Document:

EX-4.13

 Exhibit 4.13 

EXECUTION VERSION 
 Supplemental
Indenture Joining Successor Company and in Respect of Subsidiary Guarantees 
 December 1, 2016 

NINTH SUPPLEMENTAL INDENTURE, dated as of December 1, 2016 (this “Supplemental Indenture”), among the Subsidiaries
listed on Schedule A hereto (the “New Subsidiary Guarantors” and each, a “New Subsidiary Guarantor”), Envision Healthcare Corporation (f/k/a New Amethyst Corp.) (together with its successors and assigns, the
“Issuer Company”), each of the existing Subsidiary Guarantors under the Indenture (as defined below) party hereto (each an “Existing Guarantor” and, together with the New Subsidiary Guarantors, the
“Subsidiary Guarantors”) and Wilmington Trust, National Association, as Trustee under the Indenture referred to below. 
 W
I T N E S S E T H: 
 WHEREAS, Envision Healthcare Holdings, Inc. (the “Existing Issuer”), the Existing Guarantors and the
Trustee have heretofore become parties to an Indenture, dated as of June 18, 2014 (as amended, supplemented, waived or otherwise modified, the “Indenture”), providing for the issuance of Notes in series; 

WHEREAS, pursuant to that certain Agreement and Plan of Merger among the Existing Issuer, AmSurg Corp., a Tennessee corporation, and the
Issuer Company, the Existing Issuer merged with and into the Issuer Company, with the Issuer Company as the surviving entity continuing its existence as a corporation under the laws of the State of Delaware; 

WHEREAS, Section 502 of the Indenture provides that upon any transaction involving the Existing Issuer in accordance with
Section 501 in which the Existing Issuer is not the Successor Company (as defined in the Indenture), the Successor Company shall succeed to, and be substituted for, and may exercise every right and power of, the Existing Issuer under the
Indenture, and thereafter the Existing Issuer shall be relieved of all obligations and covenants under the Indenture; 
 WHEREAS,
Section 1308 of the Indenture provides that the Issuer Company is required to cause the New Subsidiary Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which the New Subsidiary Guarantors shall guarantee the
Issuer 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 New 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 New Subsidiary Guarantor is dependent on the financial performance and condition of the Issuer Company, the obligations hereunder of which such New Subsidiary
Guarantor has guaranteed, and on such New Subsidiary Guarantor’s access to working capital through the Issuer Company’s access to revolving credit borrowings under the Senior ABL Facility; and 

 WHEREAS, pursuant to Section 901 of the Indenture, the parties hereto are authorized to
execute and deliver this Supplemental Indenture to amend 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 Issuer Company 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. Assumption of Obligations. The Issuer Company hereby expressly assumes all of the
obligations of the Existing Issuer under the Notes and the Indenture and agrees to pay, perform and discharge when due each and every debt, obligation covenant and agreement incurred, made or to be paid, performed or discharged by the Existing
Issuer under the Indenture and the Notes. The Issuer Company hereby agrees to be bound by all the terms, provisions and conditions of the Indenture and the Notes and agrees that it shall be the Successor Company and shall succeed to, and be
substituted for, and may exercise every right and power of, the Existing Issuer under the Indenture and the Notes. 
 3. Agreement to
Guarantee. Each Subsidiary Guarantor hereby agrees, jointly and severally with the 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. 

4. 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. 

5. 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. 

6. 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 ISSUER 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 

  
 2 

 
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. 

7. 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. 

8. 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. 
 9. 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 and attested, all as of the date first above written. 
  

					
	ISSUER COMPANY:
	
	ENVISION HEALTHCARE CORPORATION
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Chief Financial Officer

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS:
	
	 AMSURG ABILENE, INC.

	 AMSURG ABILENE EYE, INC.

	 AMSURG ALTAMONTE SPRINGS FL, INC.

	 AMSURG ANESTHESIA MANAGEMENT SERVICES, LLC

	 AMSURG ARCADIA CA, INC.

	 AMSURG BURBANK, INC.

	 AMSURG COLTON CA, INC.

	 AMSURG CRYSTAL RIVER, INC.

	 AMSURG EC BEAUMONT, INC.

	 AMSURG EC SANTA FE, INC.

	 AMSURG EC ST. THOMAS, INC.

	 AMSURG EC TOPEKA, INC.

	 AMSURG EC WASHINGTON, INC.

	 AMSURG EL PASO, INC.

	 AMSURG ESCONDIDO CA, INC.

	 AMSURG FINANCE, INC.

	 AMSURG FRESNO ENDOSCOPY, INC.

	 AMSURG GLENDORA CA, INC.

	 AMSURG HILLMONT, INC.

	 AMSURG HOLDINGS, INC.

	 AMSURG INGLEWOOD, INC.

	 AMSURG KEC, INC.

	 AMSURG KISSIMMEE FL, INC.

	 AMSURG LA JOLLA, INC.

	 AMSURG LANCASTER PA, LLC

	 AMSURG MAIN LINE PA, LLC

	 AMSURG MARYVILLE, INC.

	 AMSURG MELBOURNE, INC.

	 AMSURG NORTHWEST FLORIDA, INC.

	 AMSURG OAKLAND CA, INC.

	 AMSURG OCALA, INC.

	 AMSURG PALMETTO, INC.

	 AMSURG POTTSVILLE PA, LLC

	 AMSURG SAN ANTONIO TX, INC.

	 AMSURG SAN LUIS OBISPO CA, INC.

	 AMSURG SUNCOAST, INC.

	 AMSURG TEMECULA CA, INC.

	 AMSURG TEMECULA II INC.

	 AMSURG TORRANCE, INC.

