EX-4.1


 Exhibit 4.1 

EXECUTION VERSION 
 FIRST
SUPPLEMENTAL INDENTURE 
 Dated as of June 3, 2016 

to 
 INDENTURE 

Dated as of August 7, 2014 

between 
 UNIVERSAL HEALTH
SERVICES, INC. 
 THE GUARANTORS NAMED ON THE SIGNATURE PAGES HERETO 

MUFG UNION BANK, N.A., 
 as Trustee

 and 
 JPMORGAN CHASE BANK,
N.A., 
 as Collateral Agent 






 First Supplemental Indenture (this “Supplemental Indenture”), dated as of
June 3, 2016, among Universal Health Services, Inc., a Delaware corporation (the “Issuer”), the Guarantors listed on the signature pages hereto, MUFG Union Bank, N.A., solely in its capacity as trustee (the
“Trustee”), and JPMorgan Chase Bank, N.A., as Collateral Agent. Capitalized terms used but not defined herein have the meanings assigned thereto in the Indenture (as defined herein). 

W I T N E S S E T H 
 WHEREAS,
each of the Issuer and the Guarantors has heretofore executed and delivered to the Trustee an indenture (as supplemented hereby, the “Indenture”), dated as of August 7, 2014; providing for the issuance of $300,000,000 aggregate
principal amount of 4.750% Senior Secured Notes due 2022 (the “2022 Initial Notes”), which Indenture further provides that an unlimited aggregate principal amount of such Notes may be authenticated and delivered thereunder; 

WHEREAS, Section 2.01 of the Indenture provides that Additional Notes ranking pari passu with the 2022 Initial Notes may be
created and issued from time to time by the Issuer (subject to the Issuer’s compliance with other provisions of the Indenture) without notice to or consent of the Holders and shall be consolidated with and form a single class with the 2022
Initial Notes and shall have the same terms as to status, redemption or otherwise as the 2022 Initial Notes (other than the issue date, the issue price and the first interest payment date); and 

WHEREAS, the Issuer and the Guarantors desire to execute and deliver this Supplemental Indenture for the purpose of issuing $400,000,000
aggregate principal amount of Additional Notes, having terms substantially identical in all material respects to the 2022 Initial Notes (together with the 2022 Initial Notes, the “2022 Notes”); and 

WHEREAS, pursuant to Section 9.01(b) of the Indenture, the Trustee is authorized to execute and deliver this Supplemental Indenture. 

NOW THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged,
the parties mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 
 1. Additional
Notes. As of the date hereof, the Issuer will issue the Additional Notes under the Indenture, having terms substantially identical in all material respects to the 2022 Initial Notes, other than the issue date, the issue price and the first
interest payment date. The Additional Notes shall be sold initially at an issue price of 101.500% of the principal amount, plus accrued and unpaid interest, if any, from February 1, 2016 to the date of issuance of the Additional Notes. The
first interest payment date on the Additional Notes shall be August 1, 2016. The Additional Notes will be fungible with, have the same CUSIP and ISIN numbers as, and vote together with the 2022 Initial Notes as a single series under the
Indenture immediately upon the date of the issuance of the Additional Notes (except that for the first 40 days after their issuance, any Additional Notes issued pursuant to Regulation S under the Securities Act will have temporary CUSIP and ISIN
numbers). 

  
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 2. Authentication of Additional Notes. The Trustee shall, pursuant to an Authentication
Order delivered in accordance with Section 2.02 of the Indenture, authenticate and deliver the Additional Notes for an aggregate principal amount specified in such Authentication Order. 

3. Confirmation of Liens. Each of the Issuer and the Guarantors hereby acknowledges that liens and security interests on the collateral
described in the Amended and Restated Collateral Agreement, dated as of August 7, 2014, by and among the Issuer, the subsidiary grantors named therein, the Collateral Agent and the Authorized Representatives, as the same may be further amended,
restated or modified from time to time (the “Amended and Restated Collateral Agreement”), are granted for the benefit of the Trustee and the Holders of the Additional Notes pursuant to the Amended and Restated Collateral Agreement
to secure the payment of principal and interest and all other amounts due and owing pursuant to the terms of the Notes on an equal and ratable basis as described in the Amended and Restated Collateral Agreement and confirms that all of the liens and
security interests created and arising under the Amended and Restated Collateral Agreement remain in full force and effect on a continuous basis, unimpaired, uninterrupted and undischarged. 

