EX-4.1



 Exhibit 4.1 

Execution Version 

TRANCHE B-8 TERM LOAN 

JOINDER AGREEMENT NO. 4 

JOINDER AGREEMENT NO. 4, dated as of February 15, 2017 (this “Agreement”), by and among Bank of America, N.A. (the
“Tranche B-8 Funding Loan Lender”), each Tranche B-8 Converting Loan Lender (as defined below), HCA INC., a Delaware corporation (the
“Borrower”) and BANK OF AMERICA, N. A., as Administrative Agent and as Collateral Agent. 
 RECITALS: 

WHEREAS, reference is hereby made to the Credit Agreement, dated as of November 17, 2006, as amended and restated as of
May 4, 2011, as further amended and restated as of February 26, 2014 and as further supplemented as of June 10, 2015, March 18, 2016 and August 15, 2016 (as further amended, restated, supplemented or otherwise modified from time
to time, the “Credit Agreement”), among the Borrower, the Lenders party thereto, Bank of America, N. A., as Administrative Agent, Collateral Agent, Swingline Lender and Letter of Credit Issuer and the other parties named therein
(capitalized terms used but not defined herein having the meaning provided in the Credit Agreement); 
 WHEREAS, subject to the terms
and conditions of the Credit Agreement, the Borrower may establish New Term Loan Commitments by, among other things, entering into one or more Joinder Agreements with New Term Loan Lenders; 

WHEREAS, the Borrower desires to establish a Series of New Term Loans pursuant to this Agreement which shall be titled the
“Tranche B-8 Term Loans”; 
 WHEREAS, the Tranche B-8 Term Loans constitute Ratio First Lien Indebtedness under the Credit Agreement; and 
 WHEREAS,
Bank of America, N.A., Citigroup Global Markets Inc., JPMorgan Chase Bank, N.A. and Wells Fargo Securities LLC are acting as joint lead arrangers and joint bookrunners for the Tranche B-8 Term Loans. 

NOW, THEREFORE, in consideration of the premises and agreements, provisions and covenants herein contained, the parties hereto
agree as follows: 
 The Tranche B-8 Funding Loan Lender hereby agrees to commit to provide its New
Term Loan Commitment with respect to the Tranche B-8 Term Loans (its “Tranche B-8 Term Loan Commitment”), as set forth on Schedule A annexed
hereto, on the terms and subject to the conditions set forth below. Each Tranche B-7 Term Loan Lender that has executed a counterpart of this Agreement in its capacity as such (each a “Tranche B-8 Converting Loan Lender” and together with the Tranche B-8 Funding Loan Lender, the “Tranche B-8 Loan
Lenders”) indicating its willingness to convert Tranche B-7 Term Loans to Tranche B-8 Term Loans, hereby agrees to have the portion of such Tranche B-7 Term Loans so converted in accordance herewith (after giving effect to any reduction as contemplated by the signature pages hereto) (as to such Tranche B-8 Converting Loan
Lender, its “Converted Tranche B-7 Term Loan”) converted to Tranche B-8 Term Loans on the terms and subject to the conditions set forth below. 

  
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 Each Tranche B-8 Loan Lender (i) confirms that it
has received a copy of the Credit Agreement and the other Credit Documents and the exhibits thereto, together with copies of the financial statements referred to therein and such other documents and information as it has deemed appropriate to make
its own credit analysis and decision to enter into this Agreement; (ii) agrees that it will, independently and without reliance upon the Administrative Agent or any other Lender or Agent and based on such documents and information as it shall
deem appropriate at the time, continue to make its own credit decisions in taking or not taking action under the Credit Agreement; (iii) appoints and authorizes the Administrative Agent to take such action as agent on its behalf and to exercise
such powers under the Credit Agreement and the other Credit Documents as are delegated to the Administrative Agent by the terms thereof, together with such powers as are reasonably incidental thereto; and (iv) agrees that it will perform in
accordance with their terms all of the obligations which by the terms of the Credit Agreement are required to be performed by it as a Tranche B-8 Loan Lender. 

