EX-10.19



 Exhibit 10.19 

SIXTH AMENDMENT TO RECEIVABLES LOAN AGREEMENT 

This SIXTH AMENDMENT TO RECEIVABLES LOAN AGREEMENT is made as of December 16, 2016 (this
“Amendment”), among CHS RECEIVABLES FUNDING, LLC, a Delaware limited liability company (“Receivables Funding”), as Borrower, THE BANK OF NOVA SCOTIA (“Scotia”), as a Committed Lender and as a
Managing Agent, CRÉDIT AGRICOLE CORPORATE AND INVESTMENT BANK (“CA-CIB”), as a Committed Lender, as a Managing Agent and as Administrative Agent, THE BANK OF TOKYO-MITSUBISHI UFJ, LTD. (“BTMU”), as a
Committed Lender and as a Managing Agent, ATLANTIC ASSET SECURITIZATION LLC (“Atlantic”), as a Conduit Lender, LIBERTY STREET FUNDING LLC (“Liberty Street”), as a Conduit Lender, VICTORY RECEIVABLES CORPORATION
(“Victory”), as a Conduit Lender, and CHSPSC, LLC (as successor-by-conversion to Community Health Systems Professional Services Corporation), a Delaware limited liability company (“Professional Services”), as
Collection Agent under the Receivables Loan Agreement, and is acknowledged and agreed by Receivables Funding, as the Company, Professional Services, as Collection Agent under each of the Contribution Agreement and the Sale Agreement, and as
Authorized Representative (as defined in the Sale Agreement, the “Authorized Representative”), CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (“CHS”), as Transferor, as Buyer and individually (as the
provider of a performance undertaking), and EACH OF THE OTHER PERSONS IDENTIFIED AS ORIGINATORS ON THE SIGNATURE PAGES HERETO AFFILIATED WITH CHS/COMMUNITY HEALTH SYSTEMS, INC., as Originators. All capitalized terms used herein without reference
shall have the meanings assigned to such terms in the Receivables Loan Agreement (as defined below) after giving effect to this Amendment. 

WHEREAS, Receivables Funding, as Borrower, Scotia, as a Committed Lender and as a Managing Agent, CA-CIB, as a Committed
Lender, as a Managing Agent and as Administrative Agent, BTMU, as a Committed Lender and as a Managing Agent, the other Lenders party thereto and Professional Services, as Collection Agent, have entered into the Receivables Loan Agreement, dated as
of March 21, 2012 (as amended, restated, supplemented or otherwise modified prior to the date hereof, the “Receivables Loan Agreement”); 

WHEREAS, CHS, as Transferor, Receivables Funding, as the Company, and Professional Services, as Collection Agent thereunder,
have entered into the Receivables Purchase and Contribution Agreement, dated as of March 21, 2012 (as amended, restated, supplemented or otherwise modified prior to the date hereof, the “Contribution Agreement”); 

WHEREAS, the Originators, Professional Services, as Collection Agent and Authorized Representative thereunder, and CHS, as
Buyer, have entered into the Receivables Sale Agreement, dated as of March 21, 2012 (as amended, restated, supplemented or otherwise modified prior to the date hereof, the “Sale Agreement”); 

WHEREAS, the parties hereto desire to amend certain provisions of the Receivables Loan Agreement pursuant to
Section 10.01 of the Receivables Loan Agreement, Section 9.01 of the Contribution Agreement, and Section 9.01 of the Sale Agreement and take the other actions set forth herein, and have agreed to do so subject to the terms and
conditions of this Amendment. 







