption Agreement) to execute the Guarantor Assumption
Agreement, the form of which is attached as Exhibit E hereto, pursuant to which
<PAGE>

each Guarantor will agree to observe and perform as a "Guarantor" all rights,
obligations and liabilities of such Guarantor under this Agreement. The parties
hereto acknowledge and agree that once (i) the Business has been validly
transferred to Triad and the Triad Assumption Agreement has been executed and
delivered by the parties thereto, Healthtrust shall automatically be fully,
unconditionally and irrevocably released from all rights, obligations and
liabilities hereunder and (ii) the Business has been validly transferred to
Holdings and the Holdings Assumption Agreement has been executed and delivered
by the parties thereto, Triad shall automatically be fully, unconditionally and
irrevocably released from all rights, obligations and liabilities hereunder. For
purposes of this Agreement, the "Company" shall refer to any of Healthtrust or
Triad or Holdings, depending on which such company has then assumed all rights,
obligations and liabilities under this Agreement as discussed in this paragraph.
As an inducement to the Purchasers to enter into the Purchase Agreement and in
satisfaction of a condition to the obligations of the Purchasers thereunder, the
Company agrees with the Purchasers for the benefit of holders (as defined
herein) from time to time of the Registrable Securities (as defined herein) as
follows:

1. Certain Definitions. For purposes of this Agreement, the following terms
shall have the following respective meanings:

          "Additional Interest" shall have the meaning assigned thereto in
     Section 2(c) hereof.

          "Agreement" shall mean this Exchange and Registration Rights
     Agreement, as the same shall be amended from time to time.

          "Base Interest" shall mean the interest that would otherwise accrue on
     the Securities under the terms thereof and the Indenture, without giving
     effect to the provisions of this Agreement.

          The term "broker-dealer" shall mean any broker or dealer registered
     with the Commission under the Exchange Act.

          "Business" shall mean the net assets, business and operations
     comprising the Pacific Group Division of Columbia/HCA.

          "Closing Date" shall mean the date on which the Securities are
     initially issued.

          "Columbia/HCA" shall mean Columbia/HCA Healthcare Corporation, a
     Delaware corporation.

          "Commission" shall mean the United States Securities and Exchange
     Commission, or any other federal agency at the time administering the
     Exchange Act or the Securities Act, whichever is the relevant statute for
     the particular purpose.
<PAGE>

          "Distribution" shall mean (i) the incurrence by Healthtrust of the
     indebtedness evidenced by the Securities and by the New Credit Agreement,
     (ii) the transfer of the Business by Healthtrust to Triad and the
     simultaneous assumption by Triad of the indebtedness evidenced by the
     Securities and by the New Credit Agreement, (iii) the subsequent transfer
     of the Business by Triad to Holdings and the simultaneous assumption by
     Holdings of the indebtedness evidenced by the Securities and the New Credit
     Agreement, (iv) the distribution by Healthtrust of all of the common stock
     of Triad to Columbia/HCA, and (v) the distribution by Columbia/HCA of all
     of the common stock of Triad to the stockholders of Columbia/HCA, in each
     case, as set forth in the offering circular.

          "Effective Time," in the case of (i) an Exchange Registration, shall
     mean the time and date as of which the Commission declares the Exchange
     Registration Statement effective or as of which the Exchange Registration
     Statement otherwise becomes effective and (ii) a Shelf Registration, shall
     mean the time and date as of which the Commission declares the Shelf
     Registration Statement effective or as of which the Shelf Registration
     Statement otherwise becomes effective.

          "Electing Holder" shall mean any holder of Registrable Securities that
     has returned a completed and signed Notice and Questionnaire to the Company
     in accordance with Section 3(d)(ii) or 3(d)(iii) hereof.

          "Exchange Act" shall mean the Securities Exchange Act of 1934, or any
     successor thereto, as the same shall be amended from time to time.

          "Exchange Offer" shall have the meaning assigned thereto in Section
     2(a) hereof.

          "Exchange Registration" shall have the meaning assigned thereto in
     Section 3(c) hereof.

          "Exchange Registration Statement" shall have the meaning assigned
     thereto in Section 2(a) hereof.

          "Exchange Securities" shall have the meaning assigned thereto in
     Section 2(a) hereof.

          "Guarantors" shall have the meaning assigned thereto in the Indenture.

          The term "holder" shall mean each of the Purchasers and other persons
     who acquire Registrable Securities from time to time (including any
     successors or assigns), in each case for so long as such person owns any
     Registrable Securities.

          "Indenture" shall mean the Indenture, dated as of May 11, 1999,
     between the Company and Citibank N.A., as Trustee, as the same shall be
     amended from time to time.

          "New Credit Agreement" shall mean the new credit agreement described
     in the offering circular.
<PAGE>

          "Notice and Questionnaire" means a Notice of Registration Statement
     and Selling Securityholder Questionnaire substantially in the form of
     Exhibit A hereto.

          The term "person" shall mean a corporation, limited liability company,
     association, partnership, organization, business, individual, government or
     political subdivision thereof or governmental agency.

          "Purchase Agreement" shall mean the Purchase Agreement, dated as of
     April 30, 1999, between the Purchasers and the Company relating to the
     Securities, as the same shall be amended from time to time.

          "Purchasers" shall mean the Purchasers named in Schedule I to the
     Purchase Agreement.

          "Registrable Securities" shall mean the Securities; provided, however,
     that a Security shall cease to be a Registrable Security when (i) in the
     circumstances contemplated by Section 2(a) hereof, the Security has been
     exchanged for an Exchange Security in an Exchange Offer as contemplated in
     Section 2(a) hereof (provided that any Exchange Security that, pursuant to
     the last two sentences of Section 2(a), is included in a prospectus for use
     in connection with resales by broker-dealers shall be deemed to be a
     Registrable Security with respect to Sections 5, 6 and 9 until resale of
     such Registrable Security has been effected within the 180-day period
     referred to in Section 2(a)); (ii) in the circumstances contemplated by
     Section 2(b) hereof, a Shelf Registration Statement registering such
     Security under the Securities Act has been declared or becomes effective
     and such Security has been sold or otherwise transferred by the holder
     thereof pursuant to and in a manner contemplated by such effective Shelf
     Registration Statement; (iii) such Security is sold pursuant to Rule 144
     under circumstances in which any legend borne by such Security relating to
     restrictions on transferability thereof, under the Securities Act or
     otherwise, is removed by the Company or pursuant to the Indenture; (iv)
     such Security is eligible to be sold pursuant to paragraph (k) of Rule 144;
     or (v) such Security shall cease to be outstanding.

          "Registration Default" shall have the meaning assigned thereto in
     Section 2(c) hereof.

          "Registration Expenses" shall have the meaning assigned thereto in
     Section 4 hereof.

          "Resale Period" shall have the meaning assigned thereto in Section
     2(a) hereof.

          "Restricted Holder" shall mean (i) a holder that is an affiliate of
     the Company within the meaning of Rule 405, (ii) a holder who acquires
     Exchange Securities outside the ordinary course of such holder's business,
     (iii) a holder who has arrangements or understandings with any person to
     participate in the Exchange Offer for the purpose of distributing Exchange
     Securities and (iv) a holder that is a broker-dealer, but only with respect
     to Exchange
<PAGE>

     Securities received by such broker-dealer pursuant to an Exchange Offer in
     exchange for Registrable Securities acquired by the broker-dealer directly
     from the Company.

          "Rule 144," "Rule 405" and "Rule 415" shall mean, in each case, such
     rule promulgated under the Securities Act (or any successor provision), as
     the same shall be amended from time to time.

          "Securities" shall mean, collectively, the 11% Senior Subordinated
     Notes due 2009 of the Company to be issued and sold to the Purchasers, and
     securities issued in exchange therefor or in lieu thereof pursuant to the
     Indenture. Each Security will be entitled to the benefit of the guarantees
     provided for in the Indenture following the assumption of the Securities by
     Holdings and the asset contributions described in the preamble in this
     Agreement (the "Guarantees") and, unless the context otherwise requires,
     any reference herein to a "Security," an "Exchange Security" or a
     "Registrable Security" shall include a reference to the related Guarantees.

          "Securities Act" shall mean the Securities Act of 1933, or any
     successor thereto, as the same shall be amended from time to time.

          "Shelf Registration" shall have the meaning assigned thereto in
     Section 2(b) hereof.

          "Shelf Registration Statement" shall have the meaning assigned thereto
     in Section 2(b) hereof.

          "Trust Indenture Act" shall mean the Trust Indenture Act of 1939, or
     any successor thereto, and the rules, regulations and forms promulgated
     thereunder, all as the same shall be amended from time to time.

     Unless the context otherwise requires, any reference herein to a "Section"
or "clause" refers to a Section or clause, as the case may be, of this Exchange
and Registration Rights Agreement, and the words "herein," "hereof" and
"hereunder" and other words of similar import refer to this Agreement as a whole
and not to any particular Section or other subdivision.

