Document:

EX-4.5

 Exhibit 4.5 

EIGHTH SUPPLEMENTAL INDENTURE, (this “Supplemental Indenture”) dated as of March 31, 2016, by and among CHS/Community
Health Systems, Inc., a Delaware corporation (“Issuer”), the party that is a signatory hereto as a Guarantor (the “Guaranteeing Subsidiary”) 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 and the Trustee 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 $3,000,000,000 of 6.875% Senior Notes due 2022 (the
“Notes”) of the Issuer; 
 WHEREAS, the Indenture provides that the Guaranteeing Subsidiary shall execute and deliver to
the Trustee a supplemental indenture 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 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 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 Subsidiary and the Trustee mutually covenant and agree for the benefit of the Trustee 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. The Guaranteeing Subsidiary 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. 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 and the Trustee the Guaranteed Obligations pursuant to Article X of the Indenture as and to the extent provided for therein. 

  
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 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. The 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. The Guaranteeing Subsidiary’s Note Guarantee is subject to the terms and conditions set
forth in the Indenture. The 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. The Trustee makes no 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. 
 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. 

  
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 SECTION 3.11. Execution and Delivery. The 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]

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

					
	 Laredo Texas Hospital Company, L.P.,

	a Texas limited partnership
		
	By:	 	Webb Hospital Corporation, its general partner
		
		 	By: /s/ James W. Doucette            
		 	      James W. Doucette
		 	      Senior Vice President and Treasurer

  
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	 Acknowledged by:

	
	CHS/Community Health Systems, Inc.
		
	 By: 
	 	/s/ James W. Doucette            
		 	 James W. Doucette

		 	 Senior Vice President and Treasurer

  
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	Regions Bank,
	 as Trustee

		
	 By: 
	 	/s/ Wallace Duke                
		 	 Wallace Duke

		 	 Vice President

  
 6EX-10.1

 Exhibit 10.1 

PERFORMANCE BASED RESTRICTED STOCK AWARD AGREEMENT 

(Most Highly Compensated Executive Officers) 

Community Health Systems, Inc. 
 2009 Stock
Option and Award Plan 
 THIS AGREEMENT between you and Community Health Systems, Inc., a Delaware corporation (the
“Company”) governs an Award of the Company’s Restricted Stock in the amount and on the date specified in your Award notification (the “Date of Grant”). 

WHEREAS, the Company has adopted the Community Health Systems, Inc. 2009 Stock Option and Award Plan (the “Plan”) in
order to provide additional incentive to certain employees and directors of the Company and its Subsidiaries; 
 WHEREAS, the
Compensation Committee of the Company’s Board of Directors (the “Committee”) has determined to grant to you this Award of Restricted Stock as provided herein to encourage your efforts toward the continuing success of the Company; 

WHEREAS, the Committee has determined to condition the Award on the attainment of certain performance-based criteria to better align
your economic interests with those of the other stockholders of the Company and to ensure that the compensation attributable to this Award constitutes “qualified performance-based compensation” pursuant to Code §162(m) and the
regulations promulgated thereunder; and 
 WHEREAS, the Committee has established the Performance Objectives (as defined in
Section 3.1 below) (a) utilizing objectively determinable criteria, (b) on a date which is prior to the ninetieth (90th) day of the Company’s fiscal year, and (c) at
a time when the attainment of the Performance Objectives is substantially uncertain. 
 NOW, THEREFORE, the parties hereto agree as
follows: 
  

	 1.
	 Grant of Restricted Stock. 

1.1         The Company hereby grants to you this Award of Shares of Performance Based
Restricted Stock in the number set out in an electronic notification by the Company’s stock option plan administrator, as may be appointed from time to time (the “Plan Administrator”). The Shares of Performance Based Restricted Stock
granted pursuant to this Award shall be issued in the form of a book entry of Shares in your name as soon as reasonably practicable after the Date of Grant and shall be subject to your (or your estate’s, if applicable) acknowledgement and
acceptance of this Agreement by electronic means to the Plan Administrator as provided in Section 9 hereof, or as you have been otherwise instructed. 

1.2         This Agreement shall be construed in accordance and consistent with, and subject to,
the provisions of the Plan (the provisions of which are hereby incorporated by reference) and, except as otherwise expressly set forth herein, the capitalized terms used in this Agreement shall have the same definitions as set forth in the Plan.

