EX-4.54



 Exhibit 4.54 

SEVENTH SUPPLEMENTAL INDENTURE, (this “Supplemental Indenture”) dated as of December 31, 2015, by and among
CHS/Community Health Systems, Inc., a Delaware corporation (“Issuer”), the parties that are signatories hereto as Guarantors (each a “Guaranteeing Subsidiary”), Credit Suisse AG, as Collateral Agent, 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
January 27, 2014 (as amended, supplemented, waived or otherwise modified, the “Indenture”), providing for the issuance on such date of an aggregate principal amount of $1,000,000,000 of 5.125% Senior Secured Notes due 2021 (the
“Notes”) of the Issuer; 
 WHEREAS, the Indenture provides that the Guaranteeing Subsidiaries shall execute and deliver to
the Trustee and the Collateral Agent 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 “Note Guarantee”), each on the terms and conditions set forth herein; 
 WHEREAS,
following the merger of the existing Guarantor listed on Schedule 1 hereto, with and into Triad Healthcare, LLC, Triad Healthcare, LLC is entering into this Supplemental Indenture pursuant to Section 3.7(a)(1) of the Indenture; 

WHEREAS, the entity listed on Schedule 1 hereto (i) has been merged into Triad Healthcare, LLC, (ii) such entity has
therefore ceased to exist, and (iii) such entity will no longer be a Guarantor under the Indenture; 
 WHEREAS, the Guarantor listed on
Schedule 2 hereto has been converted into a Delaware limited liability company; 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, the Collateral Agent 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. 

  
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 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, the Trustee and the Collateral Agent 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. 

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 Note Guarantees 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 Note Guarantee 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 Note Guarantee 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. 

  
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 SECTION 3.9. The Trustee and the Collateral Agent. Neither the Trustee nor the Collateral
Agent make any 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
Note Guarantee shall remain in full force and effect notwithstanding any absence on each Note of a notation of any such Note Guarantee. 

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. 
 [Signature page follows]


  
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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. 
  

					
	 Blue Ridge Georgia Holdings, LLC,

a Delaware limited liability company

		
	By:	 	/s/ James W. Doucette
		 	 James W. Doucette
 Senior Vice
President and Treasurer

	
	 Crestwood Healthcare, L.P.,

a Delaware limited partnership
  

By: Crestwood Hospital, LLC, its general partner

			
		 	By: 	 	/s/ James W. Doucette
		 		 	James W. Doucette
		 		 	Senior Vice President and Treasurer


  

			
	 HMA-TRI Holdings, LLC,
 a
Delaware limited liability company

		
	By:	 	/s/ James W. Doucette
		 	James W. Doucette
		 	Senior Vice President and Treasurer


  

			
	 Quorum Health Investment Company, LLC,

a Delaware limited liability company

		
	By:	 	/s/ James W. Doucette
		 	James W. Doucette
		 	Senior Vice President and Treasurer


  

			
	 Triad Healthcare, LLC,
 a
Delaware limited liability company

		
	By:	 	/s/ James W. Doucette
		 	James W. Doucette
		 	Senior Vice President and Treasurer


  

			
	Pasco Regional Medical Center, LLC,
	a Florida limited liability company
		
	By:	 	/s/ James W. Doucette
		 	 James W. Doucette
 Senior Vice President and
Treasurer




  
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	Acknowledged by:
	
	CHS/Community Health Systems, Inc.
		
	By:	 	/s/ James W. Doucette
		 	James W. Doucette
		 	Senior Vice President and Treasurer


  
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	Regions Bank,
	as Trustee
		
	By:	 	/s/ Wallace Duke
		 	Wallace Duke
		 	Vice President


  

  
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	Credit Suisse AG, Cayman Islands Branch,
	as Collateral Agent
		
	By:	 	/s/ Christopher Day
		 	Name: Christopher Day
		 	Title: Authorized Signatory


  

			
	By:	 	/s/ Warren Van Heyst
		 	Name: Warren Van Heyst
		 	Title: Authorized Signatory



  
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 Schedule 1 

Guarantor that no longer exists and 

is no longer a Guarantor under the Indenture 

Triad Healthcare Corporation, a Delaware corporation 

  
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 Schedule 2 

Guarantor converted into Delaware Limited Liability Company 

Health Management Associates, Inc., a Delaware corporation, becomes 

Health Management Associates, LLC 

  
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