The Tranche B-8 Loan Lender hereby agrees to make its respective Commitment on the following terms and
conditions: 
  

	1.	Applicable Margins. The Applicable ABR Margin and Applicable LIBOR Margin for the Tranche B-8 Term Loans shall be as set forth below: 


 

									
	
Tranche B-8 Term 
Loans
	 
	 Applicable LIBOR

Margin
	 	 	 	 	Applicable ABR
Margin	 
	 	2.25	% 	 		 	 	1.25	% 

  

	2.	Principal Payments. The Borrower shall make principal payments on the Tranche B-8 Term Loans in installments on the dates and in the amounts set forth below (with
amounts set forth below expressed as a percentage of the aggregate principal amount of the Tranche B-8 Term Loans on the Tranche B-8 Effective Date): 


 

					
	(A)	 	 	  	(B)
	 New Repayment

Date
	 	 	  	
Tranche B-8 Term 
Loan
Repayment Amount

	 June 30, 2017
	 		  	0.25%
	 September 30, 2017
	 		  	0.25%
	 December 31, 2017
	 		  	0.25%
	 March 31, 2018
	 		  	0.25%


  
 -2- 









					
	(A)	 	 	  	(B)
	 New Repayment

Date
	 	 	  	
Tranche B-8 Term 
Loan
Repayment Amount

	 June 30, 2018
	 		  	0.25%
	 September 30, 2018
	 		  	0.25%
	 December 31, 2018
	 		  	0.25%
	 March 31, 2019
	 		  	0.25%
	 June 30, 2019
	 		  	0.25%
	 September 30, 2019
	 		  	0.25%
	 December 31, 2019
	 		  	0.25%
	 March 31, 2020
	 		  	0.25%
	 June 30, 2020
	 		  	0.25%
	 September 30, 2020
	 		  	0.25%
	 December 31, 2020
	 		  	0.25%
	 March 31, 2021
	 		  	0.25%
	 June 30, 2021
	 		  	0.25%
	 September 30, 2021
	 		  	0.25%
	 December 31, 2021
	 		  	0.25%
	 March 31, 2022
	 		  	0.25%
	 June 30, 2022
	 		  	0.25%
	 September 30, 2022
	 		  	0.25%
	 December 31, 2022
	 		  	0.25%
	 March 31, 2023
	 		  	0.25%
	 June 30, 2023
	 		  	0.25%
	 September 30, 2023
	 		  	0.25%
	 December 31, 2023
	 		  	0.25%
	 Tranche B-8 Term Loan
Maturity Date
	 		  	Remaining
 outstanding amounts


 Notwithstanding the foregoing, the Borrower shall repay all outstanding Tranche B-8
Term Loans on February 15, 2024 (or, if such day is not a Business Day, the immediately preceding Business Day) (the “Tranche B-8 Term Loan Maturity Date”). 

 

	3.	Voluntary and Mandatory Prepayments. Scheduled installments of principal of the Tranche B-8 Term Loans set forth above shall be reduced in connection
with any voluntary or mandatory prepayments of the Tranche B-8 Term Loans in accordance with Sections 5.1 or 5.2 of the Credit Agreement, respectively. 


 

	4.	Prepayment Fees. In the event that prior to the date that is six months after the Tranche B-8 Effective Date a Repricing Transaction occurs with respect to the
Tranche B-8 Term Loans, the Borrower shall pay a premium to each Lender whose Tranche B-8 Term Loan is repaid or amended (including any
Non-Consenting Lender who is required to assign its Tranche B-8 Term Loans), as applicable, equal to the 1.00% of the principal amount of such Lender’s affected
Tranche B-8 Term Loan. 


  
 -3- 








 For purposes of the foregoing: 

“Repricing Transaction” shall mean the repayment, refinancing or replacement of all or a portion of the Tranche B-8 Term Loans with proceeds from the incurrence by any Credit Party of any long-term bank debt financing incurred for the primary purpose of repaying, refinancing or replacing the Tranche B-8 Term Loans having an effective interest cost or weighted average yield (excluding any arrangement or commitment fees in connection therewith) that is less than the effective interest rate for or weighted average
yield of the Tranche B-8 Term Loans, including, without limitation, as may be effected through any amendment to this Agreement relating to the interest rate for, or weighted average yield of, the Tranche B-8 Term Loans; provided that such prepayment premium shall not be payable if the prepayment or refinancing is made in connection with a Change of Control. 