  

	 2.
	 Restrictions on Transfer. 

The Shares of Performance Based Restricted Stock issued under this Agreement may not be sold, transferred or otherwise disposed of and
may not be pledged or otherwise hypothecated until all restrictions on such Performance Based Restricted Stock shall have lapsed in the manner provided in Section 3, 4 or 5 hereof. 

  
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	 3.
	 Performance Objectives; Lapse of Restrictions. 

3.1         The Award is subject to the Company attaining at least one of the following
“Performance Objectives” (herein so called): (i) the Company’s “Adjusted EBITDA for the fiscal year” in which granted, as reported by the Company in its earnings release for such fiscal year, shall be not less than the
amount which is ninety percent (90%) of the low end of the range of projected “Adjusted EBITDA for the fiscal year” in which granted as stated in the Company’s Current Report on Form 8-K filed with the SEC for the current fiscal
year; and/or (ii) the Company’s “net operating revenues for the fiscal year” in which granted, as reported by the Company in its earnings release for such fiscal year, shall be not less than the amount which is ninety percent
(90%) of the low end of the range of projected “net operating revenues for the fiscal year” in which granted as stated in the Company’s Current Report on Form 8-K filed with the SEC for the current fiscal year. The Performance
Objectives shall be adjusted upward or downward in the event the Company enters into one or more material acquisition or divestiture transactions and as a result thereof or in connection therewith files one or more Current Reports on Form 8-K
issuing revised guidance to investors projecting a higher or lower “Adjusted EBITDA for the fiscal year” in which granted and/or a higher or lower “net operating revenues for the fiscal year” in which granted (but only to the
extent such change in guidance is attributable to the material acquisition and/or divestiture transactions). The adjusted Performance Objectives shall be ninety percent (90%) of the low end of the range of the revised projected “Adjusted
EBITDA for the fiscal year” in which granted and/or ninety percent (90%) of the low end of the range of the revised projected “net operating revenues for the fiscal year” in which granted. For purposes of this Agreement,
“material acquisition” or “material divestiture” transaction shall mean any single transaction or series of related transactions in which the consideration exceeds fifteen percent (15%) of the Company’s assets on a
consolidated basis and shall also specifically include the contemplated transaction in which the Company distributes the stock of Quorum Health Corporation to its stockholders, if such distribution occurs. 

3.2         Except as provided in Sections 4, 5 and 6 hereof, if neither of the Performance
Objectives is attained, the Award shall lapse in its entirety. 
 3.3         Except as
provided in Sections 4, 5 and 6 hereof, if at least one of the Performance Objectives is attained, one-third (1/3) of the number of Shares of Performance Based Restricted Stock issued hereunder (rounded to the nearest whole Share, if necessary)
shall vest, and the restrictions with respect to such Performance Based Restricted Stock shall lapse, on each of the first three (3) anniversaries of the Date of Grant. 
  

	 4.
	 Effect of Certain Terminations of Employment. 

If your employment terminates as a result of your death or Disability, in each case if such termination occurs on or after the Date of
Grant, all Shares of Performance Based Restricted Stock which have not become vested in accordance with Section 3 or 5 hereof shall vest, and the restrictions thereon shall lapse as of the date of such termination. If your employment is
terminated by your employer for any reason other than for Cause, then your Award shall continue until such time as it is determined that at least one of the Performance Objectives set forth in Section 3.1 above has been attained, and if
attained, then the restrictions as to the entire Award shall lapse on the first anniversary of the Date of Grant (or if the termination occurs after at least one of the Performance Objectives has been attained, the restrictions as to the entire
Award shall immediately lapse upon such termination). If, however, neither of the Performance Objectives is attained, the Award shall lapse in its entirety. 

  
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	 5.
	 Effect of Change in Control. 

In the event of a Change in Control of the Company at any time on or after the Date of Grant, the terms of the Plan shall control the
vesting of any Shares of Performance Based Restricted Stock which have not become vested in accordance with Section 3 or 4 hereof. 
  

	 6.
	 Forfeiture of Performance Based Restricted Stock. 

Upon the termination of your employment by you, the Company or its Subsidiaries for any reason other than those set forth in
Section 4 hereof prior to such vesting, in addition to the circumstance described in Section 9(a) hereof, any and all Shares of Performance Based Restricted Stock which have not become vested in accordance with Section 3, 4 or 5
hereof shall be forfeited and shall revert to the Company. 
  