 NOW, THEREFORE, in consideration of the agreements hereinafter set forth, and
for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, the parties hereto agree as follows: 

SECTION 1. Amendment to Receivables Loan Agreement. Subject to all of the terms and conditions set forth in this
Amendment effective as of the Effective Date (as defined below), the Receivables Loan Agreement is hereby amended as follows: 

(a) Section 1.01 of the Receivables Loan Agreement is amended by inserting the following definitions in the appropriate
alphabetical order: 
 “Consent Fee Letter” means that certain fee letter dated as of the Sixth Amendment
Effective Date, by and among the Borrower, each Managing Agent and the Administrative Agent. 
 “Sixth Amendment
Effective Date” means December 16, 2016. 
 (b) Section 2.06 of the Receivables Loan Agreement is amended
by adding a new clause (l) to the end thereof to read as follows: 
 (l) On the Sixth Amendment
Effective Date, the Borrower shall pay to the Administrative Agent for its own benefit and the benefit of each Managing Agent and each Lender, as applicable, the fees set forth in the Consent Fee Letter that are due and payable on such date. 

(c) Section 7.01(r) of the Receivables Loan Agreement is amended and restated in its entirety to read as follows: 

(r) CHS or any subsidiary thereof shall fail to perform or observe any term, covenant or agreement contained
in (i) Section 6.12 or Section 6.13 of the Parent Credit Agreement as in effect on the Sixth Amendment Effective Date or (ii) Section 6.12 or Section 6.13 of the Parent Credit Agreement as in effect from time to time
thereafter, in each case, without regard to any waiver or modification to any of those provisions or any of the defined terms used therein and such failure shall continue for a period of 10 Business Days after the date on which financial statements
are required to be delivered with respect to the applicable fiscal quarter hereunder (the “Financial Covenant Cure Period”); or 

(d) The second paragraph of Section 7.01 is amended and restated in its entirety to read as follows: 

Notwithstanding anything to the contrary contained in this Article VII, during the Financial Covenant Cure
Period and in addition to the Borrower’s rights under Section 2.04(d), the Parent may issue Qualified Capital Stock (as defined in the Parent Credit Agreement) and elect to treat all or any portion of the net cash proceeds thereof as
having 

  
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increased Consolidated EBITDA (as defined in the Parent Credit Agreement) with respect to such applicable quarter solely for the purpose of determining actual and pro forma compliance with
Section 6.12 or Section 6.13 of the Parent Credit Agreement whether as in effect on the Sixth Amendment Effective Date or as in effect from time to time thereafter for purposes of Section 7.01(r) at the end of such applicable
quarter and applicable subsequent periods, provided that (a) such proceeds (i) are actually received by the Parent and contributed to CHS no later than ten days after the date on which financial statements are required to be
delivered with respect to such fiscal quarter hereunder and (ii) do not exceed the aggregate amount necessary to cause Parent to be in compliance with the covenants under Section 6.12 or Section 6.13 of the Parent Credit Agreement
whether as in effect on the Sixth Amendment Effective Date or as in effect from time to time thereafter for purposes of Section 7.01(r) for any applicable period and (b) in each period of four fiscal quarters, there shall be at
least two fiscal quarters in which no such right to cure permitted by this paragraph is utilized. 
 SECTION 2.
Conditions to Effectiveness. This Amendment shall become effective upon the date on which the following conditions have been satisfied (with respect to documentary conditions, in form and substance reasonably acceptable to the Administrative
Agent) (such date, the “Effective Date”): 
 (a) The Administrative Agent shall have received counterparts
of (i) this Amendment duly executed by each of the Borrower, the Collection Agent, the Managing Agents, the Committed Lenders, the Conduit Lenders and the Administrative Agent and counterparts evidencing acknowledgment and agreement duly
executed by each of the Company, the Collection Agent (as Collection Agent under each of the Contribution Agreement and the Sale Agreement), the Authorized Representative, the Transferor, the Buyer, CHS individually and the Originators and
(ii) the Consent Fee Letter duly executed by each of the Borrower, the Collection Agent, the Managing Agents, the Committed Lenders, the Conduit Lenders and the Administrative Agent. 

(b) All fees and expenses required to be paid prior to an Advance under the Receivables Loan Agreement (as amended by this
Amendment) pursuant to (i) the Receivables Loan Agreement (as amended by this Amendment) and (ii) the Consent Fee Letter shall have been paid. 