	 AMSURG SCRANTON PA, INC.

		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President, Secretary and Treasurer

  
 [Signature Page to
Supplemental Indenture] 

					
	GUARANTORS (cont’d):
	
	ASDH I, LLC
	AUSTIN NSC, LLC
	CORAL SPRINGS NSC, LLC
	DAVIS NSC, LLC
	FULLERTON NSC, LLC
	KENWOOD NSC, LLC
	LONG BEACH NSC, LLC
	NSC RBO EAST, LLC
	NSC WEST PALM, LLC
	SAN ANTONIO NSC, LLC
	SHI II, LLC
	TAMPA BAY NSC, LLC
	TORRANCE NSC, LLC
	TOWSON NSC, LLC
	TWIN FALLS NSC, LLC
	WESTON NSC, LLC
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President, Secretary and Treasurer
	
	AUSTIN NSC, LP
		
		 	By: Austin NSC, LLC, its general partner
			
		 	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President, Secretary and Treasurer
	
	WILTON NSC, LLC
		
		 	By: AmSurg Holdings, Inc. as the managing member
			
		 	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President, Secretary and Treasurer

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS (cont’d):
	
	 ALL WOMEN’S HEALTHCARE HOLDINGS, INC.

	 ALL WOMEN’S HEALTHCARE, INC.

	 ALL WOMEN’S HEALTHCARE OF DADE, INC.

	 ALL WOMEN’S HEALTHCARE OF SAWGRASS, INC.

	 ALL WOMEN’S HEALTHCARE OF WEST BROWARD, INC.

	 ALL WOMEN’S HEALTHCARE SERVICES, INC.

	 DISCOVERY CLINICAL RESEARCH, INC.

	 FM HEALTHCARE SERVICES, INC.

	 FMO HEALTHCARE HOLDINGS, INC.

	 FO INVESTMENTS, INC.

	 FO INVESTMENTS II, INC.

	 FO INVESTMENTS III, INC.

	 GLOBAL SURGICAL PARTNERS, INC.

	 SHERIDAN RADIOLOGY MANAGEMENT SERVICES, INC.

	 SHERIDAN RADIOLOGY SERVICES, INC.

		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President and Treasurer

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS (cont’d):
	
	 ANESTHESIOLOGISTS OF GREATER ORLANDO, INC.

	 ANESTHESIOLOGY ASSOCIATES OF TALLAHASSEE, INC.

	 BETHESDA ANESTHESIA ASSOCIATES, INC.

	 BOCA ANESTHESIA SERVICE, INC.

	 DRS. ELLIS, ROJAS, ROSS & DEBS, INC.

	 FLAMINGO ANESTHESIA ASSOCIATES, INC.

	 GREATER FLORIDA ANESTHESIOLOGISTS, LLC

	 GYNECOLOGIC ONCOLOGY ASSOCIATES, INC.

	 JACKSONVILLE BEACHES ANESTHESIA ASSOCIATES, INC.

	 JUPITER ANESTHESIA ASSOCIATES, L.L.C.

	 JUPITER HEALTHCARE, LLC

	 NEW GENERATIONS BABEE BAG, INC.

	 NORTH FLORIDA PERINATAL ASSOCIATES, INC.

	 PARITY HEALTHCARE, INC.

	 SHERIDAN ANESTHESIA SERVICES OF ALABAMA, INC.

	 SHERIDAN ANESTHESIA SERVICES OF LOUISIANA, INC.

	 SHERIDAN ANESTHESIA SERVICES OF VIRGINIA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF ARIZONA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF LOUISIANA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF NEW MEXICO, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF VIRGINIA, INC.

	 SHERIDAN CLINICAL RESEARCH, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF MISSOURI, INC.

		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Chief Executive Officer

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS (cont’d):
	
	 BAY AREA ANESTHESIA, L.L.C.

	 COASTAL ANESTHESIA STAFFING, LLC

	 COASTAL ANESTHESIOLOGY CONSULTANTS, LLC

	 MEDICAL INFORMATION MANAGEMENT SOLUTIONS, LLC

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF OHIO, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF KENTUCKY, INC.

	 SHERIDAN CHILDREN’S SERVICES OF ALABAMA, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF NORTH MISSOURI, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF SOUTH FLORIDA, INC.

	 SHERIDAN HEALTHCARE, INC.

	 SHERIDAN HEALTHCARE OF LOUISIANA, INC.

	 SHERIDAN HEALTHCARE OF MISSOURI, INC.

	 SHERIDAN HEALTHCARE OF VERMONT, INC.

	 SHERIDAN HEALTHCARE OF VIRGINIA, INC.

	 SHERIDAN HEALTHCARE OF WEST VIRGINIA, INC.

	 SHERIDAN HEALTHCORP, INC.

	 SHERIDAN HEALTHCORP OF CALIFORNIA, INC.

	 SHERIDAN HEALTHY HEARING SERVICES, INC.

	 SHERIDAN HOLDINGS, INC.

	 SHERIDAN ROP SERVICES OF VIRGINIA, INC.

	 SHERIDAN INVESTCO, LLC

	 SOUTHEAST PERINATAL ASSOCIATES, INC. SUNBEAM ASSET, LLC

	 SUNBEAM INTERMEDIATE HOLDINGS, INC.

	 SUNBEAM PRIMARY HOLDINGS, INC.

	 TENNESSEE VALLEY NEONATOLOGY, INC.

	 TIVA HEALTHCARE, INC.

		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Chief Executive Officer

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS (cont’d):
	
	 CHANDLER EMERGENCY MEDICAL GROUP, L.L.C. D/B/A PREMIER EMERGENCY MEDICAL
SPECIALISTS

		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Manager
	
	 PARTNERS IN MEDICAL BILLING, INC.