	 7.
	 Delivery of Restricted Stock. 

7.1 Except as otherwise provided in Section 7.2 hereof, evidence of the book entry of Shares or, if requested by you prior to such
lapse of restrictions, a stock certificate with respect to the Shares of Performance Based Restricted Stock for which the restrictions have lapsed pursuant to Section 3, 4 or 5 hereof, shall be delivered to you as soon as practicable following
the date on which the restrictions on such Shares of Performance Based Restricted Stock have lapsed, free of all restrictions hereunder. 

7.2 Evidence of the book entry of Shares with respect to Shares of Performance Based Restricted Stock in respect of which the
restrictions have lapsed upon your death pursuant to Section 4 hereof or, if requested by the executors or administrators of your estate upon such lapse of restrictions, a stock certificate with respect to such Shares of Performance Based
Restricted Stock, shall be delivered to the executors or administrators of your estate as soon as practicable following the Company’s receipt of notification of your death, free of all restrictions hereunder. In the event of your death, all
references herein to “you” shall also include your executors, administrators, heirs or assigns. 
  

	 8.
	 Dividends and Voting Rights. 

Subject to Section 9(a) hereof, upon issuance of the Shares of Performance Based Restricted Stock, you shall have all of the rights
of a stockholder with respect to such Shares, including the right to vote the Shares and to receive all dividends or other distributions paid or made with respect thereto; provided, however, that dividends or distributions declared or
paid on the Performance Based Restricted Stock by the Company shall be deferred and reinvested in Shares of Performance Based Restricted Stock based on the Fair Market Value of a Share of the Company’s common stock on the date such dividend or
distribution is paid or made (provided that no fractional Shares will be issued), and the additional Shares of Performance Based Restricted Stock thus acquired shall be subject to the same restrictions on transfer and forfeiture and the same vesting
schedule as the Performance Based Restricted Stock in respect of which such dividends or distributions were made. 
  

	 9.
	 Acknowledgement and Acceptance of Award Agreement. 

(a)         The Shares of Performance Based Restricted Stock granted to you pursuant to this
Award shall be subject to your acknowledgement and acceptance of the Award and the terms of this Agreement to the Company or its Plan Administrator (including by electronic means, if so provided) no later than the earlier of (i) 180 days from
the Date of Grant and (ii) the date that is immediately prior to the date that the Performance Based Restricted Stock vests pursuant to Section 4 or 5 hereof (the “Return Date”); provided that if you die before your Return
Date, this requirement shall be deemed to 

  
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be satisfied if the executor or administrator of your estate acknowledges and accepts this Agreement through the Company or its Plan Administrator no later than ninety (90) days following
your death (the “Executor Return Date”). If this Agreement is not so acknowledged and accepted on or prior to your Return Date or the Executor Return Date, as applicable, the Award of Shares of Performance Based Restricted Stock
evidenced by this Agreement shall be forfeited, and neither you nor your heirs, executors, administrators or successors shall have any rights with respect thereto. 

(b)         If this Agreement is so acknowledged and accepted on or prior to your Return Date or
the Executor Return Date, as applicable, all dividends and other distributions paid or made with respect to the Shares of Performance Based Restricted Stock granted hereunder prior to your Return Date or the Executor Return Date shall be treated in
the manner provided in Section 8 hereof. 
  

	 10.
	 No Right to Continued Employment. 

Nothing in this Agreement or the Plan shall interfere with or limit in any way the right of the Company or its Subsidiaries to terminate
your employment, nor confer upon you any right to continuing employment by the Company or any of its Subsidiaries or continuing service as a Board member. 
  

	 11.
	 Withholding of Taxes. 

Prior to the delivery to you of a stock certificate or evidence of the book entry of Shares with respect to the Shares of Performance
Based Restricted Stock in respect of which all restrictions have lapsed, you shall pay to the Company or the Company’s Plan Administrator, the federal, state and local income taxes and other amounts as may be required by law to be withheld by
the Company (the “Withholding Taxes”) with respect to such Performance Based Restricted Stock. By acknowledging and accepting this Agreement in the manner provided in Section 9 hereof, you shall be deemed to elect to have the
Company or the Plan Administrator withhold a portion of such Performance Based Restricted Stock having an aggregate Fair Market Value equal to the Withholding Taxes in satisfaction thereof, such election to continue in effect until you notify the
Company or its Plan Administrator before such delivery that you shall satisfy such obligation in cash, in which event the Company or the Plan Administrator shall not withhold a portion of such Performance Based Restricted Stock as otherwise provided
in this Section 11. 
  