2. Registration Under the Securities Act.

(a) Except as set forth in Section 2(b) below, the Company agrees to use its
reasonable best efforts to file under the Securities Act, as soon as
practicable, but no later than 90 days after the Closing Date, a registration
statement relating to an offer to exchange (such registration statement, the
"Exchange Registration Statement", and such offer, the "Exchange Offer") any and
all of the Securities for a like aggregate principal amount of debt securities
issued by the Company and guaranteed by the Guarantors, which debt securities
and Guarantees are substantially identical to the Securities and the related
Guarantees, respectively (and are entitled to the benefits of a trust indenture
which is substantially identical to the Indenture or is
<PAGE>

the Indenture and which has been qualified under the Trust Indenture Act),
except that they have been registered pursuant to an effective registration
statement under the Securities Act and do not contain provisions for the
Additional Interest contemplated in Section 2(c) below (such new debt securities
hereinafter called "Exchange Securities"). The Company agrees to use its
reasonable best efforts to cause the Exchange Registration Statement to become
effective under the Securities Act as soon as practicable, but no later than 180
days after the Closing Date. The Exchange Offer will be registered under the
Securities Act on the appropriate form and will comply with all applicable
tender offer rules and regulations under the Exchange Act. The Company further
agrees to use its reasonable best efforts to commence the Exchange Offer
promptly, but no later than 5 days after such registration statement has become
effective, hold the Exchange Offer open for at least 30 days and exchange
Exchange Securities for all Registrable Securities that have been properly
tendered and not withdrawn on or prior to the expiration of the Exchange Offer.
The Exchange Offer will be deemed to have been "completed" only if the debt
securities and related Guarantees received by holders other than Restricted
Holders in the Exchange Offer for Registrable Securities are, upon receipt,
transferable by each such holder without restriction under the Securities Act
and the Exchange Act and without material restrictions under the blue sky or
securities laws of a substantial majority of the States of the United States of
America. The Exchange Offer shall be deemed to have been completed upon the
earlier to occur of (i) the Company having exchanged the Exchange Securities for
all outstanding Registrable Securities pursuant to the Exchange Offer and (ii)
the Company having exchanged, pursuant to the Exchange Offer, Exchange
Securities for all Registrable Securities that have been properly tendered and
not withdrawn before the expiration of the Exchange Offer, which shall be on a
date that is at least 30 days following the commencement of the Exchange Offer.
The Company agrees (x) to include in the Exchange Registration Statement a
prospectus for use in any resales by any holder of Exchange Securities that is a
broker-dealer and (y) to keep such Exchange Registration Statement effective for
a period (the "Resale Period") beginning when Exchange Securities are first
issued in the Exchange Offer and ending upon the earlier of the expiration of
the 180th day after the Exchange Offer has been completed or such time as such
broker-dealers no longer own any Registrable Securities. With respect to such
Exchange Registration Statement, such holders shall have the benefit of the
rights of indemnification and contribution set forth in Sections 6(a), (c), (d)
and (e) hereof.

    Each holder participating in the Registered Exchange Offer shall be required
to represent to the Company that at the time of the consummation of the
Registered Exchange Offer (i) any Exchange Securities received by such holder
will be acquired in the ordinary course of business, (ii) such holder will have
no arrangements or understanding with any person to participate in the
distribution of the Securities or the Exchange Securities within the meaning of
the Securities Act, (iii) such holder is not an "affiliate," as defined in Rule
405 of the Securities Act, of the Company or if it is an affiliate, such holder
will comply with the registration and prospectus delivery requirements of the
Securities Act to the extent applicable, (iv) if such holder is not a
broker-dealer, that it is not engaged in, and does not intend to engage in, the
distribution of the Exchange Securities and (v) if such holder is a
broker-dealer, that it will receive Exchange
<PAGE>

Securities for its own account in exchange for Securities that were acquired as
a result of market-making activities or other trading activities and that it
will be required to acknowledge that it will deliver a prospectus in connection
with any resale of such Exchange Securities.

(b) If (i) on or prior to the time the Exchange Offer is completed, existing
Commission interpretations are changed such that the debt securities or the
related Guarantees received by holders other than Restricted Holders in the
Exchange Offer for Registrable Securities are not or would not be, upon receipt,
freely transferable by each such holder without restriction under the Securities
Act, (ii) the Exchange Offer has not been consummated within 220 days following
the Closing Date, (iii) any holder of Securities notifies the Company prior to
the 20th day following the consummation of the Exchange Offer that (a) due to a
change in law or policy it is not eligible to participate in the Exchange Offer,
(b) due to a change in law or policy it may not resell the Exchange Securities
acquired by it in the Exchange Offer to the public without delivering a
prospectus and the prospectus contained in the Exchange Registration Statement
is not appropriate or available for such resales by such holder or (c) it is a
broker-dealer and owns Securities acquired directly from the Company or an
affiliate of the Company, or (iv) the holders of the Securities may not resell
the Exchange Securities acquired by them in the Exchange Offer to the public
without restriction under the Securities Act and without restriction under
applicable blue sky or state securities laws, then each of the Company and the
Guarantors will, in lieu of (or in the case of clause (iii), in addition to)
conducting the Exchange Offer contemplated by Section 2(a), use its reasonable
best efforts to file under the Securities Act as soon as practicable, but no
later than the later of 90 days after the Closing Date or 90 days after the time
such obligation to file arises or in the case of clause (ii), 30 days, a "shelf"
registration statement providing for the registration of, and the sale on a
continuous or delayed basis by the holders of, all of the Registrable
Securities, or, in the case of clause (iii), of the Securities held by the
holders referred to in such clause for resale by such holders, pursuant to Rule
415 or any similar rule that may be adopted by the Commission (such filing, the
"Shelf Registration" and such registration statement, the "Shelf Registration
Statement"). The Company agrees to use its reasonable best efforts (x) to cause
the Shelf Registration Statement to become or be declared effective no later
than 90 days after such Shelf Registration Statement is filed and to keep such
Shelf Registration Statement continuously effective for a period ending on the
earlier of the second anniversary of the Effective Time or such time as there
are no longer any Registrable Securities outstanding, provided, however, that no
holder shall be entitled to be named as a selling securityholder in the Shelf
Registration Statement or to use the prospectus forming a part thereof for
resales of Registrable Securities unless such holder is an Electing Holder, and
(y) after the Effective Time of the Shelf Registration Statement, promptly upon
the request of any holder of Registrable Securities that is not then an Electing
Holder, to take any action reasonably necessary to enable such holder to use the
prospectus forming a part thereof for resales of Registrable Securities,
including, without limitation, any action necessary to identify such holder as a
selling securityholder in the Shelf Registration Statement, provided, however,
that nothing in this clause (y) shall relieve any such holder of the obligation
to return a completed and signed Notice and Questionnaire to the Company in
accordance with Section 3(d)(iii) hereof. No holder of Registrable Securities
shall be entitled to Additional Interest
<PAGE>

pursuant to Section 2(c) hereof unless and until such holder has provided all
such information. The foregoing shall not apply to actions taken (or
contemplated to be taken) by the Company in good faith and for valid business
reasons involving a material undisclosed event (but not including the avoidance
of the Company's obligations hereunder) (a "Suspension Event"), including,
without limitation, the acquisition or divestiture of assets or the offering or
sale of securities, so long as the Company promptly thereafter complies with the
requirements of Section 3(e) hereof, if applicable. Any such period during which
the Company is excused from keeping the Shelf Registration Statement effective
and usable for offers and sale of the Registrable Securities is referred to as a
"Suspension Period;" provided that, such Suspension Period shall not exceed 45
days in any 12-month period (whereafter Additional Interest shall accrue and be
payable); and provided further that the number of days of any actual Suspension
Period shall be added on to the end of the two-year period specified above. A
Suspension Period shall commence on and include the date that the Company gives
notice that the Shelf Registration Statement is no longer effective or the
prospectus included therein is no longer usable for offers and sales of
Registrable Securities and shall end on the earlier to occur of (1) the date on
which each seller of Registrable Securities covered by the Shelf Registration
Statement either receives the copies of the supplemented or amended prospectus
contemplated by Section 3(e) hereof or is advised in writing by the Company that
the use of the prospectus may be resumed and (2) the expiration of 45 days in
any 12-month period during which one or more Suspension Periods has been in
effect. The Company further agrees to supplement or make amendments to the Shelf
Registration Statement, as and when required by the rules, regulations or
instructions applicable to the registration form used by the Company for such
Shelf Registration Statement or by the Securities Act or rules and regulations
thereunder for shelf registration, and the Company agrees to furnish to each
Electing Holder copies of any such supplement or amendment prior to its being
used or promptly following its filing with the Commission.