		
	By:	 	 /s/ Jillian Marcus

		 	Name:	 	Jillian Marcus
		 	Title:	 	President
	
	 SHERIDAN ROP SERVICES OF FLORIDA, INC.

	 SENTINEL HEALTHCARE SERVICES, LLC

		
	By:	 	 /s/ Jillian Marcus

		 	Name:	 	Jillian Marcus
		 	Title:	 	Vice President
	
	 ALLEGIANTMD, INC.

	 ARIZONA PERINATAL CARE CENTERS, LLC

BROAD MIDWEST ANESTHESIA, LLC

	 DOCTORS BILLING SERVICE, INC.

	 MEDI-BILL OF NORTH FLORIDA, INC.

	 NORTH FLORIDA ANESTHESIA CONSULTANTS, INC.

SHERIDAN CADR SOLUTIONS, INC.

SHERIDAN HOSPITALIST SERVICES OF FLORIDA, INC.

SHERIDAN LEADERSHIP ACADEMY, INC.

SHERIDAN SCIENTIFIC INTELLIGENCE, INC.

	 ST. LUCIE ANESTHESIA ASSOCIATES, LLC

VALLEY CLINICAL RESEARCH, INC.

		
	By:	 	 /s/ Jillian Marcus

		 	Name:	 	Jillian Marcus
		 	Title:	 	Vice President and Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	GUARANTORS (cont’d):
	
	PHYSICIAN OFFICE PARTNERS, INC.
		
	By:	 	 /s/ Robert Davey

		 	Name:	 	Robert Davey
		 	Title:	 	President
	
	NAC PROPERTIES, LLC
	 VALLEY ANESTHESIOLOGY CONSULTANTS, INC.

		
	By:	 	 /s/ Robert Davey

		 	Name:	 	Robert Davey
		 	Title:	 	President

  
 [Signature Page to
Supplemental Indenture] 

 
					
	EXISTING GUARANTORS
	
	CLINICAL PARTNERS MANAGEMENT COMPANY, LLC
	NORTHWOOD ANESTHESIA ASSOCIATES, L.L.C.
		
	By:	 	 /s/ William A. Sanger

		 	Name:	 	William A. Sanger
		 	Title:	 	Manager

  
 [Signature Page to
Supplemental Indenture] 

 
					
	EXISTING GUARANTORS (cont’d):
	
	 A1 LEASING, INC.

	 ABBOTT AMBULANCE, INC.

	 ACCENT HOME HEALTH CARE 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 HOLDINGS, INC.

	 AMERICAN MEDICAL RESPONSE MANAGEMENT, INC.

	 AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC.

	 AMERICAN MEDICAL RESPONSE NORTHWEST, INC.

	 AMERICAN MEDICAL RESPONSE OF COLORADO, INC.

	 AMERICAN MEDICAL RESPONSE OF CONNECTICUT, INCORPORATED

	 AMERICAN MEDICAL RESPONSE OF GEORGIA, INC.

	 AMERICAN MEDICAL RESPONSE OF ILLINOIS, INC.

	 AMERICAN MEDICAL RESPONSE OF INLAND EMPIRE

	 AMERICAN MEDICAL RESPONSE OF MASSACHUSETTS, INC.

	 AMERICAN MEDICAL RESPONSE OF NORTH CAROLINA, INC.

	 AMERICAN MEDICAL RESPONSE OF OKLAHOMA, INC.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	EXISTING GUARANTORS (cont’d):
	
	 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 BAY STATE, LLC

	 AMR HOLDCO, INC.

	 AMR OF CENTRAL TEXAS I, LLC

	 AMR OF CENTRAL TEXAS II, LLC

	 APH LABORATORY SERVICES, INC.

	 ARIZONA EMS HOLDINGS, INC.

	 ASSOCIATED AMBULANCE SERVICE, INC.

	 ATLANTIC AMBULANCE SERVICES ACQUISITION, INC.

	 ATLANTIC/KEY WEST AMBULANCE, INC.

	 ATLANTIC/PALM BEACH AMBULANCE, INC.

	 BEACON TRANSPORTATION, INC.

	 BESTPRACTICES, INC.

	 BLYTHE AMBULANCE SERVICE

	 BOWERS COMPANIES, INC.

	 BROWARD AMBULANCE, INC.

	 COMMUNITY AUTO AND FLEET SERVICES L.L.C.

	 COMMUNITY EMS, INC.

	 COMTRANS AMBULANCE SERVICE, INC.

	 COMTRANS, INC.

	 CORNING AMBULANCE SERVICE INC.

	 DESERT VALLEY MEDICAL TRANSPORT, INC.

	 DONLOCK, LTD.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	 EXISTING GUARANTORS (cont’d):

	
	 E.M.S. VENTURES, INC.

	 EASTERN AMBULANCE SERVICE, INC.

	 EASTERN PARAMEDICS, INC.

	 EHR MANAGEMENT CO.

	 EMCARE ANESTHESIA PROVIDERS, INC.

	 EMCARE HOLDCO, INC.

	 EMCARE HOLDINGS INC.

	 EMCARE OF CALIFORNIA, INC.

	 EMCARE PHYSICIAN PROVIDERS, INC.

	 EMCARE PHYSICIAN SERVICES, INC.

	 EMCARE, INC.

	 EMERGENCY MEDICAL SERVICES LP CORPORATION

	 EMERGENCY MEDICAL TRANSPORT, INC.

	 EMERGENCY MEDICAL TRANSPORTATION, INC.

	 EMERGENCY MEDICINE EDUCATION SYSTEMS, INC.

	 EMS VENTURES OF SOUTH CAROLINA, INC.

