EX-4.4(j)






 Exhibit 4.4(j) 

SUPPLEMENT NO. 14 dated as of November 9, 2015 to the U.S. GUARANTEE dated as of November 17, 2006 and as amended and restated on
February 26, 2014, among each of HCA Inc., a Delaware corporation (the “Company”), the U.S. Guarantors listed on the signature pages thereto (each such subsidiary individually, a “U.S. Guarantor” and,
collectively, the “U.S. Guarantors”), and Bank of America, N.A., as Administrative Agent for the Lenders from time to time parties to the Credit Agreement referred to below (the “U.S. Guarantee”). 

A. Reference is made to the Credit Agreement, dated as of November 17, 2006 and as amended and restated as of May 4, 2011, as
further amended and restated on February 26, 2014 and as further amended on June 10, 2015, among the Company, the lending institutions from time to time parties thereto (the “Lenders”) and Bank of America N.A., as
Administrative Agent, Swingline Lender and Letter of Credit Issuer (as the same may be further amended, restated, supplemented or otherwise modified, refinanced or replaced from time to time, the “Credit Agreement”). 

B. Capitalized terms used herein and not otherwise defined herein shall have the meanings assigned to such terms in the Credit Agreement and
the U.S. Guarantee, as applicable. 
 C. The U.S. Guarantors have entered into the U.S. Guarantee in order to induce the Administrative
Agent, the Lenders and the Letter of Credit Issuer to enter into the Credit Agreement and to induce the Lenders and the Letter of Credit Issuer to make their respective Extensions of Credit to the Company under the Credit Agreement and to induce one
or more Cash Management Banks or Hedge Banks to enter into Secured Cash Management Agreements or Secured Hedge Agreements with the Company and/or its Subsidiaries. Section 9.11 of the Credit Agreement and Section 19 of the U.S. Guarantee
provide that additional Subsidiaries may become U.S. Guarantors under the U.S. Guarantee by execution and delivery of an instrument in the form of this Supplement. Each undersigned Subsidiary (each, a “New U.S. Guarantor” and
collectively, the “New U.S. Guarantors”) is executing this Supplement in accordance with the requirements of the Credit Agreement to become a U.S. Guarantor under the U.S. Guarantee in order to induce the Lenders and the Letter of
Credit Issuer to make additional Extensions of Credit and as consideration for Extensions of Credit previously made. 
 Accordingly, the
Administrative Agent and each New U.S. Guarantor agree as follows: 
 SECTION 1. In accordance with Section 19 of the U.S. Guarantee,
each New U.S. Guarantor by its signature below becomes a U.S. Guarantor under the U.S. Guarantee with the same force and effect as if originally named therein as a U.S. Guarantor, and each New U.S. Guarantor hereby (a) agrees to all the terms
and provisions of the U.S. Guarantee applicable to it as a U.S. Guarantor thereunder and (b) represents and warrants that the representations and warranties made by it as a U.S. Guarantor thereunder are true and correct on and as of the date
hereof (except where such representations and warranties expressly relate to an earlier date, in which case such representations and warranties were true and correct in all material respects as of such earlier date). Each reference to a U.S.
Guarantor in the U.S. Guarantee shall be deemed to include each New U.S. Guarantor. The U.S. Guarantee is hereby incorporated herein by reference. 

SECTION 2. Each New U.S. Guarantor represents and warrants to the Administrative Agent and the other Secured Parties that this Supplement has
been duly authorized, executed and delivered by it and constitutes its legal, valid and binding obligation, enforceable against it in accordance with its terms. 













 SECTION 3. This Supplement may be executed by one or more of the parties to this Supplement
on any number of separate counterparts (including by facsimile or other electronic transmission), and all of said counterparts taken together shall be deemed to constitute one and the same instrument. A set of the copies of this Supplement signed by
all the parties shall be lodged with the Company and the Administrative Agent. This Supplement shall become effective as to each New U.S. Guarantor when the Administrative Agent shall have received counterparts of this Supplement that, when taken
together, bear the signatures of such New U.S. Guarantor and the Administrative Agent. 
 SECTION 4. Except as expressly supplemented
hereby, the U.S. Guarantee shall remain in full force and effect. 
 SECTION 5. THIS SUPPLEMENT AND THE RIGHTS AND OBLIGATIONS OF THE
PARTIES HEREUNDER SHALL BE GOVERNED BY, AND CONSTRUED AND INTERPRETED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK. 
 SECTION
6. Any provision of this Supplement that is prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof and
in the U.S. Guarantee, and any such prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable such provision in any other jurisdiction. The parties hereto shall endeavor in good-faith negotiations to replace
the invalid, illegal or unenforceable provisions with valid provisions the economic effect of which comes as close as possible to that of the invalid, illegal or unenforceable provisions. 

SECTION 7. All notices, requests and demands pursuant hereto shall be made in accordance with Section 14.2 of the Credit Agreement. All
communications and notices hereunder to any New U.S. Guarantor shall be given to it in care of the Company at the Company’s address set forth in Section 14.2 of the Credit Agreement. 

[Signature page follows] 

  
 2 














 IN WITNESS WHEREOF, the New U.S. Guarantors and the Administrative Agent have duly executed
this Supplement to the U.S. Guarantee as of the day and year first above written. 
  

	
	PUTNAM COMMUNITY MEDICAL CENTER OF NORTH FLORIDA, LLC
	
	 /s/ John M. Franck II

	Name: John M. Franck II
	Title:   Vice President and Assistant Secretary
	
	PATIENTKEEPER, INC.
	
	 /s/ John M. Franck II

	Name: John M. Franck II
	Title:   Vice President and Assistant Secretary


 [Signature Page – Supplement to the Guarantee] 













 
			
	BANK OF AMERICA, N.A.
	as Administrative Agent
		
	By: 	 	 /s/ Brian J. Walsh

		 	 Name: Brian J. Walsh

		 	 Title:   Vice President



 [Signature Page – Supplement to the Guarantee]