EX-4.1



 Exhibit 4.1 

SIXTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2013, among CHS/COMMUNITY HEALTH SYSTEMS, INC.,
a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) and REGIONS BANK, as successor Trustee under the Indenture
(the “Trustee”). 
 W I T N E S S E T H: 

WHEREAS the Issuer has heretofore executed and delivered to the Trustee, as successor trustee, an Indenture (the
“Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 

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

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

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or
sufficiency of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 
 SECTION 7.
Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 

[Signature page follows] 

  
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 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed
as of this 30th day of September, 2013. 
  

			
	 CHS/Community Health Systems, Inc.,

a Delaware corporation

		
	By:	 	/s/ Rachel A. Seifert
		 	 Rachel A. Seifert

Executive Vice President, Secretary & General Counsel

	
	 New Subsidiary Guarantor:
  

Triad of Oregon, LLC,
 a Delaware limited liability
company

		
	By:	 	/s/ James W. Doucette
		 	 James W. Doucette
 Vice President &
Treasurer

	
	Regions Bank, as Trustee
		
	By:	 	/s/ Paul Williams
		 	 Paul Williams
 Vice President




  
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