Exhibit 4.2

 

Fourth Supplemental Indenture

 

FOURTH SUPPLEMENTAL INDENTURE, dated as of April 11, 2012 (this “Supplemental Indenture”), among Emergency Medical Services Corporation, a Delaware corporation (as successor by merger to CDRT Merger Sub, Inc., the “Company”), as issuer; Acute Management, LLC, a Texas limited liability company, Hawkeye Holdco LLC, a Delaware limited liability company, Medics Ambulance, Inc., a Florida corporation, Medics Ambulance Service, Inc., a Florida corporation, Medics Ambulance Service (Dade), Inc., a Florida corporation, Medics Emergency Services of Palm Beach County, Inc., a Florida corporation, Medics Subscription Services, Inc., a Florida corporation, and Medics Transport Services, Inc., a Florida corporation (each, a “Subsidiary Guarantor” and collectively, the “Subsidiary Guarantors”); each other then existing Subsidiary Guarantor as set forth under the Indenture referred to below (the “Existing Guarantors”); and Wilmington Trust, National Association (as successor by merger to Wilmington Trust FSB), as Trustee under the Indenture referred to below.

 

W I T N E S S E T H:

 

WHEREAS, the Company, the Existing Guarantors and the Trustee have heretofore become parties to an Indenture, dated as of May 25, 2011 (as supplemented by the First Supplemental Indenture, dated as of May 25, 2011, between CDRT Merger Sub, Inc. and the Trustee, the Second Supplemental Indenture, dated as of May 25, 2011, among the Company, the Existing Guarantors party thereto and the Trustee, and the Third Supplemental Indenture, dated as of November 7, 2011, among the Company, the Existing Guarantors party thereto and the Trustee, and as further amended, supplemented, waived or otherwise modified from time to time, the “Indenture”), providing for the issuance of Notes in series;

 

WHEREAS, Section 1308 of the Indenture provides that the Company is required to cause the Subsidiary Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which the Subsidiary Guarantors shall guarantee the Company’s Subsidiary Guaranteed Obligations under the Notes pursuant to a Subsidiary Guarantee on the terms and conditions set forth herein and in Article XIII of the Indenture;

 

WHEREAS, each Subsidiary Guarantor desires to enter into such supplemental indenture for good and valuable consideration, including substantial economic benefit in that the financial performance and condition of such Subsidiary Guarantor is dependent on the financial performance and condition of the Company, the obligations hereunder of which such Subsidiary Guarantor has guaranteed, and on such Subsidiary Guarantor’s access to working capital through the Company’s access to revolving credit borrowings under the Senior Credit Agreement; and

 

WHEREAS, pursuant to Section 901 of the Indenture, the parties hereto are authorized to execute and deliver this Supplemental Indenture to supplement the Indenture, without the consent of any Holder;

 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Subsidiary Guarantors,

 











 

the Company, the Existing Guarantors and the Trustee mutually covenant and agree for the benefit of the Holders of the Notes as follows:

 

1.             Defined Terms.  As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recital hereto are used herein as therein defined.  The words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section hereof.

 

2.             Agreement to Guarantee.  Each Subsidiary Guarantor hereby agrees, jointly and severally with all other Subsidiary Guarantors and fully and unconditionally, to guarantee the Subsidiary Guaranteed Obligations under the Indenture and the Notes on the terms and subject to the conditions set forth in Article XIII of the Indenture and to be bound by (and shall be entitled to the benefits of) all other applicable provisions of the Indenture as a Subsidiary Guarantor.  The Subsidiary Guarantee of each Subsidiary Guarantor is subject to the subordination provisions of the Indenture.

 

3.             Termination, Release and Discharge.  Each Subsidiary Guarantor’s Subsidiary Guarantee shall terminate and be of no further force or effect, and each Subsidiary Guarantor shall be released and discharged from all obligations in respect of such Subsidiary Guarantee, as and when provided in Section 1303 of the Indenture.

 

4.             Parties.  Nothing in this Supplemental Indenture is intended or shall be construed to give any Person, other than the Holders and the Trustee, any legal or equitable right, remedy or claim under or in respect of each Subsidiary Guarantor’s Subsidiary Guarantee or any provision contained herein or in Article XIII of the Indenture.

