**Exhibit4.21**

** **

**SUPPLEMENTAL INDENTURE NO. 14**

** **

THIS SUPPLEMENTAL INDENTURE NO. 14 (this “SupplementalIndenture”), dated as of November 13, 2008, is among TempletonReadings, LLC, a Maryland limited liability company and wholly owned subsidiaryof EmCare, Inc. (the “Guaranteeing Subsidiary”); the Issuers (asdefined in the Indenture referred to herein); the other Guarantors (as definedin the Indenture); and U.S. Bank Trust National Association, as trustee underthe Indenture referred to below (the “Trustee”).

 

W I T N E S S E T H

 

WHEREAS, the Issuers and the Guarantors partythereto have heretofore executed and delivered to the Trustee an indenture (the“Indenture”), dated as of February 10, 2005 providing for theissuance of 10% Senior Subordinated Notes due 2015 (the “Notes”);

 

WHEREAS, the Indenture provides that undercertain circumstances the Guaranteeing Subsidiary shall execute and deliver tothe Trustee a supplemental indenture pursuant to which the GuaranteeingSubsidiary shall unconditionally guarantee all of the Issuers’ Obligationsunder the Notes and the Indenture on the terms and conditions set forth herein(the guarantee of the Guaranteeing Subsidiary is referred to herein as a “SubsidiaryGuarantee”); and

 

WHEREAS, pursuant to Section 9.01 of theIndenture, the Trustee is authorized to execute and deliver this SupplementalIndenture.

 

NOW THEREFORE, in consideration of theforegoing and for other good and valuable consideration, the receipt of whichis hereby acknowledged, the Guaranteeing Subsidiary and the Trustee mutuallycovenant and agree for the equal and ratable benefit of the Holders of theNotes as follows:

 

# 1.             Capitalized Terms.  Capitalized terms used herein withoutdefinition shall have the meanings assigned to them in the Indenture.

#  

# 2.             Agreement to Guarantee.  The Guaranteeing Subsidiary hereby agrees asfollows with respect to its Subsidiary Guarantee:

#  

## (a)           Along with all other Guarantors, to jointly and severallyunconditionally Guarantee to each Holder of a Note authenticated and deliveredby the Trustee and to the Trustee and its successors and assigns, irrespectiveof the validity and enforceability of the Indenture, the Notes or theobligations of the Issuers hereunder or thereunder, that:

##  

### (i)            theprincipal of and interest on the Notes will be promptly paid in full when due,whether at maturity, by acceleration, redemption or otherwise, and interest onthe overdue principal of and interest on the Notes, if any, if lawful, and allother obligations of the Issuers to the Holders or the Trustee hereunder orthereunder will be promptly paid in full or performed, all in accordance withthe terms hereof and thereof; and

 

----

 

### (ii)           incase of any extension of time of payment or renewal of any Notes or any of suchother obligations, that same will be promptly paid in full when due orperformed in accordance with the terms of the extension or renewal, whether atstated maturity, by acceleration or otherwise. Failing payment when due of any amount so guaranteed or any performanceso guaranteed for whatever reason, the Guarantors shall be jointly andseverally obligated to pay the same immediately.  Each Guarantor agrees that this is aguarantee of payment and not a guarantee of collection.

###  

## (b)           The obligations hereunder shall be unconditional,irrespective of the validity, regularity or enforceability of the Notes or theIndenture, the absence of any action to enforce the same, any waiver or consentby any Holder of the Notes with respect to any provisions hereof or thereof,the recovery of any judgment against the Issuers, any action to enforce thesame or any other circumstance which might otherwise constitute a legal orequitable discharge or defense of a Guarantor. Subject to Section 6.06 of the Indenture, each Guarantor herebywaives diligence, presentment, demand of payment, filing of claims with a courtin the event of insolvency or bankruptcy of an Issuer, any right to require aproceeding first against an Issuer, protest, notice and all demands whatsoeverand covenants that this Subsidiary Guarantee shall not be discharged except bycomplete performance of the obligations contained in the Notes and theIndenture.

##  

## (c)           If any Holder or the Trustee is required by any court orotherwise to return to the Issuers, the Guarantors, or any Custodian, Trustee,liquidator or other similar official acting in relation to either the Issuersor the Guarantors, any amount paid by either to the Trustee or such Holder, thisSubsidiary Guarantee, to the extent theretofore discharged, shall be reinstatedin full force and effect.