 

	5.	Other Terms of Tranche B-8 Term Loans. Except as expressly set forth herein, the terms of the Tranche B-8 Term Loans shall be identical to the terms of the Tranche B-7 Term Loans. References in the Credit Agreement to Term Loans shall include without limitation, the Tranche B-8 Term Loans which shall be deemed to be a separate Class of Term Loans under the Credit Agreement. 

  

	6.	Funding and Conversion of Tranche B-8 Term Loans. Subject to the terms and conditions of this Agreement, on the Tranche B-8 Effective Date (i) the Tranche B-8 Funding Loan Lender agrees to make to the Borrower a Tranche B-8 Term Loan in an aggregate
principal amount equal to its Tranche B-8 Term Loan Commitment and (ii) each Converted Tranche B-7 Term Loan of each Tranche
B-8 Converting Loan Lender shall be converted into a Tranche B-8 Term Loan of such Lender effective as of the Tranche B-8
Effective Date in a principal amount equal to the principal amount of such Lender’s Converted Tranche B-7 Term Loan immediately prior to such conversion. The Tranche
B-8 Term Loan Commitment shall be automatically and permanently reduced to $0 upon the funding of the Tranche B-8 Funding Loan Lender pursuant to this Section 6.


  

	7.	Credit Agreement Governs. Except as set forth in this Agreement, the Tranche B-8 Term Loans shall otherwise be subject to the provisions of the Credit
Agreement and the other Credit Documents. 

  

	8.	Borrower’s Certifications. By its execution of this Agreement, the undersigned officer (solely in such capacity, not individually and without personal liability), to the best of his or her knowledge,
and the Borrower hereby certifies that: 

  

	 	(i)	The representations and warranties contained in the Credit Agreement and the other Credit Documents are true and correct in all material respects on and as of the date hereof to the same extent as though made on and as
of the date hereof, except to the extent such representations and warranties expressly relate to an earlier date, in which case such representations and warranties were true and correct in all material respects on and as of such earlier date; and



  
 -4- 









	 	(ii)	No event has occurred and is continuing or would result from the consummation of the proposed Borrowing contemplated hereby that would constitute a Default or an Event of Default. 


 

	9.	Conditions to Tranche B-8 Effective Date. This Agreement shall become effective on the date (the “Tranche B-8 Effective Date”) when each of the conditions set forth below has been satisfied: 


(a)    The Administrative Agent shall have received executed counterparts hereof (which may include
facsimile or other electronic transmission of a signed signature page to this Agreement) from the Borrower, the Tranche B-8 Funding Loan Lender, each Tranche B-8
Converting Loan Lender and the Administrative Agent; 
 (b)    The Administrative Agent shall have
received from the Borrower an opinion of counsel from Simpson Thacher & Bartlett LLP reasonably acceptable to the Administrative Agent covering such matters as are required pursuant to Section 2.14(a) of the Credit Agreement; 

(c)    The Administrative Agent shall have received a completed “Life-of-Loan” Federal Emergency Management Agency standard flood hazard determination with respect to each improved Mortgaged Property (together with a notice about special flood hazard area status
and flood disaster assistance duly executed by the applicable Credit Party relating thereto) and, with respect to any Mortgaged Property on which any “building” (as defined in the Flood Insurance Laws) is located in a special flood hazard
area, evidence of flood insurance as and to the extent required under Section 9.3 of the Credit Agreement; 

(d)    The Administrative Agent shall have received an officer’s certificate of the Borrower setting
forth the calculations (in reasonable detail) demonstrating compliance with (i) the financial test described in Section 10.8 of the Credit Agreement and (ii) the ratio set forth in the definition of “Ratio First Lien
Indebtedness” in the Credit Agreement; and 
 (e)    The Administrative Agent shall have received a
written notice of prepayment on the Tranche B-8 Effective Date of all Tranche B-7 Term Loans (other than the Converted Tranche
B-7 Term Loans). 
  

