Document:

<PAGE>

                                                                   Exhibit 10.24

                           [AMERICAN HEALTHWAYS LOGO]

                      NON-QUALIFIED STOCK OPTION AGREEMENT

      THIS STOCK OPTION AGREEMENT is made and entered into this ___ day of
_________, _____, by and between AMERICAN HEALTHWAYS, INC., a Delaware
corporation (the "Corporation") including its subsidiary corporations, and
<<FIRST_NAME>> <<LAST_NAME>> (the "Director").

      WHEREAS, the Corporation desires to afford the Director an opportunity to
purchase shares of Common Stock, $.001 par value per share ("Common Stock") of
the Corporation, in accordance with the provisions of the American Healthways,
Inc. 1996 Stock Incentive Plan, as amended (the "Plan").

      NOW, THEREFORE, In consideration of the mutual covenants set forth in this
Agreement and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties agree as follows:

      1. GRANT OF OPTION. Corporation hereby grants to Director the option (the
"Option"), exercisable in whole or in part to purchase <<TOTALSHARES>> shares of
the Corporation's Common Stock, for a price of <<AMOUNTPERSHARE_>> per share.

      2. OPTION PLAN. This Option is granted as a non-qualified stock option
under the Plan, and is not intended to qualify as an incentive stock option, as
that term is used in Section 422 of the Internal Revenue Code of 1986, as
amended (the "Code"). This means that, at the time Director exercises all or any
portion of this Option, Director will have taxable income equal to any positive
difference between the market value of the Common Stock at the date of the
exercise and the option exercise price paid for the Common Stock under this
Option as shown in Section 1 of this Agreement.

      This Option is subject to the terms and conditions set forth in the Plan.
In the event any of the provisions in this Agreement conflict with or are
inconsistent with the provisions of the Plan, the provisions of the Plan shall
be controlling.

      3. TIMING OF EXERCISE. Director may exercise this Option with respect to
the percentage of shares set forth below from and after the dates specified
below, provided that Director is still serving as a director of the Corporation
on such date except as set forth in Section 6 hereof:

<PAGE>

<TABLE>
<CAPTION>
PERCENTAGE VESTED               DATE OF VESTING                CUMULATIVE OPTIONS EXERCISABLE
<S>                             <C>                            <C>
     33 1/3%                    <<MoDayYrPlus1>>                   <<QuarterTotalshares>>
     66 2/3%                    <<MoDayYrPlus2>>                     <<HalfTotalShares>>
      100%                      <<MoDayYrPlus3>>                <<ThreeQuartersTotalShares>>
</TABLE>

This Option will expire ten (10) years from the date of grant of this Option.

      4. MANNER OF EXERCISE. This Option shall be exercised by the Director (or
other party entitled to exercise the Option under Section 5 of this Agreement)
by delivering written notice to the Corporation stating the number of shares of
Common Stock to be purchased, the person or persons in whose name the shares are
to be registered and each such person's address and social security number. Such
notice shall not be effective unless accompanied by the full purchase price for
all shares so purchased. The purchase price shall be payable in cash and shall
be calculated as the number of shares to be purchased times the option exercise
price per share as shown in Section 1 of this Agreement. Payment in currency or
by certified check, cashier's check or postal money order shall be considered
payment in cash. The Corporation shall have the right to require the Director to
remit to the Corporation an amount sufficient to satisfy any federal, state and
local withholding tax requirements prior to the delivery of any certificate for
such shares.

      5. NONTRANSFERABILITY OF OPTION. This Option shall not be transferable by
the Director without the prior written consent of the Board of Directors
otherwise than (i) transfers by the Director to a member of the Director's
Immediate Family or a trust for the benefit of Director or a member of such
Director's Immediate Family, or (ii) transfers by will or by the laws of descent
and distribution. The terms of this Option shall be binding on the executors,
administrators, heirs and successors of the Director.

      6. TERMINATION OR EXPIRATION OF DIRECTOR'S POSITION ON THE BOARD OF
DIRECTORS.

            (a) TERMINATION OR RESIGNATION FROM BOARD FOLLOWING TWO TERMS AS A
DIRECTOR. If the Director shall cease to serve as a director of the Corporation
for any reason other than involuntary termination by the Corporation for Cause
and if the Director has served at least two full terms as a director of the
Corporation, the shares subject to the Option granted hereunder not previously
exercisable and vested shall become fully exercisable and vested upon the date
of such termination or cessation and this Option may be exercised for a period
of one year from the date of such termination or cessation or until the
expiration of the stated term of the Option, whichever period is shorter (the
"Exercise Period"); provided, however, that if the Director dies within the
Exercise Period, the Option shall thereafter be exercisable to the extent to
which it was exercisable at the time of death for a period of three years from
the date of such death or until the expiration of the stated term of the Option,
whichever period is shorter.