(c) In the event that (i) the Company has not filed the Exchange Registration
Statement or Shelf Registration Statement on or before the date on which such
registration statement is required to be filed pursuant to Section 2(a) or 2(b),
respectively, or (ii) such Exchange Registration Statement or Shelf Registration
Statement has not become effective or been declared effective by the Commission
on or before the date on which such registration statement is required to become
or be declared effective pursuant to Section 2(a) or 2(b), respectively, or
(iii) the Exchange Offer has not been consummated within 30 business days after
the initial effective date of the Exchange Registration Statement or (iv) any
Exchange Registration Statement or Shelf Registration Statement required by
Section 2(a) or 2(b) hereof is filed and declared effective but shall thereafter
cease to be effective (other than by reason of a Suspension Event) without being
succeeded immediately by an additional registration statement filed and declared
effective (each such event referred to in clauses (i) through (iv), a
"Registration Default" and each period during which a Registration Default has
occurred and is continuing, a "Registration Default Period"), then, as
liquidated damages for such Registration Default, additional interest
("Additional Interest"), in addition to the Base Interest, shall accrue on the
Securities over and above the interest set forth in the title of the Securities,
with respect to
<PAGE>

the first 90-day period (or portion thereof) while a Registration Default or
Defaults is continuing immediately following the occurrence of such Registration
Default or Defaults, by 0.25%, such interest rate increasing by an additional
0.25% at the beginning of each subsequent 90-day period (or portion thereof)
while a Registration Default or Defaults is continuing until all Registration
Defaults have been cured, up to a maximum rate of Additional Interest of 1.0%.
Following the cure of all Registration Defaults, the accrual of Additional
Interest on the Securities will cease and the interest rate will revert to the
original rate. Additional Interest pursuant to this Section 2(c) constitutes
liquidated damages with respect to Registration Defaults and shall be the
exclusive monetary remedy available to the holders of the Securities in respect
of any Registration Default. Additional Interest will not accrue and be payable
as set forth above during any Suspension Period.

    All accrued Additional Interest shall be paid to the holders entitled
thereto, in the manner provided for the payment of interest in the Indenture and
the Securities, on each interest payment date, as more fully set forth in the
Indenture and the Securities. The amount of Additional Interest will be
determined by multiplying the applicable Additional Interest rate by the
principal amount of the Securities, as the case may be, multiplied by a
fraction, the numerator of which is the number of days such Additional Interest
rate was applicable during such period (determined on the basis of a 360-day
year comprised of twelve 30-day months), and the denominator of which is 360.

(d)  The Company shall take, and shall cause the Guarantors to take, all actions
reasonably necessary or advisable to be taken by it to ensure that the
transactions contemplated herein are effected as so contemplated, including all
actions reasonably necessary or desirable to register the Guarantees under the
registration statement contemplated in Section 2(a) or 2(b) hereof, as
applicable.

(e) Any reference herein to a registration statement as of any time shall be
deemed to include any document incorporated, or deemed to be incorporated,
therein by reference as of such time and any reference herein to any
post-effective amendment to a registration statement as of any time shall be
deemed to include any document incorporated, or deemed to be incorporated,
therein by reference as of such time.

3.   Registration Procedures.

     If the Company files a registration statement pursuant to Section 2(a) or
Section 2(b), the following provisions shall apply:

(a) At or before the Effective Time of the Exchange Offer or the Shelf
Registration, as the case may be, the Company shall qualify the Indenture under
the Trust Indenture Act.

<PAGE>

(b) In the event that such qualification would require the appointment of a new
trustee under the Indenture, the Company shall appoint a new trustee thereunder
pursuant to the applicable provisions of the Indenture.

(c) In connection with the Company's obligations with respect to the
registration of Exchange Securities as contemplated by Section 2(a) (the
"Exchange Registration"), if applicable, the Company shall, as soon as
practicable (or as otherwise specified):

     (i) prepare and file with the Commission, as soon as practicable but no
     later than 90 days after the Closing Date, an Exchange Registration
     Statement on any form which may be utilized by the Company and which shall
     permit the Exchange Offer and resales of Exchange Securities by
     broker-dealers during the Resale Period to be effected as contemplated by
     Section 2(a), and use its reasonable best efforts to cause such Exchange
     Registration Statement to become effective as soon as practicable
     thereafter, but no later than 180 days after the Closing Date;

     (ii) as soon as practicable prepare and file with the Commission such
     amendments and supplements to such Exchange Registration Statement and the
     prospectus included therein as may be necessary to effect and maintain the
     effectiveness of such Exchange Registration Statement for the periods and
     purposes contemplated in Section 2(a) hereof and as may be required by the
     applicable rules and regulations of the Commission and the instructions
     applicable to the form of such Exchange Registration Statement, and
     promptly provide each broker-dealer holding Exchange Securities with such
     number of copies of the prospectus included therein (as then amended or
     supplemented), in conformity in all material respects with the requirements
     of the Securities Act and the Trust Indenture Act and the rules and
     regulations of the Commission thereunder, as such broker-dealer reasonably
     may request prior to the expiration of the Resale Period, for use in
     connection with resales of Exchange Securities;

     (iii) promptly notify Goldman, Sachs & Co., on behalf of each broker-dealer
     that has requested or received copies of the prospectus included in such
     registration statement, and, if requested, confirm such advice in writing,
     (A) when such Exchange Registration Statement or the prospectus included
     therein or any prospectus amendment or supplement or post-effective
     amendment has been filed, and, with respect to such Exchange Registration
     Statement or any post-effective amendment, when the same has become
     effective, (B) of any comments by the Commission and by the blue sky or
     securities commissioner or regulator of any state with respect thereto or
     any request by the Commission for amendments or supplements to such
     Exchange Registration Statement or prospectus or for additional
     information, (C) of the issuance by the Commission of any stop order
     suspending the effectiveness of such Exchange Registration Statement or the
     initiation or threatening of any proceedings for that purpose, (D) if at
     any time the representations and warranties of the Company
<PAGE>

     contemplated by Section 5 cease to be true and correct in all material
     respects, (E) of the receipt by the Company of any notification with
     respect to the suspension of the qualification of the Exchange Securities
     for sale in any jurisdiction or the initiation or threatening of any
     proceeding for such purpose, or (F) at any time during the Resale Period
     when a prospectus is required to be delivered under the Securities Act,
     that such Exchange Registration Statement, prospectus, prospectus amendment
     or supplement or post-effective amendment does not conform in all material
     respects to the applicable requirements of the Securities Act and the Trust
     Indenture Act and the rules and regulations of the Commission thereunder or
     contains an untrue statement of a material fact or omits to state any
     material fact required to be stated therein or necessary to make the
     statements therein not misleading in light of the circumstances then
     existing;

     (iv) in the event that the Company would be required, pursuant to Section
     3(c)(iii)(F) hereof, to notify any broker-dealers holding Exchange
     Securities, without delay prepare and furnish to each such holder a
     reasonable number of copies of a prospectus supplemented or amended so
     that, as thereafter delivered to purchasers of such Exchange Securities
     during the Resale Period, such prospectus shall conform in all material
     respects to the applicable requirements of the Securities Act and the Trust
     Indenture Act and the rules and regulations of the Commission thereunder
     and shall not contain an untrue statement of a material fact or omit to
     state a material fact required to be stated therein or necessary to make
     the statements therein not misleading in light of the circumstances then
     existing;

     (v) use its reasonable best efforts to obtain the withdrawal of any order
     suspending the effectiveness of such Exchange Registration Statement or any
     post-effective amendment thereto at the earliest practicable date;

     (vi) use its reasonable best efforts to (A) register or qualify the
     Exchange Securities under the securities laws or blue sky laws of such
     jurisdictions as are contemplated by Section 2(a) no later than the
     commencement of the Exchange Offer, (B) keep such registrations or
     qualifications in effect and comply with such laws so as to permit the
     continuance of offers, sales and dealings therein in such jurisdictions
     until the expiration of the Resale Period and (C) take any and all other
     actions as may be reasonably necessary or advisable to enable each broker-
     dealer holding Exchange Securities to consummate the disposition thereof in
     such jurisdictions; provided, however, that neither the Company nor the
     Guarantors shall be required for any such purpose to (1) qualify as a
     foreign corporation in any jurisdiction wherein it would not otherwise be
     required to qualify but for the requirements of this Section 3(c)(vi), (2)
     consent to general service of process or become subject to taxation in any
     such jurisdiction or (3) make any changes to its certificate of
     incorporation or by-laws or any agreement between it and its stockholders;
<PAGE>

     (vii) use its reasonable best efforts to obtain the consent or approval of
     each governmental agency or authority, whether federal, state or local,
     which may be required to effect the Exchange Registration, the Exchange
     Offer and the offering and sale of Exchange Securities by broker-dealers
     during the Resale Period;

     (viii) provide a CUSIP number for all Exchange Securities, not later than
     the applicable Effective Time; and

     (ix) comply with all applicable rules and regulations of the Commission,
     and make generally available to its securityholders as soon as practicable
     but no later than eighteen months after the effective date of such Exchange
     Registration Statement, an earning statement of the Company and its
     subsidiaries complying with Section 11(a) of the Securities Act (including,
     at the option of the Company, Rule 158 thereunder).

