<PAGE>

                                                                     Exhibit 4.1

                                 March 23, 2000



Health Management Associates, Inc.
5811 Pelican Bay Blvd., Suite 500
Naples, FL 34108-2710

Attn: Robert E. Farnham

Gentlemen:

     This letter agreement (this "Agreement") documents the parties'
understandings relative to an extension of credit by FIRST UNION NATIONAL BANK
("Bank"), a national banking association, to HEALTH MANAGEMENT ASSOCIATES, INC.
("Borrower"), a Delaware corporation.  Bank and Borrower agree as follows:

1.        Definitions.  As used in this Agreement, the capitalized terms defined
          -----------
below have the respective meanings ascribed to them:

          "Advance" means an advance to Borrower of proceeds of the Loan
           -------
pursuant to this Agreement, on any given Advance Date.

          "Advance Date" means the date as of which an Advance is made.
           ------------

          "Business Day" means a weekday on which commercial banks are open for
           ------------
business in Tampa, Florida.

          "Commitment Expiration" means December 31, 2000, or such earlier date
           ---------------------
that Borrower terminates its cash management arrangements with Bank.

          "Default" has the meaning set forth in section 8.
           -------

          "Default Rate" means the highest lawful rate of interest, under
           ------------
Florida law, per annum specified in any Note to apply after a default under such
Note or, if no such rate is specified, a rate equal to the lesser of (a) two (2)
percentage points above the contract rate on the Loan otherwise in effect from
time to time or (b) the highest rate of interest allowed by law.

          "GAAP" means Generally Accepted Accounting Principles as defined by
           ----
the Financial Accounting Standards Board or its successor as in effect at the
time any calculation is required to be made under this Agreement or any
financial statement or report is prepared pursuant to it.

                                      19
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March 23, 2000




          "Governmental Authority" means any nation or government, any state or
           ----------------------
other political subdivision thereof and any entity exercising executive,
legislative, judicial, regulatory or administrative functions pertaining to
government.

          "Liabilities" means all current and future liabilities, obligations,
           -----------
and indebtedness (including interest thereon and any renewals, extensions, or
modifications) of Borrower owing to Bank pursuant to the Loan, the Note, this
Agreement, or the Loan Documents, whether now due or to become due, and whether
now existing or later created, advanced or contracted.

          "Loan" means the loan or loans from Bank to Borrower described in
           ----
section 2 and evidenced by the Note.

          "Loan Commitment" means the obligation of Bank to make Advances with
           ---------------
respect to the Loan pursuant to section 2 of this Agreement.

          "Loan Documents" mean the Note, this Agreement, and all other
           --------------
documents and agreements necessary or appropriate to document and effectuate the
Loan.

          "Master Credit Facility" means the credit facility established by
           ----------------------
Borrower pursuant to the Credit Agreement dated November 30, 1999, and any
amendments, renewals, and substitutions for that facility.

          "Maximum Loan Amount" means $15,000,000 or such other amount to which
           -------------------
Bank consents in writing from time to time.

          "Note" means the promissory note dated the same date at this
           ----
Agreement, executed by Borrower in favor of Bank, in the face amount of the
Maximum Loan Amount, and any renewal, modification, extension, or consolidation
of the Note.

          "Permitted Liens" means
           ---------------

          (a) Liens securing the Liabilities;

          (b) Liens securing Borrower's obligations under the Master Credit
     Facility;

          (c) Liens for taxes and other statutory liens, landlord's liens, and
     similar liens arising by operation of law, so long as the obligations
     secured thereby are not past due or are being contested as permitted
     herein;

          (d) Liens permitted under the Master Credit Facility; and

                                      20
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Health Management Associates, Inc.
March 23, 2000





          (e) such other Liens to which Bank consents in writing from time to
     time.

          "Person" means any natural person, corporation, unincorporated
           ------
organization, trust, joint-stock company, joint venture, association, company,
limited or general partnership, limited liability company, any government, or
any agency or political subdivision of any government.