            (b) TERMINATION BY REASON OF RETIREMENT OR DISABILITY. If the
Director shall cease to be a director of the Corporation by reason of retirement
or Disability (as that term

                                       2

<PAGE>

is defined under the Corporation's long-term disability insurance policy) before
the Director serves two full terms as a director of the Corporation, this Option
may thereafter be exercised by the Director, to the extent it was exercisable at
the time of such cessation, for a period of one year from the date of such
cessation or until the expiration of the stated term of the Option, whichever
period is shorter; provided, however, that if the Director dies within such
one-year period, the Option shall thereafter be exercisable to the extent to
which it was exercisable at the time of death for a period of three years from
the date of such death or until the expiration of the stated term of the Option,
whichever period is shorter.

            (c) TERMINATION BY DEATH. If the Director shall cease to be a
director of the Corporation by reason of death, the shares subject to the Option
granted hereunder not previously exercisable and vested shall become fully
exercisable and vested and may thereafter be exercised, by the legal
representative of the estate or by the legatee of the Director under the will of
the Director, for a period of three years from the date of such death or until
the expiration of the stated term of the Option, whichever period is the
shorter.

            (d) TERMINATION FOR ANY OTHER REASON OTHER THAN CAUSE. If the
Director shall cease to be a director of the Corporation for any reason other
retirement, death or Disability before the Director serves two full terms as a
director of the Corporation, this Option shall thereupon terminate, except that
this Option may be exercised by the Director, to the extent otherwise then
exercisable on the date of such cessation, if the Director's position as a
director was involuntarily terminated by the Corporation without Cause, for a
period of three months from the date of such cessation or the expiration of the
Option's term, whichever period is the shorter.

            (e) TERMINATION FOR CAUSE. If the Corporation terminates the
Director's position as a director for Cause, this Option shall immediately
terminate.

      7. RESTRICTIONS ON PURCHASE AND SALE OF SHARES. The Corporation shall be
obligated to sell or issue shares pursuant to the exercise of this Option only
in the event that the shares are at that time effectively registered or
otherwise exempt from registration under the Securities Act of 1933, as amended
("the 1933 Act"). In the event that the shares are not registered under the 1933
Act, the Director hereby agrees that, as a further condition to the exercise of
this Option, the Director (or his successor under Section 5 of this Agreement),
if the Corporation so requests, will execute an agreement in form satisfactory
to the Corporation in which the Director represents that he or she is purchasing
the shares for investment purposes, and not with a view to resale or
distribution. The Director further agrees that if the shares of Common Stock to
be issued upon the exercise of this Option are not subject to an effective
registration statement filed with the Securities and Exchange Commission
pursuant to the requirements of the 1933 Act, such shares shall bear an
appropriate restrictive legend.

      8. ADJUSTMENT. In the event of any merger, reorganization, consolidation,
recapitalization, extraordinary cash dividend, stock dividend, stock split or
other change in corporate structure affecting the Common Stock, the number of
shares of Common Stock of the Corporation subject to this Option and the price
per share of such shares may be adjusted by the Corporation as may be determined
by the Board of Directors pursuant to the Plan.

                                       3

<PAGE>

      9. CHANGE IN CONTROL. Upon a Change in Control, and if and to the
extent so determined by the Board of Directors upon a Potential Change in
Control, the shares subject to the Option granted hereunder not previously
exercisable and vested shall become fully exercisable and vested.

      10. NO RIGHTS UNTIL EXERCISE. The Director shall have no rights hereunder
as a stockholder with respect to any shares subject to this Option until the
date of the issuance of a stock certificate to him or her for such shares upon
due exercise of this Option.

      11. AMENDMENT. The Board of Directors may amend the terms of this Option,
prospectively or retroactively, but, subject to Section 8 above, no such
amendment shall impair the rights of the Director hereunder without the
Director's consent.

      12. NOTICES. All notices required to be given under this Option shall be
deemed to be received if delivered or mailed as provided for herein, to the
parties at the following addresses, or to such other address as either party may
provide in writing from time to time.

      To the Corporation:

                                                 American Healthways, Inc.
                                                 3841 Green Hills Village Drive
                                                 Nashville, Tennessee 37215

      To the Director:                           _______________________________
      (Director name and address)                _______________________________
                                                 _______________________________

      13. SEVERABILITY. If any provision of this Agreement is, or becomes, or is
deemed to be invalid, illegal, or unenforceable in any jurisdiction or as to any
person or the award of the Option, or would disqualify the Plan or the Option
under any laws deemed applicable by the Committee, such provision shall be
construed or deemed amended to conform to the applicable laws, or if it cannot
be construed or deemed amended without, in the determination of the Committee,
materially altering the intent of the Plan or the Option, such provision shall
be stricken as to such jurisdiction, person or Option, and the remainder of the
Plan and Option shall remain in full force and effect.

      14. GOVERNING LAW. The validity, construction and effect of this Agreement
shall be determined in accordance with the laws of the State of Delaware without
giving effect to conflicts of laws principles.