4. Amendment to the Indenture. Pursuant to Section 9.01(a) of the Indenture, the Indenture is hereby amended to include the
following definition: 
 “Reference Treasury Dealer” means each of J.P. Morgan Securities LLC, Merrill
Lynch, Pierce, Fenner & Smith Incorporated, Goldman, Sachs & Co., SunTrust Robinson Humphrey, Inc., Credit Agricole Securities (USA) Inc., Wells Fargo Securities LLC and each of their respective successors and any other nationally
recognized investment banking firm that is a primary U.S. government securities dealer in New York City (a “Primary Treasury Dealer”) appointed from time to time by the Issuer; provided that if any of the foregoing
shall cease to be a Primary Treasury Dealer, the Issuer shall substitute for such entity another nationally recognized investment banking firm that is a Primary Treasury Dealer. 

For the avoidance of doubt, the amendment described above shall apply to all Notes issued under the Indenture, including but not limited to the 2022 Initial
Notes, the Additional Notes, and the 2019 Notes. 
 5. Ratification of Indenture; Supplemental Indenture 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. 
 6. Governance. This
Supplemental Indenture is executed and shall constitute an indenture supplemental to the Indenture and shall be construed in connection with and as part of the Indenture. This Supplemental Indenture shall be governed by and construed in accordance
with the laws of the jurisdiction that governs the Indenture and its construction. 

  
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 7. Counterparts. This Supplemental Indenture may be executed in any number of
counterparts, each of which shall be deemed to be an original for all purposes, but such counterparts shall together be deemed to constitute but one and the same instrument. 

8. No Personal Liability of Directors, Officers, Employers, Members, Partners and Stockholders. No past, present or future director,
officer, employee, incorporator, member, partner or stockholder of the Issuer or any Guarantor shall have any liability for any obligations of the Issuer or any Guarantor under the Notes, the Guarantees, this Indenture or the Security Documents or
for any claim based on, in respect of, or by reason of, such obligations or their creation. Each Holder by accepting a Note waives and releases all such liability. The waiver and release are part of the consideration for issuance of the Notes. 

9. Notices. Any and all notices, requests, certificates and other instruments executed and delivered after the execution and delivery
of this Supplemental Indenture may refer to the Indenture without making specific reference to this Supplemental Indenture, but nevertheless all such references shall include this Supplemental Indenture unless the context otherwise requires. 

10. Effectiveness. This Supplemental Indenture shall be deemed to have become effective upon the date first written above. 

11. Conflict. In the event of a conflict between the terms of this Supplemental Indenture and the Indenture, this Supplemental
Indenture shall control. 
 12. Sufficiency. The Trustee shall not be responsible in any manner whatsoever for or in respect of the
validity or sufficiency of this Supplemental Indenture or for or in respect of the recital contained herein, all of which recitals are made solely by the Issuer. 

[Remainder of Page Intentionally Blank, Signature Pages Follow] 

  
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 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of
the day and year first set forth above. 
  

			
	UNIVERSAL HEALTH SERVICES, INC.
		
	By:	 	 /s/ Cheryl K. Ramagano

	Name:	 	Cheryl K. Ramagano
	Title:	 	Vice President and Treasurer



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	MUFG UNION BANK, N.A., as Trustee
		
	By:	 	 /s/ Fernando Moreyra

	Name:	 	Fernando Moreyra
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 








							
	 ASCEND HEALTH CORPORATION
 ASSOCIATED CHILD CARE
EDUCATIONAL SERVICES, INC.
 CCS/LANSING, INC.
 CHILDREN’S
COMPREHENSIVE SERVICES, INC.
 DEL AMO HOSPITAL, INC.
 FRONTLINE
BEHAVIORAL HEALTH, INC.
 LANCASTER HOSPITAL CORPORATION

MCALLEN MEDICAL CENTER, INC.
 MERION BUILDING MANAGEMENT, INC.