(d) In connection with the Company's obligations with respect to the Shelf
Registration, if applicable, the Company shall, as soon as practicable (or as
otherwise specified):

     (i) prepare and file with the Commission, as soon as practicable but in any
     case within the time periods specified in Section 2(b) hereof, a Shelf
     Registration Statement on any form which may be utilized by the Company and
     which shall register all of the Registrable Securities for resale by the
     holders thereof in accordance with such method or methods of disposition as
     may be specified by such of the holders as, from time to time, may be
     Electing Holders and use its reasonable best efforts to cause such Shelf
     Registration Statement to become effective as soon as practicable but in
     any case within the time periods specified in Section 2(b) hereof;

     (ii) not less than 30 calendar days prior to the Effective Time of the
     Shelf Registration Statement, mail the Notice and Questionnaire to the
     holders of Registrable Securities; no holder shall be entitled to be named
     as a selling securityholder in the Shelf Registration Statement as of the
     Effective Time, and no holder shall be entitled to use the prospectus
     forming a part thereof for resales of Registrable Securities at any time,
     unless such holder has returned a completed and signed Notice and
     Questionnaire to the Company by the deadline for response set forth
     therein; provided, however, holders of Registrable Securities shall have at
     least 21 calendar days from the date on which the Notice and Questionnaire
     is first mailed to such holders to return a completed and signed Notice and
     Questionnaire to the Company;

     (iii) after the Effective Time of the Shelf Registration Statement, upon
     the request of any holder of Registrable Securities that is not then an
     Electing Holder, promptly send a Notice and Questionnaire to such holder;
     provided that the Company shall not be required to take any action to name
     such holder as a selling securityholder in the Shelf Registration Statement
     or to enable such holder to use the prospectus forming a

<PAGE>

     part thereof for resales of Registrable Securities until such holder has
     returned a completed and signed Notice and Questionnaire to the Company;

     (iv) as soon as reasonably practicable prepare and file with the Commission
     such amendments and supplements to such Shelf Registration Statement and
     the prospectus included therein as may be necessary to effect and maintain
     the effectiveness of such Shelf Registration Statement for the period
     specified in Section 2(b) hereof and as may be required by the applicable
     rules and regulations of the Commission and the instructions applicable to
     the form of such Shelf Registration Statement, and furnish to the Electing
     Holders copies of any such supplement or amendment simultaneously with or
     prior to its being used or filed with the Commission;

     (v) comply with the provisions of the Securities Act with respect to the
     disposition of all of the Registrable Securities covered by such Shelf
     Registration Statement in accordance with the intended methods of
     disposition by the Electing Holders provided for in such Shelf Registration
     Statement;

     (vi) provide (A) the Electing Holders, (B) the underwriters (which term,
     for purposes of this Agreement, shall include a person deemed to be an
     underwriter within the meaning of Section 2(a)(11) of the Securities Act),
     if any, thereof, (C) any sales or placement agent therefor, (D) counsel for
     any such underwriter or agent and (E) not more than one counsel for all the
     Electing Holders the opportunity to participate in the preparation of such
     Shelf Registration Statement, each prospectus included therein or filed
     with the Commission and each amendment or supplement thereto;

     (vii) for a reasonable period prior to the filing of such Shelf
     Registration Statement, and throughout the period specified in Section 2(b)
     hereof, make reasonably available at reasonable times at the Company's
     principal place of business or such other reasonable place for inspection
     by the persons referred to in Section 3(d)(vi) hereof who shall certify to
     the Company that they have a current intention to sell the Registrable
     Securities pursuant to the Shelf Registration such relevant financial and
     other information and books and pertinent corporate records of the Company,
     and cause the officers, employees, counsel and independent certified public
     accountants of the Company to supply all relevant information reasonably
     requested, as shall be reasonably necessary, in the judgment of the
     respective counsel referred to in such Section, to conduct a reasonable
     investigation within the meaning of Section 11 of the Securities Act;
     provided, however, that each such party shall be required to maintain in
     confidence and not to disclose to any other person any information or
     records reasonably designated by the Company as being confidential, until
     such time as (A) such information becomes a matter of public record
     (whether by virtue of its inclusion in such registration statement or
     otherwise), or (B) such person shall be required so to disclose such
     information pursuant to a subpoena or order of any court or other
     governmental agency or body having jurisdiction over the matter (subject to
     the requirements of such order, and only

<PAGE>

     after such person shall have given the Company prompt prior written notice
     of such requirement), or (C) subject to the provisions of Section 2(b)
     relating to Suspension Periods, such information is required to be set
     forth in such Shelf Registration Statement or the prospectus included
     therein or in an amendment to such Shelf Registration Statement or an
     amendment or supplement to such prospectus in order that such Shelf
     Registration Statement, prospectus, amendment or supplement, as the case
     may be, complies with applicable requirements of the federal securities
     laws and the rules and regulations of the Commission and does not contain
     an untrue statement of a material fact or omit to state therein a material
     fact required to be stated therein or necessary to make the statements
     therein not misleading in light of the circumstances then existing and
     provided, further, that the foregoing inspection and information gathering
     shall be coordinated on behalf of the purchasers by you and on behalf of
     the other parties by one counsel designated by and on behalf of such other
     parties as described herein;

     (viii) promptly notify each of the Electing Holders, any sales or placement
     agent therefor and any underwriter thereof (which notification may be made
     through any managing underwriter that is a representative of such
     underwriter for such purpose) and, if requested by such holder, confirm
     such advice in writing, (A) when such Shelf Registration Statement or the
     prospectus included therein or any prospectus amendment or supplement or
     post-effective amendment has been filed, and, with respect to such Shelf
     Registration Statement or any post-effective amendment, when the same has
     become effective, (B) of any comments by the Commission and by the blue sky
     or securities commissioner or regulator of any state with respect thereto
     or any request by the Commission for amendments or supplements to such
     Shelf Registration Statement or prospectus included therein or for
     additional information, (C) of the issuance by the Commission of any stop
     order suspending the effectiveness of such Shelf Registration Statement or
     the initiation or threatening of any proceedings for that purpose, (D) if
     at any time the representations and warranties of the Company contemplated
     by Section 3(d)(xvii) or Section 5 hereof cease to be true and correct in
     all material respects, (E) of the receipt by the Company of any
     notification with respect to the suspension of the qualification of the
     Registrable Securities for sale in any jurisdiction or the initiation or
     threatening of any proceeding for such purpose, or (F) if at any time when
     a prospectus is required to be delivered under the Securities Act, that
     such Shelf Registration Statement, prospectus, prospectus amendment or
     supplement or post-effective amendment does not conform in all material
     respects to the applicable requirements of the Securities Act and the Trust
     Indenture Act and the rules and regulations of the Commission thereunder or
     contains an untrue statement of a material fact or omits to state any
     material fact required to be stated therein or necessary to make the
     statements therein not misleading in light of the circumstances then
     existing;

     (ix) use its reasonable best efforts to obtain the withdrawal of any order
     suspending the effectiveness of such registration statement or any
     post-effective amendment thereto at the earliest practicable date;
<PAGE>

     (x) if requested by any managing underwriter or underwriters, any placement
     or sales agent or any Electing Holder, promptly incorporate in a prospectus
     supplement or post-effective amendment such information as is required by
     the applicable rules and regulations of the Commission and as such managing
     underwriter or underwriters, such agent or such Electing Holder specifies
     should be included therein relating to the terms of the sale of such
     Registrable Securities, including information with respect to the principal
     amount of Registrable Securities being sold by such Electing Holder or
     agent or to any underwriters, the name and description of such Electing
     Holder, agent or underwriter, the offering price of such Registrable
     Securities and any discount, commission or other compensation payable in
     respect thereof, the purchase price being paid therefor by such
     underwriters and with respect to any other terms of the offering of the
     Registrable Securities to be sold by such Electing Holder or agent or to
     such underwriters; and make all required filings of such prospectus
     supplement or post-effective amendment promptly after notification of the
     matters to be incorporated in such prospectus supplement or post-effective
     amendment;

     (xi) furnish to each Electing Holder, each placement or sales agent, if
     any, therefor, each underwriter, if any, thereof and the respective counsel
     referred to in Section 3(d)(vi) hereof an executed copy (or, in the case of
     an Electing Holder, a conformed copy) of such Shelf Registration Statement,
     each such amendment and supplement thereto (in each case including all
     exhibits thereto (in the case of an Electing Holder of Registrable
     Securities, upon request) and documents incorporated by reference therein)
     and such number of copies of such Shelf Registration Statement (excluding
     exhibits thereto and documents incorporated by reference therein unless
     specifically so requested by such Electing Holder, agent or underwriter, as
     the case may be) and of the prospectus included in such Shelf Registration
     Statement (including each preliminary prospectus and any summary
     prospectus), in conformity in all material respects with the applicable
     requirements of the Securities Act and the Trust Indenture Act and the
     rules and regulations of the Commission thereunder, and such other
     documents, as such Electing Holder, agent, if any, and underwriter, if any,
     may reasonably request in order to facilitate the offering and disposition
     of the Registrable Securities owned by such Electing Holder, offered or
     sold by such agent or underwritten by such underwriter and to permit such
     Electing Holder, agent and underwriter to satisfy the prospectus delivery
     requirements of the Securities Act; and the Company hereby consents,
     subject to the provisions of this Agreement, to the use of such prospectus
     (including such preliminary and summary prospectus) and any amendment or
     supplement thereto by each such Electing Holder and by any such agent and
     underwriter, in each case in the form most recently provided to such person
     by the Company, in connection with the offering and sale of the Registrable
     Securities covered by the prospectus (including such preliminary and
     summary prospectus) or any supplement or amendment thereto;
<PAGE>