##  

## (d)           The Guaranteeing Subsidiary shall not be entitled to anyright of subrogation in relation to the Holders in respect of any obligationsguaranteed hereby until payment in full of all obligations guaranteedhereby.  The Guaranteeing Subsidiaryfurther agrees that, as between the Guarantors, on the one hand, and theHolders and the Trustee, on the other hand, (x) the maturity of theobligations guaranteed hereby may be accelerated as provided in Article 6of the Indenture for the purposes of this Subsidiary Guarantee, notwithstandingany stay, injunction or other prohibition preventing such acceleration inrespect of the obligations guaranteed hereby, and (y) in the event of anydeclaration of acceleration of such obligations as provided in Article 6of the Indenture, such obligations (whether or not due and payable) shallforthwith become due and payable by the Guarantors for the purpose of thisSubsidiary Guarantee.  The Guarantorsshall have the right to seek contribution from any non-paying Guarantor so longas the exercise of such right does not impair the rights of the Holders underthe Guarantee.

##  

## (e)           Pursuant to Section 11.03 of the Indenture, aftergiving effect to any maximum amount and any other contingent and fixed liabilitiesthat are relevant under any applicable Bankruptcy or fraudulent conveyancelaws, and after giving effect to any collections from, rights to receivecontribution from or payments made by or on behalf of any other Guarantor inrespect of the obligations of such other Guarantor under Article 11 of theIndenture 

 

2

----

 

## shallresult in the obligations of such Guarantor under its Subsidiary Guarantee notconstituting a fraudulent transfer or conveyance.

##  

# 3.             Execution and Delivery.  The Guaranteeing Subsidiary agrees that theSubsidiary Guarantee shall remain in full force and effect notwithstanding anyfailure to endorse on each Note a notation of such Subsidiary Guarantee.

#  

# 4.             Releases.

#  

## (a)           The Subsidiary Guarantee of a Subsidiary Guarantor shall bereleased:

##  

### (i)            inconnection with any sale or other disposition of all or substantially all ofthe assets of that Subsidiary Guarantor (including by way of merger orconsolidation), if the Issuer that directly or indirectly owns such SubsidiaryGuarantor applies the Net Proceeds of such sale or other disposition, inaccordance with the applicable provisions of the Indenture;

###  

### (ii)           inconnection with the sale of all of the capital stock of a Subsidiary Guarantor,if the Issuer that directly or indirectly owns such Subsidiary Guarantorapplies the Net Proceeds of that sale, in accordance with the applicableprovisions of the Indenture;

###  

### (iii)          inconnection with any transaction which results in a Subsidiary Guarantor ceasingto be a Restricted Subsidiary of an Issuer, if the transaction is not inviolation of the applicable provisions of the Indenture;

###  

### (iv)          ifan Issuer designates any Restricted Subsidiary of such Issuer that is aSubsidiary Guarantor as an Unrestricted Subsidiary, in accordance with theapplicable provisions of the Indenture; or

###  

### (v)           ifa Subsidiary Guarantor has no outstanding Indebtedness after giving effect tosuch release other than pursuant to clause (2), (4), (5), (6) (withrespect to Permitted Refinancing Indebtedness in respect of Indebtednessinitially incurred under clause (2) or (5) only), (7), (10), (11),(12), (13), (14) or (15) of Section 4.09 of the Indenture or pursuant toclause (9) of Section 4.09 of the Indenture (with respect to Indebtednessincurred under any of the foregoing clauses) and an Officers’ Certificatecertifying the foregoing is presented to the Trustee together with a request torelease such Subsidiary Guarantor from its Subsidiary Guarantee.

###  

Upon delivery by the Issuers to the Trusteeof an Officers’ Certificate and an Opinion of Counsel to the effect that suchsale or other disposition was made by the Issuers in accordance with theprovisions of the Indenture, including without limitation Section 4.10 ofthe Indenture, the Trustee shall execute any documents reasonably required inorder to evidence the release of any Subsidiary Guarantor from its obligationsunder its Subsidiary Guarantee.

 

## (b)           Any Subsidiary Guarantor not released from its obligationsunder its Subsidiary Guarantee shall remain liable for the full amount ofprincipal of and interest on the 

 

3

----

 

## Notesand for the other obligations of any Guarantor under the Indenture as providedin Article 11 of the Indenture.

##  

# 5.             No Recourse Against Others.  No past, present or future director, officer,employee, incorporator, stockholder or agent of Parent or the GuaranteeingSubsidiary, as such, shall have any liability for any obligations of theIssuers, Parent or the Guaranteeing Subsidiary under the Notes, any Guarantees,the Indenture, or this Supplemental Indenture or for any claim based on, inrespect of, or by reason of, such obligations or their creation.  Each Holder of the Notes by accepting a Notewaives and releases all such liability. The waiver and release are part of the consideration for issuance of theNotes.  Such waiver may not be effectiveto waive liabilities under the federal securities laws and it is the view ofthe SEC that such a waiver is against public policy.

