EX-4.10





 Exhibit 4.10 

TWENTIETH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 27, 2019, among CHS/COMMUNITY
HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), the parties identified as New Subsidiary Guarantors on the signature pages hereto (each, a “New Subsidiary Guarantor” and, collectively, the “New
Subsidiary Guarantors”) and REGIONS BANK, as successor Trustee under the Indenture (the “Trustee”). 
 W I T N E S
S E T H: 
 WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended,
supplemented, waived or otherwise modified (the “Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 

WHEREAS, each of the undersigned New Subsidiary Guarantors has deemed it advisable and in its best interest to execute and deliver this
Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of
the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantors are authorized to execute and deliver this Supplemental Indenture. 

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

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

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

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

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK. 
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 












 SECTION 6. Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall
constitute effective execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other
electronic transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Effect of Headings. The
Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 
 [Signature page
follows] 

  
 2 













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

			
	 CHS/COMMUNITY HEALTH SYSTEMS, INC.,

a Delaware corporation

		
	By:	 	  /s/ Kevin J. Hammons                          
		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief Financial Officer, Chief Accounting Officer and Treasurer
	
	New Subsidiary Guarantors:
	
	HERNANDO HMA, LLC,
		 	a Florida limited liability company
	WARSAW HEALTH SYSTEM, LLC,
		 	a Delaware limited liability company
		
	By:	 	  /s/ Kevin J. Hammons                            
		 	Kevin J. Hammons
		 	Senior Vice President and Treasurer
	
	Acting on behalf of each of the New Subsidiary Guarantors set forth above



  
 [Signature Page to
Twentieth Supplemental Indenture (2019 Notes)] 













 
			
	REGIONS BANK, as Trustee
		
	By:	 	   /s/ Kristine Prall

		 	Kristine Prall
		 	Vice President


 [Signature Page to Twentieth Supplemental Indenture (2019 Notes)]