 

5.             Governing Law.  THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.  THE TRUSTEE, THE COMPANY, ANY OTHER OBLIGOR IN RESPECT OF THE NOTES AND (BY THEIR ACCEPTANCE OF THE NOTES) THE HOLDERS AGREE TO SUBMIT TO THE JURISDICTION OF ANY UNITED STATES FEDERAL OR STATE COURT LOCATED IN THE BOROUGH OF MANHATTAN, IN THE CITY OF NEW YORK IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS SUPPLEMENTAL INDENTURE.

 

6.             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, and every Holder of Notes heretofore or hereafter authenticated and delivered shall be bound hereby.  The Trustee makes no representation or warranty as to the validity or sufficiency of this Supplemental Indenture or as to the accuracy of the recitals to this Supplemental Indenture.

 

2











 

7.             Counterparts.  The parties hereto may sign one or more copies of this Supplemental Indenture in counterparts, all of which together shall constitute one and the same agreement.

 

8.             Headings.  The section headings herein are for convenience of reference only and shall not be deemed to alter or affect the meaning or interpretation of any provisions hereof.

 

3











 

IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly executed as of the date first above written.

 

	
 
    	
EMERGENCY   MEDICAL SERVICES CORPORATION
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
ACUTE   MANAGEMENT, LLC
    
	
 
    	
HAWKEYE   HOLDCO LLC
    
	
 
    	
MEDICS   AMBULANCE, INC.
    
	
 
    	
MEDICS   AMBULANCE SERVICE, INC.
    
	
 
    	
MEDICS   AMBULANCE SERVICE (DADE), INC.
    
	
 
    	
MEDICS EMERGENCY SERVICES OF PALM BEACH   COUNTY, INC.
    
	
 
    	
MEDICS   SUBSCRIPTION SERVICES, INC.
    
	
 
    	
MEDICS   TRANSPORT SERVICES, INC. as Subsidiary Guarantors
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    
					


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
Existing   Guarantors:
    
	
 
    	
 
    
	
 
    	
A1   LEASING, INC.
    
	
 
    	
ABBOTT   AMBULANCE, INC.
    
	
 
    	
ADAM   TRANSPORTATION SERVICE, INC.
    
	
 
    	
AFFILION, INC.
    
	
 
    	
AIR   AMBULANCE SPECIALISTS, INC.
    
	
 
    	
AMBULANCE   ACQUISITION, INC.
    
	
 
    	
AMERICAN EMERGENCY PHYSICIANS   MANAGEMENT, INC. 
    
	
 
    	
AMERICAN   INVESTMENT ENTERPRISES, INC.
    
	
 
    	
AMERICAN   MEDICAL PATHWAYS, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE AMBULANCE   SERVICE, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE MID ATLANTIC, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF COLORADO, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE OF   CONNECTICUT, INCORPORATED
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF GEORGIA, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE HOLDINGS, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF ILLINOIS, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF INLAND EMPIRE
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
AMERICAN   MEDICAL RESPONSE MANAGEMENT, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE NORTHWEST, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE OF   MASSACHUSETTS, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE OF NORTH   CAROLINA, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF OKLAHOMA, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE OF SOUTH   CAROLINA, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF TENNESSEE, INC.
    
	
 
    	
AMERICAN   MEDICAL RESPONSE OF TEXAS, INC.
    
	
 
    	
AMERICAN MEDICAL RESPONSE WEST
    
	
 
    	
AMERICAN MEDICAL RESPONSE, INC.
    
	
 
    	
AMR   HOLDCO, INC.
    
	
 
    	
ARIZONA   OASIS ACQUISITION, INC.
    
	
 
    	
ASSOCIATED   AMBULANCE SERVICE, INC.
    
	
 
    	
ATLANTIC   AMBULANCE SERVICES ACQUISITION, INC.
    
	
 
    	
ATLANTIC/KEY   WEST AMBULANCE, INC.
    
	
 
    	
ATLANTIC/PALM   BEACH AMBULANCE, INC.
    
	
 
    	
BESTPRACTICES, INC.
    
	
 
    	
BLYTHE AMBULANCE SERVICE
    
	
 
    	
BROWARD AMBULANCE, INC.
    
	
 
    	
DESERT   VALLEY MEDICAL TRANSPORT, INC.
    
	
 
    	
EHR   MANAGEMENT CO.
    
	
 
    	
EMCARE   ANESTHESIA PROVIDERS, INC.
    
	
 
    	
EMCARE   HOLDCO, INC.
    
	
 
    	
EMCARE   HOLDINGS, INC.
    
	
 
    	
EMCARE, INC.
    