#  

# 6.             NEW YORK LAW TO GOVERN.  THE INTERNAL LAW OF THE STATE OF NEW YORKSHALL GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE BUT WITHOUTGIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO THE EXTENT THATTHE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY.

#  

# 7.             Counterparts.  The parties may sign any number of copies ofthis Supplemental Indenture.  Each signedcopy shall be an original, but all of them together represent the sameagreement.

#  

# 8.             Effect of Headings.  The Section headings herein are forconvenience only and shall not affect the construction hereof.

#  

# 9.             The Trustee.  The Trustee shall not be responsible in anymanner whatsoever for or in respect of the validity or sufficiency of thisSupplemental Indenture or for or in respect of the recitals contained herein,all of which recitals are made solely by the Guaranteeing Subsidiary and theIssuers.

#  

[*Signature Pages Follow.*]

 

4

----

 

IN WITNESS WHEREOF, the parties hereto havecaused this Supplemental Indenture to be duly executed and attested, all as ofthe date first above written.

 

 
| TEMPLETON  READINGS, LLC                                         |                     |
|------------------------------------------------------------------|--------------------------|
|                                                             |                     |   |
|                                                             |                     |   |
| By:                                                              | /s/  William A. Sanger   |   |
| Name:                                                            | William  A. Sanger       |   |
| Title:                                                           | Chief  Executive Officer |   |
|                                                             |                     |   |
|                                                             |                     |   |
| AMR  HOLDCO, INC.                                                |                     |
|                                                             |                     |   |
|                                                             |                     |   |
| By:                                                              | /s/  William A. Sanger   |   |
| Name:                                                            | William  A. Sanger       |   |
| Title:                                                           | Chief  Executive Officer |   |
|                                                             |                     |   |
|                                                             |                     |   |
| EMCARE  HOLDCO, INC.                                             |                     |
|                                                             |                     |   |
|                                                             |                     |   |
| By:                                                              | /s/  William A. Sanger   |   |
| Name:                                                            | William  A. Sanger       |   |
| Title:                                                           | Chief  Executive Officer |   |
|                                                             |                     |   |
|                                                             |                     |   |
| EMERGENCY  MEDICAL SERVICES L.P.                                 |                     |
| By:  Emergency Medical Services Corporation, its general partner |                     |
|                                                             |                     |   |
|                                                             |                     |   |
| By:                                                              | /s/  William A. Sanger   |   |
| Name:                                                            | William  A. Sanger       |   |
| Title:                                                           | Chief  Executive Officer |   |

 

 
| AMERICAN  MEDICAL RESPONSE, INC.            |   |   |
|---------------------------------------------|--------|--------|
| HANK’S  ACQUISITION CORP.              |   |   |
| FOUNTAIN  AMBULANCE SERVICE, INC.           |   |   |
| MEDLIFE  EMERGENCY MEDICAL SERVICE, INC.    |   |   |
| AMERICAN  MEDICAL RESPONSE NORTHWEST, INC.  |   |   |
| AMERICAN  MEDICAL RESPONSE WEST             |   |   |
| METROPOLITAN  AMBULANCE SERVICE             |   |   |
| AMERICAN  MEDICAL RESPONSE OF INLAND EMPIRE |   |   |
| DESERT  VALLEY MEDICAL TRANSPORT, INC.      |   |   |
| SPRINGS  AMBULANCE SERVICE, INC.            |   |   |

 

[SignaturePage to Supplemental Indenture No. 14]

 