     (xii) use reasonable best efforts to (A) register or qualify the
     Registrable Securities to be included in such Shelf Registration Statement
     under such securities laws or blue sky laws of such jurisdictions as any
     Electing Holder and each placement or sales agent, if any, therefor and
     underwriter, if any, thereof shall reasonably request in writing, (B) keep
     such registrations or qualifications in effect and comply with such laws so
     as to permit the continuance of offers, sales and dealings therein in such
     jurisdictions during the period the Shelf Registration is required to
     remain effective under Section 2(b) hereof and for so long as may be
     necessary to enable any such Electing Holder, agent or underwriter to
     complete its distribution of Securities pursuant to such Shelf Registration
     Statement and (C) take any and all other actions as may be reasonably
     necessary to enable each such Electing Holder, agent, if any, and
     underwriter, if any, to consummate the disposition in such jurisdictions of
     such Registrable Securities; provided, however, that neither the Company
     nor the Guarantors shall be required for any such purpose to (1) qualify as
     a foreign corporation in any jurisdiction wherein it would not otherwise be
     required to qualify but for the requirements of this Section 3(d)(xii), (2)
     consent to general service of process or subject itself to taxation in any
     such jurisdiction or (3) make any changes to its certificate of
     incorporation or by-laws or any agreement between it and its stockholders;

     (xiii) use its reasonable best efforts to obtain the consent or approval of
     each governmental agency or authority, whether federal, state or local,
     which may be required to effect the Shelf Registration or the offering or
     sale in connection therewith;

     (xiv) unless any Registrable Securities shall be in book-entry only form,
     cooperate with the Electing Holders and the managing underwriters, if any,
     to facilitate the timely preparation and delivery of certificates
     representing Registrable Securities to be sold, which certificates, if so
     required by any securities exchange upon which any Registrable Securities
     are listed, shall be penned, lithographed or engraved, or produced by any
     combination of such methods, on steel engraved borders, and which
     certificates shall not bear any restrictive legends; and, in the case of an
     underwritten offering, enable such Registrable Securities to be in such
     denominations and registered in such names as the managing underwriters may
     request at least two business days prior to any sale of the Registrable
     Securities;

     (xv) provide a CUSIP number for all Registrable Securities, not later than
     the applicable Effective Time;

     (xvi) enter into one or more underwriting agreements, agency agreements,
     "best efforts" underwriting agreements or similar agreements, as
     appropriate, including customary provisions relating to indemnification and
     contribution, and take such other actions in connection therewith as any
     Electing Holders aggregating at least 35% in aggregate principal amount of
     the Registrable Securities at the time outstanding
<PAGE>

     shall reasonably request in order to expedite or facilitate the disposition
     of such Registrable Securities;

     (xvii) whether or not an agreement of the type referred to in Section
     3(d)(xvi) hereof is entered into and whether or not any portion of the
     offering contemplated by the Shelf Registration is an underwritten offering
     or is made through a placement or sales agent or any other entity, (A) make
     such representations and warranties to the Electing Holders and the
     placement or sales agent, if any, therefor and the underwriters, if any,
     thereof in form, substance and scope as are customarily made in connection
     with an offering of debt securities of the type contemplated hereby
     pursuant to any appropriate agreement or to a registration statement filed
     on the form applicable to the Shelf Registration; (B) obtain an opinion of
     counsel to the Company in customary form and covering such matters, of the
     type customarily covered by such an opinion, as the managing underwriters,
     if any, or as any Electing Holders of at least 35% in aggregate principal
     amount of the Registrable Securities at the time outstanding may reasonably
     request, addressed to such Electing Holder or Electing Holders and the
     placement or sales agent, if any, therefor and the underwriters, if any,
     thereof and dated the effective date of such Shelf Registration Statement
     (or if such Shelf Registration Statement contemplates an underwritten
     offering of a part or all of the Registrable Securities, dated the date of
     the closing under the underwriting agreement relating thereto) (it being
     agreed that the matters to be covered by such opinion shall include the due
     incorporation and good standing of the Company and its significant
     subsidiaries; the qualification of the Company and its significant
     subsidiaries to transact business as foreign corporations; the due
     authorization, execution and delivery of the relevant agreement of the type
     referred to in Section 3(d)(xvi) hereof; the due authorization, execution,
     authentication and issuance, and the validity and enforceability, of the
     Securities; the absence of material legal or governmental proceedings
     involving the Company; the absence of governmental approvals required to be
     obtained in connection with the Shelf Registration, the offering and sale
     of the Registrable Securities, this Agreement or any agreement of the type
     referred to in Section 3(d)(xvi) hereof, except such approvals as may be
     required under state securities or blue sky laws and any other customary
     exclusions; the material compliance as to form of such Shelf Registration
     Statement and any documents incorporated by reference therein and of the
     Indenture with the requirements of the Securities Act and the Trust
     Indenture Act and the rules and regulations of the Commission thereunder,
     respectively; and, as of the date of the opinion and of the Shelf
     Registration Statement or most recent post-effective amendment thereto, as
     the case may be, the absence from such Shelf Registration Statement and the
     prospectus included therein, as then amended or supplemented, and from the
     documents incorporated by reference therein (in each case other than the
     financial statements and other financial information contained therein) of
     an untrue statement of a material fact or the omission to state therein a
     material fact necessary to make the statements therein not misleading (in
     the case of such documents, in the light of the circumstances existing at
     the time that such documents were filed with the Commission under the
     Exchange Act));
<PAGE>

     (C) obtain a "cold comfort" letter or letters from the independent
     certified public accountants of the Company addressed to the selling
     Electing Holders, the placement or sales agent, if any, therefor or the
     underwriters, if any, thereof, dated (i) the effective date of such Shelf
     Registration Statement and (ii) the effective date of any prospectus
     supplement to the prospectus included in such Shelf Registration Statement
     or post-effective amendment to such Shelf Registration Statement which
     includes unaudited or audited financial statements as of a date or for a
     period subsequent to that of the latest such statements included in such
     prospectus (and, if such Shelf Registration Statement contemplates an
     underwritten offering pursuant to any prospectus supplement to the
     prospectus included in such Shelf Registration Statement or post-effective
     amendment to such Shelf Registration Statement which includes unaudited or
     audited financial statements as of a date or for a period subsequent to
     that of the latest such statements included in such prospectus, dated the
     date of the closing under the underwriting agreement relating thereto),
     such letter or letters to be in customary form and covering such matters of
     the type customarily covered by letters of such type; (D) deliver such
     documents and certificates, including officers' certificates, as may be
     reasonably requested by any Electing Holders of at least 35% in aggregate
     principal amount of the Registrable Securities at the time outstanding or
     the placement or sales agent, if any, therefor and the managing
     underwriters, if any, thereof to evidence the accuracy of the
     representations and warranties made pursuant to clause (A) above or those
     contained in Section 5(a) hereof and the compliance with or satisfaction of
     any agreements or conditions contained in the underwriting agreement or
     other agreement entered into by the Company or the Guarantors; and (E)
     undertake such obligations relating to expense reimbursement,
     indemnification and contribution as are provided in Section 6 hereof;

     (xviii) notify in writing each holder of Registrable Securities of any
     proposal by the Company to amend or waive any provision of this Exchange
     and Registration Rights Agreement pursuant to Section 9(h) hereof and of
     any amendment or waiver effected pursuant thereto, each of which notices
     shall contain the text of the amendment or waiver proposed or effected, as
     the case may be;

     (xix) in the event that any broker-dealer registered under the Exchange Act
     shall underwrite any Registrable Securities or participate as a member of
     an underwriting syndicate or selling group or "assist in the distribution"
     (within the meaning of the Conduct Rules (the "Conduct Rules") of the
     National Association of Securities Dealers, Inc. ("NASD") or any successor
     thereto, as amended from time to time) thereof, whether as a holder of such
     Registrable Securities or as an underwriter, a placement or sales agent or
     a broker or dealer in respect thereof, or otherwise, assist such broker-
     dealer in complying with the requirements of such Conduct Rules, including
     by (A) if such Conduct Rules shall so require, engaging a "qualified
     independent underwriter" (as defined in such Conduct Rules) to participate
     in the preparation of the Shelf Registration Statement relating to such
     Registrable Securities, to exercise usual standards of due diligence in
     respect thereto and, if any portion of the offering contemplated by such
     Shelf Registration Statement is an underwritten offering or is made

<PAGE>

     through a placement or sales agent, to recommend the yield of such
     Registrable Securities, (B) indemnifying any such qualified independent
     underwriter to the extent of the indemnification of underwriters provided
     in Section 6 hereof (or to such other customary extent as may be reasonably
     requested by such underwriter), and (C) providing such information to such
     broker-dealer as may be required in order for such broker-dealer to comply
     with the requirements of the Conduct Rules; and

     (xx) comply with all applicable rules and regulations of the Commission,
     and make generally available to its securityholders (or otherwise provide
     in accordance with Section 11(a) of the Securities Act) as soon as
     practicable but in any event not later than eighteen months after the
     effective date of such Shelf Registration Statement, an earning statement
     of the Company and its subsidiaries complying with Section 11(a) of the
     Securities Act (including, at the option of the Company, Rule 158
     thereunder).