          "Prime Rate" means that index rate of interest per annum announced
           ----------
from time to time by Bank (or its successor) as its "Prime Rate" or "Prime
Lending Rate" (which rate shall not necessarily be the best or lowest rate for
any particular type of loan or for loans to any particular class or category of
customer).  A change in the Prime Rate will become effective from the beginning
of the day on which such change is announced by Bank.

          "Requirement of Law" means, as to any Person, the articles of
           ------------------
incorporation and bylaws or other organizational or governing documents of the
person, and any law, treaty, rule, or regulation or determination of an
arbitrator or a court or other Governmental Authority in each case applicable to
or binding on the Person or any of its property or to which the Person or any of
its property is subject.

          "Responsible Officer" means a financial officer of Borrower.
           -------------------

          "Subsidiary"  means any corporation, partnership, or other Person in
           ----------
which Borrower, directly or indirectly, owns more than fifty percent (50%) of
the stock, capital, or income interests, or other beneficial interests, or which
is effectively controlled by Borrower.

          2.   Loan.  Subject to the terms and conditions of this Agreement,
               ----
Bank shall make available to Borrower loans for short-term working capital in a
total principal amount not to exceed the Maximum Loan Amount (the "Loan").  The
Loan is to be used by Borrower solely to facilitate day-to-day cash management
needs in conjunction with services provided by Bank.  Borrower shall execute and
deliver to Bank the Note, which will evidence the outstanding principal balance
of the Loan, as it may change from time to time, and provide for accrual and
payment of interest and repayment in accordance with the terms of this
Agreement.  Advances under the Loan will be subject to the following terms:

          (a) Borrower may borrow, repay, and reborrow from time to time from
     the Loan for a period from the date of this Agreement to the earlier of the
     Commitment Expiration or the termination of the Loan Commitment pursuant to
     section 8 of this Agreement.

          (b) The outstanding balance of the Loan may increase and decrease from
     time to time, and Advances thereunder may be repaid and reborrowed, but the
     total of Advances outstanding at any one time under the Loan shall never
     exceed the Maximum

                                      21
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Health Management Associates, Inc.
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     Loan Amount. Borrower immediately shall pay to Bank any such excess. Bank
     may, in its discretion, make or permit to remain outstanding Advances to
     Borrower under the Loan in excess of the Maximum Loan Amount, which will
     become part of the Loan and the indebtedness under the Note, bear interest
     as provided in the Note, be payable upon demand, and be entitled to all
     rights and benefits under this Agreement and under all other Loan
     Documents.

          (c) Borrower shall repay on the Commitment Expiration all Advances and
     accrued interest under the Loan not previously repaid.

          (d) Borrower shall make all payments of interest and principal under
     the Note without setoff or counterclaim, in immediately available funds, at
     Bank's offices set forth in this Agreement, and in such coin or currency of
     the United States of America that at the time of payment is legal tender
     for the payment of public and private debt.

          (e) Borrower may prepay the principal balance of the Loan, in whole or
     in part, at any time without premium or penalty.

          3.   Computation and Payment of Interest.
               -----------------------------------

          (a) From the date of this Agreement to and including the Commitment
Expiration, the outstanding principal balance of the Loan shall bear interest
until paid in full at a rate per annum equal to the Prime Rate minus one-quarter
of one percent ( 1/4%).

          (b) Borrower shall pay interest monthly on the outstanding principal
balance of the Loan, on the last day of each month beginning on the first of
such days to occur after an Advance has been made.

          (c) All interest and fees under the Note or this Agreement will be
calculated on a 365-day year for the actual number of days elapsed in an
interest period (actual/365 method).

          (d) Any payments not made as and when due (whether at stated maturity,
by acceleration, or otherwise) shall bear interest at the Default Rate from the
date due until paid, payable on demand.

          4.   Conditions Precedent to Initial Advance.  In addition to any
               ---------------------------------------
other requirement set forth in this Agreement, Bank will not make the initial
Advance under the Loan unless and until the following conditions have been
satisfied, in the sole opinion of Bank and its counsel:

          (a) Cash Management System.  Borrower has entered into the cash
              ----------------------
     management system with Bank contemplated by this Agreement.

                                      22
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Health Management Associates, Inc.
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          (b) Loan Documents.  Borrower and each other party to any Loan
              --------------
     Documents, as applicable, have executed and delivered this Agreement and
     the Note.