      15. RESOLUTION OF DISPUTES. Any dispute or disagreement which may arise
under, or as a result of, or in any way related to, the interpretation,
construction or application of this

                                       4

<PAGE>

Agreement shall be determined by the Board of Directors. Any determination made
hereunder shall be final, binding and conclusive on the Director and the
Corporation for all purposes.

      [remainder of page intentionally left blank; signature page follows]

                                       5

<PAGE>

      IN WITNESS WHEREOF, the parties have caused the Stock Option Agreement to
be duly executed as of the day and year first above written.

                                                AMERICAN HEALTHWAYS, INC.:

                                                ________________________________
                                                Name: Ben R. Leedle, Jr.
                                                Title: Chairman & CEO

                                                DIRECTOR:

                                                ________________________________

                                       6<PAGE>
                                                                    EXHIBIT 10.1

                               FOURTH AMENDMENT TO
                                CREDIT AGREEMENT

         THIS FOURTH AMENDMENT to Credit Agreement (this "Amendment") dated as
of November 12, 2004 is by and among Ardent Health Services, Inc., a Delaware
corporation (the "Borrower"), the Guarantors, the Lenders party hereto and
Citicorp North America, Inc., as Administrative Agent (in such capacity, "CNAI"
or the "Administrative Agent") on behalf of itself and the Lenders. All
capitalized terms used herein but not otherwise defined herein shall have the
meanings provided to such terms in the Credit Agreement (as defined below).

                               W I T N E S S E T H

         WHEREAS, a credit facility was established in favor of the Borrower
pursuant to the terms of that certain Credit Agreement dated as of August 19,
2003 among the Borrower, the Guarantors, the Lenders and CNAI (as successor to
Bank One, NA), as Administrative Agent, as amended by that certain First
Amendment to Credit Agreement dated as of December 31, 2003, that certain Second
Amendment to Credit Agreement dated as of July 12, 2004 and that certain Third
Amendment to Credit Agreement dated as of August 12, 2004 (as further amended,
modified and supplemented from time to time, the "Credit Agreement");

         WHEREAS, the Borrower has requested the Required Lenders to amend the
Credit Agreement as set forth herein; and

         WHEREAS, the Required Lenders have agreed to amend the Credit Agreement
on the terms and conditions set forth herein.

         NOW, THEREFORE, IN CONSIDERATION of the premises and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereto agree as follows:

         1. Amendments. The Credit Agreement is amended in the following
respects:

                  (a) The following definition is hereby added to Section 1.01
         in the appropriate alphabetical order and shall read as follows:

                           "Fourth Amendment Effective Date" means November 12,
                  2004.

                  (b) The last sentence in the definition of "Consolidated
         EBITDA" in Section 1.01 is hereby amended to read as follows:

                           Notwithstanding anything to the contrary in this
                  Agreement, for purposes of calculating the Consolidated
                  Interest Coverage Ratio, the Consolidated Leverage Ratio and
                  the Consolidated Senior Leverage Ratio as of the end of the
                  fiscal quarters ending September 30, 2004, December 31, 2004
                  and March 31, 2005, Consolidated EBITDA for the twelve month
                  period ending as of the applicable fiscal quarter shall be an
                  amount for such period as agreed to by the Parent and the
                  Required Lenders.

                  (c) A new proviso is hereby added immediately prior to the
         period (".") now appearing at the end of Section 7.01(b)(i) to read as
         follows:

<PAGE>

                  ; provided that, notwithstanding the foregoing, with respect
                  to the fiscal quarter ended September 30, 2004 only, the Loan
                  Parties shall have until January 14, 2005 to deliver to the
                  Administrative Agent and the Lenders all the financial
                  statements required by Section 7.01(b)(i) as of the end of the
                  fiscal quarter ended September 30, 2004

                  (d) A new proviso is hereby added immediately prior to the
         period (".") now appearing at the end of Section 7.01(b)(ii) to read as
         follows:

                  ; provided that, notwithstanding the foregoing, with respect
                  to the fiscal quarter ended September 30, 2004 only, the Loan
                  Parties shall have until January 14, 2005 to deliver to the
                  Administrative Agent and the Lenders all the financial
                  statements required by Section 7.01(b)(ii) as of the end of
                  the fiscal quarter ended September 30, 2004

                  (e) A new subsection (d) is hereby added to the end of Section
         7.01 to read as follows:

                           (d) Restated Financial Statements.