	 FIVE COUNTIES AMBULANCE SERVICE, INC.

	 FLORIDA EMERGENCY PARTNERS, INC.

	 FOUNTAIN AMBULANCE SERVICE, INC.

	 GILA HOLDCO LLC

	 GOLD COAST AMBULANCE SERVICE

	 GOLD CROSS AMBULANCE SERVICE OF PA., INC.

	 GOLD CROSS AMBULANCE SERVICES, INC.

	 GRACE BEHAVIORAL HEALTH, L.L.C.

	 GREATER PINELLAS TRANSPORTATION MANAGEMENT SERVICES, INC.

	 GUARDIAN HEALTH CARE, INC.

	 GUARDIAN HEALTHCARE GROUP, INC.

	 GUARDIAN HEALTHCARE HOLDINGS, INC.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	 EXISTING GUARANTORS (cont’d):

	
	 HANK’S ACQUISITION CORP.

	 HEALTH PRIORITY HOME CARE, INC.

	 HEALTHCARE ADMINISTRATIVE SERVICES, INC.

	 HEMET VALLEY AMBULANCE SERVICE, INC.

	 HERREN ENTERPRISES, INC.

	 HOLIDAY ACQUISITION COMPANY, INC.

	 INTERNATIONAL LIFE SUPPORT, INC.

	 JLM HEALTHCARE, INC.

	 KMAC, INC.

	 KUTZ AMBULANCE SERVICE, INC.

	 LASALLE AMBULANCE INC.

	 LIFE LINE AMBULANCE SERVICE, INC.

	 LIFECARE AMBULANCE SERVICE, INC.

	 LIFEFLEET SOUTHEAST, INC.

	 MAINSTAY SOLUTIONS, LLC

	 MARLBORO HUDSON AMBULANCE & WHEELCHAIR SERVICE, INC.

	 MEDEVAC MEDICAL RESPONSE, INC.

	 MEDEVAC MIDAMERICA, INC.

	 MEDIC ONE AMBULANCE SERVICES, INC.

	 MEDIC ONE OF COBB, INC.

	 MEDICAL EMERGENCY DEVICES AND SERVICES (MEDS), INC.

	 MEDI-CAR AMBULANCE SERVICE, INC.

	 MEDI-CAR SYSTEMS, INC.

	 MEDICS AMBULANCE SERVICE (DADE), INC.

	 MEDICS AMBULANCE SERVICE, INC.

	 MEDICS AMBULANCE, INC.

	 MEDICS EMERGENCY SERVICES OF PALM BEACH COUNTY, INC.

	 MEDICS SUBSCRIPTION SERVICES, INC.

	 MEDICS TRANSPORT SERVICES, INC.

	 MEDICWEST AMBULANCE, INC.

	 MEDICWEST HOLDINGS, INC.

	 MEDLIFE EMERGENCY MEDICAL SERVICE, INC.

	 MEDSTAT EMS, INC.

	 MERCURY AMBULANCE SERVICE, INC.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	 EXISTING GUARANTORS (cont’d):

	
	 MERCY AMBULANCE OF EVANSVILLE, INC.

	 MERCY LIFE CARE

	 MERCY, INC.

	 METRO AMBULANCE SERVICE (RURAL), INC.

	 METRO AMBULANCE SERVICE, INC.

	 METRO AMBULANCE SERVICES, INC.

	 METRO CARE CORP.

	 METROPOLITAN AMBULANCE SERVICE

	 MIDWEST AMBULANCE MANAGEMENT COMPANY

	 MOBILE MEDIC AMBULANCE SERVICE, INC.

	 NATIONAL AMBULANCE & OXYGEN SERVICE, INC.

	 NEVADA RED ROCK AMBULANCE, INC.

	 NEVADA RED ROCK HOLDINGS, INC.

	 NORTH MISS. AMBULANCE SERVICE, INC.

	 OHERBST, INC.

	 PACIFIC AMBULANCE, INC.

	 PARAMED, INC.

	 PARK AMBULANCE SERVICE INC.

	 PHYSICIAN ACCOUNT MANAGEMENT, INC.

	 PHYSICIANS & SURGEONS AMBULANCE SERVICE, INC.

	 PROFESSIONAL MEDICAL TRANSPORT, INC.

	 PROVIDER ACCOUNT MANAGEMENT, INC.

	 PUCKETT AMBULANCE SERVICE, INC.

	 R/M ARIZONA HOLDINGS, INC.

	 R/M MANAGEMENT CO., INC.

	 R/M OF TENNESSEE G.P., INC.

	 R/M OF TENNESSEE L.P., INC.

	 RADIOLOGY STAFFING SOLUTIONS, INC.

	 RADSTAFFING MANAGEMENT SOLUTIONS, INC.

	 RANDLE EASTERN AMBULANCE SERVICE, INC.

	 REIMBURSEMENT TECHNOLOGIES, INC.

	 RIVER MEDICAL INCORPORATED

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	 EXISTING GUARANTORS (cont’d):

	
	 RURAL/METRO (DELAWARE), INC.

	 RURAL/METRO CORPORATION

	 RURAL/METRO CORPORATION

	 RURAL/METRO CORPORATION OF FLORIDA

	 RURAL/METRO CORPORATION OF TENNESSEE

	 RURAL/METRO FIRE DEPT., INC.

	 RURAL/METRO OF BREWERTON, INC.

	 RURAL/METRO OF CALIFORNIA, INC.

	 RURAL/METRO OF CENTRAL ALABAMA, INC.

	 RURAL/METRO OF CENTRAL COLORADO, INC.

	 RURAL/METRO OF CENTRAL OHIO, INC.