(c) Each Managing Agent and the Administrative Agent shall have completed satisfactory due diligence and obtained the
requisite credit approvals. 
 SECTION 3. Representations and Warranties. 

(a) Each of the Borrower and the Collection Agent represents and warrants as of the date hereof that (i) it has taken
all necessary action to authorize the execution, delivery and performance of this Amendment and the performance of the Receivables Loan Agreement and the other Facility Documents, each as amended hereby, as applicable, and (ii) no consent,
approval, authorization or order of, or filing, registration or qualification with, any court or governmental authority or third party is required in connection with the execution, delivery or performance by such Person of this Amendment other than
such as has been met or obtained and are in full force and effect. 

  
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 (b) Each of the Borrower and the Collection Agent represents and warrants as of
the date hereof that each of this Amendment and each Facility Document (as amended by this Amendment or otherwise as of the date hereof, as applicable) constitutes such Person’s legal, valid and binding obligation, enforceable against such
person in accordance with its terms, except as such enforceability may be subject to (A) bankruptcy, insolvency, reorganization, fraudulent conveyance or transfer, moratorium or similar laws affecting creditors’ rights generally and
(B) general principles of equity (regardless of whether such enforceability is considered in a proceeding at law or in equity). 

(c) The Borrower hereby makes each of the representations and warranties contained in Sections 4.01 and 4.03 of the
Receivables Loan Agreement as of the date hereof, in each case after giving effect to this Amendment, except for those representations and warranties that refer to specific dates, which are made as of the dates indicated therein. 

(d) The Collection Agent hereby makes each of the representations and warranties contained in Section 4.02 of the
Receivables Loan Agreement as of the date hereof, in each case after giving effect to this Amendment, except for those representations and warranties that refer to specific dates, which are made as of the dates indicated therein. 

(e) Each of the Borrower and the Collection Agent further represents and warrants that, both before and after giving effect
to this Amendment, no event has occurred and is continuing which constitutes an Event of Default, or would, with the passage of time or the giving of notice, constitute an Event of Default. 

SECTION 4. Facility Document. This Amendment shall constitute a Facility Document under the terms of the Receivables
Loan Agreement as amended hereby. 
 SECTION 5. Further Assurances. The Borrower and the Collection Agent agree to
promptly take such action, upon the reasonable request of the Administrative Agent, as is necessary to carry out the intent of this Amendment. 

SECTION 6. Confirmation of Agreement. On and after the date hereof, all references to the Receivables Loan Agreement in
the Facility Documents and the other documents and instruments delivered pursuant to or in connection with such Facility Documents shall mean the Receivables Loan Agreement as amended by this Amendment, and as hereafter modified, amended or restated
in accordance with its terms. Except as herein expressly amended, the Receivables Loan Agreement is ratified and confirmed in all respects and shall remain in full force and effect in accordance with its terms. 

SECTION 7. Confirmation of Undertaking. CHS, as undertaking party under the Collection Agent Performance Undertaking,
dated as of March 21, 2012 (as amended, restated, supplemented or otherwise modified prior to the date hereof, the “Performance Undertaking”), in favor of CA-CIB as administrative agent on behalf of the Lenders, hereby consents
to the amendment to the Receivables Loan Agreement set forth in Section 1 of this Amendment, and hereby confirms and agrees that, notwithstanding the effectiveness of this Amendment, the Performance Undertaking heretofore executed and delivered
by it is, and shall continue to be, in 