                                    In the event that the Loan Parties shall be
                           required, or shall elect at the advice of their
                           independent auditor, to restate any financial
                           statements of the Parent and its Subsidiaries
                           delivered prior to the Fourth Amendment Effective
                           Date pursuant to this Agreement upon the completion
                           of the Loan Parties' internal review of accounting
                           practices at Lovelace conducted and concluded prior
                           to January 14, 2005, no breach of this Agreement
                           prior to the Fourth Amendment Effective Date due to
                           the failure to timely deliver the financial
                           statements that are subject to such restatement under
                           this Section 7.01(d) or due to the inaccuracy of any
                           representation delivered or deemed delivered pursuant
                           to Section 6.05(a), (b), (d) or (e) or Section 6.15
                           due to the inaccuracy of previously delivered
                           financial statements shall be deemed to have occurred
                           or resulted therefrom unless and until the Loan
                           Parties shall fail to deliver any such restated
                           financial statements in accordance with the terms
                           hereof (together with restated and duly completed
                           Compliance Certificate(s) in respect thereof in
                           accordance with the terms hereof reflecting
                           compliance for all applicable periods with all
                           financial covenants set forth in Section 8.11) to the
                           Administrative Agent and the Lenders on or prior to
                           January 14, 2005.

                  (f) A new proviso is hereby added immediately prior to the
         period (".") now appearing at the end of the first sentence of Section
         7.08 to read as follows:

                  ; provided that, notwithstanding the foregoing, the Loan
                  Parties' failure to file within the time periods specified in
                  the SEC's rules and regulations the financial statements of
                  the Parent and its Subsidiaries for the fiscal quarter ended
                  September 30, 2004 shall not constitute a breach of this
                  Section 7.08 unless and until the Loan Parties shall fail to
                  file such financial statements with the SEC on or before
                  January 14, 2005.

         2. Acknowledgement. The parties hereto acknowledge and agree that no
new Loans will be made, nor will new Letters of Credit be issued, under and
pursuant to the terms of the Credit Agreement on or before January 14, 2005.

         3. Conditions Precedent. This Amendment shall be effective as of the
date hereof upon receipt by the Administrative Agent of this Amendment executed
by the Borrower, the Guarantors, the Required Lenders and the Administrative
Agent.

<PAGE>

         4. Miscellaneous.

                  (a) The Credit Agreement, as amended hereby, and the
         obligations of the Loan Parties thereunder and under the other Loan
         Documents shall remain in full force and effect according to their
         terms.

                  (b) Each Guarantor (i) acknowledges and consents to all of the
         terms and conditions of this Amendment, (ii) affirms all of its
         obligations under the Loan Documents, (iii) agrees that this Amendment
         and all documents executed in connection herewith do not operate to
         reduce or discharge its obligations under the Credit Agreement or the
         other Loan Documents and (iv) hereby confirms and agrees that its
         Guaranty shall continue and remain in full force and effect after
         giving effect to this Amendment and that, notwithstanding any contrary
         terms in such Guaranty, such Guaranty now applies to the Credit
         Agreement as amended by this Amendment.

                  (c) The Borrower and the Guarantors hereby represent and
         warrant as follows:

                           (i) Each Loan Party has taken all necessary action to
                  authorize the execution, delivery and performance of this
                  Amendment.

                           (ii) This Amendment has been duly executed and
                  delivered by the Loan Parties and constitutes each of the Loan
                  Parties' legal, valid and binding obligations, enforceable in
                  accordance with its terms, except as such enforceability may
                  be subject to (A) bankruptcy, insolvency, reorganization,
                  fraudulent conveyance or transfer, moratorium or similar laws
                  affecting creditors' rights generally and (B) general
                  principles of equity (regardless of whether such
                  enforceability is considered in a proceeding at law or in
                  equity).

                           (iii) No consent, approval, authorization or order
                  of, or filing, registration or qualification with, any court
                  or governmental authority or third party is required in
                  connection with the execution, delivery or performance by any
                  Loan Party of this Amendment, other than those that have
                  already been obtained and are in full force and effect as of
                  the date hereof.

                  (d) The Loan Parties represent and warrant to the Lenders that
         no event has occurred and is continuing which constitutes a Default or
         an Event of Default.

                  (e) The Borrower agrees to pay all reasonable costs and
         expenses of the Administrative Agent in connection with the
         preparation, execution and delivery of this Amendment, including
         without limitation the reasonable fees and expenses of Moore & Van
         Allen, PLLC.

                  (f) This Amendment may be executed in any number of
         counterparts, each of which when so executed and delivered shall be an
         original, but all of which shall constitute one and the same
         instrument. Delivery of an executed counterpart of this Amendment by
         telecopy shall be effective as an original and shall constitute a
         representation that an executed original shall be delivered.

                  (g) THIS AMENDMENT AND THE RIGHTS AND OBLIGATIONS OF THE
         PARTIES HEREUNDER SHALL BE GOVERNED BY AND CONSTRUED AND INTERPRETED IN
         ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.

<PAGE>

                            [Signature Pages Follow]

<PAGE>

         IN WITNESS WHEREOF, each of the parties hereto has caused a counterpart
of this Amendment to be duly executed and delivered as of the date and year
first above written.