	 RURAL/METRO OF GREATER SEATTLE, INC.

	 RURAL/METRO OF NEW YORK, INC.

	 RURAL/METRO OF NORTHERN CALIFORNIA, INC.

	 RURAL/METRO OF NORTHERN OHIO, INC.

	 RURAL/METRO OF OHIO, INC.

	 RURAL/METRO OF OREGON, INC.

	 RURAL/METRO OF ROCHESTER, INC.

	 RURAL/METRO OF SAN DIEGO, INC.

	 RURAL/METRO OF SOUTHERN CALIFORNIA, INC.

	 RURAL/METRO OF SOUTHERN OHIO, INC.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
					
	 EXISTING GUARANTORS (cont’d):

	
	 S. FISHER & S. THOMAS INC.

	 SEMINOLE COUNTY AMBULANCE, INC.

	 SIOUX FALLS AMBULANCE, INC.

	 SOUTHWEST AMBULANCE AND RESCUE OF ARIZONA, INC.

	 SOUTHWEST AMBULANCE OF CASA GRANDE, INC.

	 SOUTHWEST AMBULANCE OF NEW MEXICO, INC.

	 SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA, INC.

	 SOUTHWEST AMBULANCE OF TUCSON, INC.

	 SOUTHWEST GENERAL SERVICES, INC.

	 SPRINGS AMBULANCE SERVICE, INC.

	 SSAG, LLC

	 STAT HEALTHCARE, INC.

	 SUNRISE HANDICAP TRANSPORT CORP.

	 SW GENERAL, INC.

	 T.M.S. MANAGEMENT GROUP INC.

	 TEK AMBULANCE, INC.

	 THE AID AMBULANCE COMPANY, INC.

	 THE AID COMPANY, INC.

	 TIDEWATER AMBULANCE SERVICE, INC.

	 TKG, INC.

	 TOWNS AMBULANCE SERVICE, INC.

	 TRANSPORTATION MANAGEMENT SERVICES OF BREVARD, INC.

	 TROUP COUNTY EMERGENCY MEDICAL SERVICES, INC.

	 VALLEY FIRE SERVICE, INC.

	 VELITA SMITH HOME HEALTH, INC.

	 V.I.P. PROFESSIONAL SERVICES, INC.

	 VISTA STAFFING SOLUTIONS, INC.

	 VITAL ENTERPRISES, INC.

	 W&W LEASING COMPANY, INC.

	 WP ROCKET HOLDINGS INC.

		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
							
	EXISTING GUARANTORS (cont’d):
	
	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
	
	ACUTE MANAGEMENT, LLC
		
		 	By: HAWKEYE HOLDCO LLC, as Sole Member of Acute Management, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	AGAPE HEALTH CARE AGENCY, LLC.
	CARE CONNECTION OF CINCINNATI LLC
	GEM CITY HOME CARE, LLC
	GUARDIAN OHIO NEWCO, LLC
		
		 	By: GUARDIAN HEALTHCARE HOLDINGS, INC., as Sole Member of Agape Health Care Agency, LLC, Care Connection of Cincinnati LLC, Gem City Home Care, LLC and Guardian Ohio NewCo, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	 EXISTING GUARANTORS (cont’d):

	
	 ALPHA PHYSICIAN RESOURCES, L.L.C.

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE DELAWARE VALLEY, LLC

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE HPPP, LLC

		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of American Medical Response HPPP, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE OF MARICOPA, LLC

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE OF PIMA, LLC

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	AMR BROCKTON, L.L.C.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	APEX ACQUISITION LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	BRAVO REIMBURSEMENT SPECIALIST, L.L.C.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	CMORX, LLC
		
		 	By: EMCARE, INC., as Sole Member of CMORx, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	ED SOLUTIONS, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	EDIMS, L.L.C.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EMS MANAGEMENT LLC
			
		 	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
	
	EMSC SERVICESCO, LLC
			
		 	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

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	EVOLUTION HEALTH LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EVOLUTION MOBILE IMAGING, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

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

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	MISSION CARE OF MISSOURI, LLC
		
		 	By: MISSION CARE SERVICES, LLC, as Manager of Mission Care of Missouri, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as 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 Manager of Mission Care Services, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	MSO NEWCO, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	PHOENIX PHYSICIANS, LLC
	STREAMLINED MEDICAL SOLUTIONS LLC
		
		 	By: EMCARE, INC., as Sole Member of Phoenix Physicians, LLC and Streamlined Medical Solutions LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 PINNACLE CONSULTANTS MID-ATLANTIC, L.L.C.

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 PROVEN HEALHCARE SOLUTIONS OF NEW JERSEY, 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
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	QRX MEDICAL MANAGEMENT, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Senior Vice President and Secretary
	
	RMC CORPORATE CENTER, L.L.C.
		
		 	By: RURAL/METRO CORPORATION, as Member of RMC Corporate Center, L.L.C.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	RURAL/METRO MID-SOUTH, L.P.
		
		 	By: R/M OF TENNESSEE G.P., INC., as General Partner of Rural/Metro Mid-South, L.P.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	RURAL/METRO OF INDIANA, L.P.
		
		 	By: THE AID AMBULANCE COMPANY, INC., as General Partner of Rural/Metro of Indiana, L.P.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	RURAL/METRO OF TENNESSEE, L.P.
		
