EX-4.1



 Exhibit 4.1 
  

 
  

HCA INC., 
 as Issuer, 

HCA HOLDINGS, INC., 
 as Parent
Guarantor, 
 THE SUBSIDIARY GUARANTORS NAMED ON SCHEDULE I HERETO, 

and 
 DELAWARE TRUST COMPANY, 

as Trustee 
 SUPPLEMENTAL INDENTURE
NO. 17 
 Dated as of December 9, 2016 

To SUPPLEMENTAL INDENTURE NO. 2 

Dated as of August 1, 2011 

SUPPLEMENTAL INDENTURE NO. 4 

Dated as of February 16, 2012 

SUPPLEMENTAL INDENTURE NO. 6 

Dated as of October 23, 2012 

SUPPLEMENTAL INDENTURE NO. 7 

Dated as of March 17, 2014 

SUPPLEMENTAL INDENTURE NO. 8 

Dated as of March 17, 2014 

SUPPLEMENTAL INDENTURE NO. 9 

Dated as of October 17, 2014 

SUPPLEMENTAL INDENTURE NO. 10 

Dated as of October 17, 2014 

SUPPLEMENTAL INDENTURE NO. 15 

Dated as of March 15, 2016 

and 
 SUPPLEMENTAL INDENTURE
NO. 16 
 Dated as of August 15, 2016 
  

 
  







 SUPPLEMENTAL INDENTURE NO. 17 (the “Seventeenth Supplemental Indenture”),
dated as of December 9, 2016, among HCA Inc., a Delaware corporation (the “Issuer”), HCA Holdings, Inc. (the “Parent Guarantor”), the other guarantors listed in Schedule I hereto (the “Subsidiary
Guarantors”, and together with the Parent Guarantor, the “Guarantors”), Delaware Trust Company (as successor to Law Debenture Trust Company of New York), as Trustee (the “Trustee”), and Deutsche Bank Trust
Company Americas, as Paying Agent, Registrar and Transfer Agent. 
 W I T N E S S E T H 

WHEREAS, the Issuer, the Guarantors and the Trustee have executed and delivered a base indenture, dated as of August 1, 2011 (as amended,
supplemented or otherwise modified from time to time, the “Base Indenture”) to provide for the future issuance of the Issuer’s senior debt securities to be issued from time to time in one or more series; 

WHEREAS, as specified below, each of the Issuer and the Guarantors have heretofore executed and delivered to the Trustee a supplemental
indenture relating to each series of the Issuer’s outstanding senior secured notes; 
 WHEREAS, each of the Issuer and the Guarantors
have heretofore executed and delivered to the Trustee a supplemental indenture (the “Second Supplemental Indenture”), dated as of August 1, 2011, providing for the issuance of an unlimited aggregate principal amount of 6.50%
Senior Secured Notes due 2020 (the “6.50% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore
executed and delivered to the Trustee a supplemental indenture (the “Fourth Supplemental Indenture”), dated as of February 16, 2012, providing for the issuance of an unlimited aggregate principal amount of 5.875% Senior Secured
Notes due 2022 (the “5.875% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and
delivered to the Trustee a supplemental indenture (the “Sixth Supplemental Indenture”), dated as of October 23, 2012, providing for the issuance of an unlimited aggregate principal amount of 4.75% Senior Secured Notes due 2023
(the “4.75% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered to the
Trustee a supplemental indenture (the “Seventh Supplemental Indenture”), dated as of March 17, 2014, providing for the issuance of an unlimited aggregate principal amount of 3.75% Senior Secured Notes due 2019 (the
“3.75% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered to the
Trustee a supplemental indenture (the “Eighth Supplemental Indenture”), dated as of March 17, 2014, providing for the issuance of an unlimited aggregate principal amount of 5.00% Senior Secured Notes due 2024 (the
“5.00% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered to the
Trustee a supplemental indenture (the “Ninth Supplemental Indenture”), dated as of October 17, 2014, providing for the issuance of an unlimited aggregate principal amount of 4.25% Senior Secured Notes due 2019 (the
“4.25% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered to the
Trustee a supplemental indenture (the “Tenth Supplemental Indenture”), dated as of October 17, 2014, providing for the issuance of an unlimited aggregate principal amount of 5.25% Senior Secured Notes due 2025 (the
“First 5.25% Notes”); 

