Document:

EX-4.1

 Exhibit 4.1 

EIGHTEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 31, 2019, among CHS/COMMUNITY
HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), the parties identified as New Subsidiary Guarantors on the signature pages hereto (each, a “New Subsidiary Guarantor” and, collectively, the “New
Subsidiary Guarantors”) and REGIONS BANK, as successor Trustee under the Indenture (the “Trustee”). 
 W I T N E S
S E T H: 
 WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended,
supplemented, waived or otherwise modified (the “Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 

WHEREAS, each of the undersigned New Subsidiary Guarantors has deemed it advisable and in its best interest to execute and deliver this
Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of
the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantors are authorized to execute and deliver this Supplemental Indenture. 

NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the
Issuer, the New Subsidiary Guarantors and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows: 

SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.

 SECTION 2. Guaranties. Each of the New Subsidiary Guarantors hereby agrees to guarantee the Issuer’s obligations under the
Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is
in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK. 
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 

 SECTION 6. Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall
constitute effective execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other
electronic transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Effect of Headings. The
Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 
 [Signature page
follows] 

  
 2 

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

			
	 CHS/Community Health Systems, Inc.,

a Delaware corporation

		
	By:  	 	     /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief Financial Officer, Chief Accounting Officer and Treasurer

  

			
	 New Subsidiary Guarantors:

CHSPSC, LLC,
 a Delaware limited liability
company
 Clarksdale HMA, LLC,
 a
Mississippi limited liability company

		
	By:  	 	     /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief Financial Officer, Chief Accounting Officer and Treasurer of CHSPSC, LLC
		
		 	Senior Vice President of Clarksdale HMA, LLC
	
	Acting on behalf of each of the New Subsidiary Guarantors set forth above

 [Signature Page to Eighteenth Supplemental Indenture (2019 Notes)] 

 
			
	Regions Bank, as Trustee
		
	By:  	 	     /s/ Kristine Prall

		 	Kristine Prall
		 	Vice President

 [Signature Page to Eighteenth Supplemental Indenture (2019 Notes)]EX-4.2

 Exhibit 4.2 

FIFTEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 31, 2019, among CHS/COMMUNITY
HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), the parties identified as New Subsidiary Guarantors on the signature pages hereto (each, a “New Subsidiary Guarantor” and, collectively, the “New
Subsidiary Guarantors”) and REGIONS BANK, as Trustee under the Indenture (the “Trustee”). 
 W I T N E S S E T H:

 WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended, supplemented,
waived or otherwise modified (the “Indenture”), dated as of July 18, 2012, providing for the issuance of the 7.125% Senior Notes due 2020 (the “Securities”); 

WHEREAS, each of the undersigned New Subsidiary Guarantors has deemed it advisable and in its best interest to execute and deliver this
Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of
the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantors are authorized to execute and deliver this Supplemental Indenture. 

NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the
Issuer, the New Subsidiary Guarantors and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows: 

SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.

 SECTION 2. Guaranties. Each of the New Subsidiary Guarantors hereby agrees to guarantee the Issuer’s obligations under the
Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is
in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK. 
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 

 SECTION 6. Counterparts. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall
constitute effective execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other
electronic transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Effect of Headings. The
Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 
 [Signature page
follows] 

  
 2 

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

			
	CHS/Community Health Systems, Inc.,
	a Delaware corporation
		
	By:  	 	       /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief
		 	Financial Officer, Chief Accounting Officer and Treasurer

  

			
	New Subsidiary Guarantors:
	CHSPSC, LLC,
	        a Delaware limited liability company
	Clarksdale HMA, LLC,
	        a Mississippi limited liability company
		
	By:  	 	       /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief
		 	Financial Officer, Chief Accounting Officer
		 	and Treasurer of CHSPSC, LLC
		
		 	Senior Vice President of Clarksdale HMA, LLC
	
	Acting on behalf of each of the New Subsidiary
	Guarantors set forth above

  
 [Signature Page to
Fifteenth Supplemental Indenture (2020 Notes)] 

 
			
	Regions Bank, as Trustee
		
	By:  	 	       /s/ Kristine Prall

		 	Kristine Prall
		 	Vice President

  
  

 
 [Signature Page to Fifteenth Supplemental Indenture (2020
Notes)]EX-4.3

 Exhibit 4.3 

TWELFTH SUPPLEMENTAL INDENTURE, (this “Supplemental Indenture”) dated as of March 31, 2019, by and among CHS/Community
Health Systems, Inc., a Delaware corporation (“Issuer”), the parties that are signatories hereto as Guarantors (each, a “Guaranteeing Subsidiary” and, collectively, the “Guaranteeing Subsidiaries”),
Credit Suisse AG, as Collateral Agent, and Regions Bank, as Trustee under the Indenture referred to below. 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors, the Trustee and the Collateral Agent have heretofore executed and delivered an indenture dated as
of January 27, 2014 (as amended, supplemented, waived or otherwise modified, the “Indenture”), providing for the issuance on such date of an aggregate principal amount of $1,000,000,000 of 5.125% Senior Secured Notes due 2021
(the “Notes”) of the Issuer; 
 WHEREAS, the Indenture provides that the Guaranteeing Subsidiaries shall execute and
deliver to the Trustee and the Collateral Agent a supplemental indenture pursuant to which the Guaranteeing Subsidiaries shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on the terms and
conditions set forth herein and under the Indenture (the “Note Guarantee”), each on the terms and conditions set forth herein; and 