          (c) Closing Certificate.  Borrower has delivered to Bank an incumbency
              -------------------
     certificate and certified resolutions of the board of directors (or other
     appropriate persons) of Borrower authorizing the execution, delivery, and
     performance of the Loan Documents.

          (d) Opinion Letter.  Borrower has delivered to Bank a favorable
              --------------
     opinion letter of Borrower's general counsel in form and substance
     satisfactory to Bank and its counsel.

          (e) Additional Matters.  All corporate and other proceedings, and all
              ------------------
     documents, instruments, and other legal matters in connection with the
     transactions contemplated by this Agreement and the Loan Documents, must be
     satisfactory in form and substance to Bank, and Bank must have received any
     of the documents, legal opinions, and other opinions pertaining to any
     aspect or consequence of the transaction contemplated by this Agreement
     that it reasonably requests.

          5.   Conditions Precedent to Each Advance.  The following conditions,
               ------------------------------------
in addition to any other requirement set forth in this Agreement, must have been
satisfied or performed by each Advance Date, in the sole opinion of Bank and its
counsel:

          (a) Accuracy of Representations.  All representations and warranties
              ---------------------------
     made by Borrower in this Agreement or otherwise in writing in connection
     with this Agreement are true and correct as if made on and as of the
     proposed Advance Date, and at Bank's request, Borrower has so certified in
     an Advance Request.

          (b) No Default.  No Default has occurred and is continuing, and
              ----------
     Borrower has so certified in the Advance Request.

          6.   Representations and Warranties.  Unless otherwise specified, the
               ------------------------------
following representations and warranties will be deemed made as of the date of
this Agreement and as of the Advance Date of any Advance by Bank to Borrower.
Borrower represents and warrants to Bank as follows:

          (a) Financial Condition.  The financial statements of Borrower, copies
              -------------------
     of which have been furnished to Bank, are complete and correct and fairly
     represent the financial condition of Borrower as of that date and the
     results of its operations and its cash flow for the applicable fiscal year
     or interim period then ended.  As of the date of its most recent balance
     sheet, December 31, 1999, furnished by Borrower to Bank (the "Balance Sheet
     Date"), Borrower had no other material liabilities or obligations

                                      23
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Health Management Associates, Inc.
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     (including contingent, indemnity, or suretyship obligations, liabilities
     for taxes, long-term leases or unusual forward or long-term commitments)
     not reflected in the balance sheet or in the notes to it.  All financial
     statements of Borrower previously furnished to Bank were prepared in
     accordance with GAAP applied on a consistent basis.  Since the Balance
     Sheet Date, there has not been any material adverse change in the financial
     condition of Borrower.

          (b) Corporate Organization and Authority; Compliance with Law.
              ---------------------------------------------------------
     Borrower (i) is a corporation duly organized and validly existing in good
     standing under the laws of the jurisdiction of its incorporation and (ii)
     has all requisite power and authority, and the legal right to own its
     assets and to conduct its business as now conducted and to execute,
     deliver, and perform this Agreement and the other Loan Documents, and to
     borrow under this Agreement.  Borrower further (x) is in compliance in all
     material respects with all Requirements of Law applicable to it, (y)
     possesses all governmental franchises, licenses, and permits that are
     necessary to own or lease its assets and to carry on its business as now
     conducted, and (z) is qualified to transact business as a foreign
     corporation or organization in any jurisdiction in which such qualification
     is necessary.

          (c) Authorization and Validity of Agreements.  The execution, delivery
              ----------------------------------------
     and performance by Borrower of the Loan Documents and Borrower's borrowings
     pursuant to this Agreement: (i) have been duly authorized by all requisite
     action of Borrower; (ii) will not conflict with the articles of
     incorporation or bylaws of Borrower; and (iii) will not require any
     registration with, or consent or approval of, or other act by any
     Government Authority.  This Agreement has been, and each other Loan
     Document to which it is a party will be, duly executed and delivered to
     Bank on behalf of Borrower.  In addition, the Note, this Agreement, and the
     other Loan Documents, when executed and delivered to Bank, will be valid
     and legally binding obligations of Borrower enforceable against Borrower in
     accordance with their terms.