  
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 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered to the
Trustee a supplemental indenture (the “Fifteenth Supplemental Indenture”), dated as of March 15, 2016, providing for the issuance of an unlimited aggregate principal amount of 5.250% Senior Secured Notes due 2026 (the
“Second 5.25% Notes”); 
 WHEREAS, each of the Issuer and the Guarantors have heretofore executed and delivered
to the Trustee a supplemental indenture (the “Sixteenth Supplemental Indenture” and, together with the Second Supplemental Indenture, the Fourth Supplemental Indenture, the Sixth Supplemental Indenture, the Seventh Supplemental
Indenture, the Eighth Supplemental Indenture, the Ninth Supplemental Indenture, the Tenth Supplemental Indenture, and the Fifteenth Supplemental Indenture, each a “Supplemental Indenture” and, collectively, the “Supplemental
Indentures”), dated as of August 15, 2016, providing for the issuance of an unlimited aggregate principal amount of 4.500% Senior Secured Notes due 2027 (the “4.500% Notes” and, together with the 6.50% Notes,
the 5.875% Notes, the 4.75% Notes, the 3.75% Notes, the 5.00% Notes, the 4.25% Notes, the First 5.25% Notes, and the Second 5.25% Notes, the “Notes”); 

WHEREAS, each of the Supplemental Indentures restated in their entirety the terms of the Base Indenture as supplemented by such Supplemental
Indenture and did not incorporate the terms of the Base Indenture; 
 WHEREAS, the changes, modifications and supplements to the Base
Indenture affected by each of the Supplemental Indentures are applicable only with respect to, and only govern the terms of, the applicable series of Notes, except as otherwise provided therein, and do not apply to any other series of Notes or other
securities that may be issued under the Base Indenture unless a supplemental indenture with respect to such other securities specifically incorporates such changes, modifications and supplements; 

WHEREAS, pursuant to Section 7.09 of each Supplemental Indenture, Delaware Trust Company became the successor Trustee without any further
act, due to its acquisition of substantially all of the corporate trust business of Law Debenture Trust Company of New York on December 7, 2016; 

WHEREAS, pursuant to Section 9.01(2) of each Supplemental Indenture, such Supplemental Indenture provides that the Issuer, the Guarantors
and the Trustee may amend or supplement such Supplemental Indenture without the consent of Holders of the applicable series of Notes to add to the covenants for the benefit of such Holders; 

WHEREAS, pursuant to Section 9.01(7) of each Supplemental Indenture, such Supplemental Indenture provides that the Issuer, the Guarantors
and the Trustee may amend or supplement such Supplemental Indenture without the consent of Holders of the applicable series of Notes to evidence a successor Trustee; 

WHEREAS, pursuant to Section 9.01 of each Supplemental Indenture, this Seventeenth Supplemental Indenture may be executed and delivered
by the Issuer, the Guarantors and the Trustee without the consent of the Holders of the applicable series of Notes; 
 WHEREAS, the Issuer
and each of the Guarantors has duly authorized the execution of this Seventeenth Supplemental Indenture and its delivery to the Trustee; and 

  
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 WHEREAS, all acts and things necessary to make this Seventeenth Supplemental Indenture the valid,
binding and legal obligations of the Issuer and the Guarantors in accordance with its terms have been done; 
 NOW, THEREFORE, in
consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the parties mutually covenant and agree for the benefit of the Holders of each series of Notes as follows: 

(1)    Definitions. Capitalized terms used herein without definition shall have the meanings assigned to them in
each of the Supplemental Indentures, as applicable. 
 (2)    Amendments to each Supplemental Indenture.
(a) Section 4.10(a) of each Supplemental Indenture is hereby amended and restated in its entirety, as follows: 