BORROWER:                  ARDENT HEALTH SERVICES, INC.,
                           a Delaware corporation

                           By:  /s/ R. Dirk Allison
                              -----------------------------------------
                           Name:  R. Dirk Allison
                           Title: Executive Vice President

GUARANTORS:                ARDENT HEALTH SERVICES LLC,
                           a Delaware limited liability company

                           By:  /s/  R. Dirk Allison
                              -----------------------------------------
                           Name: R. Dirk Allison
                           Title: Executive Vice President and Chief
                                  Financial Officer

                           AHS ALBUQUERQUE HOLDINGS, LLC,
                           a New Mexico limited liability company
                           AHS CUMBERLAND HOSPITAL, LLC,
                           a Virginia limited liability company
                           AHS KENTUCKY HOLDINGS, INC.,
                           a Delaware corporation
                           AHS KENTUCKY HOSPITALS, INC.,
                           a Delaware corporation
                           AHS LOUISIANA HOLDINGS, INC.,
                           a Delaware corporation
                           AHS LOUISIANA HOSPITALS, INC.,
                           a Delaware corporation
                           AHS MANAGEMENT COMPANY, INC.,
                           a Tennessee corporation
                           AHS NEW MEXICO HOLDINGS, INC.,
                           a New Mexico corporation
                           AHS SAMARITAN HOSPITAL, LLC,
                           a Kentucky limited liability company
                           AHS S.E.D. MEDICAL LABORATORIES, INC.,
                           a New Mexico corporation
                           AHS SUMMIT HOSPITAL, LLC,
                           a Delaware limited liability company
                           ARDENT MEDICAL SERVICES, INC.,
                           a Delaware corporation
                           BEHAVIORAL HEALTHCARE CORPORATION,
                           a Delaware corporation

                           By:  /s/  R. Dirk Allison
                              -----------------------------------------
                           Name: R. Dirk Allison
                           Title: Senior Vice President of each of the
                                  foregoing Guarantors

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                           BHC MANAGEMENT SERVICES OF NEW MEXICO, LLC,
                           a Delaware limited liability company
                           BHC MANAGEMENT SERVICES OF STREAMWOOD, LLC,
                           a Delaware limited liability company
                           BHC MEADOWS PARTNER, INC.,
                           a Delaware corporation
                           BHC MONTEVISTA HOSPITAL, INC.,
                           a Nevada corporation
                           BHC OF INDIANA, GENERAL PARTNERSHIP,
                           a Tennessee general partnership
                           BHC ALHAMBRA HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC BELMONT PINES HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC CEDAR VISTA HOSPITAL, INC.,
                           a California corporation
                           BHC COLUMBUS HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC FAIRFAX HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC FOX RUN HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC FREMONT HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC GULF COAST MANAGEMENT GROUP, INC.,
                           a Tennessee corporation
                           BHC HEALTH SERVICES OF NEVADA, INC.,
                           a Nevada corporation
                           BHC HERITAGE OAKS HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC HOSPITAL HOLDINGS, INC.,
                           a Delaware corporation
                           BHC INTERMOUNTAIN HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC LEBANON HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC MANAGEMENT HOLDINGS, INC.,
                           a Delaware corporation
                           BHC MANAGEMENT SERVICES, LLC,
                           a Delaware limited liability company
                           BHC MANAGEMENT SERVICES OF INDIANA, LLC,
                           a Delaware limited liability company
                           BHC MANAGEMENT SERVICES OF KENTUCKY, LLC,
                           a Delaware limited liability company

                           By:    /s/ R. Dirk Allison
                              -----------------------------------------
                           Name:  R. Dirk Allison
                           Title: Senior Vice President of each of the
                                  foregoing Guarantors

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                           BHC OF NORTHERN INDIANA, INC.,
                           a Tennessee corporation
                           BHC PHYSICIAN SERVICES OF KENTUCKY, LLC,
                           a Delaware limited liability company
                           BHC PINNACLE POINTE HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC PROPERTIES, INC.,
                           a Tennessee corporation
                           BHC SIERRA VISTA HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC SPIRIT OF ST. LOUIS HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC STREAMWOOD HOSPITAL, INC.,
                           a Tennessee corporation
                           BHC WINDSOR HOSPITAL, INC.,
                           an Ohio corporation
                           COLUMBUS HOSPITAL, LLC,
                           a Delaware limited liability company
                           INDIANA PSYCHIATRIC INSTITUTES, INC.,
                           a Delaware corporation
                           LEBANON HOSPITAL, LLC,
                           a Delaware limited liability company
                           MESILLA VALLEY GENERAL PARTNERSHIP,
                           a New Mexico general partnership
                           MESILLA VALLEY MENTAL HEALTH ASSOCIATES, INC.,
                           a New Mexico corporation
                           NORTHERN INDIANA HOSPITAL, LLC,
                           a Delaware limited liability company
                           VALLE VISTA, LLC,
                           a Delaware limited liability company
                           WILLOW SPRINGS, LLC,
                           a Delaware limited liability company
                           AHS RESEARCH AND REVIEW, LLC,
                           a New Mexico limited liability company
                           BHC NORTHWEST PSYCHIATRIC HOSPITAL, LLC,
                           a Delaware limited liability company

