Exhibit 10.42  ***
Confidential Information Omitted and filed separately with the Securities and
Exchange Commission.  CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 20  Contract
  No.
  
  00-83122Facility:
  
  ALTA
  LOS ANGELES HOSPITALS, INC.
  dba:LOS ANGELES COMMUNITY
  HOSPITALAddress:
  
  4081
  East Olympic Boulevard
  Los Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE  Exempt
from Public Records Act
(Government Code Section 6254[q])


AMENDMENT
NO. 20 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 0083122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph One  Appendix D  Appendix
Dis hereby
amended to read as attached.  Paragraph Two  Notice of
Termination  In
accordance with Welfare and Institutions Code section 14166.12 (p), Provider
shall not submit a 120day notice for the purpose of terminating this Contract
as provided in Paragraph 6.15 of this Contract, Termination without Cause,
until on or after December 31, 2009, unless a later date is specified in
Paragraph 6.15 or otherwise specified in this Contract.  Paragraph Three  Effective
Date of Contract Amendment  Unless
otherwise specified herein, Contract changes agreed to in this Amendment are
effective on February 5, 2009.  Paragraph Four  30 Days to
Sign and Return Contract Amendment  If
this Amendment is not signed and returned to the California Medical Assistance
Commission within 30 days of its effective date, then the California Medical
Assistance Commission may take action to disapprove this Amendment.  Paragraph Five 
Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.   Provider
  
  State
  of California Department of Health Care Services/s/
  David Topper
  
  Nancy
  HutchisonSignature
  
  SignatureDavid
  Topper
  
  for
  David Maxwell-Jolly, Ph.D.Type
  Name
  
  DirectorChief
  Executive OfficerType
  TitleDate:February 4,
  2009
  
  Date:
  2/27/09  3


APPENDIX D  PRIVATE HOSPITAL SUPPLEMENTAL
FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2008-09.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund) , the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, the State agrees to pay the Provider from the Fund:  (1)For services rendered from July 1, 2008 through February 28,
2009:  (a)The installment amount of $*** if Provider is listed
on the 2008-09 tentative Disproportionate Share Hospital (DSH) list issued by
the California Department of Health Care Services (Department).  Payment will be made by November 1,
2000, or as soon thereafter as practicable.  (b)The installment amount of $***.  Payment will be made by March 1, 2009,
or as soon thereafter as practicable.  B.Recovery, Right of Offset, and Hold Harmless  (1)Payment(s) received by Provider from the Fund for
the 2008-09 state fiscal year may be subject to recovery by the Department if
the Department determines that the Provider fails at any time during the
2008-09 state fiscal year to meet the eligibility criteria for Fund
disbursements, as specified in Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (a)Provider must promptly return to the Department all
payments received from the Fund for the 2008-09 state fiscal year if the
Department determines that the provider fails at any time during the 2008-09
state fiscal year to receive and/or maintain final DSH status, under Welfare
and Institutions Code Sections 14166.11, 14105.98, and 14163, for the 2008-09
DSH payment adjustment year.  (b)Unless Subparagraph (a) applies, Provider must
promptly return to the Department amounts received from the Fund for the
2008-09 state fiscal year that equal the prorate portion of Providers 2002-03
supplement fund


amount, plus any payments
over the Providers 2002-03 supplement fund amount received from the Fund for
the 2008-09 state fiscal year if the Department determines that the Provider
failed to meet participation criteria for the entire 2008-09 state fiscal year,
other than DSH status addressed in Subparagraph (a) above, specified in
Welfare end Institutions Code Sections 14085.6 and 14166.12, which includes,
but is not limited to, failed for any reason to maintain its Emergency
Department as operational and licensed at the Basic Level or higher level.  For purposes of this Subparagraph (b), the
amount equal to the pro-rata portion of Providers 2002-03 supplement fund
payment, pursuant to Welfare and Institutions Code Section 14166.12 (j),
will be calculated on the number of days during the 2008-09 state fiscal year
that the Provider failed to meet participation criteria.  (2)It is understood that payment made to the Provider
pursuant to this Appendix D, and all prior versions of Appendix D, include
State and federal funds.  The State shall
be held harmless from any federal disallowance or withholding resulting from
payment made to Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, and the Provider shall be liable for any reduced federal financial
participation resulting from the payment of funds pursuant to this Appendix D,
or any prior versions of Appendix D.  In
the event of federal disallowance or withholding of federal financial
participation for any payments made to the Provider pursuant to this Appendix
D, or any prior version(s) of Appendix D, at the time of the federal
disallowance or withholding the State, in its sole discretion, may limit its
recovery from the Provider to the amount of funds disallowed and paid by the
State to the Provider.  Provider agrees
that the amount of any such recovery may be recouped by the State by
withholding and offsetting, under Welfare and Institutions Code Section 14115.5,
the amount due from what would otherwise be the States liability to the
Provider under this Contract or otherwise, seeking recovery by payment from the
Provider, or a combination of these two methods.  If, after federal disallowance or withholding
and State recovery or offset of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the federal end related state funds
shall be repaid by the State to the Provider.  5


