EX-4.41



 Exhibit 4.41 

TENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of December 31, 2015, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a
Delaware corporation (the “Issuer”), each of the parties identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New Subsidiary Guarantor” and collectively, the “New Subsidiary
Guarantors”), REGIONS BANK, as Trustee under the Indenture (the “Trustee”) and Credit Suisse AG (the “Collateral Agent”). 

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 as amended, supplemented, waived or otherwise modified (the “Indenture”), dated as of August 17, 2012, providing for the
issuance of the 5.125% Senior Secured Notes due 2018 (the “Securities”); 
 WHEREAS, each of the undersigned New Subsidiary
Guarantors 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; 

WHEREAS, following the merger of the existing Subsidiary Guarantor listed on Schedule 1 hereto, with and into Triad Healthcare, LLC,
Triad Healthcare, LLC is entering into this Supplemental Indenture pursuant to Section 4.12 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 Subsidiary Guarantor under the Indenture; 

WHEREAS, the Subsidiary Guarantor listed on Schedule 2 hereto has been converted into a Delaware limited liability company; and 

WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Collateral Agent, the Issuer and the New Subsidiary Guarantors
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 Guarantors 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. Each 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. 

  
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 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. 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 7. Benefits Acknowledged. Each New
Subsidiary Guarantor’s Note Guarantee is subject to the terms and conditions set forth in the Indenture. Each New Subsidiary Guarantor 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 8. 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 31st day of December, 2015. 
  

			
	 CHS/Community Health Systems, Inc.,

a Delaware corporation

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



  

			
	 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




  
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	 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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	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 

Subsidiary Guarantor that no longer exists and 

is no longer a Subsidiary Guarantor under the Indenture 

Triad Healthcare Corporation, a Delaware corporation 

  
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 Schedule 2 

Subsidiary Guarantor converted into Delaware Limited Liability Company 

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

Health Management Associates, LLC 

  
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