(e) In the event that the Company would be required, pursuant to Section
3(d)(viii)(F) hereof, to notify the Electing Holders, the placement or sales
agent, if any, therefor and the managing underwriters, if any, thereof, the
Company shall without delay prepare and furnish to each of the Electing Holders,
to each placement or sales agent, if any, and to each such underwriter, if any,
a reasonable number of copies of a prospectus supplemented or amended so that,
as thereafter delivered to purchasers of Registrable Securities, such prospectus
shall conform in all material respects to the applicable requirements of the
Securities Act and the Trust Indenture Act and the rules and regulations of the
Commission thereunder and shall not contain an untrue statement of a material
fact or omit to state a material fact required to be stated therein or necessary
to make the statements therein not misleading in light of the circumstances then
existing. Each Electing Holder agrees that upon receipt of any notice from the
Company pursuant to Section 3(d)(viii)(E) hereof, such Electing Holder shall
forthwith discontinue the disposition of Registrable Securities pursuant to the
Shelf Registration Statement applicable to such Registrable Securities until
such Electing Holder shall have received copies of such amended or supplemented
prospectus, and if so directed by the Company, such Electing Holder shall
deliver to the Company (at the Company's expense) all copies, other than
permanent file copies, then in such Electing Holder's possession of the
prospectus covering such Registrable Securities at the time of receipt of such
notice.

(f) In the event of a Shelf Registration, in addition to the information
required to be provided by each Electing Holder in its Notice Questionnaire, the
Company may require such Electing Holder to furnish to the Company such
additional information regarding such Electing Holder and such Electing Holder's
intended method of distribution of Registrable Securities as may be required in
order to comply with the Securities Act. Each such Electing Holder agrees to
notify the Company as promptly as practicable of any inaccuracy or change in
information previously furnished by such Electing Holder to the Company or of
the occurrence of any event in either case as a result of which any prospectus
relating to such Shelf Registration contains or would contain an untrue
statement of a material fact regarding such Electing Holder or such Electing
Holder's intended method of disposition of such Registrable Securities or omits
to state
<PAGE>

any material fact regarding such Electing Holder or such Electing Holder's
intended method of disposition of such Registrable Securities required to be
stated therein or necessary to make the statements therein not misleading in
light of the circumstances then existing, and promptly to furnish to the Company
any additional information required to correct and update any previously
furnished information or required so that such prospectus shall not contain,
with respect to such Electing Holder or the disposition of such Registrable
Securities, an untrue statement of a material fact or omit to state a material
fact required to be stated therein or necessary to make the statements therein
not misleading in light of the circumstances then existing.

(g) Until the expiration of two years after the Closing Date, the Company will
not, and will use reasonable best efforts not to permit any of its "affiliates"
(as defined in Rule 144) to, resell any of the Securities that have been
reacquired by any of them except pursuant to an effective registration statement
under the Securities Act.

<PAGE>

4.   Registration Expenses.

     The Company agrees to bear and to pay or cause to be paid promptly all
expenses incident to the Company's performance of or compliance with this
Exchange and Registration Rights Agreement, including (a) all Commission and any
NASD registration, filing and review fees and expenses including fees and
disbursements of counsel for the placement or sales agent or underwriters in
connection with such registration, filing and review, (b) all fees and expenses
in connection with the qualification of the Securities for offering and sale
under the State securities and blue sky laws referred to in Section 3(d)(xii)
hereof and determination of their eligibility for investment under the laws of
such jurisdictions as any managing underwriters or the Electing Holders may
designate, including any fees and disbursements of counsel for the Electing
Holders or underwriters in connection with such qualification and determination,
(c) all expenses relating to the preparation, printing, production, distribution
and reproduction of each registration statement required to be filed hereunder,
each prospectus included therein or prepared for distribution pursuant hereto,
each amendment or supplement to the foregoing, the expenses of preparing the
Securities for delivery and the expenses of printing or producing any
underwriting agreements, agreements among underwriters, selling agreements and
blue sky or legal investment memoranda and all other documents in connection
with the offering, sale or delivery of Securities to be disposed of (including
certificates representing the Securities), (d) messenger, telephone and delivery
expenses relating to the offering, sale or delivery of Securities and the
preparation of documents referred in clause (c) above, (e) the reasonable fees
and expenses of the Trustee under the Indenture, any agent of the Trustee and
any counsel for the Trustee and of any collateral agent or custodian, (f)
internal expenses (including all salaries and expenses of the Company's officers
and employees performing legal or accounting duties), (g) the reasonable fees,
disbursements and expenses of counsel and independent certified public
accountants of the Company (including the expenses of any opinions or "cold
comfort" letters required by or incident to such performance and compliance),
(h) fees, disbursements and expenses of any "qualified independent underwriter"
engaged pursuant to Section 3(d)(xix) hereof, (i) reasonable fees, disbursements
and expenses of one counsel for the Electing Holders retained in connection with
a Shelf Registration, as selected by the Electing Holders of at least a majority
in aggregate principal amount of the Registrable Securities held by Electing
Holders (which counsel shall be reasonably satisfactory to the Company), (j) any
fees charged by securities rating services for rating the Securities, and (k)
fees, expenses and disbursements of any other persons, including special
experts, retained by the Company in connection with such registration
(collectively, the "Registration Expenses"). To the extent that any Registration
Expenses are incurred, assumed or paid by any holder of Registrable Securities
or any placement or sales agent therefor or underwriter thereof, the Company
shall reimburse such person for the full amount of the Registration Expenses so
incurred, assumed or paid promptly after receipt of a request therefor.
Notwithstanding the foregoing, the holders of the Registrable Securities being
registered shall pay all agency fees and commissions and underwriting discounts
and commissions and transfer taxes, if any, attributable to the sale of such
Registrable Securities and the fees and disbursements of any counsel or other
advisors or experts retained by such holders (severally or jointly), other than
the counsel and experts specifically referred to above.
<PAGE>

5.   Representations and Warranties.

     The Company represents and warrants to, and agrees with, each Purchaser and
each of the holders from time to time of Registrable Securities that:

     (a) Each registration statement covering Registrable Securities and each
     prospectus (including any preliminary or summary prospectus) contained
     therein or furnished pursuant to Section 3(d) or Section 3(c) hereof and
     any further amendments or supplements to any such registration statement or
     prospectus, when it becomes effective or is filed with the Commission, as
     the case may be, and, in the case of an underwritten offering of
     Registrable Securities, at the time of the closing under the underwriting
     agreement relating thereto, will conform in all material respects to the
     requirements of the Securities Act and the Trust Indenture Act and the
     rules and regulations of the Commission thereunder and will not contain an
     untrue statement of a material fact or omit to state a material fact
     required to be stated therein or necessary to make the statements therein
     not misleading in light of the circumstances then existing; and at all
     times subsequent to the Effective Time when a prospectus would be required
     to be delivered under the Securities Act, other than from (i) such time as
     a notice has been given to holders of Registrable Securities pursuant to
     Section 3(d)(viii)(F) or Section 3(c)(iii)(F) hereof until (ii) such time
     as the Company furnishes an amended or supplemented prospectus pursuant to
     Section 3(e) or Section 3(c)(iv) hereof, each such registration statement,
     and each prospectus (including any summary prospectus) contained therein or
     furnished pursuant to Section 3(d) or Section 3(c) hereof, as then amended
     or supplemented, will conform in all material respects to the requirements
     of the Securities Act and the Trust Indenture Act and the rules and
     regulations of the Commission thereunder and will not contain an untrue
     statement of a material fact or omit to state a material fact required to
     be stated therein or necessary to make the statements therein not
     misleading in the light of the circumstances then existing; provided,
     however, that this representation and warranty shall not apply to any
     statements or omissions made in reliance upon and in conformity with
     information furnished in writing to the Company by a holder of Registrable
     Securities expressly for use therein.