CONTRACT FOR HOSPITAL INPATIENT SERVICES  Amendment No. 21  Contract
  No.
  00-83122Facility:
  ALTA
  LOS ANGELES HOSPITALS, INC.dba:LOS ANGELES
  COMMUNITY HOSPITALAddress:
  4081
  East Olympic BoulevardLos
  Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE  Exempt
from Public Records Act
(Government Code Section 6254[q])


AMENDMENT
NO. 21 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 0083122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph One  Appendix D  Appendix
Dis hereby
amended to read as attached.  Paragraph Two  Notice of
Termination  In
accordance with Welfare and Institutions Code section 14166.12 (p), Provider
shall not submit a 120day notice for the purpose of terminating this Contract
as provided in Paragraph 6.15 of this Contract, Termination without Cause,
until on or after December 31, 2010, unless a later date is specified in
Paragraph 6.15 or otherwise specified in this Contract.  Paragraph Three  Effective
Date of Contract Amendment  Unless
otherwise specified herein, Contract changes agreed to in this Amendment are
effective on September 24, 2009.  Paragraph Four  30 Days to
Sign and Return Contract Amendment  If
this Amendment is not signed and returned to the California Medical Assistance
Commission within 30 days of its effective date, then the California Medical
Assistance Commission may take action to disapprove this Amendment.  Paragraph Five 
Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  2


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.   Provider
  
  State
  of California Department of Health Care Services/s/
  David Topper
  
  /s/
  [illegible]Signature
  
  SignatureDavid
  Topper
  
  for
  David Maxwell-Jolly, Ph.D.Type
  Name
  
  DirectorChief
  Executive OfficerType
  TitleDate:     October 1,
  2009
  
  Date:
  10/12/09  3


APPENDIX D  PRIVATE HOSPITAL
SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2009-10.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund) , the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, the State agrees to pay the Provider from the Fund:  (1)For services rendered from July 1, 2009 through September 30,
2009:  (a)The installment amount of $*** if Provider is listed
on the 2009-10 tentative Disproportionate Share Hospital (DSH) list issued by
the California Department of Health Care Services (Department).  Payment will be made by November 1,
2000, or as soon thereafter as practicable.  (b)The installment amount of $*** Payment will be made
by October 1, 2009, or as soon thereafter as practicable.  B.Recovery, Right of Offset, and Hold Harmless  (1)Payment(s) received by Provider from the Fund for
the 2009-10 state fiscal year may be subject to recovery by the Department if
the Department determines that the Provider fails at any time during the
2009-10 state fiscal year to meet the eligibility criteria for Fund
disbursements, as specified in Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (a)Provider must promptly return to the Department all
payments received from the Fund for the 2009-10 state fiscal year if the Department
determines that the provider fails at any time during the 2009-10 state fiscal
year to receive and/or maintain final DSH status, under Welfare and
Institutions Code Sections 14166.11, 14105.98, and 14163, for the 2009-10 DSH
payment adjustment year.  (b)Unless Subparagraph (a) applies, Provider must
promptly return to the Department amounts received from the Fund for the
2009-10 state fiscal year that equal the prorate portion of Providers 2002-03
supplement fund


amount, plus any payments
over the Providers 2002-03 supplement fund amount received from the Fund for
the 2009-10 state fiscal year if the Department determines that the Provider
failed to meet participation criteria for the entire 2009-10 state fiscal year,
other than DSH status addressed in Subparagraph (a) above, specified in
Welfare end Institutions Code Sections 14085.6 and 14166.12, which includes,
but is not limited to, failed for any reason to maintain its Emergency
Department as operational and licensed at the Basic Level or higher level.  For purposes of this Subparagraph (b), the
amount equal to the pro-rata portion of Providers 2002-03 supplement fund
payment, pursuant to Welfare and Institutions Code Section 14166.12 (j),
will be calculated on the number of days during the 2009-10 state fiscal year
that the Provider failed to meet participation criteria.  (2)It is understood that payment made to the Provider
pursuant to this Appendix D, and all prior versions of Appendix D, include
State and federal funds.  The State shall
be held harmless from any federal disallowance or withholding resulting from
payment made to Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, and the Provider shall be liable for any reduced federal financial
participation resulting from the payment of funds pursuant to this Appendix D,
or any prior versions of Appendix D.  In
the event of federal disallowance or withholding of federal financial
participation for any payments made to the Provider pursuant to this Appendix
D, or any prior version(s) of Appendix D, at the time of the federal
disallowance or withholding the State, in its sole discretion, may limit its
recovery from the Provider to the amount of funds disallowed and paid by the
State to the Provider.  Provider agrees
that the amount of any such recovery may be recouped by the State by
withholding and offsetting, under Welfare and Institutions Code Section 14115.5,
the amount due from what would otherwise be the States liability to the
Provider under this Contract or otherwise, seeking recovery by payment from the
Provider, or a combination of these two methods.  If, after federal disallowance or withholding
and State recovery or offset of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the federal end related state
funds shall be repaid by the State to the Provider.  5