“(a)    If on any date following the Issue Date (i) each of the Rating Agencies shall have issued
an Investment Grade Rating with respect to both the Notes and the “corporate family rating” (or comparable designation) for the Parent Guarantor and its Subsidiaries and (ii) no Default has occurred and is continuing under this
Supplemental Indenture (the occurrence of the events described in the foregoing clauses (i) and (ii) being collectively referred to as a “Investment Grade Rating Event”), the Issuer and the Subsidiaries shall not be
subject to Section 4.07 hereof (the “Suspended Covenant”). For avoidance of doubt, the Issuer agrees not to take any action that would have been permitted under Section 4.11(a) under the original provisions of this
Supplemental Indenture unless an Investment Grade Rating Event (as such term has been modified pursuant to the Seventeenth Supplemental Indenture) has occurred.” 

(b)    Section 14.02 of each Supplemental Indenture is hereby amended by replacing the address for any
notice or communication to the Trustee with the following: 
 “If to the Trustee: 

Delaware Trust Company 
 Little
Falls Centre One 
 2711 Centerville Road 

Wilmington, Delaware 19808 
 Fax
No.: (302) 636-8666 
 Attention: Corporate Trust Administration” 

(3)    Execution and Delivery. The Issuer, each Guarantor and the Trustee agree that this Seventeenth Supplemental
Indenture shall remain in full force and effect notwithstanding the absence of the endorsement of any notation on any series of Notes. 

(4)    Trust Indenture Act Controls. If any provision of this Seventeenth Supplemental Indenture limits, qualifies
or conflicts with the duties imposed by Trust Indenture Act Section 318(c), the imposed duties shall control. 

(5)    No Personal Liability of Directors, Officers, Employees and Stockholders. No director, officer, employee,
incorporator or stockholder of the Issuer or any Guarantor or any of their parent companies (other than the Issuer and the Guarantors) shall have any liability for any obligations of the Issuer or the Guarantors under the Notes, the Guarantees or
this Seventeenth Supplemental Indenture or for any claim based on, in respect of, or by reason of such obligations or their creation. Each Holder by accepting the Notes waives and releases all such liability. The waiver and release are part of the
consideration for issuance of the Notes. 

  
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 (6)    Governing Law. THIS SEVENTEENTH SUPPLEMENTAL INDENTURE WILL BE
GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 
 (7)    Waiver of Jury Trial.
EACH OF THE ISSUER, THE GUARANTORS AND THE TRUSTEE HEREBY IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO THIS SEVENTEENTH SUPPLEMENTAL
INDENTURE, THE GUARANTEE, THE NOTES OR THE TRANSACTIONS CONTEMPLATED HEREBY. 
 (8)    Force Majeure. In no event
shall the Trustee be responsible or liable for any failure or delay in the performance of its obligations under this Seventeenth Supplemental Indenture arising out of or caused by, directly or indirectly, forces beyond its reasonable control,
including without limitation strikes, work stoppages, accidents, acts of war or terrorism, civil or military disturbances, nuclear or natural catastrophes or acts of God, and interruptions, loss or malfunctions of utilities, communications or
computer (software or hardware) services. 
 (9)    No Adverse Interpretation of Other Agreements. This
Seventeenth Supplemental Indenture may not be used to interpret any other indenture, loan or debt agreement of the Issuer or its Subsidiaries or of any other Person. Any such indenture, loan or debt agreement may not be used to interpret this
Seventeenth Supplemental Indenture. 
 (10)    Successors. All agreements of the Issuer in this Seventeenth
Supplemental Indenture and the Notes shall bind its successors. All agreements of the Trustee in this Seventeenth Supplemental Indenture shall bind its successors. All agreements of each Guarantor in this Seventeenth Supplemental Indenture shall
bind its successors, except as otherwise provided in Section 12.06 or 12.07(i) of the applicable Supplemental Indenture. 

(11)    Severability. In case any provision in this Seventeenth Supplemental Indenture or in the Notes 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. 