	10.	Mortgage Requirements. No later than 90 days following the Tranche B-8 Effective Date, the Borrower shall deliver or cause to be delivered to the Collateral Agent:


  

	 	(a)	No Mortgage Amendment Necessary 

 Written or
e-mail confirmation from local counsel in the jurisdiction in which the Mortgaged Property is located substantially to the effect that: (i) the recording of the existing Mortgage (and any related fixture
filing) is the only filing or recording 

  
 -5- 








 
necessary to give constructive notice to third parties of the lien created by such Mortgage as security for the Obligations, including the Obligations evidenced by this Agreement and the other
documents executed in connection herewith, for the benefit of the Secured Parties, and (ii) no other documents, instruments, filings, recordings, re-recordings,
re-filings or other actions, including, without limitation, the payment of any mortgage recording taxes or similar taxes are necessary or appropriate under applicable law in order to maintain the continued
enforceability, validity or priority of the lien created by such Mortgage as security for the Obligations, including the Obligations evidenced by this Agreement and the other documents executed in connection herewith, for the benefit of the Secured
Parties, unless any such mortgage recording taxes are payable in connection with the transactions contemplated by this Agreement, in which case such written confirmation shall so state; or, for any Mortgage recorded in a jurisdiction in which local
counsel is unable to provide the foregoing written or email confirmation, with respect to such Mortgage, the deliverables listed in Section 5(b) below. 
  

	 	(b)	Mortgage Amendment Necessary 

  

	 	(i)	an amendment to each Mortgage (each, a “Mortgage Amendment”) to which a Credit Party is then party duly executed and acknowledged by the applicable Credit Party, and in form for recording in the
recording office where the respective Mortgage was recorded, together with such certificates, affidavits, questionnaires or returns as shall be required in connection with the recording or filing thereof under applicable law, in each case in form
and substance reasonably satisfactory to the Administrative Agent; 

  

	 	(ii)	executed legal opinions, in form and substance reasonably satisfactory to the Administrative Agent, with respect to such amended Mortgages; and 


 

	 	(iii)	with respect to each amended Mortgage (i) a title search of the relevant Mortgaged Property (except for Mortgaged Properties located in Texas) confirming that there are no Liens of record in violation of the
provisions of the applicable Mortgage and (ii) for Mortgaged Properties located in Texas, a TX T.38 modification endorsement to the existing policy or policies of title insurance insuring the Lien of each applicable Mortgage in form and
substance reasonably satisfactory to the Administrative Agent and having the effect of a valid, issued and binding endorsement to the respective title insurance policy. 


 

	11.	Recordation of the New Loans. Upon execution and delivery hereof, the Administrative Agent will record the Tranche B-8 Term Loans made or
converted by each Tranche B-8 Loan Lender in the Register. 

  

	12.	 Certain U.S. Federal Income Tax Matters. The Borrower, the
Administrative Agent and the Lenders agree that the Tranche B-8 Term Loans shall be treated in their entirety as one fungible tranche for U.S. federal income tax purposes (i.e., the Tranche B-8 Term 



  
 -6- 









	 	
Loans received upon conversion of the Converted Tranche B-7 Term Loans shall be fungible for U.S. federal income tax purposes with the Tranche B-8 Term Loans made pursuant to the Tranche B-8 Term Loan Commitment). For the avoidance of doubt and solely for purposes of FATCA, the Administrative Agent shall treat (and
the Lenders hereby authorize the Administrative Agent to treat) the Tranche B-8 Term Loans as not qualifying as “grandfathered obligations” within the meaning of Treasury Regulation Section 1.1471-2(b)(2)(i). 

  

	13.	Amendment, Modification and Waiver. This Agreement may not be amended, modified or waived except by an instrument or instruments in writing signed and delivered on behalf of each of the
parties hereto. 

  

	14.	Entire Agreement. This Agreement, the Credit Agreement and the other Credit Documents constitute the entire agreement among the parties hereto and thereto with respect to the subject matter hereof and
thereof and supersede all other prior agreements and understandings, both written and verbal, among the parties or any of them with respect to the subject matter hereof. 