  
 4 








 
full force and effect in accordance with its terms and shall apply to the Receivables Loan Agreement (as amended by this Amendment), the Contribution Agreement and the Sale Agreement and the
Performance Undertaking is hereby so ratified and confirmed. 
 SECTION 8. GOVERNING LAW. THIS AMENDMENT SHALL, IN
ACCORDANCE WITH SECTION 5-1401 OF THE GENERAL OBLIGATIONS LAW OF THE STATE OF NEW YORK, BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. EACH OF THE PARTIES HERETO HEREBY SUBMITS TO THE EXCLUSIVE JURISDICTION OF
THE STATE AND FEDERAL COURTS OF THE UNITED STATES AND THE NON-EXCLUSIVE JURISDICTION OF THE STATE AND FEDERAL COURTS SITTING IN NEW YORK COUNTY, NEW YORK IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS AMENDMENT, ANY OTHER FACILITY
DOCUMENT, ANY OTHER DOCUMENT DELIVERED PURSUANT HERETO OR THERETO, OR THE TRANSACTIONS CONTEMPLATED HEREBY OR THEREBY. EACH OF THE PARTIES HERETO HEREBY WAIVES ANY OBJECTION BASED ON FORUM NON CONVENIENS THE MAINTENANCE OF ANY SUCH ACTION OR
PROCEEDING AND CONSENTS TO THE GRANTING OF SUCH LEGAL OR EQUITABLE RELIEF AS IS DEEMED APPROPRIATE BY SUCH COURT. 
 SECTION
9. Execution in Counterparts. This Amendment may be executed in any number of counterparts and by different parties hereto in separate counterparts, each of which when so executed shall be deemed to be an original and all of which when taken
together shall constitute one and the same agreement. Delivery of an executed counterpart of a signature page to this Amendment by facsimile or by electronic mail in portable document format (pdf) shall be effective as delivery of a manually
executed counterpart of this Amendment. 
 SECTION 10. Severability of Provisions. Any provision of this Amendment
which is prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof or affecting the validity or
enforceability of such provision in any other jurisdiction. 
 SECTION 11. Headings. Section headings used herein are
for convenience of reference only, are not part of this Amendment and shall not affect the construction of, or be taken into consideration in interpreting, this Amendment. 

[Signature Pages Follow] 

  
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 IN WITNESS WHEREOF, this Amendment has been duly executed as of the date first written above.

  

					
	CHS RECEIVABLES FUNDING, LLC,
as Borrower
		
	 By:  
	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	 Title:
	 	Vice President and Treasurer
	
	 CHS Receivables Funding, LLC

4000 Meridian Boulevard

Franklin, Tennessee 37067

Attention: Rachel A. Seifert

Telephone No: (615) 465-7000

Facsimile No: (615) 373-9704

Email: rachel_seifert@chs.net

	
	CHSPSC, LLC, as Collection Agent under the Receivables Loan Agreement
		
	 By:
	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	 Vice President and Treasurer

	
	 CHSPSC, LLC

	 4000 Meridian Boulevard

Franklin, Tennessee 37067

Attention: Rachel A. Seifert

Telephone No: (615) 465-7000

Facsimile No: (615) 373-9704

Email: rachel_seifert@chs.net




  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	CRÉDIT AGRICOLE CORPORATE AND INVESTMENT BANK, as Administrative Agent, as a Managing Agent and as a Committed Lender
		
	By:  	 	 /s/ Kostantina Kourmpetis

		 	Name:	 	Kostantina Kourmpetis
		 	Title:	 	Managing Director
		
	By:	 	 /s/ Michael Regan

		 	Name:	 	Michael Regan
		 	Title:	 	Managing Director
	
	 Crédit Agricole CIB
 1301
Avenue of the Americas
 New York, NY 10019
 Attention: Sunny
Gulrajani
 Telephone No: (212) 261-7845
 Facsimile No:
(917) 849-5584
 Email: sunny.gulrajani@ca-cib.com