		 	By: R/M OF TENNESSEE G.P., INC., as General Partner of Rural/Metro of Tennessee, L.P.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	RURAL/METRO OPERATING COMPANY, LLC
		
		 	By: RURAL/METRO CORPORATION, as Sole Member of Rural/Metro Operating Company, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	SAN DIEGO MEDICAL SERVICES ENTERPRISE, LLC
		
		 	By: RURAL/METRO OF SOUTHERN CALIFORNIA, INC., as Member of San Diego Medical Services Enterprise, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
		
		 	By: RURAL/METRO OF SAN DIEGO, INC., as Member of San Diego Medical Services Enterprise, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	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
	
	ROSE RADIOLOGY, LLC
		
		 	By: SPOTLIGHT HOLDCO LLC, as Sole Member of Rose Radiology, LLC
		
		 	By: EMCARE, INC., as Sole Member of EmCare, Inc.
			
		 	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
	
	SPOTLIGHT HOLDCO LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

							
	EXISTING GUARANTORS (cont’d):
	
	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
	
	WHITAKER PHYSICIANS SERVICES, L.L.C.
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

 
							
	EXISTING GUARANTORS (cont’d):
	
	 AMERICAN MEDICAL RESPONSE OF NEW YORK, LLC

		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of American Medical Response of New York, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	METROCARE SERVICES – ABILENE, L.P.
		
		 	By: AMR OF CENTRAL TEXAS II, LLC, as General Partner of MetroCare Services – Abilene, L.P.
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of AMR of Central Texas II, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	PATIENT ADVOCACY GROUP, LLC
		
		 	By: AMR HOLDCO, INC., as Sole Member of Patient Advocacy Group, LLC
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Supplemental Indenture] 

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

		 	Authorized Officer

  
 [Signature Page to
Supplemental Indenture] 

 SCHEDULE A 
  

					
	 	  	 New Subsidiary Guarantors
	  	 Jurisdiction of

Organization

	1.	  	All Women’s Healthcare Holdings, Inc.	  	Delaware
	2.	  	All Women’s Healthcare of Dade, Inc.	  	Florida
	3.	  	All Women’s Healthcare of Sawgrass, Inc.	  	Florida
	4.	  	All Women’s Healthcare of West Broward, Inc.	  	Florida
	5.	  	All Women’s Healthcare Services, Inc.	  	Florida
	6.	  	All Women’s Healthcare, Inc.	  	Florida
	7.	  	AllegiantMD, Inc.	  	Florida
	8.	  	AmSurg Abilene Eye, Inc.	  	Tennessee
	9.	  	AmSurg Abilene, Inc.	  	Tennessee
	10.	  	AmSurg Altamonte Springs FL, Inc.	  	Tennessee
	11.	  	AmSurg Anesthesia Management Services, LLC	  	Tennessee
	12.	  	AmSurg Arcadia CA, Inc.	  	Tennessee
	13.	  	AmSurg Burbank, Inc.	  	Tennessee
	14.	  	AmSurg Colton CA, Inc.	  	Tennessee
	15.	  	AmSurg Crystal River, Inc.	  	Tennessee
	16.	  	AmSurg EC Beaumont, Inc.	  	Tennessee
	17.	  	AmSurg EC Santa Fe, Inc.	  	Tennessee
	18.	  	AmSurg EC St. Thomas, Inc.	  	Tennessee
	19.	  	AmSurg EC Topeka, Inc.	  	Tennessee
	20.	  	AmSurg EC Washington, Inc.	  	Tennessee
	21.	  	AmSurg El Paso, Inc.	  	Tennessee
	22.	  	AmSurg Escondido CA, Inc.	  	Tennessee
	23.	  	AmSurg Finance, Inc.	  	Tennessee
	24.	  	AmSurg Fresno Endoscopy, Inc.	  	Tennessee
	25.	  	AmSurg Glendora CA, Inc.	  	Tennessee
	26.	  	AmSurg Hillmont, Inc.	  	Tennessee
	27.	  	AmSurg Holdings, Inc.	  	Delaware
	28.	  	AmSurg Inglewood, Inc.	  	Tennessee
	29.	  	AmSurg KEC, Inc.	  	Tennessee
	30.	  	AmSurg Kissimmee FL, Inc.	  	Tennessee
	31.	  	AmSurg La Jolla, Inc.	  	Tennessee
	32.	  	AmSurg Lancaster PA, LLC	  	Tennessee
	33.	  	AmSurg Main Line PA, LLC	  	Tennessee
	34.	  	AmSurg Maryville, Inc.	  	Tennessee
	35.	  	AmSurg Melbourne, Inc.	  	Tennessee
	36.	  	AmSurg Northwest Florida, Inc.	  	Tennessee
	37.	  	AmSurg Oakland CA, Inc.	  	Tennessee
	38.	  	AmSurg Ocala, Inc.	  	Tennessee
	39.	  	AmSurg Palmetto, Inc.	  	Tennessee
	40.	  	AmSurg Pottsville PA, LLC	  	Tennessee
	41.	  	AmSurg San Antonio TX, Inc.	  	Tennessee