----

 
| AMERICAN  MEDICAL RESPONSE OF COLORADO, INC.            |   |   |
|---------------------------------------------------------|--------|--------|
| INTERNATIONAL  LIFE SUPPORT, INC.                       |   |   |
| MEDEVAC  MIDAMERICA, INC.                               |   |   |
| MEDEVAC  MEDICAL RESPONSE, INC.                         |   |   |
| AMERICAN  MEDICAL RESPONSE OF OKLAHOMA, INC.            |   |   |
| AMERICAN  MEDICAL RESPONSE OF TEXAS, INC.               |   |   |
| KUTZ  AMBULANCE SERVICE, INC.                           |   |   |
| AMERICAN  MEDICAL RESPONSE HOLDINGS, INC.               |   |   |
| AMERICAN  MEDICAL RESPONSE MANAGEMENT, INC.             |   |   |
| A1  LEASING, INC.                                       |   |   |
| FLORIDA  EMERGENCY PARTNERS, INC.                       |   |   |
| MOBILE  MEDIC AMBULANCE SERVICE, INC.                   |   |   |
| METRO  AMBULANCE SERVICE, INC.                          |   |   |
| METRO  AMBULANCE SERVICE (RURAL), INC.                  |   |   |
| MEDIC  ONE AMBULANCE SERVICES, INC.                     |   |   |
| AMERICAN  MEDICAL RESPONSE OF SOUTH CAROLINA, INC.      |   |   |
| AMERICAN  MEDICAL RESPONSE OF NORTH CAROLINA, INC.      |   |   |
| AMERICAN  MEDICAL RESPONSE OF GEORGIA, INC.             |   |   |
| TROUP  COUNTY EMERGENCY MEDICAL SERVICES, INC.          |   |   |
| RANDLE  EASTERN AMBULANCE SERVICE, INC.                 |   |   |
| MEDI-CAR  SYSTEMS, INC.                                 |   |   |
| MEDI-CAR  AMBULANCE SERVICE, INC.                       |   |   |
| AMERICAN  MEDICAL RESPONSE OF TENNESSEE, INC.           |   |   |
| PHYSICIANS &  SURGEONS AMBULANCE SERVICE, INC. |   |   |
| AMERICAN  MEDICAL RESPONSE OF ILLINOIS, INC.            |   |   |
| MIDWEST  AMBULANCE MANAGEMENT COMPANY                   |   |   |
| PARAMED,  INC.                                          |   |   |
| MERCY  AMBULANCE OF EVANSVILLE, INC.                    |   |   |
| TIDEWATER  AMBULANCE SERVICE, INC.                      |   |   |
| AMERICAN  MEDICAL RESPONSE OF CONNECTICUT, INCORPORATED |   |   |
| AMERICAN  MEDICAL RESPONSE OF MASSACHUSETTS, INC.       |   |   |
| AMERICAN  MEDICAL RESPONSE MID-ATLANTIC, INC.           |   |   |
| AMBULANCE  ACQUISITION, INC.                            |   |   |
| METRO  AMBULANCE SERVICES, INC.                         |   |   |
| BROWARD  AMBULANCE, INC.                                |   |   |
| ATLANTIC  AMBULANCE SERVICES ACQUISITION, INC.          |   |   |
| ATLANTIC/KEY  WEST AMBULANCE, INC.                      |   |   |
| ATLANTIC/PALM  BEACH AMBULANCE, INC.                    |   |   |
| SEMINOLE  COUNTY AMBULANCE, INC.                        |   |   |
| LIFEFLEET  SOUTHEAST, INC.                              |   |   |
| AMERICAN  MEDICAL PATHWAYS, INC.                        |   |   |
| ADAM  TRANSPORTATION SERVICE, INC.                      |   |   |
| ASSOCIATED  AMBULANCE SERVICE, INC.                     |   |   |
| PARK  AMBULANCE SERVICE INC.                            |   |   |
| FIVE  COUNTIES AMBULANCE SERVICE, INC.                  |   |   |

 

[Signature Page toSupplemental Indenture No. 14]

 

----

 
| SUNRISE  HANDICAP TRANSPORT CORP.                                       |   |   |
|-------------------------------------------------------------------------|--------|--------|
| STAT  HEALTHCARE, INC.                                                  |   |   |
| LAIDLAW  MEDICAL TRANSPORTATION, INC.                                   |   |   |
| MERCY,  INC.                                                            |   |   |
| AMERICAN  INVESTMENT ENTERPRISES, INC.                                  |   |   |
| LIFECARE  AMBULANCE SERVICE, INC.                                       |   |   |
| TEK,  INC.                                                              |   |   |
| MERCY  LIFE CARE                                                        |   |   |
| HEMET  VALLEY AMBULANCE SERVICE, INC.                                   |   |   |
| AMERICAN  MEDICAL RESPONSE OF SOUTHERN CALIFORNIA                       |   |   |
| MEDIC  ONE OF COBB, INC.                                                |   |   |
| PUCKETT  AMBULANCE SERVICE, INC.                                        |   |   |
| AMERICAN  MEDICAL RESPONSE DELAWARE VALLEY, LLC                         |   |   |
| By:  American Medical Response Mid-Atlantic, Inc., its sole member |   |   |
| REGIONAL  EMERGENCY SERVICES, LP                                        |   |   |
| By:  Florida Emergency Partners, Inc., its general partner         |   |   |
| PROVIDACARE,  L.L.C.                                                    |   |   |
| By:  American Medical Pathways, Inc., its sole member              |   |   |
| AMR  BROCKTON, L.L.C.                                                   |   |   |
| By:  American Medical Response of Massachusetts, Inc., its manager |   |   |