 

	15.	GOVERNING LAW. THIS AGREEMENT AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES HEREUNDER SHALL BE GOVERNED
BY, AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 


 

	16.	Severability. Any term or provision of this Agreement which is invalid or unenforceable in any jurisdiction shall, as to that jurisdiction, be ineffective to the extent of such invalidity or unenforceability
without rendering invalid or unenforceable the remaining terms and provisions of this Agreement or affecting the validity or enforceability of any of the terms or provisions of this Agreement in any other jurisdiction. If any provision of this
Agreement is so broad as to be unenforceable, such provision shall be interpreted to be only so broad as would be enforceable. 

  

	17.	Counterparts. This Agreement may be executed in counterparts (including by facsimile or other electronic transmission), each of which shall be deemed to be an original, but all of which shall constitute one and
the same agreement. 

  

	18.	Effect of Joinder Agreement. Each and every term, condition, obligation, covenant and agreement contained in the Credit Agreement or any other Credit Document is hereby ratified and
reaffirmed in all respects and shall continue in full force and effect. Each Credit Party reaffirms its obligations under the Credit Documents to which it is party and the validity of the Liens granted by it pursuant to the Security Documents. From
and after the effective date of this Agreement, all references to the Credit Agreement in any Credit Document shall, unless expressly provided otherwise, refer to the Credit Agreement as supplemented by this Agreement. This Agreement shall be deemed
a Credit Document under the Credit Agreement. 

 [Remainder of page intentionally left blank.
Signature pages follow.] 

  
 -7- 








 IN WITNESS WHEREOF, each of the undersigned has caused its duly authorized officer to
execute and deliver this Agreement as of the date set forth above. 
  

			
	HCA INC.
		
	By:	 	 /s/ J. William B. Morrow

	Name:	 	J. William B. Morrow
	Title:	 	Senior Vice President – Finance and Treasurer
	
	Each of the GUARANTORS listed on Schedule I hereto
		
	By:	 	 /s/ Christopher F. Wyatt

	Name:	 	Christopher F. Wyatt
	Title:	 	Senior Vice President
	
	MEDICREDIT, INC.
		
	By:	 	 /s/ N. Eric Ward

	Name:	 	N. Eric Ward
	Title:	 	President and Chief Executive Officer


 [Joinder Agreement Signature Page] 







 SCHEDULE I 
  

									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 American Medicorp Development Co.
	 				 			
	 Bay Hospital, Inc.
	 				 			
	 Brigham City Community Hospital, Inc.
	 				 			
	 Brookwood Medical Center of Gulfport, Inc.
	 				 			
	 Capital Division, Inc.
	 				 			
	 Centerpoint Medical Center of Independence, LLC
	 				 			
	 Central Florida Regional Hospital, Inc.
	 				 			
	 Central Shared Services, LLC
	 				 			
	 Central Tennessee Hospital Corporation
	 				 			
	 CHCA Bayshore, L.P.
	 	 	*	  	 			
	 CHCA Conroe, L.P.
	 	 	*	  	 			
	 CHCA Mainland, L.P.
	 	 	*	  	 			
	 CHCA Pearland, L.P.
	 	 	*	  	 			
	 CHCA West Houston, L.P.
	 	 	*	  	 			
	 CHCA Woman’s Hospital, L.P.
	 	 	*	  	 			
	 Chippenham & Johnston-Willis Hospitals, Inc.
	 				 			
	 Citrus Memorial Hospital, Inc.
	 				 			
	 Citrus Memorial Property Management, Inc.
	 				 			
	 Colorado Health Systems, Inc.
	 				 			
	 Columbia ASC Management, L.P.
	 	 	*	  	 			
	 Columbia Healthcare System of Louisiana, Inc.
	 				 			
	 Columbia Jacksonville Healthcare System, Inc.
	 				 			
	 Columbia LaGrange Hospital, LLC
	 				 			
	 Columbia Medical Center of Arlington Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Medical Center of Denton Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Medical Center of Las Colinas, Inc.
	 				 			
	 Columbia Medical Center of Lewisville Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Medical Center of McKinney Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Medical Center of Plano Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia North Hills Hospital Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Ogden Medical Center, Inc.
	 				 			