					
	42.	  	AmSurg San Luis Obispo CA, Inc.	  	Tennessee
	43.	  	AmSurg Scranton PA, Inc.	  	Tennessee
	44.	  	AmSurg Suncoast, Inc.	  	Tennessee
	45.	  	AmSurg Temecula CA, Inc.	  	Tennessee
	46.	  	AmSurg Temecula II Inc.	  	Tennessee
	47.	  	AmSurg Torrance, Inc.	  	Tennessee
	48.	  	Anesthesiologists of Greater Orlando, Inc.	  	Florida
	49.	  	Anesthesiology Associates of Tallahassee, Inc.	  	Florida
	50.	  	Arizona Perinatal Care Centers, LLC	  	Arizona
	51.	  	ASDH I, LLC	  	Tennessee
	52.	  	Austin NSC, LLC	  	Tennessee
	53.	  	Austin NSC, LP	  	Texas
	54.	  	Bay Area Anesthesia, L.L.C.	  	Florida
	55.	  	Bethesda Anesthesia Associates, Inc.	  	Florida
	56.	  	Boca Anesthesia Service, Inc.	  	Florida
	57.	  	Broad Midwest Anesthesia, LLC	  	Missouri
	58.	  	Chandler Emergency Medical Group, L.L.C. d/b/a Premier Emergency Medical Specialists	  	Arizona
	59.	  	Coastal Anesthesia Staffing, LLC	  	Florida
	60.	  	Coastal Anesthesiology Consultants, LLC	  	Florida
	61.	  	Coral Springs NSC, LLC	  	Tennessee
	62.	  	Davis NSC, LLC	  	Tennessee
	63.	  	Discovery Clinical Research, Inc.	  	Florida
	64.	  	Doctors Billing Service, Inc.	  	California
	65.	  	Drs. Ellis, Rojas, Ross & Debs, Inc.	  	Florida
	66.	  	Flamingo Anesthesia Associates, Inc.	  	Florida
	67.	  	FM Healthcare Services, Inc.	  	Florida
	68.	  	FMO Healthcare Holdings, Inc.	  	Delaware
	69.	  	FO Investments II, Inc.	  	Florida
	70.	  	FO Investments III, Inc.	  	Florida
	71.	  	FO Investments, Inc.	  	Florida
	72.	  	Fullerton NSC, LLC	  	Tennessee
	73.	  	Global Surgical Partners, Inc.	  	Florida
	74.	  	Greater Florida Anesthesiologists, LLC	  	Florida
	75.	  	Gynecologic Oncology Associates, Inc.	  	Florida
	76.	  	Jacksonville Beaches Anesthesia Associates, Inc.	  	Florida
	77.	  	Jupiter Anesthesia Associates, L.L.C.	  	Florida
	78.	  	Jupiter Healthcare, LLC	  	Florida
	79.	  	Kenwood NSC, LLC	  	Tennessee
	80.	  	Long Beach NSC, LLC	  	Tennessee
	81.	  	Medi-Bill of North Florida, Inc.	  	Florida
	82.	  	Medical Information Management Solutions, LLC	  	Arizona
	83.	  	NAC Properties, LLC	  	Georgia
	84.	  	New Generations Babee Bag, Inc.	  	Florida
	85.	  	North Florida Anesthesia Consultants, Inc.	  	Florida

					
	86.	  	North Florida Perinatal Associates, Inc.	  	Florida
	87.	  	NSC RBO East, LLC	  	Tennessee
	88.	  	NSC West Palm, LLC	  	Tennessee
	89.	  	Parity Healthcare, Inc.	  	Florida
	90.	  	Partners in Medical Billing, Inc.	  	Florida
	91.	  	Physician Office Partners, Inc.	  	Kansas
	92.	  	San Antonio NSC, LLC	  	Tennessee
	93.	  	Sentinel Healthcare Services, LLC	  	Georgia
	94.	  	Sheridan Anesthesia Services of Alabama, Inc.	  	Florida
	95.	  	Sheridan Anesthesia Services of Louisiana, Inc.	  	Florida
	96.	  	Sheridan Anesthesia Services of Virginia, Inc.	  	Florida
	97.	  	Sheridan CADR Solutions, Inc.	  	Florida
	98.	  	Sheridan Children’s Healthcare Services of Virginia, Inc.	  	Florida
	99.	  	Sheridan Children’s Healthcare Services of Arizona, Inc.	  	Florida
	100.	  	Sheridan Children’s Healthcare Services of Kentucky, Inc.	  	Florida
	101.	  	Sheridan Children’s Healthcare Services of Louisiana, Inc.	  	Florida
	102.	  	Sheridan Children’s Healthcare Services of New Mexico, Inc.	  	Florida
	103.	  	Sheridan Children’s Healthcare Services of Ohio, Inc.	  	Florida
	104.	  	Sheridan Children’s Healthcare Services, Inc.	  	Florida
	105.	  	Sheridan Children’s Services of Alabama, Inc.	  	Florida
	106.	  	Sheridan Clinical Research, Inc.	  	Florida
	107.	  	Sheridan Emergency Physician Services of Missouri, Inc.	  	Florida
	108.	  	Sheridan Emergency Physician Services of North Missouri, Inc.	  	Florida
	109.	  	Sheridan Emergency Physician Services of South Florida, Inc.	  	Florida
	110.	  	Sheridan Emergency Physician Services, Inc.	  	Florida
	111.	  	Sheridan Healthcare of Louisiana, Inc.	  	Florida
	112.	  	Sheridan Healthcare of Missouri, Inc.	  	Florida
	113.	  	Sheridan Healthcare of Vermont, Inc.	  	Florida
	114.	  	Sheridan Healthcare of Virginia, Inc.	  	Florida
	115.	  	Sheridan Healthcare of West Virginia, Inc.	  	West Virginia
	116.	  	Sheridan Healthcare, Inc.	  	Delaware
	117.	  	Sheridan Healthcorp of California, Inc.	  	California
	118.	  	Sheridan Healthcorp, Inc.	  	Florida
	119.	  	Sheridan Healthy Hearing Services, Inc.	  	Florida
	120.	  	Sheridan Holdings, Inc.	  	Delaware
	121.	  	Sheridan Hospitalist Services of Florida, Inc.	  	Florida
	122.	  	Sheridan InvestCo, LLC	  	Delaware
	123.	  	Sheridan Leadership Academy, Inc.	  	Florida
	124.	  	Sheridan Radiology Management Services, Inc.	  	Delaware
	125.	  	Sheridan Radiology Services, Inc.	  	Delaware
	126.	  	Sheridan ROP Services of Florida, Inc.	  	Florida
	127.	  	Sheridan ROP Services of Virginia, Inc.	  	Florida
	128.	  	Sheridan Scientific Intelligence, Inc.	  	Florida
	129.	  	SHI II, LLC	  	Tennessee
	130.	  	Southeast Perinatal Associates, Inc.	  	Florida