MERRIDELL ACHIEVEMENT CENTER, INC.
 NORTHWEST TEXAS HEALTHCARE
SYSTEM, INC.
 OAK PLAINS ACADEMY OF TENNESSEE, INC.
 PARK
HEALTHCARE COMPANY
 PENNSYLVANIA CLINICAL SCHOOLS, INC.
 PSI
SURETY, INC.
 RIVER OAKS, INC.
 SOUTHEASTERN HOSPITAL
CORPORATION
 SPARKS FAMILY HOSPITAL, INC.
 STONINGTON
BEHAVIORAL HEALTH, INC.
 TEMECULA VALLEY HOSPITAL, INC.
 THE
ARBOUR, INC.
 TWO RIVERS PSYCHIATRIC HOSPITAL, INC.
 UHS
CHILDREN’S SERVICES, INC.
	 		 	 UHS OF HAMPTON, INC.
 UHS OF
HARTGROVE, INC.
 UHS OF LAKESIDE, LLC
 UHS OF OKLAHOMA,
INC.
 UHS OF PARKWOOD, INC.
 UHS OF PENNSYLVANIA, INC.

UHS OF PROVO CANYON, INC.
 UHS OF PUERTO RICO, INC.

UHS OF RIVER PARISHES, INC.
 UHS OF SPRING MOUNTAIN, INC.

UHS OF TEXOMA, INC.
 UHS OF TIMBERLAWN, INC.

UHS OF TIMPANOGOS, INC.
 UHS OF WESTWOOD PEMBROKE, INC.

UHS OF WYOMING, INC.
 UHS SAHARA, INC.

UHS-CORONA, INC.
 UNITED HEALTHCARE OF HARDIN, INC.

UNIVERSAL HEALTH SERVICES OF PALMDALE, INC.
 UNIVERSAL HEALTH
SERVICES OF RANCHO SPRINGS, INC.
 VALLEY HOSPITAL MEDICAL CENTER, INC.

WELLINGTON REGIONAL MEDICAL CENTER, INCORPORATED
 WISCONSIN AVENUE
PSYCHIATRIC CENTER, INC.

	 UHS HOLDING COMPANY, INC.
 UHS OF CORNERSTONE,
INC.
	 		 	  
 By:
	 	  
 /s/ Steve Filton

	UHS OF CORNERSTONE HOLDINGS, INC.	 		 	Name:	 	Steve Filton
	UHS OF D.C., INC.	 		 	Title:	 	Vice President
	UHS OF DELAWARE, INC.	 		 		 	
	UHS OF DENVER, INC.	 		 		 	
	UHS OF FAIRMOUNT, INC.	 		 		 	
	UHS OF FULLER, INC.	 		 		 	
	UHS OF GEORGIA, INC.	 		 		 	
	UHS OF GEORGIA HOLDINGS, INC.	 		 		 	


  
 [Signature Page to First
Supplemental Indenture] 








							
	 ABS LINCS SC, INC.
 ABS LINCS VA, INC.

ALLIANCE HEALTH CENTER, INC.
 ALTERNATIVE BEHAVIORAL SERVICES,
INC.
 BENCHMARK BEHAVIORAL HEALTH SYSTEM, INC.
 BHC ALHAMBRA
HOSPITAL, INC.
 BHC BELMONT PINES HOSPITAL, INC.
 BHC FAIRFAX
HOSPITAL, INC.
 BHC FOX RUN HOSPITAL, INC.
 BHC FREMONT
HOSPITAL, INC.
 BHC HEALTH SERVICES OF NEVADA, INC.
 BHC
HERITAGE OAKS HOSPITAL, INC.
 BHC HOLDINGS, INC.
 BHC
INTERMOUNTAIN HOSPITAL, INC.
 BHC MONTEVISTA HOSPITAL, INC.
	 		 	 KIDS BEHAVIORAL HEALTH OF UTAH, INC.

LAUREL OAKS BEHAVIORAL HEALTH CENTER, INC.
 MICHIGAN PSYCHIATRIC
SERVICES, INC.
 NORTH SPRING BEHAVIORAL HEALTHCARE, INC.