	 Columbia Parkersburg Healthcare System, LLC
	 				 			
	 Columbia Plaza Medical Center of Fort Worth Subsidiary, L.P.
	 	 	*	  	 			
	 Columbia Rio Grande Healthcare, L.P.
	 	 	*	  	 			
	 Columbia Riverside, Inc.
	 				 			
	 Columbia Valley Healthcare System, L.P.
	 	 	*	  	 			
	 Columbia/Alleghany Regional Hospital Incorporated
	 				 			









									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 Columbia/HCA John Randolph, Inc.
	 				 			
	 Columbine Psychiatric Center, Inc.
	 				 			
	 Columbus Cardiology, Inc.
	 				 			
	 Conroe Hospital Corporation
	 				 			
	 Dallas/Ft. Worth Physician, LLC
	 				 			
	 Dublin Community Hospital, LLC
	 				 			
	 Eastern Idaho Health Services, Inc.
	 				 			
	 East Florida - DMC, Inc.
	 				 			
	 Edward White Hospital, Inc.
	 				 			
	 El Paso Surgicenter, Inc.
	 				 			
	 Encino Hospital Corporation, Inc.
	 				 			
	 EP Health, LLC
	 				 			
	 Fairview Park GP, LLC
	 				 			
	 Fairview Park, Limited Partnership
	 	 	*	  	 			
	 Frankfort Hospital, Inc.
	 				 			
	 Galen Property, LLC
	 				 			
	 Good Samaritan Hospital, L.P.
	 	 	*	  	 			
	 Goppert-Trinity Family Care, LLC
	 				 			
	 GPCH-GP, Inc.
	 				 			
	 Grand Strand Regional Medical Center, LLC
	 				 			
	 Green Oaks Hospital Subsidiary, L.P.
	 	 	*	  	 			
	 Greenview Hospital, Inc.
	 				 			
	 H2U Wellness Centers, LLC
	 				 			
	 HCA - IT&S Field Operations, Inc.
	 				 			
	 HCA - IT&S Inventory Management, Inc.
	 				 			
	 HCA-HealthONE LLC
	 				 			
	 HCA American Finance LLC
	 				 			
	 HCA Central Group, Inc.
	 				 			
	 HCA Health Services of Florida, Inc.
	 				 			
	 HCA Health Services of Louisiana, Inc.
	 				 			
	 HCA Health Services of Oklahoma, Inc.
	 				 			
	 HCA Health Services of Tennessee, Inc.
	 				 			
	 HCA Health Services of Virginia, Inc.
	 				 			
	 HCA Management Services, L.P.
	 	 	*	  	 			
	 HCA Pearland GP, Inc.
	 				 			
	 HCA Realty, Inc.
	 				 			
	 HCA SFB 1 LLC
	 				 			
	 HD&S Corp. Successor, Inc.
	 				 			
	 Health Midwest Office Facilities Corporation
	 				 			
	 Health Midwest Ventures Group, Inc.
	 				 			
	 HealthTrust Workforce Solutions, LLC
	 				 			









									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 Hendersonville Hospital Corporation
	 				 			
	 Hospital Corporation of Tennessee
	 				 			
	 Hospital Corporation of Utah
	 				 			
	 Hospital Development Properties, Inc.
	 				 			
	 HPG Enterprises, LLC
	 				 			
	 HSS Holdco, LLC
	 				 			
	 HSS Systems, LLC
	 				 			
	 HSS Virginia, L.P.
	 	 	*	  	 			
	 HTI Memorial Hospital Corporation
	 				 			
	 HTI MOB, LLC
	 				 	 	*	  
	 Integrated Regional Lab, LLC
	 				 			
	 Integrated Regional Laboratories, LLP
	 	 	*	  	 			
	 JPM AA Housing, LLC
	 				 			
	 JFK Medical Center Limited Partnership
	 	 	*	  	 			
	 KPH-Consolidation, Inc.
	 				 			
	 Lakeview Medical Center, LLC
	 				 			
	 Largo Medical Center, Inc.
	 				 			