                           By:    /s/ R. Dirk Allison
                              -----------------------------------------
                           Name:  R. Dirk Allison
                           Title: Senior Vice President of each of the
                                  foregoing Guarantors

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                           AHS ACADEMIC HEALTH CENTER, LLC., a Delaware
                           limited liability company
                           AHS BRISTOW HOSPITAL, LLC, a Delaware limited
                           liability company
                           AHS CLEVELAND HOSPITAL, LLC, a Delaware limited
                           liability company
                           AHS CUSHING HOSPITAL, LLC, a Delaware limited
                           liability company
                           AHS EASTERN OKLAHOMA MEDICAL CENTER, LLC, a
                           Delaware limited liability company
                           AHS HENRYETTA HOSPITAL, LLC, a Delaware limited
                           liability company
                           AHS HILLCREST MEDICAL CENTER, LLC, a Delaware
                           limited liability company
                           AHS HILLCREST SPECIALTY HOSPITAL, LLC, a Delaware
                           limited liability company
                           AHS MANAGEMENT SERVICES OF OKLAHOMA, LLC, a
                           Delaware limited liability company
                           AHS OKLAHOMA HEALTH SYSTEM, LLP, a Delaware
                           limited liability partnership
                           AHS OKLAHOMA HOLDINGS, INC., a Delaware corporation
                           AHS OKLAHOMA HOSPITALS, INC., a Delaware corporation
                           AHS OKLAHOMA PHYSICIAN GROUP, LLC, a
                           Delaware limited liability company
                           AHS PAWNEE HOSPITAL, LLC, a Delaware limited
                           liability company
                           AHS RIVERSIDE PHO, LLC, a Delaware limited liability
                           company
                           AHS TULSA HOLDINGS, LLC, a Delaware limited liability
                           company
                           AHS TULSA REGIONAL MEDICAL CENTER, LLC, a
                           Delaware limited liability company
                           AHS WAGONER HOSPITAL, LLC, a Delaware limited
                           liability company
                           BHC MANAGEMENT SERVICES OF LOUISIANA, LLC, a
                           Delaware limited liability company
                           BHC MANAGEMENT SERVICES OF TULSA, LLC, a
                           Delaware limited liability company

                           By:  /s/ R. Dirk Allison
                              -----------------------------------------
                           Name: R. Dirk Allison
                           Title: Senior Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                           BLOOMINGTON MEADOWS, G.P., a
                           Delaware general partnership

                           By:  BHC of Indiana, General Partnership,
                                its partner

                                By:  BHC Valle Vista Hospital, Inc., as
                                     a partner

                                     By: /s/ R. Dirk Allison
                                        ---------------------------------------
                                     Name: R. Dirk Allison
                                          -------------------------------------
                                     Title: Senior Vice President
                                           ------------------------------------

                                By:  Indiana Psychiatric Institutes, Inc.,
                                     its partner

                                     By: /s/ R. Dirk Allison
                                        ---------------------------------------
                                     Name: R. Dirk Allison
                                          -------------------------------------
                                     Title: Senior Vice President
                                           ------------------------------------

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

ADMINISTRATIVE
AGENT:
                                   CITICORP NORTH AMERICA, INC.,
                                   as Administrative Agent and Swing Line Lender

                                   By: /s/ Allen Fisher
                                      -----------------------------------------
                                   Name: Allen Fisher
                                   Title: Vice President

L/C ISSUERS:                       BANK ONE, NA,
                                   as an L/C Issuer

                                   By: /s/ Timothy K. Boyle FVP
                                      -----------------------------------------
                                   Name: Timothy K. Boyle
                                   Title: First Vice President

                                   CITIBANK N.A.,
                                   as an L/C Issuer

                                   By: /s/ Allen Fisher
                                      -----------------------------------------
                                   Name: Allen Fisher
                                   Title: Vice President

                                   BANK OF OKLAHOMA, N.A.,
                                   as an L/C Issuer

                                   By: /s/ Brad A. Vincent
                                      -----------------------------------------
                                   Name: Brad A. Vincent
                                   Title: SVP

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

LENDERS:                            CITICORP NORTH AMERICA, INC.

                                    By: /s/ Allen Fisher
                                       -----------------------------------------
                                    Name: Allen Fisher
                                    Title: Vice President

                                    BANK ONE, NA

                                    By: /s/ Timothy K. Boyle FVP
                                       -----------------------------------------
                                    Name: Timothy K. Boyle
                                    Title: First Vice President

                                    BANK OF AMERICA, N.A.

                                    By: /s/ Gabriela Millhorn
                                       -----------------------------------------
                                    Name: Gabriela Millhorn
                                    Title: Principal

                                    BANK OF OKLAHOMA, N.A.