     (b) Any documents incorporated by reference in any prospectus referred to
     in Section 5(a) hereof, when they become or became effective or are or were
     filed with the Commission, as the case may be, will conform or conformed in
     all material respects to the requirements of the Securities Act or the
     Exchange Act, as applicable, and none of such documents will contain or
     contained an untrue statement of a material fact or will omit or omitted to
     state a material fact required to be stated therein or necessary to make
     the statements therein not misleading; provided, however, that this
     representation and warranty shall not apply to any statements or omissions
     made in reliance upon and in conformity with information furnished in
     writing to the Company by a holder of Registrable Securities expressly for
     use therein.
<PAGE>

     (c) The compliance by the Company with all of the provisions of this
     Agreement and the consummation of the transactions herein contemplated will
     not conflict with or result in a breach of any of the terms or provisions
     of, or constitute a default under, any indenture, mortgage, deed of trust,
     loan agreement or other agreement or instrument to which the Company or any
     subsidiary of the Company is a party or by which the Company or any
     subsidiary of the Company is bound or to which any of the property or
     assets of the Company or any subsidiary of the Company is subject, nor will
     such action result in any violation of the provisions of the certificate of
     incorporation, as amended, or the by-laws of the Company or the Guarantors
     or any statute or any order, rule or regulation of any court or
     governmental agency or body having jurisdiction over the Company or any
     subsidiary of the Company or any of their properties; and no consent,
     approval, authorization, order, registration or qualification of or with
     any such court or governmental agency or body is required for the
     consummation by the Company and the Guarantors of the transactions
     contemplated by this Agreement, except the registration under the
     Securities Act of the Securities, qualification of the Indenture under the
     Trust Indenture Act and such consents, approvals, authorizations,
     registrations or qualifications as may be required under State securities
     or blue sky laws in connection with the offering and distribution of the
     Securities, except as would not materially adversely affect the
     consummation of the transactions contemplated by this Agreement.

     (d) This Agreement has been duly authorized, executed and delivered by the
     Company.

6.   Indemnification.

(a) Indemnification by the Company and the Guarantors. The Company and the
Guarantors, jointly and severally, will indemnify and hold harmless each of the
holders of Registrable Securities included in an Exchange Registration
Statement, each of the Electing Holders of Registrable Securities included in a
Shelf Registration Statement and each person who participates as an underwriter
in any offering or sale of such Registrable Securities against any losses,
claims, damages or liabilities, joint or several, to which such holder, agent or
underwriter may become subject under the Securities Act or otherwise, insofar as
such losses, claims, damages or liabilities (or actions in respect thereof)
arise out of or are based upon an untrue statement or alleged untrue statement
of a material fact contained in any Exchange Registration Statement or Shelf
Registration Statement, as the case may be, under which such Registrable
Securities were registered under the Securities Act, or any preliminary, final
or summary prospectus contained therein or furnished by the Company to any such
holder, Electing Holder, agent or underwriter, or any amendment or supplement
thereto, or arise out of or are based upon the omission or alleged omission to
state therein a material fact required to be stated therein or necessary to make
the statements therein in light of circumstances then existing, not misleading,
and will reimburse such holder, such Electing Holder, such agent and such
underwriter for any legal or other expenses reasonably incurred by them in
connection with investigating or defending any such action or claim as such
expenses are incurred; provided,
<PAGE>

however, that neither the Company nor the Guarantors shall be liable to any such
person in any such case to the extent that any such loss, claim, damage or
liability arises out of or is based upon an untrue statement or alleged untrue
statement or omission or alleged omission made in such registration statement,
or preliminary, final or summary prospectus, or amendment or supplement thereto,
in reliance upon and in conformity with written information furnished to the
Company by or on behalf of such person expressly for use therein.

(b) Indemnification by the Holders and any Agents and Underwriters. The Company
may require, as a condition to including any Registrable Securities in any
registration statement filed pursuant to Section 2(b) hereof and to entering
into any underwriting agreement with respect thereto, that the Company shall
have received an undertaking reasonably satisfactory to it from the Electing
Holder of such Registrable Securities and from each underwriter named in any
such underwriting agreement, severally and not jointly, to (i) indemnify and
hold harmless the Company, the Guarantors, and all other holders of Registrable
Securities, against any losses, claims, damages or liabilities to which the
Company, the Guarantors or such other holders of Registrable Securities may
become subject, under the Securities Act or otherwise, insofar as such losses,
claims, damages or liabilities (or actions in respect thereof) arise out of or
are based upon an untrue statement or alleged untrue statement of a material
fact contained in such registration statement, or any preliminary, final or
summary prospectus contained therein or furnished by the Company to any such
Electing Holder, agent or underwriter, or any amendment or supplement thereto,
or arise out of or are based upon the omission or alleged omission to state
therein a material fact required to be stated therein or necessary to make the
statements therein in light of circumstances then existing, not misleading, in
each case to the extent, but only to the extent, that such untrue statement or
alleged untrue statement or omission or alleged omission was made in reliance
upon and in conformity with written information furnished to the Company by such
Electing Holder or underwriter expressly for use therein, and (ii) reimburse the
Company and the Guarantors for any legal or other expenses reasonably incurred
by the Company and the Guarantors in connection with investigating or defending
any such action or claim as such expenses are incurred; provided, however, that
no such Electing Holder shall be required to undertake liability to any person
under this Section 6(b) for any amounts in excess of the dollar amount of the
proceeds to be received by such Electing Holder from the sale of such Electing
Holder's Registrable Securities pursuant to such registration.

(c) Notices of Claims, Etc. Promptly after receipt by an indemnified party under
Section 6(a) or 6(b) hereof of written notice of the commencement of any action,
such indemnified party shall, if a claim in respect thereof is to be made
against an indemnifying party pursuant to the indemnification provisions of or
contemplated by this Section 6, notify such indemnifying party in writing of the
commencement of such action; but the omission so to notify the indemnifying
party shall not relieve it from any liability which it may have to any
indemnified party otherwise than under the indemnification provisions of or
contemplated by Section 6(a) or 6(b) hereof. In case any such action shall be
brought against any indemnified party and it shall notify an indemnifying party
of the commencement thereof, such indemnifying
<PAGE>

party shall be entitled to participate therein and, to the extent that it shall
wish, jointly with any other indemnifying party similarly notified, to assume
the defense thereof, with counsel reasonably satisfactory to such indemnified
party (who shall not, except with the consent of the indemnified party, be
counsel to the indemnifying party), and, after notice from the indemnifying
party to such indemnified party of its election so to assume the defense
thereof, such indemnifying party shall not be liable to such indemnified party
for any legal expenses of other counsel or any other expenses, in each case
subsequently incurred by such indemnified party, in connection with the defense
thereof other than reasonable costs of investigation. No indemnifying party
shall, without the written consent of the indemnified party, effect the
settlement or compromise of, or consent to the entry of any judgment with
respect to, any pending or threatened action or claim in respect of which
indemnification or contribution may be sought hereunder (whether or not the
indemnified party is an actual or potential party to such action or claim)
unless such settlement, compromise or judgment (i) includes an unconditional
release of the indemnified party from all liability arising out of such action
or claim and (ii) does not include a statement as to or an admission of fault,
culpability or a failure to act by or on behalf of any indemnified party.

(d) Contribution. If for any reason the indemnification provisions contemplated
by Section 6(a) or Section 6(b) hereof are unavailable to or insufficient to
hold harmless an indemnified party in respect of any losses, claims, damages or
liabilities (or actions in respect thereof) referred to therein, then each
indemnifying party shall contribute to the amount paid or payable by such
indemnified party as a result of such losses, claims, damages or liabilities (or
actions in respect thereof) in such proportion as is appropriate to reflect the
relative fault of the indemnifying party and the indemnified party in connection
with the statements or omissions which resulted in such losses, claims, damages
or liabilities (or actions in respect thereof), as well as any other relevant
equitable considerations. The relative fault of such indemnifying party and
indemnified party shall be determined by reference to, among other things,
whether the untrue or alleged untrue statement of a material fact or omission or
alleged omission to state a material fact relates to information supplied by
such indemnifying party or by such indemnified party, and the parties' relative
intent, knowledge, access to information and opportunity to correct or prevent
such statement or omission. The parties hereto agree that it would not be just
and equitable if contributions pursuant to this Section 6(d) were determined by
pro rata allocation (even if the holders or any agents or underwriters or all of
them were treated as one entity for such purpose) or by any other method of
allocation which does not take account of the equitable considerations referred
to in this Section 6(d). The amount paid or payable by an indemnified party as a
result of the losses, claims, damages, or liabilities (or actions in respect
thereof) referred to above shall be deemed to include any legal or other fees or
expenses reasonably incurred by such indemnified party in connection with
investigating or defending any such action or claim. Notwithstanding the
provisions of this Section 6(d), no holder shall be required to contribute any
amount in excess of the amount by which the dollar amount of the proceeds
received by such holder from the sale of any Registrable Securities (after
deducting any fees, discounts and commissions applicable thereto) exceeds the
amount of any damages which such holder has otherwise been required to pay by
reason of such untrue or alleged untrue statement or omission or alleged
omission, and no underwriter shall be required to contribute any amount in
excess of the amount by which the total price at which the Registrable
Securities underwritten by it and distributed to the public were offered to the
public exceeds the amount of any damages which such underwriter has otherwise
been required to pay by reason of such untrue or alleged untrue statement or
<PAGE>

omission or alleged omission. No person guilty of fraudulent misrepresentation
(within the meaning of Section 11(f) of the Securities Act) shall be entitled to
contribution from any person who was not guilty of such fraudulent
misrepresentation. The holders' and any underwriters' obligations in this
Section 6(d) to contribute shall be several in proportion to the principal
amount of Registrable Securities registered or underwritten, as the case may be,
by them and not joint.