(12)    Counterpart Originals. The parties may sign any number of copies of this Seventeenth Supplemental
Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 

(13)    Effect of Headings. The Section headings of this Seventeenth Supplemental Indenture have been inserted for
convenience of reference only, are not to be considered a part of this Seventeenth Supplemental Indenture and shall in no way modify or restrict any of the terms or provisions hereof. 

(14)    The Trustee. The Trustee shall not be responsible in any manner whatsoever for or in respect of the
validity or sufficiency of this Seventeenth Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Issuer and the Guarantors. 

(15)    Ratification of each Supplemental Indenture. Each Supplemental Indenture, as supplemented by this
Seventeenth Supplemental Indenture, is in all respects ratified and confirmed, and this Seventeenth Supplemental Indenture shall be deemed part of each Supplemental Indenture in the manner and to the extent herein provided. For the avoidance of
doubt, each of the Issuer, the Guarantors and each Holder of each series of Notes, by its acceptance of such Notes, acknowledges and agrees that all of the rights, privileges, protections, immunities ad benefits afforded to the Trustee under each


  
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applicable Supplemental Indenture, including without limitation the right to indemnification, are deemed to be incorporated herein, and shall be enforceable by the Trustee hereunder, in each of
its capacities hereunder as if set forth herein in full. 
 [Signatures on following pages] 

  
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	HCA INC.
		
	By:	 	 /s/ David G. Anderson

		 	Name:	 	David G. Anderson
		 	Title:	 	Senior Vice President – Finance









 
					
	HCA HOLDINGS, INC., as Parent Guarantor
		
	By:	 	 /s/ David G. Anderson

		 	Name:	 	David G. Anderson
		 	Title:	 	Senior Vice President – Finance









 
					
	 Each of the SUBSIDIARY GUARANTORS

listed on Schedule I hereto

		
	By:	 	 /s/ John M. Franck II

		 	Name:	 	John M. Franck II
		 	Title:	 	Authorized Signatory









 
					
	DELAWARE TRUST COMPANY, as Trustee
		
	By:	 	 /s/ Alan R. Halpern

		 	Name:	 	Alan R. Halpern
		 	Title:	 	Vice President









 SCHEDULE I 

Subsidiary Guarantors 
 American Medicorp
Development Co. 
 Bay Hospital, Inc. 
 Brigham City Community
Hospital, Inc. 
 Brookwood Medical Center of Gulfport, Inc. 

Capital Division, Inc. 
 Centerpoint Medical Center of
Independence, LLC 
 Central Florida Regional Hospital, Inc. 

Central Shared Services, LLC 
 Central Tennessee Hospital
Corporation 
 CHCA Bayshore, L.P. 
 CHCA Conroe, L.P. 

CHCA Mainland, L.P. 
 CHCA Pearland, L.P. 

CHCA West Houston, L.P. 
 CHCA Woman’s Hospital, L.P. 

Chippenham & Johnston-Willis Hospitals, Inc. 
 Citrus
Memorial Hospital, Inc. 
 Citrus Memorial Property Management, Inc. 

Colorado Health Systems, Inc. 
 Columbia ASC Management, L.P. 

Columbia Healthcare System of Louisiana, Inc. 
 Columbia
Jacksonville Healthcare System, Inc. 
 Columbia LaGrange Hospital, LLC 

Columbia Medical Center of Arlington Subsidiary, L.P. 
 Columbia
Medical Center of Denton Subsidiary, L.P. 
 Columbia Medical Center of Las Colinas, Inc. 

Columbia Medical Center of Lewisville Subsidiary, L.P. 
 Columbia
Medical Center of McKinney Subsidiary, L.P. 
 Columbia Medical Center of Plano Subsidiary, L.P. 

Columbia North Hills Hospital Subsidiary, L.P. 
 Columbia Ogden
Medical Center, Inc. 
 Columbia Parkersburg Healthcare System, LLC 

Columbia Plaza Medical Center of Fort Worth Subsidiary, L.P. 