WHEREAS, pursuant to Section 9.1 of the Indenture, the Issuer, any Guarantor, the Collateral Agent and the Trustee
are authorized to execute and deliver this Supplemental Indenture to amend or supplement the Indenture, without the consent of any Holder; 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged,
the Issuer, the Guaranteeing Subsidiaries, the Collateral Agent and the Trustee mutually covenant and agree for the benefit of the Trustee, the Collateral Agent and the Holders of the Notes as follows: 

ARTICLE I 
 DEFINITIONS 

SECTION 1.1. Defined Terms. As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recitals
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. 
 ARTICLE II 

AGREEMENT TO BE BOUND; GUARANTEE 

SECTION 2.1. Agreement to be Bound. Each of the Guaranteeing Subsidiaries hereby becomes a party to the Indenture as a
“Guarantor” and as such will have all of the rights and be subject to all of the obligations and agreements of a “Guarantor” under the Indenture. 

SECTION 2.2. Guarantee. Each of the Guaranteeing Subsidiaries agrees, on a joint and several basis with all the existing
Guarantors, to fully, unconditionally and irrevocably 

 
Guarantee to each Holder of the Notes, the Trustee and the Collateral Agent the Guaranteed Obligations pursuant to Article X of the Indenture as and to the extent provided for therein.

 ARTICLE III 
 MISCELLANEOUS

 SECTION 3.1. Notices. All notices and other communications to the Guarantors shall be given as provided in the Indenture.

 SECTION 3.2. Merger and Consolidation. Each Guaranteeing Subsidiary shall not sell or otherwise dispose of all or
substantially all of its assets to, or consolidate with or merge with or into, another Person (other than the Issuer or any Restricted Subsidiary that is a Guarantor or becomes a Guarantor concurrently with the transaction) except in accordance with
Section 4.1(e) of the Indenture. 
 SECTION 3.3. Release of Guarantee. The Note Guarantees hereunder may be released in
accordance with Section 10.2 of the Indenture. 
 SECTION 3.4. Parties. Nothing expressed or mentioned herein is intended
or shall be construed to give any Person, firm or corporation, other than the Holders and the Trustee, any legal or equitable right, remedy or claim under or in respect of this Supplemental Indenture or the Indenture or any provision herein or
therein contained. 
 SECTION 3.5. Governing Law. This Supplemental Indenture shall be governed by, and construed in accordance
with, the laws of the State of New York. 
 SECTION 3.6. Severability. In case any provision in this Supplemental Indenture
shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby and such provision shall be ineffective only to the extent of such invalidity,
illegality or unenforceability. 
 SECTION 3.7. Benefits Acknowledged. Each Guaranteeing Subsidiary’s Note Guarantee is
subject to the terms and conditions set forth in the Indenture. Each Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture
and that the guarantee and waivers made by it pursuant to its Note Guarantee are knowingly made in contemplation of such benefits. 

SECTION 3.8. 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. 
 SECTION 3.9. The Trustee and the Collateral
Agent. Neither the Trustee nor the Collateral Agent make any representation or warranty as to the validity or sufficiency of this Supplemental Indenture or with respect to the recitals contained herein, all of which recitals are made solely by
the other parties hereto. 

  
 2 

 SECTION 3.10. Counterparts. The parties hereto 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. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission
shall constitute effective execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or
other electronic transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 3.11. Execution and
Delivery. Each Guaranteeing Subsidiary agrees that its Note Guarantee shall remain in full force and effect notwithstanding any absence on each Note of a notation of any such Note Guarantee. 

SECTION 3.12. Headings. The headings of the Articles and the Sections in this Supplemental Indenture are for convenience of
reference only and shall not be deemed to alter or affect the meaning or interpretation of any provisions hereof. 
 [Signature page
follows] 

  
 3 

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

			
	CHSPSC, LLC,
	        a Delaware limited liability company
	Clarksdale HMA, LLC,
	        a Mississippi limited liability company
		
	By:  	 	       /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief
		 	Financial Officer, Chief Accounting Officer
		 	and Treasurer of CHSPSC, LLC
		
		 	Senior Vice President of Clarksdale HMA, LLC
	
	Acting on behalf of each of the Guaranteeing
	Subsidiaries set forth above

 Acknowledged by: 

CHS/Community Health Systems, Inc. 
  

			
		
	By:  	 	       /s/ Kevin J. Hammons

		 	Kevin J. Hammons
		 	Senior Vice President, Assistant Chief
		 	Financial Officer, Chief Accounting
		 	Officer and Treasurer

  
 [Signature Page to Twelfth
Supplemental Indenture (2021 Notes)] 

 
			
	Regions Bank,
	as Trustee
		
	By: 	 	      /s/ Kristine Prall
		 	  Kristine Prall
		 	  Vice President

  
  

 
 [Signature Page to Twelfth Supplemental Indenture (2021 Notes)]

 
			
	Credit Suisse AG, as Collateral Agent
		
	By:	 	  /s/ Lingzi Huang
		 	  Name:   Lingzi Huang
		 	  Title:   Authorized Signatory
		
	By:	 	  /s/ Marc Zihlmann
		 	  Name:   Marc Zihlmann
		 	  Title:   Authorized Zihlmann

  
  

 
  

[Signature Page to Twelfth Supplemental Indenture (2021 Notes)]

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