          (d) No Legal Bar.  The execution, delivery, and performance by
              ------------
     Borrower of this Agreement and the other Loan Documents, Borrower's
     borrowings pursuant to this Agreement, and use of the loan proceeds, will
     not to the best knowledge of Borrower violate any Requirement of Law
     applicable to Borrower or constitute a breach or violation of, a default
     under, or require any consent under, any of its material contractual
     obligations.

          (e) No Material Litigation.  No litigation, investigation, or
              ----------------------
     proceeding of or before any arbitrator or Governmental Authority is pending
     or, to the knowledge of Borrower, threatened by or against Borrower or
     against any of its respective businesses, properties, or revenues (i) with
     respect to any of the Loan Documents or any of the transactions
     contemplated by them, or (ii) which could have a material adverse effect on
     the assets, business, operations, property, or condition (financial or
     other) of Borrower.

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Health Management Associates, Inc.
March 23, 2000




          (f) No Default.  To the best knowledge of Borrower, no Default or
              ----------
     event that with notice or the passage of time or both would constitute a
     Default has occurred and is continuing.  Borrower is not in default under
     or with respect to the Master Credit Facility or any material Contractual
     Obligations.

          (g) Full Disclosure.  All information furnished by Borrower to Bank
              ---------------
     concerning Borrower, its financial condition, or otherwise for the purpose
     of obtaining credit for the Borrower is, or will be at the time the same is
     furnished, accurate and correct in all material respects.

          7.   Covenants.  From the date of this Agreement and until payment in
               ---------
full of the Liabilities and formal termination of this Agreement, Borrower shall
comply fully with the following provisions:

          (a) Investigation of Borrower.  Borrower shall:  (i) give agents and
              -------------------------
     representatives of Bank, upon reasonable notice, access during normal
     business hours to its business premises, offices, properties, books,
     records, and information; (ii) permit agents and representatives of Bank to
     make such audit and examination thereof, and conduct such other
     investigation, as they consider appropriate to determine and verify its
     assets, business, operation, property, or condition (financial or other)
     and to consummate the transactions contemplated by this Agreement; and
     (iii) furnish to Bank and its agents and representatives such additional
     information with respect to its business and affairs as Bank or they
     reasonably request from time to time.  Borrower shall bear the costs of
     such audits, reports, and inspections.

          (b) Conduct of Business.  Borrower shall (i) conduct and maintain its
              -------------------
     present business in the ordinary course; (ii) maintain itself at all times
     as a corporation organized and validly existing in good standing under the
     laws of its state of incorporation; and (iii) comply in all material
     respects with all Requirements of Law and Contractual Obligations
     applicable to it and its business and properties.

          (c) Use of Loan Proceeds.  Borrower shall use the proceeds of the Loan
              --------------------
     only to facilitate the cash management arrangement contemplated by this
     Agreement and furnish to Bank all evidence that it may reasonably require
     with respect to such use.

          (d) Notices.  Borrower promptly shall notify Bank of:  (i) any
              -------
     Default, (ii) a default in the performance of, or compliance with, any
     Requirement of Law or Contractual Obligation of Borrower that might
     reasonably be expected to have a material adverse effect on Borrower; (iii)
     any litigation, dispute, or proceeding that is pending or known by
     Borrower's officers to be threatened against Borrower and that might
     involve a claim for damages or a request for injunctive, enforcement, or
     other relief that, if granted, might reasonably be expected to have a
     material adverse effect on Borrower; (iv) a change in either the name or
     the principal place of business of

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Health Management Associates, Inc.
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     Borrower or the office where its books and records are kept; and (v) a
     material adverse change in the assets, business, operations, property, or
     condition (financial or other) of Borrower. Borrower shall provide with
     each notice pursuant to this section a statement of a Responsible Officer
     setting forth details of the occurrence referred to in the notice and
     stating what action Borrower proposes to take with respect to it.