(e) The obligations of the Company and the Guarantors under this Section 6 shall
be in addition to any liability which the Company or the Guarantors may
otherwise have and shall extend, upon the same terms and conditions, to each
officer, director and partner of each holder, agent and underwriter and each
person, if any, who controls any holder, agent or underwriter within the meaning
of the Securities Act; and the obligations of the holders and any agents or
underwriters contemplated by this Section 6 shall be in addition to any
liability which the respective holder, agent or underwriter may otherwise have
and shall extend, upon the same terms and conditions, to each officer and
director of the Company or the Guarantors (including any person who, with his
consent, is named in any registration statement as about to become a director of
the Company or the Guarantors) and to each person, if any, who controls the
Company within the meaning of the Securities Act.

7.   Underwritten Offerings.

(a) Selection of Underwriters. If any of the Registrable Securities covered by
the Shelf Registration are to be sold pursuant to an underwritten offering, the
managing underwriter or underwriters thereof shall be designated by Electing
Holders holding at least a majority in aggregate principal amount of the
Registrable Securities to be included in such offering, provided that such
designated managing underwriter or underwriters is or are reasonably acceptable
to the Company.

(b) Participation by Holders. Each holder of Registrable Securities hereby
agrees with each other such holder that no such holder may participate in any
underwritten offering hereunder unless such holder (i) agrees to sell such
holder's Registrable Securities on the basis provided in any underwriting
arrangements approved by the persons entitled hereunder to approve such
arrangements and (ii) completes and executes all questionnaires, powers of
attorney, indemnities, underwriting agreements and other documents reasonably
required under the terms of such underwriting arrangements.

8.   Rule 144.

<PAGE>

   The Company covenants to the holders of Registrable Securities that to the
extent it shall be required to do so under the Exchange Act, the Company shall
timely file the reports required to be filed by it under the Exchange Act or the
Securities Act (including the reports under Section 13 and 15(d) of the Exchange
Act referred to in subparagraph (c)(1) of Rule 144 adopted by the Commission
under the Securities Act) and the rules and regulations adopted by the
Commission thereunder, and shall take such further action as any holder of
Registrable Securities may reasonably request, all to the extent required from
time to time to enable such holder to sell Registrable Securities without
registration under the Securities Act within the limitations of the exemption
provided by Rule 144 under the Securities Act, as such Rule may be amended from
time to time, or any similar or successor rule or regulation hereafter adopted
by the Commission. Upon the request of any holder of Registrable Securities in
connection with that holder's sale pursuant to Rule 144, the Company shall
deliver to such holder a written statement as to whether it has complied with
such requirements.

9. Miscellaneous.

(a) No Inconsistent Agreements. The Company represents, warrants, covenants and
agrees that it has not granted, and shall not grant, registration rights with
respect to Registrable Securities or any other securities which would be
inconsistent with the terms contained in this Agreement.

(b) Notices. All notices, requests, claims, demands, waivers and other
communications hereunder shall be in writing and shall be deemed to have been
duly given when delivered by hand, if delivered personally or by courier, or
three days after being deposited in the mail (registered or certified mail,
postage prepaid, return receipt requested) or when receipt is acknowledged if
telecopied as follows: If to the Company, to it at 13455 Noel Road, 20th Floor,
Dallas, Texas 75240, Attention: Donald P. Fay, with a copy to Dewey Ballantine
LLP, 1301 Avenue of the Americas, New York, New York 10019, Attention: Morton A.
Pierce, Esq., and if to a holder, to the address of such holder set forth in the
security register or other records of the Company, or to such other address as
the Company or any such holder may have furnished to the other in writing in
accordance herewith, except that notices of change of address shall be effective
only upon receipt.

(c) Parties in Interest. All the terms and provisions of this Agreement shall be
binding upon, shall inure to the benefit of and shall be enforceable by the
parties hereto and the holders from time to time of the Registrable Securities
and the respective successors and assigns of the parties hereto and such
holders. In the event that any transferee of any holder of Registrable
Securities shall acquire Registrable Securities, in any manner, whether by gift,
bequest, purchase, operation of law or otherwise, such transferee shall, without
any further writing or action of any kind, be deemed a beneficiary hereof for
all purposes and such Registrable Securities shall be held subject to all of the
terms of this Agreement, and by taking and holding such Registrable Securities
such transferee shall be entitled to receive the benefits of, and be
conclusively deemed to have agreed to be bound by all of the applicable terms
and
<PAGE>

provisions of this Agreement. If the Company shall so request, any such
successor, assign or transferee shall agree in writing to acquire and hold the
Registrable Securities subject to all of the applicable terms hereof.

(d) Survival. The respective indemnities, agreements, representations,
warranties and each other provision set forth in this Agreement or made pursuant
hereto shall remain in full force and effect regardless of any investigation (or
statement as to the results thereof) made by or on behalf of any holder of
Registrable Securities, any director, officer or partner of such holder, any
agent or underwriter or any director, officer or partner thereof, or any
controlling person of any of the foregoing, and shall survive delivery of and
payment for the Registrable Securities pursuant to the Purchase Agreement and
the transfer and registration of Registrable Securities by such holder and the
consummation of an Exchange Offer.

(e) Governing Law. This Agreement shall be governed by and construed in
accordance with the laws of the State of New York.

(f) Headings. The descriptive headings of the several Sections and paragraphs of
this Agreement are inserted for convenience only, do not constitute a part of
this Agreement and shall not affect in any way the meaning or interpretation of
this Agreement.

(g) Entire Agreement; Amendments. This Agreement and the other writings referred
to herein (including the Indenture and the form of Securities) or delivered
pursuant hereto which form a part hereof contain the entire understanding of the
parties with respect to its subject matter. This Agreement supersedes all prior
agreements and understandings between the parties with respect to its subject
matter. This Agreement may be amended and the observance of any term of this
Agreement may be waived (either generally or in a particular instance and either
retroactively or prospectively) only by a written instrument duly executed by
the Company and the holders of at least a majority in aggregate principal amount
of the Registrable Securities at the time outstanding. Each holder of any
Registrable Securities at the time or thereafter outstanding shall be bound by
any amendment or waiver effected pursuant to this Section 9(h), whether or not
any notice, writing or marking indicating such amendment or waiver appears on
such Registrable Securities or is delivered to such holder.

(h) Inspection. For so long as this Agreement shall be in effect, this Agreement
and a complete list of the names and addresses of all the holders of Registrable
Securities shall be made available on reasonable prior notice for inspection and
copying on any business day by any holder of Registrable Securities for proper
purposes only (which shall include any purpose related to the rights of the
holders of Registrable Securities under the Securities, the Indenture and this
Agreement) at the offices of the Company at the address thereof set forth in
Section 9(c) hereof and at the office of the Trustee under the Indenture.

<PAGE>

(i) Counterparts. This Agreement may be executed by the parties in counterparts,
each of which shall be deemed to be an original, but all such respective
counterparts shall together constitute one and the same instrument.
<PAGE>

     If the foregoing is in accordance with your understanding, please sign and
return to us one for the Company and the Representatives plus one for each
counsel counterparts hereof, and upon the acceptance hereof by you, on behalf of
each of the Purchasers, this letter and such acceptance hereof shall constitute
a binding agreement between each of the Purchasers and the Company. It is
understood that your acceptance of this letter on behalf of each of the
Purchasers is pursuant to the authority set forth in a form of Agreement among
Purchasers, the form of which shall be submitted to the Company for examination
upon request, but without warranty on your part as to the authority of the
signers thereof.
(a)


                                                  Very truly yours,


                                                  HEALTHTRUST, INC.-THE HOSPITAL
                                                    COMPANY

                                               By: /s/ R. Milton Johnson
                                                  ______________________________
                                                  Name: R. Milton Johnson
                                                  Title: Vice President

Accepted as of the date hereof:
Goldman, Sachs & Co.
NationsBanc Montgomery Securities LLC
Chase Securities Inc.
Salomon Smith Barney Inc.
SG Cowen Securities Corporation

By: /s/ Goldman, Sachs & Co.
   ______________________________
       (Goldman, Sachs & Co.)