PREMIER BEHAVIORAL SOLUTIONS OF FLORIDA, INC.
 PREMIER BEHAVIORAL
SOLUTIONS, INC.
 PSYCHIATRIC SOLUTIONS, INC.
 PSYCHIATRIC
SOLUTIONS OF VIRGINIA, INC.
 RAMSAY YOUTH SERVICES OF GEORGIA, INC.

RIVEREDGE HOSPITAL HOLDINGS, INC.
 SPRINGFIELD HOSPITAL, INC.

SUMMIT OAKS HOSPITAL, INC.
 TEXAS HOSPITAL HOLDINGS, INC.

WINDMOOR HEALTHCARE INC.
 WINDMOOR HEALTHCARE OF PINELLAS PARK,
INC.

	BHC PINNACLE POINTE HOSPITAL, INC.	 		 		 	
	BHC SIERRA VISTA HOSPITAL, INC.	 		 	By:	 	 /s/ Steve Filton

	BHC STREAMWOOD HOSPITAL, INC.	 		 	Name:	 	Steve Filton
	BRENTWOOD ACQUISITION, INC.	 		 	Title:	 	Vice President
	BRENTWOOD ACQUISITION - SHREVEPORT, INC.	 		 		 	
	BRYNN MARR HOSPITAL, INC.	 		 		 	
	CANYON RIDGE HOSPITAL, INC.	 		 		 	
	CALVARY CENTER, INC.	 		 		 	
	CEDAR SPRINGS HOSPITAL, INC.	 		 		 	
	FIRST HOSPITAL CORPORATION OF VIRGINIA BEACH	 		 		 	
	FORT LAUDERDALE HOSPITAL, INC.	 		 		 	
	FRN, INC.	 		 		 	
	GREAT PLAINS HOSPITAL, INC.	 		 		 	
	GULF COAST TREATMENT CENTER, INC.	 		 		 	
	H. C. CORPORATION	 		 		 	
	HARBOR POINT BEHAVIORAL HEALTH CENTER, INC.	 		 		 	
	HAVENWYCK HOSPITAL INC.	 		 		 	
	HHC AUGUSTA, INC.	 		 		 	
	HHC CONWAY INVESTMENT, INC.	 		 		 	
	HHC DELAWARE, INC.	 		 		 	
	HHC INDIANA, INC.	 		 		 	
	HHC OHIO, INC.	 		 		 	
	HHC RIVER PARK, INC.	 		 		 	
	HHC SOUTH CAROLINA, INC.	 		 		 	
	HHC ST. SIMONS, INC.	 		 		 	
	HORIZON HEALTH AUSTIN, INC.	 		 		 	
	HORIZON HEALTH CORPORATION	 		 		 	
	HSA HILL CREST CORPORATION	 		 		 	


  
 [Signature Page to First
Supplemental Indenture] 







 
			
	AIKEN REGIONAL MEDICAL CENTERS, LLC
	DHP 2131 K ST, LLC
	LA AMISTAD RESIDENTIAL TREATMENT CENTER, LLC
	TENNESSEE CLINICAL SCHOOLS, LLC
	THE BRIDGEWAY, LLC
	TURNING POINT CARE CENTER, LLC
	UHS OF BENTON, LLC
	UHS OF BOWLING GREEN, LLC
	UHS OF GREENVILLE, LLC
	UHS OF PHOENIX, LLC
	UHS OF RIDGE, LLC
	UHS OF ROCKFORD, LLC
	UHS OF TUCSON, LLC
	UHS SUB III, LLC
	UHSD, LLC
	
	By: Universal Health Services, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Senior Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	FORT DUNCAN MEDICAL CENTER, L.P.
	