					
	131.	  	St. Lucie Anesthesia Associates, LLC	  	Florida
	132.	  	Sunbeam Asset LLC	  	Delaware
	133.	  	Tampa Bay NSC, LLC	  	Tennessee
	134.	  	Tennessee Valley Neonatology, Inc.	  	Florida
	135.	  	Tiva Healthcare, Inc.	  	Florida
	136.	  	Torrance NSC, LLC	  	Tennessee
	137.	  	Towson NSC, LLC	  	Tennessee
	138.	  	Twin Falls NSC, LLC	  	Tennessee
	139.	  	Valley Anesthesiology Consultants, Inc.	  	Arizona
	140.	  	Valley Clinical Research, Inc.	  	Florida
	141.	  	Weston NSC, LLC	  	Tennessee
	142.	  	Wilton NSC, LLC	  	ConnecticutEX-4.17

 Exhibit 4.17 

SUPPLEMENTAL INDENTURE 
 Supplemental Indenture
(this “Supplemental Indenture”), dated as of December 1, 2016, among AmSurg Corp. (the “Issuer”), AllegiantMD, Inc., a Florida corporation, Arizona Perinatal Care Centers, LLC, an Arizona limited liability company,
Broad Midwest Anesthesia, LLC, a Missouri limited liability company, Doctors Billing Service, Inc., a California corporation, Medi-Bill of North Florida, Inc., a Florida corporation, North Florida Anesthesia Consultants, Inc., a Florida corporation,
Sheridan CADR Solutions, Inc., a Florida corporation, Sheridan Hospitalist Services of Florida, Inc., a Florida corporation, Sheridan Leadership Academy, Inc., a Florida corporation, Sheridan Scientific Intelligence, Inc., a Florida corporation,
Valley Clinical Research, Inc., a Florida corporation, and St. Lucie Anesthesia Associates, LLC, a Florida limited liability company (each, a “Guaranteeing Subsidiary” and collectively the “Guaranteeing
Subsidiaries”), and U.S. Bank National Association, a national banking corporation (or its permitted successor), as trustee under the Indenture referred to below (the “Trustee”). 

W I T N E S S E T H 
 WHEREAS,
the Issuer and the Subsidiary Guarantors party thereto have heretofore executed and delivered to the Trustee an indenture (the “Indenture”), dated as of July 16, 2014, as heretofore amended, providing for the issuance of the
Issuer’s 5.625% Senior Notes due 2022 (the “Notes”); 
 WHEREAS, the Indenture provides that under certain
circumstances a Guaranteeing Subsidiary shall execute and deliver to the Trustee a supplemental indenture and a related Notation of Guarantee pursuant to which the Guaranteeing Subsidiary shall unconditionally guarantee all of the Issuer’s
obligations under the Notes and the Indenture on the terms and conditions set forth herein (the “Subsidiary Guarantee”); and 

WHEREAS, pursuant to Sections 8.01 and 8.06 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 Issuer, the Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 

1. Capitalized Terms. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture.

 2. Agreement to Guarantee. Each Guaranteeing Subsidiary hereby agrees to provide an unconditional Subsidiary Guarantee on the
terms and conditions set forth in the Indenture, including, without limitation, Article X of the Indenture. 
 3. No Recourse Against
Others. Pursuant to Section 11.12 of the Indenture, no director, officer, employee, incorporator or stockholder of the Guaranteeing Subsidiaries shall have any liability for any obligations of such Guaranteeing Subsidiary under the Notes,
the Indenture, the Subsidiary Guarantee or for any claim based on, in respect of, or by reason of, such obligations or their creation. 

 4. NEW YORK LAW TO GOVERN. THE LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED
TO CONSTRUE THIS SUPPLEMENTAL INDENTURE. 
 5. 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. 
 6. Effect of
Headings. The Section headings herein are for convenience only and shall not affect the construction hereof. 
 7.
Trustee. 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 recitals contained herein, all of which recitals are made
solely by the Guaranteeing Subsidiary and the Issuer. 
 [SIGNATURE PAGE FOLLOWS] 

  
 2 

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

					
	NEW AMETHYST CORP.
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Vice President, Secretary and Director
	
	ALLEGIANTMD, INC.
	ARIZONA PERINATAL CARE CENTERS, LLC
	BROAD MIDWEST ANESTHESIA, LLC
	DOCTORS BILLING SERVICE, INC.
	MEDI-BILL OF NORTH FLORIDA, INC.
	NORTH FLORIDA ANESTHESIA CONSULTANTS, INC.
	SHERIDAN CADR SOLUTIONS, INC.
	SHERIDAN HOSPITALIST SERVICES OF FLORIDA, INC.
	SHERIDAN LEADERSHIP ACADEMY, INC.
	SHERIDAN SCIENTIFIC INTELLIGENCE, INC.
	VALLEY CLINICAL RESEARCH, INC.
	ST. LUCIE ANESTHESIA ASSOCIATES, LLC
		
	By:	 	 /s/ Jillian Marcus

	Name:	 	Jillian Marcus
	Title:	 	Vice President and Secretary

 [Signatures continue on following page] 

 
					
	U.S. BANK NATIONAL ASSOCIATION,
	AS TRUSTEE
		
	By:	 	 /s/ Wally Jones

		 	Name:	 	Wally Jones
		 	Title:	 	Vice President

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