          (e) Financial Statements and Periodic Reports.  Borrower shall keep
              -----------------------------------------
     true books, records, and accounts that completely, accurately, and fairly
     reflect all dealings and transactions relating to its assets, business, and
     activities and shall record all transactions in such manner as is necessary
     to permit preparation of its financial statements in accordance with GAAP
     applied on a Consistent Basis.  Borrower shall furnish to Bank:

          (i) Quarterly Reports.  As soon as available and in any event within
              -----------------
          45 days after the end of each calendar quarter, an income statement
          and a balance sheet of Borrower prepared in accordance with GAAP
          applied on a Consistent Basis as of the end of such month and year-to-
          date, each certified by a Responsible Officer of Borrower as being
          true and accurate;

          (ii) Annual Reports.  Within 90 days after the end of each fiscal
               --------------
          year, an income statement and a reconciliation of surplus statement of
          Borrower for such year, and a balance sheet as of the end of such
          year, prepared in accordance with GAAP applied on a Consistent Basis,
          certified without qualification by Borrower's independent accountants.

     The financial statements required above shall be in consolidated and, if
required by Bank, consolidating form for Borrower and all Subsidiaries required
by GAAP to be consolidated for financial reporting purposes.  In addition to the
financial statements required herein, Bank reserves the right to require from
time to time other or additional financial or other information concerning
Borrower.

          (f) Certificates; Other Information.  Borrower shall furnish to Bank:
              -------------------------------

               (i) concurrently with the delivery of the annual financial
          statements referred to in section 6(e)(ii), a certificate from its
          independent accountants stating that after reviewing the financial
          statements, the accountants do not know of any Default by Borrower
          under this Agreement or the other Loan Documents;


               (ii) concurrently with the delivery of the annual and quarterly
          financial statements referred to in section 7(e), a certificate from a
          Responsible Officer (x) containing computations confirming Borrower's
          compliance with the financial covenants in the Master Credit Facility,
          and (y) stating that the officer

                                      26
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Health Management Associates, Inc.
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          does not know of any Default by Borrower under this Agreement or the
          other Loan Documents; and

               (iii)  all other information regarding the affairs of Borrower
          that Bank from time to time reasonably requests.

          (g) Payment of Debt, Taxes, and Other Obligations.  Borrower shall (i)
              ---------------------------------------------
     pay and perform all of its indebtedness and obligations promptly and in
     accordance with normal terms; and (ii) pay and discharge or cause to be
     paid and discharged promptly when due and payable and before they are in
     default, all taxes, assessments, and other governmental charges or levies
     imposed on it or its income, profits, property, or business, and all lawful
     claims for labor, material and supplies, or other goods or services which,
     if unpaid, might become a lien or charge on its properties.  However, any
     tax, assessment, charge, levy, or claim need not be paid if its validity is
     being contested in good faith by appropriate proceedings, Borrower has made
     adequate reserves for it on its books in accordance with GAAP applied on a
     consistent basis and no lien resulting therefrom attaches to any property
     of Borrower and becomes enforceable by its creditors.

          (h) Limitation on Liens.  Borrower shall not create or permit to exist
              -------------------
     any Liens on any of its property, except Permitted Liens.

          (i) Margin Stock.  Borrower shall not use any proceeds of the Loan to
              ------------
     purchase or carry any margin stock (within the meaning of Regulation U of
     the Board of Governors of the Federal Reserve System) or extend credit to
     others for the purpose of purchasing or carrying any margin stock.

          (j) Further Assurances.  Borrower shall take such further action,
              ------------------
     execute such further agreements, and provide to Bank such further
     assurances as may be reasonably requested to ensure compliance with the
     intent of this Agreement and the other Loan Documents.

