EX-4.1



 Exhibit 4.1 

Supplemental Indenture 

SUPPLEMENTAL INDENTURE, (this “Supplemental Indenture”) dated as of April 29, 2016, by and among Quorum Health
Corporation, a Delaware corporation (“Issuer”), the parties that are signatories hereto as Guarantors (each a “Guaranteeing Subsidiary”) and Regions Bank, as Trustee under the Indenture referred to below. 

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 dated as of April 22,
2016 (as amended, supplemented, waived or otherwise modified, the “Indenture”), providing for the issuance on such date of an aggregate principal amount of $400,000,000 of 11.625% Senior Notes due 2023 (the “Notes”)
of the Issuer; 
 WHEREAS, the Indenture provides that the Guaranteeing Subsidiaries shall execute and deliver to the Trustee a supplemental
indenture pursuant to which the Guaranteeing Subsidiaries shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on the terms and conditions set forth herein and under the Indenture (the
“Guarantee”), each on the terms and conditions set forth herein; and 
 WHEREAS, pursuant to Section 9.1 of the
Indenture, the Issuer, any Guarantor and the Trustee are authorized to execute and deliver this Supplemental Indenture to amend or supplement the Indenture, without the consent of any Holder; 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged,
the Issuer, the Guaranteeing Subsidiaries and the Trustee mutually covenant and agree for the benefit of the Trustee and the Holders of the Notes as follows: 

ARTICLE I 
 DEFINITIONS 

SECTION 1.1. Defined Terms. As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recitals
hereto are used herein as therein defined. The words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any
particular section hereof. 
 ARTICLE II 

AGREEMENT TO BE BOUND; GUARANTEE 

SECTION 2.1. Agreement to be Bound. Each of the Guaranteeing Subsidiaries hereby becomes a party to the Indenture as a
“Guarantor” and as such will have all of the rights and be subject to all of the obligations and agreements of a “Guarantor” under the Indenture. 

SECTION 2.2. Guarantee. Each of the Guaranteeing Subsidiaries agrees, on a joint and several basis with all the existing Guarantors, to
fully, unconditionally and irrevocably Guarantee to each Holder of the Notes and the Trustee the Guaranteed Obligations pursuant to Article X of the Indenture as and to the extent provided for therein. 

ARTICLE III 
 MISCELLANEOUS 

SECTION 3.1. Notices. All notices and other communications to the Guarantors shall be given as provided in the Indenture. 

  
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 SECTION 3.2. Merger and Consolidation. Each Guaranteeing Subsidiary shall not sell or
otherwise dispose of all or substantially all of its assets to, or consolidate with or merge with or into, another Person (other than the Issuer or any Restricted Subsidiary that is a Guarantor or becomes a Guarantor concurrently with the
transaction) except in accordance with Section 4.1(e) of the Indenture. 
 SECTION 3.3. Release of Guarantee. The
Guarantees of the Notes hereunder may be released in accordance with Section 10.2 of the Indenture. 
 SECTION 3.4.
Parties. Nothing expressed or mentioned herein is intended or shall be construed to give any Person, firm or corporation, other than the Holders and the Trustee, any legal or equitable right, remedy or claim under or in respect of this
Supplemental Indenture or the Indenture or any provision herein or therein contained. 
 SECTION 3.5. Governing Law. This
Supplemental Indenture shall be governed by, and construed in accordance with, the laws of the State of New York. 
 SECTION 3.6.
Severability. In case any provision in this Supplemental Indenture shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby and such
provision shall be ineffective only to the extent of such invalidity, illegality or unenforceability. 
 SECTION 3.7. Benefits
Acknowledged. Each Guaranteeing Subsidiary’s Guarantee of the Notes is subject to the terms and conditions set forth in the Indenture. Each Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the
financing arrangements contemplated by the Indenture and this Supplemental Indenture and that the guarantee and waivers made by it pursuant to its Guarantee of the Notes are knowingly made in contemplation of such benefits. 

SECTION 3.8. 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, and every Holder of Notes heretofore
or hereafter authenticated and delivered shall be bound hereby. 
 SECTION 3.9. The Trustee. The Trustee makes no representation or
warranty as to the validity or sufficiency of this Supplemental Indenture or with respect to the recitals contained herein, all of which recitals are made solely by the other parties hereto. 

SECTION 3.10. Counterparts. The parties hereto 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 3.11. Execution and Delivery. Each Guaranteeing Subsidiary agrees that its
Guarantee of the Notes shall remain in full force and effect notwithstanding any absence on each Note of a notation of any such Guarantee of the Notes. 

SECTION 3.12. Headings. The headings of the Articles and the Sections in this Supplemental Indenture are for convenience of reference
only and shall not be deemed to alter or affect the meaning or interpretation of any provisions hereof. 

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

			
	By:	 	 /s/ Michael J. Culotta

	Name:	 	Michael J. Culotta
	Title:	 	President
		 	Acting on behalf of each of the Guarantors set forth below


  

			
	Anna Hospital Corporation	  	Massillon Community Health System LLC
	Big Bend Hospital Corporation	  	Massillon Health System LLC
	Big Spring Hospital Corporation	  	Massillon Holdings, LLC
	Blue Island Hospital Company, LLC	  	McKenzie Tennessee Hospital Company, LLC
	Blue Island Illinois Holdings, LLC	  	MMC of Nevada, LLC
	Blue Ridge Georgia Holdings, LLC	  	Monroe HMA, LLC
	Centre Hospital Corporation	  	MWMC Holdings, LLC
	Clinton Hospital Corporation	  	National Healthcare of Mt. Vernon, Inc.
	CSRA Holdings, LLC	  	Phillips Hospital Corporation
	Deming Hospital Corporation	  	QHC California Holdings, LLC
	DHSC, LLC	  	QHG of Massillon, Inc.
	Evanston Hospital Corporation	  	Quorum Health Investment Company, LLC
	Forrest City Arkansas Hospital Company, LLC	  	Quorum Health Resources, LLC
	Forrest City Hospital Corporation	  	Red Bud Hospital Corporation
	Fort Payne Hospital Corporation	  	Red Bud Illinois Hospital Company, LLC
	Galesburg Hospital Corporation	  	San Miguel Hospital Corporation
	Granite City Hospital Corporation	  	Sunbury Hospital Company, LLC
	Granite City Illinois Hospital Company, LLC	  	Tooele Hospital Corporation
	Greenville Hospital Corporation	  	Triad of Oregon, LLC
	Hamlet H.M.A., LLC	  	Watsonville Hospital Corporation
	Hospital of Barstow, Inc.	  	Waukegan Hospital Corporation
	Hospital of Louisa, Inc.	  	Waukegan Illinois Hospital Company, LLC
	Jackson Hospital Corporation (KY)	  	Williamston Hospital Corporation
	Lexington Hospital Corporation	  	Winder HMA, LLC
	Marion Hospital Corporation	  	








 Acknowledged by: 
  

			
	QUORUM HEALTH CORPORATION
		
	By:	 	 /s/ Thomas D. Miller

	Name:	 	Thomas D. Miller
	Title:	 	President and Chief Executive Officer








 
			
	REGIONS BANK,
	as Trustee
		
	By:	 	 /s/ Wallace L. Duke, Jr.

	Name:	 	Wallace L. Duke, Jr.
	Title:	 	Vice President