 

 
| By:    | /s/  Randel G. Owen |   |
|--------|---------------------|--------|
| Name:  | Randel  G. Owen     |   |
| Title: | Vice  President     |   |

 

 
| EMCARE  HOLDINGS INC.              |   |   |
|------------------------------------|--------|--------|
| EMCARE,  INC.                      |   |   |
| EMCARE  OF ALABAMA, INC.           |   |   |
| EMCARE  CONTRACT OF ARKANSAS, INC. |   |   |
| EMCARE  OF ARIZONA, INC.           |   |   |
| EMCARE  OF CALIFORNIA, INC.        |   |   |
| EMCARE  OF COLORADO, INC.          |   |   |
| EMCARE  OF CONNECTICUT, INC.       |   |   |
| EMCARE  OF FLORIDA, INC.           |   |   |
| EMCARE  OF GEORGIA, INC.           |   |   |
| EMCARE  OF HAWAII, INC.            |   |   |
| EMCARE  OF INDIANA, INC.           |   |   |
| EMCARE  OF IOWA, INC.              |   |   |
| EMCARE  OF KENTUCKY, INC.          |   |   |
| EMCARE  OF LOUISIANA, INC.         |   |   |
| EMCARE  OF MAINE, INC.             |   |   |
| EMCARE  OF MICHIGAN, INC.          |   |   |
| EMCARE  OF MINNESOTA, INC.         |   |   |
| EMCARE  OF MISSISSIPPI, INC.       |   |   |

 

[Signature Page toSupplemental Indenture No. 14]

 

----

 
| EMCARE  OF MISSOURI, INC.                                            |   |   |
|----------------------------------------------------------------------|--------|--------|
| EMCARE  OF NEVADA, INC.                                              |   |   |
| EMCARE  OF NEW HAMPSHIRE, INC.                                       |   |   |
| EMCARE  OF NEW JERSEY, INC.                                          |   |   |
| EMCARE  OF NEW MEXICO, INC.                                          |   |   |
| EMCARE  OF NEW YORK, INC.                                            |   |   |
| EMCARE  OF NORTH CAROLINA, INC.                                      |   |   |
| EMCARE  OF NORTH DAKOTA, INC.                                        |   |   |
| EMCARE  OF OHIO, INC.                                                |   |   |
| EMCARE  OF OKLAHOMA, INC.                                            |   |   |
| EMCARE  OF OREGON, INC.                                              |   |   |
| EMCARE  OF PENNSYLVANIA, INC.                                        |   |   |
| EMCARE  OF RHODE ISLAND, INC.                                        |   |   |
| EMCARE  OF SOUTH CAROLINA, INC.                                      |   |   |
| EMCARE  OF TENNESSEE, INC.                                           |   |   |
| EMCARE  OF TEXAS, INC.                                               |   |   |
| EMCARE  OF VERMONT, INC.                                             |   |   |
| EMCARE  OF VIRGINIA, INC.                                            |   |   |
| EMCARE  OF WASHINGTON, INC.                                          |   |   |
| EMCARE  OF WEST VIRGINIA, INC.                                       |   |   |
| EMCARE  OF WISCONSIN, INC.                                           |   |   |
| EMCARE  PHYSICIAN PROVIDERS, INC.                                    |   |   |
| EMCARE  PHYSICIAN SERVICES, INC.                                     |   |   |
| EMCARE  SERVICES OF ILLINOIS, INC.                                   |   |   |
| EMCARE  SERVICES OF MASSACHUSETTS, INC.                              |   |   |
| EMCARE  ANESTHESIA SERVICES, INC.                                    |   |   |
| ECEP,  INC.                                                          |   |   |
| COORDINATED  HEALTH SERVICES, INC.                                   |   |   |
| EM-CODE  REIMBURSEMENT SOLUTIONS, INC.                               |   |   |
| EMERGENCY  MEDICINE EDUCATION SYSTEMS, INC.                          |   |   |
| EMERGENCY  SPECIALISTS OF ARKANSAS, INC. II                          |   |   |
| FIRST  MEDICAL/EMCARE, INC.                                          |   |   |
| HEALTHCARE  ADMINISTRATIVE SERVICES, INC.                            |   |   |
| OLD  STAT, INC.                                                      |   |   |
| REIMBURSEMENT  TECHNOLOGIES, INC.                                    |   |   |
| STAT  PHYSICIANS, INC.                                               |   |   |
| THE  GOULD GROUP, INC.                                               |   |   |
| TIFTON  MANAGEMENT SERVICES, INC.                                    |   |   |
| TUCKER  EMERGENCY SERVICES, INC.                                     |   |   |
| EMERGENCY  MEDICAL SERVICES CORPORATION                              |   |   |
| EMS  MANAGEMENT LLC                                                  |   |   |
| By:  AMR Holdco, Inc. and EmCare Holdco, Inc., its members |   |   |
| HELIX  PHYSICIANS MANAGEMENT, INC.                                   |   |   |
| NORMAN  BRUCE JETTON, INC.                                           |   |   |
| PACIFIC  EMERGENCY SPECIALISTS MANAGEMENT, INC.                      |   |   |
| AMERICAN  EMERGENCY PHYSICIANS MANAGEMENT, INC.                      |   |   |

