EX-4.4



 








Exhibit 4.4




          FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of July 25, 2007, among
CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), each of the parties
identified as a Triad Guarantor on the schedules to the signature pages hereto (each, a “Triad
Guarantor” and collectively, the “Triad Guarantors”) and U.S. BANK NATIONAL ASSOCIATION, as 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 an Indenture (the
“Indenture”), dated as of July 25, 2007, providing for the issuance of the 87/8% Senior Notes due
2015 (the “Securities”);




          WHEREAS, each of the undersigned Triad Guarantors has deemed it advisable and in its best
interest to execute and deliver this Supplemental Indenture, and to become a Triad Guarantor under
the Indenture; and




          WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the Triad
Guarantors 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 Triad Guarantors 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. Each Triad 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, 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.




 









 





     IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly
executed as of this 25th day of July, 2007.



	 	 	 	 	 
	 	 	CHS/COMMUNITY HEALTH SYSTEMS, INC.
	 
	 	 	 	 
	 

	 	By:
	 	/s/ W. Larry Cash
	 

	 	 	 	 
	 

	 	Name:
	 	W. Larry Cash
	 

	 	Title:
	 	Executive Vice President and Chief
Financial Officer










	 	 	 	 	 
	 	 	U.S. BANK NATIONAL ASSOCIATION,
as Trustee
	 
	 	 	 	 
	 

	 	By:
	 	/s/ Wally Jones
	 

	 	 	 	 
	 

	 	Name:

Title:
	 	Wally Jones

Assistant Vice President







Supplemental
Indenture - 8 7/8% Senior Notes due 2015





 









 






QHG of Enterprise, Inc.

QHG of Jacksonville, Inc.

QHG of Springdale, Inc.

Triad-El Dorado, Inc.

Abilene Hospital, LLC

Abilene Merger, LLC

Arizona DH, LLC

ARMC, LP

Birmingham Holdings, LLC

Bluffton Health System, LLC

Brownwood Hospital, L.P.

Brownwood Medical Center, LLC

Carlsbad Medical Center, LLC

Claremore Regional Hospital, LLC

Clarksville Holdings, LLC

College Station Hospital, L.P.

College Station Medical Center, LLC

College Station Merger, LLC

CP Hospital GP, LLC

CPLP, LLC

Crestwood Hospital LP, LLC

Crestwood Hospital, LLC

CSMC, LLC

CSRA Holdings, LLC

Deaconess Holdings, LLC

Deaconess Hospital Holdings, LLC

Desert Hospital Holdings, LLC

Detar Hospital, LLC

Dukes Health System, LLC

Gadsden Regional Medical Center, LLC

Greenbrier VMC, LLC

GRMC Holdings, LLC

Hobbs Medco, LLC

Las Cruces Medical Center, LLC

Lea Regional Hospital, LLC

Longview Merger, LLC

LRH, LLC

Lutheran Health Network of Indiana, LLC

Massillon Health System, LLC

Medical Center of Brownwood, LLC




	 	 	 	 	 
	 	 	 
	 	By:  	        /s/ James W. Doucette
 	 
	 	 	Name:  	James W. Doucette 	 
	 	 	Title:  	Vice President, Finance and Treasurer 	 
	 



[SIGNATURE PAGES CONTINUED]



Supplemental
Indenture - 8 7/8% Senior Notes due 2015




 









 




MMC of Nevada, LLC

Navarro Hospital, L.P.

Navarro Regional, LLC

NRH, LLC

Oregon Healthcorp, LLC

Palmer-Wasilla Health System, LLC

Quorum Health Resources, LLC

Regional Hospital of Longview, LLC

Russellville Holdings, LLC

SACMC, LLC

San Angelo Community Medical Center, LLC

San Angelo Hospital, L.P.

San Angelo Medical, LLC

Southern Texas Medical Center, LLC

St. Joseph Health System, LLC

Tennyson Holdings, Inc.

Triad Holdings III, LLC

Triad Holdings IV, LLC

Triad Holdings V, LLC

Triad Healthcare Corporation

Triad of Alabama, LLC

Triad of Oregon, LLC

Triad-ARMC, LLC

Triad-Denton Hospital GP, LLC

Triad-Denton Hospital, L.P.

Triad-Navarro Regional Hospital Subsidiary, LLC

VHC Medical, LLC

Vicksburg Healthcare, LLC

Victoria Hospital, LLC

Victoria of Texas, L.P.

WHMC, LLC

Willamette Valley Medical Center, LLC

Women & Children’s Hospital, LLC

Woodland Heights Medical Center, LLC

Woodward Health System, LLC

QHG Georgia Holdings, Inc.

QHG Georgia, L.P.

Frankfort Health Partner, Inc.

IOM Health System, L.P.

QHG of Bluffton, Inc.

QHG of Clinton County, Inc.

QHG of Fort Wayne, Inc.




	 	 	 	 	 
	 	 	 
	 	By:  	        /s/ James W. Doucette
 	 
	 	 	Name:  	James W. Doucette 	 
	 	 	Title:  	Vice President, Finance and Treasurer 	 
	 



[SIGNATURE PAGES CONTINUED]



Supplemental
Indenture - 8 7/8% Senior Notes due 2015





 









 




QHG of Warsaw, Inc.

QHG of Forrest County, Inc.

QHG of Hattiesburg, Inc.

QHG of Massillon, Inc.

SouthCrest, L.L.C.

River Region Medical Corporation

NC-DSH, Inc.

QHG of Barberton, Inc.

Triad-South Tulsa Hospital Company, Inc.

QHG of South Carolina, Inc.

QHG of Spartanburg, Inc.




	 	 	 	 	 
	 	 	 
	 	By:  	        /s/ James W. Doucette
 	 
	 	 	Name:  	James W. Doucette 	 
	 	 	Title:  	Vice President, Finance and Treasurer 	 
	 



Supplemental
Indenture - 8 7/8% Senior Notes due 2015