Columbia Rio Grande Healthcare, L.P. 
 Columbia Riverside, Inc.

 Columbia Valley Healthcare System, L.P. 
 Columbia/Alleghany
Regional Hospital, Incorporated 
 Columbia/HCA John Randolph, Inc. 

Columbine Psychiatric Center, Inc. 
 Columbus Cardiology, Inc.

 Conroe Hospital Corporation 
 Dallas/Ft. Worth
Physician, LLC 
 Dublin Community Hospital, LLC 
 Eastern Idaho
Health Services, Inc. 
 Edward White Hospital, Inc. 

El Paso Surgicenter, Inc. 

  
 Schedule I-1 








 Encino Hospital Corporation, Inc. 

EP Health, LLC 
 Fairview Park GP, LLC 

Fairview Park, Limited Partnership 
 Frankfort Hospital, Inc. 

Galen Property, LLC 
 Good Samaritan Hospital, L.P. 

Goppert-Trinity Family Care, LLC 
 GPCH-GP, Inc. 

Grand Strand Regional Medical Center, LLC 
 Green Oaks Hospital
Subsidiary, L.P. 
 Greenview Hospital, Inc. 
 HCA American
Finance LLC 
 HCA — HealthONE LLC 
 HCA —
IT&S Field Operations, Inc. 
 HCA — IT&S Inventory Management, Inc. 

HCA Central Group, Inc. 
 HCA Health Services of Florida, Inc.

 HCA Health Services of Louisiana, Inc. 
 HCA Health Services
of Oklahoma, Inc. 
 HCA Health Services of Tennessee, Inc. 

HCA Health Services of Virginia, Inc. 
 HCA Management Services,
L.P. 
 HCA Pearland GP, Inc. 
 HCA Realty, Inc. 

HCA SFB 1 LLC 
 HD&S Corp. Successor, Inc. 

HealthTrust Workforce Solutions, LLC 
 Health Midwest Office
Facilities Corporation 
 Health Midwest Ventures Group, Inc. 

Hendersonville Hospital Corporation 
 Hospital Corporation of
Tennessee 
 Hospital Corporation of Utah 
 Hospital Development
Properties, Inc. 
 HPG Enterprises, LLC 
 HSS Holdco, LLC 

HSS Systems, LLC 
 HSS Virginia, L.P. 

HTI Memorial Hospital Corporation 
 HTI MOB, LLC 

Integrated Regional Lab, LLC 
 Integrated Regional Laboratories,
LLP 
 JFK Medical Center Limited Partnership 

KPH-Consolidation, Inc. 
 Lakeland Medical Center, LLC 

Lakeview Medical Center, LLC 
 Largo Medical Center, Inc. 

Las Vegas Surgicare, Inc. 
 Lawnwood Medical Center, Inc. 

Lewis-Gale Hospital, Incorporated 
 Lewis-Gale Medical Center, LLC


  
 Schedule I-2 








 Lewis-Gale Physicians, LLC 

Lone Peak Hospital, Inc. 
 Los Robles Regional Medical Center 

Management Services Holdings, Inc. 
 Marietta Surgical Center,
Inc. 
 Marion Community Hospital, Inc. 
 MCA Investment Company

 Medical Centers of Oklahoma, LLC 
 Medical Office Buildings
of Kansas, LLC 
 Memorial Healthcare Group, Inc. 
 Midwest
Division — ACH, LLC 
 Midwest Division — LRHC, LLC 

Midwest Division — LSH, LLC 
 Midwest
Division — MCI, LLC 
 Midwest Division — MMC, LLC 

Midwest Division — OPRMC, LLC 
 Midwest
Division — PFC, LLC 
 Midwest Division — RBH, LLC 

Midwest Division — RMC, LLC 
 Midwest Holdings, Inc.

 Montgomery Regional Hospital, Inc. 
 Mountain Division —
CVH, LLC 
 Mountain View Hospital, Inc. 
 Nashville Shared
Services General Partnership 
 National Patient Account Services, Inc. 