	 12.
	 Acknowledgement that You Are Bound by the Plan. 

By acknowledging and accepting this Award and the terms of this Agreement you hereby confirm the availability and your review of a copy
of the Plan and the Prospectus, and other documents provided to you in connection with this Award by the Company or its Plan Administrator, and you agree to be bound by all the terms and provisions thereof. 

 

	 13.
	 Modification of Agreement. 

This Agreement may be modified, amended, supplemented or terminated, and any terms or conditions may be waived, but only by a written
instrument executed by both parties hereto; provided that the Company may modify, amend, supplement or terminate this Agreement in a writing signed by the Company without any further action by you if such modification, amendment, supplement or
termination does not adversely affect your rights hereunder. 

  
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	 14.
	 Severability. 

Should any provision of this Agreement be held by a court of competent jurisdiction to be unenforceable or invalid for any reason, the
remaining provisions of this Agreement shall not be affected by such holding and shall continue in full force in accordance with their terms. 
  

	 15.
	 Governing Law. 

The validity, interpretation, construction and performance of this Agreement shall be governed by the laws of the State of Delaware
without giving effect to the conflicts of laws principles thereof. 
  

	 16.
	 Successors in Interest. 

This Agreement shall inure to the benefit of and be binding upon any successor to the Company. This Agreement shall inure to the benefit
of your legal representatives. All obligations imposed upon the Company and all rights granted to you under this Agreement shall be binding upon the Company’s successors and upon your heirs, executors, administrators and successors. 

 

	 17.
	 Resolution of Disputes. 

Any dispute or disagreement which may arise under, or as a result of, or in any way relate to, the interpretation, construction or
application of this Agreement shall first be referred to the Chief Executive Officer for informal resolution, and if necessary, referred to the Committee for its determination. Any determination made hereunder shall be final, binding and conclusive
on you, your heirs, executors, administrators and successors, and the Company and its Subsidiaries for all purposes. 
  

	 18.
	 Entire Agreement. 

This Agreement and the terms and conditions of the Plan constitute the entire understanding between you and the Company and its
Subsidiaries, and supersede all other agreements, whether written or oral, with respect to the Award. 
  

	 19.
	 Headings. 

The headings of this Agreement are inserted for convenience only and do not constitute a part of this Agreement. 

 

	 20.
	 Notice. 

All notifications and other communications hereunder shall be in writing and, unless otherwise provided herein, shall be deemed to have
been given when received by the party to whom such notice is to be given at its address set forth below, or such other address for the party as shall be specified by notice given pursuant hereto: 

(a)     If to the Company, by regular mail to: 

Community Health Systems, Inc. 

4000 Meridian Boulevard 

Franklin, TN 37067 

Attention: General Counsel 

(b)     If to you or your legal representative, to such person at the address as reflected in the records of the
Company. 

  
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	 21.
	 Consent to Jurisdiction. 

Each party hereby irrevocably and unconditionally consents to submit to the exclusive jurisdiction of the courts of the State of
Tennessee and of the United States of America, in each case located in the County of Williamson, for any actions, suits or proceedings arising out of or relating to this Agreement, the Award or the Plan and the transactions contemplated hereby and
thereby (“Litigation”) (and agrees not to commence any Litigation except in any such court), and further agrees that service of process, summons, notice or document by U.S. certified mail to such party’s respective address set forth
in Section 20 hereof shall be effective service of process for any Litigation brought against such party in any such court. Each party hereby irrevocably and unconditionally waives any objection to the laying of venue of any litigation in the
courts of the State of Tennessee or of the United States of America, in each case located in the County of Williamson, and hereby further irrevocably and unconditionally waives and agrees not to plead or claim in any such court that any Litigation
brought in any such court has been brought in an inconvenient forum. 
 22.       Deemed Execution. On the
date of your electronic acceptance of the terms of the Award and this Agreement, this Agreement shall be deemed to have been executed and delivered by you and the Company. 

COMMUNITY HEALTH SYSTEMS, INC. 

  
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