                                    By: /s/ Brad A. Vincent
                                       -----------------------------------------
                                    Name: Brad A. Vincent
                                    Title: SVP

                                    FIFTH THIRD BANK

                                    By: /s/ Sandy Hamrick
                                       -----------------------------------------
                                    Name: Sandy Hamrick
                                    Title: Vice President

                                    GENERAL ELECTRIC CAPITAL CORPORATION

                                    By: /s/ Jeffrey P. Hoffman
                                       -----------------------------------------
                                    Name: Jeffrey P. Hoffman
                                    Title: Its Duly Authorized Signatory

                                    OLD NATIONAL BANK

                                    By: /s/ Darrin McCauley
                                       -----------------------------------------
                                    Name: Darrin McCauley
                                    Title: Senior Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                   WELLS FARGO BANK N.A.

                                   By: /s/ Michael Rogholt
                                      -----------------------------------------
                                   Name: Michael Rogholt
                                   Title: Vice President

                                   UBS AG, CAYMAN ISLANDS BRANCH

                                   By: /s/ Wilfred V. Saint
                                      -----------------------------------------
                                   Name: Wilfred V. Saint
                                   Title: Director
                                          Banking Products Services, US

                                   By: /s/ Joselin Fernandes
                                      -----------------------------------------
                                   Name: Joselin Fernandes
                                   Title: Associate Director
                                          Banking Products Services, US

                                   UBS AG, Stamford Branch

                                   By: /s/ Wilfred V. Saint
                                      -----------------------------------------
                                   Name:  Wilfred V. Saint
                                   Title: Director
                                          Banking Products
                                          Services, US

                                   By: /s/ Joselin Fernandes
                                      -----------------------------------------
                                   Name:  Joselin Fernandes
                                   Title: Associate Director
                                          Banking Products
                                          Services, US

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                      FORTRESS PORTFOLIO TRUST, as Lender
                                      By: Four Corners Capital Management LLC
                                          As Collateral Manager

                                      By: /s/  Adam Brown
                                          ---------------------------------
                                      Name:    ADAM BROWN
                                      Title:   Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                      MACQUARIE/FIRST TRUST GLOBAL
                                      INFRASTRUCTURE/UTILITIES DIVIDEND
                                      & INCOME FUND, as Lender

                                      By: Four Corners Capital Management LLC
                                          As Collateral Manager

                                      By: /s/  Adam Brown
                                          ---------------------------------
                                      Name:    ADAM BROWN
                                      Title:   Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                    FIRST TRUST/FOUR CORNERS SENIOR
                                    FLOATING RATE INCOME FUND II, as Lender
                                    By: Four Corners Capital Management LLC
                                        As Collateral Manager

                                    By:    /s/ Adam Brown
                                        -----------------------------------
                                    Name:  ADAM BROWN
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>
                                   LCM I LIMITED PARTNERSHIP

                                   By:   Lyon Capital Management LLC,
                                         As Collateral Manager

                                   By: /s/ Alexander B. Kenna
                                      -----------------------------------------
                                   Name: Alexander B. Kenna
                                   Title: Portfolio Manager

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>
                                   LCM II LIMITED PARTNERSHIP

                                   By:   Lyon Capital Management LLC,
                                         As Attorney-In-Fact

                                   By: /s/ Alexander B. Kenna
                                      -----------------------------------------
                                   Name: Alexander B. Kenna
                                   Title: Portfolio Manager

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    STANFIELD ARBITRAGE CDO, LTD.
                                    By: Stanfield Capital Partners LLC
                                        as its Collateral Manager

                                    By:    /s/ Christopher E. Jansen
                                        -----------------------------------
                                    Name:  Christopher E. Jansen
                                    Title: Managing Partner

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    STANFIELD MODENA CLO, LTD.
                                    By: Stanfield Capital Partners LLC
                                        as its Asset Manager

                                    By:    /s/ Christopher E. Jansen
                                        -----------------------------------
                                    Name:  Christopher E. Jansen
                                    Title: Managing Partner

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    EAGLE LOAN TRUST
                                    By: Stanfield Capital Partners LLC
                                        as its Collateral Manager

                                    By:    /s/ Christopher E. Jansen
                                        -----------------------------------
                                    Name:  Christopher E. Jansen
                                    Title: Managing Partner

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    STANFIELD/RMF TRANSATLANTIC CDO LTD.
                                    By: Stanfield Capital Partners LLC
                                        as its Collateral Manager

                                    By:    /s/ Christopher E. Jansen
                                        -----------------------------------
                                    Name:  Christopher E. Jansen
                                    Title: Managing Partner

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                 Centurion CDO II, Ltd.
                                 By: American Express Asset Management
                                 Group, Inc. as Collateral Manager

                                 By: /s/ Vincent P. Pham
                                     ------------------------
                                 Name:  Vincent P. Pham
                                 Title: Director - Operations