New Iberia Healthcare, LLC 
 New Port Richey Hospital, Inc. 

New Rose Holding Company, Inc. 
 North Florida Immediate Care
Center, Inc. 
 North Florida Regional Medical Center, Inc. 

North Texas — MCA, LLC 
 Northern Utah Healthcare Corporation

 Northern Virginia Community Hospital, LLC 
 Northlake Medical
Center, LLC 
 Notami Hospitals of Louisiana, Inc. 
 Notami
Hospitals, LLC 
 Okaloosa Hospital, Inc. 
 Okeechobee Hospital,
Inc. 
 Outpatient Cardiovascular Center of Central Florida, LLC 

Palms West Hospital Limited Partnership 
 Palmyra Park Hospital,
LLC 
 Parallon Business Solutions, LLC 
 Parallon Enterprises,
LLC 
 Parallon Health Information Solutions, LLC 
 Parallon
Holdings, LLC 
 Parallon Payroll Solutions, LLC 
 Parallon
Physician Services, LLC 
 Parallon Technology Solutions, LLC 

Pasadena Bayshore Hospital, Inc. 
 PatientKeeper, Inc. 

Pearland Partner, LLC 

  
 Schedule I-3 








 Plantation General Hospital, L.P. 

Poinciana Medical Center, Inc. 
 Primary Health, Inc. 

Pulaski Community Hospital, Inc. 
 Putnam Community Medical Center
of North Florida, LLC 
 Redmond Park Hospital, LLC 
 Redmond
Physician Practice Company 
 Reston Hospital Center, LLC 

Retreat Hospital, LLC 
 Rio Grande Regional Hospital, Inc. 

Riverside Healthcare System, L.P. 
 Riverside Hospital, Inc. 

Samaritan, LLC 
 San Jose Healthcare System, LP 

San Jose Hospital, L.P. 
 San Jose Medical Center, LLC

 San Jose, LLC 
 Sarah Cannon Research Institute, LLC

 Sarasota Doctors Hospital, Inc. 
 SCRI Holdings, LLC 

SJMC, LLC 
 Southern Hills Medical Center, LLC 

Southpoint, LLC 
 Spalding Rehabilitation L.L.C. 

Spotsylvania Medical Center, Inc. 
 Spring Branch Medical Center,
Inc. 
 Spring Hill Hospital, Inc. 
 Sun City Hospital, Inc.

 Sunrise Mountainview Hospital, Inc. 
 Surgicare of Brandon,
Inc. 
 Surgicare of Florida, Inc. 
 Surgicare of Houston
Women’s, Inc. 
 Surgicare of Manatee, Inc. 
 Surgicare of
Newport Richey, Inc. 
 Surgicare of Palms West, LLC 
 Surgicare
of Riverside, LLC 
 Tallahassee Medical Center, Inc. 
 TCMC
Madison-Portland, Inc. 
 Terre Haute Hospital GP, Inc. 
 Terre
Haute Hospital Holdings, Inc. 
 Terre Haute MOB, L.P. 
 Terre
Haute Regional Hospital, L.P. 
 The Regional Health System of Acadiana, LLC 

Timpanogos Regional Medical Services, Inc. 
 Trident Medical
Center, LLC 
 U.S. Collections, Inc. 
 Utah Medco, LLC 

VH Holdco, Inc. 
 VH Holdings, Inc. 

Virginia Psychiatric Company, Inc. 
 Vision Consulting Group, LLC


  
 Schedule I-4 








 Vision Holdings, LLC 

W & C Hospital, Inc. 
 Walterboro Community Hospital,
Inc. 
 Wesley Medical Center, LLC 
 West Florida — MHT,
LLC 
 West Florida — PPH, LLC 
 West Florida — TCH,
LLC 
 West Florida Regional Medical Center, Inc. 
 West Valley
Medical Center, Inc. 
 Western Plains Capital, Inc. 
 WCP
Properties, LLC 
 WHMC, Inc. 
 Woman’s Hospital of Texas,
Incorporated 

  
 Schedule I-5