	
	ATLANTIC ASSET SECURITIZATION LLC, as a Conduit Lender
		
	By:	 	 CRÉDIT AGRICOLE CORPORATE AND INVESTMENT BANK,

as attorney-in-fact

		
	By:	 	 /s/ Kostantina Kourmpetis

		 	Name:	 	Kostantina Kourmpetis
		 	Title:	 	Managing Director
		
	By:	 	 /s/ Michael Regan

		 	Name:	 	Michael Regan
		 	Title:	 	Managing Director
	
	 Atlantic Asset Securitization
 c/o
Crédit Agricole CIB
 1301 Avenue of the Americas
 New
York, NY 10019
 Attention: Sunny Gulrajani
 Telephone No:
(212) 261-7845
 Facsimile No: (917) 849-5584
 Email:
sunny.gulrajani@ca-cib.com




  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	THE BANK OF NOVA SCOTIA, as a Managing
Agent and as a Committed Lender
		
	By:  	 	 /s/ Michelle C. Phillips

		 	Name:	 	Michelle C. Phillips
		 	Title:	 	Director and Execution Head
	
	LIBERTY STREET FUNDING LLC,
as a Conduit Lender
		
	By:	 	  

		 	Name:	 	
		 	Title:	 	



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 









							
	     
	 	THE BANK OF NOVA SCOTIA, as a Managing
Agent and as a Committed Lender
			
		 	By:  	 	     

		 		 	Name:	  	
		 		 	Title:	  	
		
		 	LIBERTY STREET FUNDING LLC,
as a Conduit Lender
			
		 	By:	 	 /s/ Jill A. Russo

		 		 	Name:	  	Jill A. Russo
		 		 	Title:	  	Vice President


  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 









							
	     
	  	THE BANK OF TOKYO-MITSUBISHI UFJ, LTD.,
as a Managing Agent
			
		  	By:  	 	 /s/ Christopher Pohl

		  		 	Name:	 	Christopher Pohl
		  		 	Title:	 	Managing Director
		
		  	THE BANK OF TOKYO-MITSUBISHI UFJ, LTD.,
as a Committed Lender
			
		  	By:	 	 /s/ Christopher Pohl

		  		 	Name:	 	Christopher Pohl
		  		 	Title:	 	Managing Director
		
		  	VICTORY RECEIVABLES CORPORATION,
as a Conduit Lender
			
		  	By:	 	 /s/ David V. DeAngelis

		  		 	Name:	 	David V. DeAngelis
		  		 	Title:	 	Vice President


  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 ACKNOWLEDGED AND AGREED: 
  

							
		 	CHS RECEIVABLES FUNDING, LLC,
as Company
			
		 	By:  	 	 /s/ Edward W. Lomicka

		 		 	Name:	 	Edward W. Lomicka
		 		 	Title:	 	Vice President and Treasurer
		
		 	 CHS Receivables Funding, LLC

4000 Meridian Boulevard
 Franklin, Tennessee 37067

Attention: Rachel A. Seifert
 Telephone No: (615) 465-7000

Facsimile No: (615) 373-9704
 Email:
rachel_seifert@chs.net

		
		 	 CHSPSC, LLC,
 as Collection Agent
under each of the Contribution Agreement and the Sale Agreement and as Authorized Representative

			
		 	By:	 	 /s/ Edward W. Lomicka

		 		 	Name:	 	Edward W. Lomicka
		 		 	Title:	 	Vice President and Treasurer
		
		 	 CHSPSC, LLC
 4000 Meridian
Boulevard
 Franklin, Tennessee 37067
 Attention: Rachel A.
Seifert
 Telephone No: (615) 465-7000
 Facsimile No: (615)
373-9704
 Email: rachel_seifert@chs.net



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 ACKNOWLEDGED AND AGREED: 

 

					
	CHS/COMMUNITY HEALTH SYSTEMS, INC.,
as Transferor, as Buyer and individually
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 ACKNOWLEDGED AND AGREED: 

 

					
	ORIGINATORS:
	