	
 
    	
EMCARE   OF CALIFORNIA, INC.
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
EMCARE   PHYSICIAN PROVIDERS, INC.
    
	
 
    	
EMCARE   PHYSICIAN SERVICES, INC.
    
	
 
    	
EMERGENCY   MEDICINE EDUCATION SYSTEMS, INC.
    
	
 
    	
FIVE   COUNTIES AMBULANCE SERVICE, INC.
    
	
 
    	
FLORIDA   EMERGENCY PARTNERS, INC.
    
	
 
    	
FOUNTAIN   AMBULANCE SERVICE, INC.
    
	
 
    	
HANK’S   ACQUISITION CORP.
    
	
 
    	
HEALTHCARE   ADMINISTRATIVE SERVICES, INC.
    
	
 
    	
HEMET   VALLEY AMBULANCE SERVICE, INC.
    
	
 
    	
HERREN   ENTERPRISES, INC.
    
	
 
    	
HOLIDAY   ACQUISITION COMPANY, INC.
    
	
 
    	
INTERNATIONAL   LIFE SUPPORT, INC.
    
	
 
    	
KUTZ   AMBULANCE SERVICE, INC.
    
	
 
    	
LIFECARE   AMBULANCE SERVICE, INC.
    
	
 
    	
LIFEFLEET   SOUTHEAST, INC.
    
	
 
    	
MEDEVAC   MEDICAL RESPONSE, INC.
    
	
 
    	
MEDEVAC   MIDAMERICA, INC.
    
	
 
    	
MEDIC   ONE AMBULANCE SERVICES, INC.
    
	
 
    	
MEDIC   ONE OF COBB, INC.
    
	
 
    	
MEDI-CAR   AMBULANCE SERVICE, INC.
    
	
 
    	
MEDI-CAR   SYSTEMS, INC.
    
	
 
    	
MEDICWEST   AMBULANCE, INC.
    
	
 
    	
MEDICWEST   HOLDINGS, INC.
    
	
 
    	
MEDLIFE   EMERGENCY MEDICAL SERVICE, INC.
    
	
 
    	
MERCY   AMBULANCE OF EVANSVILLE, INC.
    
	
 
    	
MERCY   LIFE CARE
    
	
 
    	
MERCY, INC.
    
	
 
    	
METRO   AMBULANCE SERVICE (RURAL), INC.
    
	
 
    	
METRO   AMBULANCE SERVICE, INC.
    
	
 
    	
METRO   AMBULANCE SERVICES, INC.
    
	
 
    	
MIDWEST   AMBULANCE MANAGEMENT COMPANY
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:   
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    


 

[Signature Page to Fourth Supplemental Indenture]

 












 

	
 
    	
MOBILE MEDIC AMBULANCE SERVICE, INC.
    
	
 
    	
NEVADA RED ROCK AMBULANCE, INC.
    
	
 
    	
NEVADA RED ROCK HOLDINGS, INC.
    
	
 
    	
PARAMED, INC.
    
	
 
    	
PARK AMBULANCE SERVICE INC.
    
	
 
    	
PHYSICIAN ACCOUNT MANAGEMENT, INC.
    
	
 
    	
PHYSICIANS & SURGEONS AMBULANCE
   SERVICE, INC.
    
	
 
    	
PROVIDER ACCOUNT MANAGEMENT, INC.
    
	
 
    	
PUCKETT AMBULANCE SERVICE, INC.
    
	
 
    	
RADIOLOGY STAFFING SOLUTIONS, INC.
    
	
 
    	
RADSTAFFING MANAGEMENT SOLUTIONS, INC.
    
	
 
    	
RANDLE EASTERN AMBULANCE SERVICE, INC.
    
	
 
    	
REIMBURSEMENT TECHNOLOGIES, INC.
    
	
 
    	
RIVER MEDICAL INCORPORATED
    
	
 
    	
SEMINOLE COUNTY AMBULANCE, INC.
    
	
 
    	
SPRINGS AMBULANCE SERVICE, INC.
    
	
 
    	
STAT HEALTHCARE, INC.
    
	
 
    	
SUNRISE HANDICAP TRANSPORT CORP.
    
	
 
    	
TEK AMBULANCE, INC.
    
	
 
    	
TIDEWATER AMBULANCE SERVICE, INC.
    