	 Las Vegas Surgicare, Inc.
	 				 			
	 Lawnwood Medical Center, Inc.
	 				 			
	 Lewis-Gale Hospital, Incorporated
	 				 			
	 Lewis-Gale Medical Center, LLC
	 				 			
	 Lewis-Gale Physicians, LLC
	 				 			
	 Lone Peak Hospital, Inc.
	 				 			
	 Los Robles Regional Medical Center
	 				 			
	 Management Services Holdings, Inc.
	 				 			
	 Marietta Surgical Center, Inc.
	 				 			
	 Marion Community Hospital Inc
	 				 			
	 MCA Investment Company
	 				 			
	 Medical Centers of Oklahoma, LLC
	 				 			
	 Medical Office Buildings of Kansas, LLC
	 				 			
	 Memorial Healthcare Group, Inc.
	 				 			
	 Midwest Division - ACH, LLC
	 				 			
	 Midwest Division - LRHC, LLC
	 				 			
	 Midwest Division - LSH, LLC
	 				 			
	 Midwest Division - MCI, LLC
	 				 			
	 Midwest Division - MMC, LLC
	 				 			
	 Midwest Division - OPRMC, LLC
	 				 			
	 Midwest Division - PFC, LLC
	 				 			
	 Midwest Division - RBH, LLC
	 				 			
	 Midwest Division - RMC, LLC
	 				 			
	 Midwest Holdings, Inc.
	 				 			









									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 Montgomery Regional Hospital, Inc.
	 				 			
	 Mountain Division - CVH, LLC
	 				 			
	 Mountain View Hospital, Inc.
	 				 			
	 Nashville Shared Services General Partnership
	 	 	*	  	 			
	 National Patient Account Services, Inc.
	 				 			
	 New Iberia Healthcare, LLC
	 				 			
	 New Port Richey Hospital, Inc.
	 				 			
	 New Rose Holding Company, Inc.
	 				 			
	 North Florida Immediate Care Center, Inc.
	 				 			
	 North Florida Regional Medical Center, Inc.
	 				 			
	 North Texas – MCA, LLC
	 				 			
	 Northern Utah Healthcare Corporation
	 				 			
	 Northern Virginia Community Hospital, LLC
	 				 			
	 Northlake Medical Center, LLC
	 				 			
	 Notami Hospitals of Louisiana, Inc.
	 				 			
	 Notami Hospitals, LLC
	 				 			
	 Okaloosa Hospital, Inc.
	 				 			
	 Okeechobee Hospital, Inc.
	 				 			
	 Oklahoma Holding Company, LLC
	 				 			
	 Outpatient Cardiovascular Center of Central Florida, LLC
	 				 			
	 Outpatient Services Holdings, Inc.
	 				 			
	 Oviedo Medical Center, LLC
	 				 			
	 Palms West Hospital Limited Partnership
	 	 	*	  	 			
	 Palmyra Park Hospital, LLC
	 				 			
	 Parallon Business Solutions, LLC
	 				 			
	 Parallon Enterprises, LLC
	 				 			
	 Parallon Health Information Solutions, LLC
	 				 			
	 Parallon Holdings, LLC
	 				 			
	 Parallon Payroll Solutions, LLC
	 				 			
	 Parallon Physician Services, LLC
	 				 			
	 Parallon Technology Solutions, LLC
	 				 			
	 Pasadena Bayshore Hospital, Inc.
	 				 			
	 PatientKeeper, Inc.
	 				 			
	 Pearland Partner, LLC
	 				 			
	 Plantation General Hospital, L.P.
	 	 	*	  	 			
	 Poinciana Medical Center, Inc.
	 				 			
	 Primary Health, Inc.
	 				 			
	 Pulaski Community Hospital, Inc.
	 				 			
	 Putnam Community Medical Center of North Florida, LLC
	 				 			
	 Redmond Park Hospital, LLC
	 				 			









									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 Redmond Physician Practice Company
	 				 			
	 Reston Hospital Center, LLC
	 				 			
	 Retreat Hospital, LLC
	 				 			
	 Rio Grande Regional Hospital, Inc.
	 				 			