          8.   Default.  The occurrence of one or more of the following events
               -------
constitutes a Default under this Agreement and with respect to the other Loan
Documents:

          (a) Nonpayment.  Borrower fails to pay any principal or interest on
              ----------
     the Note within 3 days of when the same becomes due and payable in
     accordance with its terms or fails to pay any other Liabilities when the
     same becomes due and payable, subject to any applicable cure periods or
     grace periods; or

          (b) Representation False.  Any representation or warranty made by
              --------------------
     Borrower or any other party to any Loan Document (other than Bank) herein
     or therein or in any certificate or report furnished in connection herewith
     or therewith shall prove to have

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Health Management Associates, Inc.
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     been untrue or incorrect in any material respect when made; or

          (c) Other Covenants.  Borrower fails to observe or perform any
              ---------------
     agreement, covenant, or obligation contained in this Agreement or any other
     Loan Document not provided for elsewhere in this section 8 and such default
     is not cured within 20 days of receipt by Borrower of written notice of any
     breach; or

          (d) Other Debts.  Borrower shall be in default under the Master Credit
              -----------
     Facility or any material Contractual Obligation; or

          (e) Voluntary Proceedings.  Borrower shall (i) voluntarily liquidate
              ---------------------
     or terminate operations or apply for or consent to the appointment of, or
     the taking of possession by, a receiver, custodian, trustee or liquidator
     of such Person or of all or of a substantial part of its assets, (ii) admit
     in writing its inability, or be generally unable, to pay its debts as the
     debts become due, (iii) make a general assignment for the benefit of its
     creditors, (iv) commence a voluntary case under the federal Bankruptcy Code
     (as now or hereafter in effect), (v) file a petition seeking to take
     advantage of any other law relating to bankruptcy, insolvency,
     reorganization, winding-up, or composition or adjustment of debts, (vi)
     fail to controvert in a timely and appropriate manner, or acquiesce in
     writing to, any petition filed against it in an involuntary case under the
     Bankruptcy Code, or (vii) take any corporate action for the purpose of
     effecting any of the foregoing; or

          (f) Judgments.  Judgments in excess of $5,000,000 in the aggregate
              ---------
     shall be rendered against Borrower and shall remain undischarged,
     undismissed, and unstayed for more than 30 days (except judgments validly
     covered by insurance) or there shall occur any levy upon, or attachment,
     garnishment or other seizure of, any material portion of the assets of
     Borrower, by reason of the issuance of any tax levy, judicial attachment or
     garnishment or levy of execution; or

          (g) Material Adverse Change.  Borrower suffers a material adverse
              -----------------------
     change in its assets, business, operation, property, or condition
     (financial or other), or any material loss, theft, damage, or destruction
     of the assets of Borrower, which loss is not fully insured and which could
     have material adverse effect on the business, operations, property, or
     condition (financial or other) of Borrower, or

If any Default occurs, Bank may, without notice to Borrower, at its option,
terminate the Loan Commitment and withhold further Advances to Borrower, and may
declare any or all Liabilities to be immediately due and payable (if not earlier
demanded), bring suit against Borrower to collect the Liabilities, exercise any
remedy available to Bank hereunder and take any action or exercise any remedy
provided herein or in any other Loan Document or under applicable law.  No
remedy shall be exclusive of other remedies or impair the right of Bank to
exercise any other remedies.

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          9.   Expenses.  Borrower shall pay on demand (i) all of Bank's costs
               --------
and expenses in connection with the negotiation, preparation, execution,
delivery, administration of, and any amendment, supplement, or modification to,
the Note, this Agreement, and the other Loan Documents including the reasonable
fees and out-of-pocket expenses of counsel for Bank with respect thereto and all
reasonable costs and expenses incurred in enforcing or preserving Bank's rights
under the foregoing documents (including all reasonable attorney's fees and
expenses) incurred in all matters of enforcement, negotiation, interpretation,
and collection, before, during, and after demand, suit, proceeding, trial,
appeal, and post-judgment collection efforts, and any bankruptcy,
reorganization, or similar proceeding (including efforts to obtain relief from
any stay) if Borrower or any other Person or entity liable for the Loan becomes
involved in any bankruptcy, reorganization, or similar proceeding, (ii) any and
all stamp and other taxes and fees payable or determined to be payable in
connection with the execution, delivery, filing, and recording of the Note, this
Agreement, and the other Loan Documents, and Borrower shall save Bank harmless
from and against any and all liabilities with respect to or resulting from any
delay in paying or omission by Borrower to pay such taxes and fees.  Bank's
legal fees in connection with preparation of this Agreement will not exceed
$2,500.  The agreements in this section will survive the repayment of the
Liabilities and the termination of this Agreement.

