EX-4.1



 Exhibit 4.1 

 
 FIFTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”),
dated as of March 31, 2013, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary
Guarantor”) and REGIONS BANK, as successor Trustee under the Indenture (the “Trustee”). 
 W I T N E S
S E T H: 
 WHEREAS the Issuer has heretofore executed and delivered to the Trustee, as successor trustee, an Indenture (the
“Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 
 WHEREAS, the undersigned New Subsidiary Guarantor 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; and 
 WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the New Subsidiary
Guarantor 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 Guarantor 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. The 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. 
 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. 
 SECTION 7. 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 March, 2013.
			
		 		 	CHS/Community Health Systems, Inc.,
		 		 	a Delaware corporation	 	
					
		 		 	By:	 	   /s/ Rachel A. Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President, Secretary & General Counsel
		 		 	  
  
 New Subsidiary Guarantor:
	 	
		 		 	  
  
 Clarksville Holdings II, LLC,
 a Delaware limited liability company
	 	
					
		 		 	By:	 	   /s/ James W. Doucette
	 	
		 		 		 	James W. Doucette	 	
		 		 		 	Vice President & Treasurer	 	
		 		 	  
  
 Regions Bank, as Trustee
	 	
					
		 		 	By:	 	   /s/ Paul Williams
	 	
		 		 		 	Paul Williams	 	
		 		 		 	Vice President	 	


  
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