	 AFFINITY HOSPITAL, LLC
 BERWICK
HOSPITAL COMPANY, LLC
 BLUEFIELD HOSPITAL COMPANY, LLC

BLUFFTON HEALTH SYSTEM LLC
 BULLHEAD CITY HOSPITAL CORPORATION

CARLSBAD MEDICAL CENTER, LLC
 CLEVELAND TENNESSEE HOSPITAL
COMPANY, LLC
 COATESVILLE HOSPITAL CORPORATION

CRESTVIEW HOSPITAL CORPORATION
 DEACONESS HEALTH SYSTEM, LLC

DUKES HEALTH SYSTEM, LLC
 DYERSBURG HOSPITAL CORPORATION

EMPORIA HOSPITAL CORPORATION
 FOLEY HOSPITAL CORPORATION

FRANKLIN HOSPITAL CORPORATION
 GADSDEN REGIONAL MEDICAL
CENTER, LLC
 GRANBURY HOSPITAL CORPORATION

GREENBRIER VMC, LLC
 HOSPITAL OF MORRISTOWN, INC.

JACKSON, TENNESSEE HOSPITAL
 COMPANY, LLC

JOURDANTON HOSPITAL CORPORATION
 KAY COUNTY OKLAHOMA
HOSPITAL COMPANY, LLC
 LAKE WALES HOSPITAL CORPORATION

LANCASTER HOSPITAL CORPORATION
 LAS CRUCES MEDICAL CENTER, LLC

LEA REGIONAL HOSPITAL, LLC
 MARTIN HOSPITAL CORPORATION

MARY BLACK HEALTH SYSTEM LLC
 MCSA, L.L.C.

MOBERLY HOSPITAL COMPANY, LLC

		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	ORIGINATORS (CONT.):
	
	 NATIONAL HEALTHCARE OF LEESVILLE, INC.

NORTHAMPTON HOSPITAL COMPANY, LLC
 NORTHWEST HOSPITAL,
LLC
 ORO VALLEY HOSPITAL, LLC
 PETERSBURG HOSPITAL COMPANY,
LLC
 PHOENIXVILLE HOSPITAL COMPANY, LLC
 POTTSTOWN HOSPITAL
COMPANY, LLC
 PORTER HOSPITAL, LLC
 QHG OF ENTERPRISE, INC.

QHG OF SOUTH CAROLINA, INC.
 ROSWELL HOSPITAL CORPORATION

RUSTON LOUISIANA HOSPITAL COMPANY, LLC
 SCRANTON HOSPITAL COMPANY,
LLC
 SHELBYVILLE HOSPITAL CORPORATION
 SILOAM SPRINGS ARKANSAS
HOSPITAL COMPANY, LLC
 SPOKANE VALLEY WASHINGTON HOSPITAL COMPANY, LLC

SPOKANE WASHINGTON HOSPITAL COMPANY, LLC
 ST.
JOSEPH HEALTH SYSTEM LLC TOMBALL TEXAS HOSPITAL COMPANY, LLC
 WARREN OHIO HOSPITAL COMPANY, LLC

WARREN OHIO REHAB HOSPITAL COMPANY, LLC
 WARSAW HEALTH SYSTEM
LLC
 WEATHERFORD TEXAS HOSPITAL COMPANY, LLC
 WESLEY HEALTH
SYSTEM, LLC
 WEST GROVE HOSPITAL COMPANY, LLC
 WILKES-BARRE
HOSPITAL COMPANY, LLC
 WOMEN & CHILDREN’S HOSPITAL, LLC

YOUNGSTOWN OHIO HOSPITAL COMPANY, LLC

		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	ORIGINATORS (CONT.):
	
	 KIRKSVILLE MISSOURI HOSPITAL COMPANY, LLC

LUTHERAN MUSCULOSKELETAL CENTER, LLC
 OAK HILL HOSPITAL
CORPORATION SALEM HOSPITAL CORPORATION SCRANTON QUINCY HOSPITAL COMPANY, LLC
 WOODWARD HEALTH SYSTEM, LLC

		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	ORIGINATORS (CONT.):
	