	By: Fort Duncan Medical Center, Inc.
	Its general partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	FRONTLINE HOSPITAL, LLC
	FRONTLINE RESIDENTIAL TREATMENT CENTER, LLC
	
	By: Frontline Behavioral Health, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	KEYS GROUP HOLDINGS LLC
	
	By: UHS Children Services, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	KEYSTONE/CCS PARTNERS LLC
	
	By: Children’s Comprehensive Services, Inc.
	Its Minority Member
	
	 By: KEYS Group Holdings LLC

	 Its Managing Member and sole member of the minority member

	
	 By: UHS Children Services, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	KEYSTONE CONTINUUM, LLC
	KEYSTONE NPS LLC
	KEYSTONE RICHLAND CENTER, LLC
	
	By: Keystone/CCS Partners LLC
	Its managing member
	
	 By: Children’s Comprehensive Services, Inc.

	 Its minority member

	
	 By: KEYS Group Holdings LLC

	 Its managing member and sole member of the minority member

	
	 By: UHS Children Services, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	KEYSTONE EDUCATION AND YOUTH SERVICES, LLC
	
	By: KEYS Group Holdings LLC
	Its sole member
	
	 By: UHS Children Services, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	KEYSTONE MARION, LLC
	KEYSTONE MEMPHIS, LLC
	KEYSTONE NEWPORT NEWS, LLC
	KEYSTONE WSNC, L.L.C.
	
	By: Keystone Education and Youth Services, LLC
	Its sole member
	
	 By: KEYS Group Holdings LLC

	 Its sole member

	
	 By: UHS Children Services, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	MANATEE MEMORIAL HOSPITAL, L.P.
	
	By: Wellington Regional Medical Center, Incorporated
	Its general partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	MCALLEN HOSPITALS, L.P.
	
	By: McAllen Medical Center, Inc.
	Its general partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	PENDLETON METHODIST HOSPITAL, L.L.C.
	
	By: UHS of River Parishes, Inc.
	Its managing member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS KENTUCKY HOLDINGS, L.L.C.
	
	By: UHS of Delaware, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF ANCHOR, L.P.
	UHS OF LAUREL HEIGHTS, L.P.
	UHS OF PEACHFORD, L.P.
	
	By: UHS of Georgia, Inc.
	Its general partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President
	
	By: UHS of Georgia Holdings, Inc.
	Its limited partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF CENTENNIAL PEAKS, L.L.C.
	
	By: UHS of Denver, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF DOVER, L.L.C.
	
	By: UHS of Rockford, LLC
	Its sole member
	
	 By: Universal Health Services, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Senior Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF DOYLESTOWN, L.L.C.
	
	By: UHS of Pennsylvania, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF SALT LAKE CITY, L.L.C.
	
	By: UHS of Provo Canyon, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF SAVANNAH, L.L.C.
	
	By: UHS of Georgia Holdings, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OKLAHOMA CITY LLC
	UHS OF SPRINGWOODS, L.L.C.
	
	By: UHS of New Orleans, LLC
	Its sole member
	
	 By: UHS of Delaware, Inc.

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	UHS OF SUMMITRIDGE, LLC
	
	By: UHS of Peachford, L.P.
	Its managing member
	
	 By: UHS of Georgia, Inc.

	 Its general partner

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	PSYCHIATRIC SOLUTIONS HOSPITALS, LLC
	
	By: Psychiatric Solutions, Inc.
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	DIAMOND GROVE CENTER, LLC
	KMI ACQUISITION, LLC
	LIBERTY POINT BEHAVIORAL HEALTHCARE, LLC
	ROLLING HILLS HOSPITAL, LLC
	PSJ ACQUISITION, LLC
	SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC
	TBD ACQUISITION, LLC
	
	By: Psychiatric Solutions Hospitals, LLC
	Its Sole Member
	
	 By: Psychiatric Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	ATLANTIC SHORES HOSPITAL, L.L.C.
	EMERALD COAST BEHAVIORAL HOSPITAL, LLC
	OCALA BEHAVIORAL HEALTH, LLC
	PALMETTO BEHAVIORAL HEALTH HOLDINGS, LLC
	
	By: Premier Behavioral Solutions, Inc.
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	PALMETTO BEHAVIORAL HEALTH SYSTEM, L.L.C.
	
	By: Palmetto Behavioral Health Holdings, LLC
	Its Sole Member
	
	 By: Premier Behavioral Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, L.L.C.
	