	
 
    	
TROUP COUNTY EMERGENCY MEDICAL
   SERVICES, INC.
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:   
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
EMERGENCY   MEDICAL SERVICES LP
    
	
 
    	
CORPORATION
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:   
    	
Secretary
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
ACCESS   2 CARE, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By: MISSION   CARE SERVICES, LLC as manager of Access 2 Care, LLC
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMERICAN MEDICAL RESPONSE, INC. as manager of Mission Care Services, LLC
    
	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
AMR   BROCKTON, L.L.C.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:AMERICAN   MEDICAL RESPONSE OF MASSACHUSETTS, INC., as manager and sole member of   AMR Brockton, L.L.C.
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
AMERICAN   MEDICAL RESPONSE
    
	
 
    	
 
    	
DELAWARE   VALLEY, LLC
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:AMERICAN   MEDICAL RESPONSE MID-ATLANTIC, INC., as sole member of American Medical   Response Delaware Valley, LLC
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
								


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
APEX   ACQUISITION LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   EMCARE, INC. as sole member of Apex Acquisition LLC
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
EMS   MANAGEMENT LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMR HOLDCO, INC. and EMCARE HOLDCO, INC., it members
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
EVERRAD,   LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   TEMPLETON READINGS, LLC, as sole member of EverRad, LLC
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:EMCARE, INC.,   as sole member of Templeton Readings, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
MEDASSOCIATES,   LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:EMCARE, INC.,   as sole member of MedAssociates, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
MISSION   CARE OF ILLINOIS, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   MISSION CARE SERVICES, LLC, as the manager of Mission Care of Illinois
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMERICAN MEDICAL RESPONSE, INC., as the manager of Mission Care Services, LLC
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
MISSION   CARE OF MISSOURI, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   MISSION CARE SERVICES, LLC, as the manager of Mission Care of Missouri, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMERICAN MEDICAL RESPONSE, INC., as the manager of Mission Care Services, LLC
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
MISSION   CARE SERVICES, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMERICAN MEDICAL RESPONSE, INC., as the manager of Mission Care Services, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:   
    	
Secretary
    	
 
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
MSO   NEWCO, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   APEX ACQUISITION LLC, as sole member of MSO Newco, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   EMCARE, INC. as sole member of Apex Acquisition LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
PINNACLE   CONSULTANTS MID-ATLANTIC,
    
	
 
    	
 
    	
L.L.C.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   APEX ACQUISITION LLC, as sole member of Pinnacle Consultants Mid- Atlantic,   L.L.C.
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   EMCARE, INC. as sole member of Apex Acquisition LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:   
    	
Craig   A. Wilson
    
	
 
    	
 
    	
 
    	
Title:   
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
PROVIDACARE,   L.L.C.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   AMERICAN MEDICAL PATHWAYS, INC., as sole member of ProvidaCare, L.L.C.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    


 

[Signature Page to Fourth Supplemental Indenture]

 











 

	
 
    	
REGIONAL   EMERGENCY SERVICES, L.P.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   FLORIDA EMERGENCY PARTNERS, INC., as general partner of Regional   Emergency Services, L.P.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
SUN   DEVIL ACQUISITION LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   EMCARE, INC. as sole member of Sun Devil Acquisition LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
TEMPLETON   READINGS, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:   EMCARE, INC. as sole member of Templeton Readings, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
GOLD   COAST AMBULANCE SERVICE
   V.I.P. PROFESSIONAL SERVICES, INC.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    
	
 
    	
 
    	
Title:
    	
Secretary
    
								


 

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METROPOLITAN   AMBULANCE SERVICE
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
EMS   OFFSHORE MEDICAL SERVICES, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
SEAWALL   ACQUISITION, LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
CLINICAL   PARTNERS MANAGEMENT
    
	
 
    	
 
    	
COMPANY,   LLC
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
NORTHWOOD   ANESTHESIA ASSOCIATES,
    
	
 
    	
 
    	
L.L.C.
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Craig A. Wilson
    	
 
    
	
 
    	
 
    	
Name:
    	
Craig   A. Wilson
    	
 
    
	
 
    	
 
    	
Title:
    	
Secretary
    	
 
    	
 
    
								


 

[Signature Page to Fourth Supplemental Indenture]

 











 

 

	
 
    	
WILMINGTON   TRUST, NATIONAL ASSOCIATION, as Trustee
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/   Joseph P. O’Donnell
    	
 
    
	
 
    	
 
    	
Name:
    	
Joseph   P. O’Donnell
    
	
 
    	
 
    	
Title:
    	
Vice   President
    	
 
    	
 
    


 

[Signature Page to Fourth Supplemental Indenture]