          10.  Waiver and Modification; Remedies Cumulative.  A waiver,
               --------------------------------------------
amendment, discharge, extension, termination, or modification of this Agreement
or the other Loan Documents will be valid and effective only if it is in writing
and signed by all the parties to the agreement.  A written waiver by the Bank of
a Default under any provision of this Agreement or the other Loan Documents will
not operate as a waiver of either any other Default or a succeeding Default
under the same provision or as a waiver of the provision itself.  No delay or
course of dealing by the Bank will operate as a waiver of any right, power, or
remedy of the Bank, except to the extent manifested in writing by the Bank and
except when this Agreement or the other Loan Documents expressly requires a
right, power, or remedy to be exercised within a specified time.

          11.  Notices.  Every demand, consent, notice, or approval required or
               -------
permitted to be given by a party under this Agreement or the other Loan
Documents will be valid only if it is in writing (whether or not the applicable
provision of this Agreement or the other Loan Documents state that it must be in
writing) and delivered personally or by telecopy, commercial courier, or first
class, postage prepaid, United States mail (whether or not certified or
registered

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Health Management Associates, Inc.
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and regardless of whether a return receipt is requested or received by the
sender), and addressed by the sender as follows:

          (a)  If to Borrower:
               --------------

               Health Management Associates, Inc.
               5811 Pelican Bay Blvd., Suite 500
               Naples, FL  34108

               Attention:  Robert E. Farnham

          (b)  If to Bank:
               ----------

               First Union National Bank
               5th Floor
               One First Union Center
               301 South College Street
               Charlotte, North Carolina  28288

               Attention:  Ann M. Dodd

or to such other address as Bank or Borrower may designate by notice given to
the other parties in accordance with this section.  A validly given demand,
consent, notice, or approval will be effective on its receipt.  The Bank and
Borrower shall promptly notify each other of any change in their respective
mailing addresses that are listed in this Agreement.

          12.  Governing Law.  The validity, construction, enforcement, and
               -------------
interpretation of this Agreement will be governed by the laws of the State of
Florida and the federal laws of the United States of America, excluding the laws
of those jurisdiction pertaining to the resolution of conflicts of laws with
other jurisdictions.

          13.  Miscellaneous.  Time is of the essence with respect to the
               -------------
performance or satisfaction by Borrower of every term, condition, covenant,
agreement, and obligation under the Loan Documents.  The Loan Documents are not
assignable by Borrower, and any purported assignment will be invalid and
unenforceable against Bank.  This Agreement is binding on the respective heirs,
assignees, successors, and personal representatives of the parties to it and
inures to the benefit of Bank's assignees, successors, and legal representatives
and any subsequent holder of the Note.  If this Agreement calls for the approval
or consent of Bank, such approval or consent may be given or withheld in the
discretion of Bank unless otherwise specified in this Agreement.  The parties
may execute each Loan Document in counterparts.  Each executed counterpart will
constitute an original document, and all of them, together, will constitute the
same agreement.

                                      30
<PAGE>

Health Management Associates, Inc.
March 23, 2000



          14.  Waiver of Jury Trial.  BORROWER AND BANK WAIVE TRIAL BY JURY IN
               --------------------
CONNECTION WITH LITIGATION ARISING IN CONNECTION WITH THIS AGREEMENT.


                           -------------------------

If this Agreement accurately states our understandings and agreements with you,
please so signify by signing in the space provided below for your signature in
the presence of a notary public, and have the notary contemporaneously sign this
Agreement in the space provided below.

                              Sincerely yours,

                              FIRST UNION NATIONAL  BANK


                              By:      /s/  Ann M. Dodd
                                   --------------------------------------
                                      Name:   Ann M. Dodd
                                             ----------------------------
                                      Title:  Senior Vice President
                                             ----------------------------

                `             Accepted and Approved:

                              HEALTH MANAGEMENT ASSOCIATES,
                              INC.


                              By:      /s/  Robert E. Farnham
                                   --------------------------------------
                                      Name:   Robert E. Farnham
                                             ----------------------------
                                      Title:  Vice President
                                             ----------------------------
                                              Corporate Controller