	By: Palmetto Behavioral Health System, L.L.C.
	Its Sole Member
	
	 By: Palmetto Behavioral Health Holdings, LLC

	 Its Sole Member

	
	 By: Premier Behavioral Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	RAMSAY MANAGED CARE, LLC
	SAMSON PROPERTIES, LLC
	TBJ BEHAVIORAL CENTER, LLC
	THREE RIVERS HEALTHCARE GROUP, LLC
	ZEUS ENDEAVORS, LLC
	WEKIVA SPRINGS CENTER, LLC
	
	By: Premier Behavioral Solutions, Inc.
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	SP BEHAVIORAL, LLC
	UNIVERSITY BEHAVIORAL, LLC
	
	By: Ramsay Managed Care, LLC
	Its Sole Member
	
	 By: Premier Behavioral Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	THREE RIVERS BEHAVIORAL HEALTH, LLC
	
	By: Three Rivers Healthcare Group, LLC
	Its Sole Member
	
	 By: Premier Behavioral Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	THE NATIONAL DEAF ACADEMY, LLC
	
	By: Zeus Endeavors, LLC
	Its Sole Member
	
	 By: Premier Behavioral Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	WILLOW SPRINGS, LLC
	
	By: BHC Health Services of Nevada, Inc.
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	BHC PROPERTIES, LLC
	
	By: Behavioral Healthcare LLC
	Its Sole Member
	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	BHC MESILLA VALLEY HOSPITAL, LLC
	
	By: BHC Properties, LLC
	Its Sole Member
	
	 By: Behavioral Healthcare LLC

	 Its Sole Member

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
 [Signature Page to First
Supplemental Indenture] 







 
			
	BHC NORTHWEST PSYCHIATRIC HOSPITAL, LLC
	
	By: BHC Properties, LLC
	Its Sole Member
	
	 By: Behavioral Healthcare LLC

	 Its Sole Member

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	HOLLY HILL HOSPITAL, LLC
	
	By: Behavioral Healthcare LLC
	Its Sole Member
	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	CUMBERLAND HOSPITAL PARTNERS, LLC
	
	By: BHC Properties, LLC
	Its Sole Member
	
	 By: Behavioral Healthcare LLC

	 Its Sole Member

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	CUMBERLAND HOSPITAL, LLC
	
	By: Cumberland Hospital Partners, LLC
	Its Managing Member
	
	By: BHC Properties, LLC
	Its Minority Member and Sole Member of the Managing Member
	
	 By: Behavioral Healthcare LLC

	 Its Sole Member

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	COLUMBUS HOSPITAL PARTNERS, LLC
	LEBANON HOSPITAL PARTNERS, LLC
	NORTHERN INDIANA PARTNERS, LLC
	VALLE VISTA HOSPITAL PARTNERS, LLC
	
	By: Behavioral Healthcare LLC
	Its Sole Member
	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	VALLE VISTA, LLC
	
	By: BHC of Indiana, General Partnership
	Its Sole Member
	
	 By: Columbus Hospital Partners, LLC

	 Its General Partner

	
	 By: Lebanon Hospital Partners, LLC

	 Its General Partner

	
	 By: Northern Indiana Partners, LLC

	 Its General Partner

	
	 By: Valle Vista Hospital Partners, LLC

	 Its General Partner

	
	 By: Behavioral Healthcare LLC

	 The Sole Member of each of the above General Partners

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	WELLSTONE REGIONAL HOSPITAL ACQUISITION, LLC
	
	By: Wellstone Holdings, Inc.
	Its Minority Member
	
	 By: Behavioral Healthcare LLC

	 Its Managing Member and Sole Member of the Minority Member

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	BEHAVIORAL HEALTHCARE, LLC
	
	By: BHC Holdings, Inc.
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	HORIZON HEALTH HOSPITAL SERVICES, LLC
	HORIZON MENTAL HEALTH MANAGEMENT, LLC
	SUNSTONE BEHAVIORAL HEALTH, LLC
	