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                 Centurion CDO VI, Ltd.
                                 By: American Express Asset Management
                                 Group as Collateral Manager

                                 By: /s/ Vincent P. Pham
                                     ------------------------
                                 Name:  Vincent P. Pham
                                 Title: Director - Operations

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                 Centurion CDO VII, Ltd.
                                 By: American Express Asset Management
                                 Group, Inc. as Collateral Manager

                                 By: /s/ Vincent P. Pham
                                     ------------------------
                                 Name:  Vincent P. Pham
                                 Title: Director - Operations

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                          Western Asset
                                          Floating Rate High Income Fund

                                          By: /s/ [Illegible]
                                              -------------------------
                                          Name:
                                          Title:

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                       PPM MONARCH BAY FUNDING LLC

                                       By: /s/ Diana M. Himes
                                           ---------------------------
                                       Name:  Diana M. Himes
                                       Title: Assistant Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                       RIVIERA FUNDING LLC

                                       By: /s/ Diana M. Himes
                                           ---------------------------
                                       Name:  Diana M. Himes
                                       Title: Assistant Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                       SEMINOLE FUNDING LLC

                                       By: /s/ Diana M. Himes
                                           ---------------------------
                                       Name:  Diana M. Himes
                                       Title: Assistant Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                   ACCESS INSTITUTIONAL LOAN FUND
                                   By:   Deerfield Capital Management LLC
                                         as its Portfolio Manager

                                   By: /s/ Dale Burrow
                                      -----------------------------------------
                                   Name: Dale Burrow
                                   Title: Senior Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                   BRYN MAWR CLO, Ltd.
                                   By:   Deerfield Capital Management LLC
                                         as its Collateral Manager

                                   By: /s/ Dale Burrow
                                      -----------------------------------------
                                   Name: Dale Burrow
                                   Title: Senior Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>
                                   FOREST CREEK CLO, Ltd.
                                   By:   Deerfield Capital Management LLC
                                         as its Collateral Manager

                                   By: /s/ Dale Burrow
                                      -----------------------------------------
                                   Name: Dale Burrow
                                   Title: Senior Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>
                                   LONG GROVE CLO, LIMITED
                                   By:   Deerfield Capital Management LLC
                                         as its Collateral Manager

                                   By: /s/ Dale Burrow
                                      -----------------------------------------
                                   Name: Dale Burrow
                                   Title: Senior Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>
                                   ROSEMONT CLO, Ltd.
                                   By:   Deerfield Capital Management LLC
                                         as its Collateral Manager

                                   By: /s/ Dale Burrow
                                      -----------------------------------------
                                   Name: Dale Burrow
                                   Title: Senior Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                  MARKET SQUARE CLO, Ltd.
                  By: Deerfield Capital Management LLC as its Collateral Manager

                  By: /s/ Dale Burrow
                     -----------------------------------
                  Name: Dale Burrow
                  Title: Senior Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    BIRCHWOOD FUNDING LLC

                                    By:    /s/ Diana M. Himes
                                        -----------------------------------
                                    Name:  Diana M. Himes
                                    Title: Assistant Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    MUIRFIELD TRADING LLC

                                    By:    /s/ Diana M. Himes
                                        -----------------------------------
                                    Name:  Diana M. Himes
                                    Title: Assistant Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    FOOTHILL INCOME TRUST, L.P.
                                    By FIT GP, LLC, its General Partner

                                    By:    /s/ M.E. Stevens
                                        -----------------------------------
                                    Name:  M.E. Stevens
                                    Title: Managing Member

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                          Franklin Floating Rate Trust

                                          By: /s/ Richard Hsu
                                             --------------------------------
                                          Name:  Richard Hsu
                                          Title: Vice President

                                                   ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

<PAGE>

                                    FRANKLIN FLOATING RATE MASTER SERIES

                                    By:    /s/ Richard Hsu
                                        -----------------------------------
                                    Name:  Richard Hsu
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    FRANKLIN FLOATING RATE DAILY ACCESS FUND

                                    By:    /s/ Richard Hsu
                                        -----------------------------------
                                    Name:  Richard Hsu
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    FRANKLIN CLO I, LIMITED

                                    By:    /s/ David Ardini
                                        -----------------------------------
                                    Name:  David Ardini
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    FRANKLIN CLO III, LIMITED

                                    By:    /s/ David Ardini
                                        -----------------------------------
                                    Name:  David Ardini
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                                    FRANKLIN CLO IV, LIMITED

                                    By:    /s/ David Ardini
                                        -----------------------------------
                                    Name:  David Ardini
                                    Title: Vice President

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT
<PAGE>

                              Venture IV CDO, Limited

                              By its investment advisor MJX Asset Management LLC

                              /s/ Kenneth Ostmann
                              -----------------------------------
                              Name: Kenneth Ostmann
                              Title: Director

                                                    ARDENT HEALTH SERVICES, INC.
                                            FOURTH AMENDMENT TO CREDIT AGREEMENT

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