	 AMORY HMA, LLC
 ANNISTON HMA,
LLC
 BILOXI H.M.A., LLC
 BRANDON HMA, LLC

CAMPBELL COUNTY HMA, LLC CARLISLE HMA, LLC
 CHESTER HMA, LLC

CITRUS HMA, LLC
 CLARKSDARE HMA, LLC

CLINTON HMA, LLC
 COCKE COUNTY HMA, LLC

DURANT H.M.A., LLC
 EAST GEORGIA REGIONAL MEDICAL CENTER, LLC

FORT SMITH HMA, LLC
 HAINES CITY HMA, LLC

HERNANDO HMA, LLC
HMA FENTRESS COUNTY GENERAL HOSPITAL, LLC

HMA SANTA ROSA MEDICAL CENTER, LLC
 JACKSON HMA, LLC

JEFFERSON COUNTY HMA, LLC
 KEY WEST HMA, LLC

LANCASTER HMA, LLC
 LEBANON HMA, LLC

MADISON HMA, LLC
 MARSHALL COUNTY HMA, LLC

MELBOURNE HMA, LLC
 METRO KNOXVILLE HMA, LLC

MIDWEST REGIONAL MEDICAL CENTER, LLC

		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	ORIGINATORS (CONT.):
	
	NORTHWEST ARKANSAS HOSPITALS, LLC
	PASCO REGIONAL MEDICAL CENTER, LLC
	POPLAR BLUFF REGIONAL MEDICAL
	CENTER, LLC
	PORT CHARLOTTE HMA, LLC
	PUNTA GORDA HMA, LLC
	RIVER OAKS HOSPITAL, LLC
	ROCKLEDGE HMA, LLC
	ROH, LLC
	ROSE CITY HMA, LLC
	SEBASTIAN HOSPITAL, LLC
	SEBRING HOSPITAL MANAGEMENT
	ASSOCIATES, LLC
	SEMINOLE HMA, LLC
	STATESVILLE HMA, LLC
	TRIAD OF ALABAMA, LLC
	TULLAHOMA HMA, LLC
	TUNKHANNOCK HOSPITAL COMPANY LLC
	VENICE HMA, LLC
	VICKSBURG HEALTHCARE, LLC
	YAKIMA HMA, LLC
	YORK PENNSYLVANIA HOSPITAL
	COMPANY, LLC
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 









					
	ORIGINATORS (CONT.):
	
	BROWNWOOD HOSPITAL, L.P.
	By:	 	Brownwood Medical Center, LLC
	Its:	 	General Partner
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	COLLEGE STATION HOSPITAL, L.P.
	By:	 	College Station Medical Center, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	IOM HEALTH SYSTEM, L.P.
	By:	 	Lutheran Health Network Investors, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 









					
	ORIGINATORS (CONT.):
	
	LAREDO TEXAS HOSPITAL COMPANY, L.P.
	By:	 	Webb Hospital Corporation
	Its:	 	General Partner
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	LONGVIEW MEDICAL CENTER, L.P.
	By:	 	Regional Hospital of Longview, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	NAVARRO HOSPITAL, L.P.
	By:	 	Navarro Regional, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 









					
	ORIGINATORS (CONT.):
	
	PINEY WOODS HEALTHCARE SYSTEM, L.P.
	By:	 	Woodland Heights Medical Center, LLC
	Its:	 	General Partner
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	REHAB HOSPITAL OF FORT WAYNE GENERAL PARTNERSHIP
	By:	 	Lutheran Health Network Investors, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	SAN ANGELO HOSPITAL, L.P.
	By:	 	San Angelo Community Medical Center, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	VICTORIA OF TEXAS, L.P.
	By:	 	Detar Hospital, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement 








 
					
	ORIGINATORS (CONT.):
	
	ARMC, L.P.
	By:	 	Triad-ARMC, LLC
	Its:	 	General Partner
		
	By:  	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	CRESTWOOD HEALTHCARE, L.P.
	By:	 	Crestwood Hospital, LLC
	Its:	 	General Partner
		
	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer



  
 Signature Page to Sixth
Amendment to Receivables Loan Agreement