	 Riverside Healthcare System, L.P.
	 	 	*	  	 			
	 Riverside Hospital, Inc.
	 				 			
	 Samaritan, LLC
	 				 			
	 San Jose Healthcare System, LP
	 	 	*	  	 			
	 San Jose Hospital, L.P.
	 	 	*	  	 			
	 San Jose Medical Center, LLC
	 				 			
	 San Jose, LLC
	 				 			
	 Sarah Cannon Research Institute, LLC
	 				 	 	*	  
	 Sarasota Doctors Hospital, Inc.
	 				 			
	 SCRI Holdings, LLC
	 				 			
	 SJMC, LLC
	 				 			
	 Southern Hills Medical Center, LLC
	 				 			
	 Southpoint, LLC
	 				 			
	 Spalding Rehabilitation L.L.C.
	 				 			
	 Spotsylvania Medical Center, Inc.
	 				 			
	 Spring Branch Medical Center, Inc.
	 				 			
	 Spring Hill Hospital, Inc.
	 				 			
	 SSHR Holdco, LLC
	 				 			
	 Sun City Hospital, Inc.
	 				 			
	 Sunrise Mountainview Hospital, Inc.
	 				 			
	 Surgicare of Brandon, Inc.
	 				 			
	 Surgicare of Florida, Inc.
	 				 			
	 Surgicare of Houston Women’s, Inc.
	 				 			
	 Surgicare of Manatee, Inc.
	 				 			
	 Surgicare of Newport Richey, Inc.
	 				 			
	 Surgicare of Palms West, LLC
	 				 			
	 Surgicare of Riverside, LLC
	 				 			
	 Tallahassee Medical Center, Inc.
	 				 			
	 TCMC Madison-Portland, Inc.
	 				 			
	 Terre Haute Hospital GP, Inc.
	 				 			
	 Terre Haute Hospital Holdings, Inc.
	 				 			
	 Terre Haute MOB, L.P.
	 	 	*	  	 			
	 Terre Haute Regional Hospital, L.P.
	 	 	*	  	 			
	 The Regional Health System of Acadiana, LLC
	 				 			
	 The Outsource Group, Inc.
	 				 			
	 Timpanogos Regional Medical Services, Inc.
	 				 			
	 Trident Medical Center, LLC
	 				 			









									
	 Guarantor
	 	
By its
General
Partner
	 	 	
By its
Sole
Member
	 
	 U.S. Collections, Inc.
	 				 			
	 Utah Medco, LLC
	 				 			
	 VH Holdco, Inc.
	 				 			
	 VH Holdings, Inc.
	 				 			
	 Virginia Psychiatric Company, Inc.
	 				 			
	 Vision Consulting Group, LLC
	 				 			
	 Vision Holdings, LLC
	 				 			
	 W & C Hospital, Inc.
	 				 			
	 Walterboro Community Hospital, Inc.
	 				 			
	 WCP Properties, LLC
	 				 			
	 Wesley Medical Center, LLC
	 				 			
	 West Florida – MHT, LLC
	 				 			
	 West Florida – PPH, LLC
	 				 			
	 West Florida – TCH, LLC
	 				 			
	 West Florida Regional Medical Center, Inc.
	 				 			
	 West Valley Medical Center, Inc.
	 				 			
	 Western Plains Capital, Inc.
	 				 			
	 WHMC, Inc.
	 				 			
	 Woman’s Hospital of Texas, Incorporated
	 				 			








 
			
	 Consented to by:

	
	 BANK OF AMERICA, N.A.,

as Administrative Agent and Collateral Agent

		
	 By:
	 	 /s/ Liliana Claar

	 Name:
	 	Liliana Claar
	 Title:
	 	Vice President
	
	 BANK OF AMERICA, N.A.,

as the Tranche B-8 Funding Loan Lender

		
	 By:
	 	 /s/ Joseph L. Corah

	 Name:
	 	Joseph L. Corah
	 Title:
	 	Director



  
 [Joinder Agreement
Signature Page] 








 [ADDITIONAL LENDER SIGNATURES OMITTED] 

  
 [Joinder Agreement
Signature Page]