 

[Signature Page toSupplemental Indenture No. 14]

 

----

 
| PHYSICIAN  ACCOUNT MANAGEMENT, INC.                          |   |   |
|--------------------------------------------------------------|--------|--------|
| PROVIDER  ACCOUNT MANAGEMENT, INC.                           |   |   |
| CHARLES  T. MITCHELL, M.D., INC.                             |   |   |
| GLOBAL  MEDICAL RESPONSE, INC.                               |   |   |
| AIR  AMBULANCE SPECIALISTS, INC.                             |   |   |
| EHR  MANAGEMENT CO.                                          |   |   |
| EMCARE  OF MARYLAND LLC,                                     |   |   |
| By:  EmCare Holdings Inc. and EmCare, Inc., its members |   |   |
| NEVADA  RED ROCK HOLDINGS, INC.                              |   |   |
| NEVADA  RED ROCK AMBULANCE, INC.                             |   |   |
| MEDICWEST  HOLDINGS, INC.                                    |   |   |
| MEDICWEST  AMBULANCE, INC.                                   |   |   |
| MISSION  CARE SERVICES, LLC                                  |   |   |
| By:  American Medical Response, Inc., its manager       |   |   |
| MISSION  CARE OF ILLINOIS, LLC                               |   |   |
| By:  Mission Care Services, Inc., its manager           |   |   |
| By:  American Medical Response, Inc., its manager       |   |   |
| MISSION  CARE OF MISSOURI, LLC                          |   |   |
| By:  Mission Care Services, Inc., its manager           |   |   |
| By:  American Medical Response, Inc., its manager       |   |   |
| ACCESS2CARE,  LLC                                       |   |   |
| By:  Mission Care Services, Inc., its manager           |   |   |
| By:  American Medical Response, Inc., its manager       |   |   |
| ABBOTT  AMBULANCE, INC.                                      |   |   |
| ARIZONA  OASIS ACQUISITION, INC.                             |   |   |
| RADIOLOGY  STAFFING SOLUTIONS, INC.                          |   |   |
| RADSTAFFING  MANAGEMENT SOLUTIONS, INC.                      |   |   |
| RIVER  MEDICAL INCORPORATED                                  |   |   |
| CLINICAL  PARTNERS MANAGEMENT COMPANY, LLC                   |   |   |
| MEDASSOCIATES,  LLC                                          |   |   |

 

 
| By:    | /s/  William A. Sanger   |   |
|--------|--------------------------|--------|
| Name:  | William  A. Sanger       |   |
| Title: | Chief  Executive Officer |   |

 

 
| U.S.  BANK TRUST NATIONAL ASSOCIATION, as Trustee |                 |
|---------------------------------------------------|----------------------|
|                                              |                 |   |
|                                              |                 |   |
| By:                                               | /s/  John J. Doherty |   |
| Name:                                             | John  J. Doherty     |   |
| Title:                                            | Vice  President      |   |

 

[Signature Page toSupplemental Indenture No. 14]

 

----