	By: Horizon Health Corporation
	Its Sole Member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	HHC PENNSYLVANIA, LLC
	HHC POPLAR SPRINGS, LLC
	KINGWOOD PINES HOSPITAL, LLC
	TOLEDO HOLDING CO., LLC
	
	By: Horizon Health Hospital Services, LLC
	Its Sole Member
	
	 By: Horizon Health Corporation

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	HICKORY TRAIL HOSPITAL, L.P.
	NEURO INSTITUTE OF AUSTIN, L.P.
	TEXAS CYPRESS CREEK HOSPITAL, L.P.
	TEXAS LAUREL RIDGE HOSPITAL, L.P.
	TEXAS OAKS PSYCHIATRIC HOSPITAL, L.P.
	TEXAS SAN MARCOS TREATMENT CENTER, L.P.
	TEXAS WEST OAKS HOSPITAL, L.P.
	
	By: Texas Hospital Holdings, LLC
	Its General Partner
	
	 By: Psychiatric Solutions Hospitals, LLC

	 Its Sole Member

	
	 By: Psychiatric Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	SHC-KPH, LP
	
	By: HHC Kingwood Investment, LLC
	Its General Partner
	
	 By: Horizon Health Hospital Services, LLC

	 Sole member of the General Partner

	
	 By: Horizon Health Corporation

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	H.C. PARTNERSHIP
	
	By: H.C. Corporation
	Its General Partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President
	
	By: HSA Hill Crest Corporation
	Its General Partner
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	BHC OF INDIANA, GENERAL PARTNERSHIP
	
	By: Columbus Hospital Partners, LLC
	Its General Partner
	
	By: Lebanon Hospital Partners, LLC
	Its General Partner
	
	By: Northern Indiana Partners, LLC
	Its General Partner
	
	By: Valle Vista Hospital Partners, LLC
	Its General Partner
	
	 By: BHC Healthcare, LLC

	 The Sole Member of each of the above General Partners

	
	 By: BHC Holdings, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	SCHICK SHADEL OF FLORIDA, LLC
	
	By: Horizon Health Hospital Services, LLC
	       Its sole member
	
	 By: Horizon Health Corporation

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	UHS OF NEW ORLEANS, LLC
	UHSL, LLC
	
	By: UHS of Delaware, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Senior Vice President



  
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	INDEPENDENCE PHYSICIAN MANAGEMENT, LLC
	
	By: UHS of Fairmount, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	BEHAVIORAL HEALTH MANAGEMENT, LLC
	BEHAVIORAL HEALTH REALTY, LLC
	CAT REALTY, LLC
	CAT SEATTLE, LLC
	MAYHILL BEHAVIORAL HEALTH, LLC
	PSYCHIATRIC REALTY, LLC
	RR RECOVERY, LLC
	SALT LAKE BEHAVIORAL HEALTH, LLC
	SALT LAKE PSYCHIATRIC REALTY, LLC
	UBH OF OREGON, LLC
	UBH OF PHOENIX, LLC
	UBH OF PHOENIX REALTY, LLC
	UNIVERSITY BEHAVIORAL HEALTH OF EL PASO, LLC
	
	By: Ascend Health Corporation
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	GARFIELD PARK HOSPITAL, LLC
	
	By: UHS of Hartgrove, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	ABS LINCS KY, LLC
	HUGHES CENTER, LLC
	
	By: Alternative Behavioral Services, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	MILLWOOD HOSPITAL, L.P.
	
	By: Texas Hospital Holdings, LLC
	Its general partner
	
	 By: Psychiatric Solutions Hospitals, LLC

	 Its general partner

	
	 By: Psychiatric Solutions, Inc.

	 Its Sole Member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President
	
	VALLEY HEALTH SYSTEM LLC
	
	By: Valley Hospital Medical Center, Inc.
	Its sole member
		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	UHP LP
	
	By: Island 77 LLC
	Its general partner
	
	 By: Ascend Health Corporation

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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	BEACH 77 LP
	
	By: 2026 W. University Properties, LLC
	Its general partner
	
	 By: Ascend Health Corporation

	 Its sole member

		
	By:	 	 /s/ Steve Filton

	Name:	 	Steve Filton
	Title:	 	Vice President



  
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