Document:

Exhibit

FIRST AMENDMENT TO THE MASTER SERVICES AGREEMENT

This First Amendment (the “Amendment”) dated August 1, 2019 (the “Amendment Effective Date”), is made to the Master Services Agreement (the “Agreement”) by and between Molina Healthcare, Inc., (“Molina”) and
Infosys Limited (“Service Provider”) dated February 4, 2019. 

For good and mutual consideration, the sufficiency of which is hereby acknowledged, this Amendment amends the Agreement in the manner set forth below.

The parties agree to the following:

1. Purpose; Limited Application of Amendment. The purpose of this Amendment is to amend the terms and conditions of the Agreement as set forth below.

2. Definitions. Capitalized terms used herein and not otherwise defined shall have the meaning given to them in the Agreement.

3. Amendments to the body of the Agreement. The body of the Agreement is modified as follows:

		
	A.
	Clause 4.1 of the Agreement is hereby deleted and replaced in its entirety with the following language “Molina may extend the term for a maximum of one (1) additional period of twelve (12) months.” 

4. Amendments to Schedule 1 (“Definitions and Interpretation”) of the Agreement. Schedule 1 of the Agreement is modified as follows:

		
	A.
	The definition of “Initial Expiry Date” is hereby deleted and replaced in its entirety with the following language: ““Initial Expiry Date” means the date five (5) years after the Effective Date.” 

5. Amendments to Appendix 3A (Pricing Matrix). Appendix 3A (Pricing Matrix) is hereby deleted and replaced in its entirety with a new Appendix 3A dated the Amendment Effective Date, a copy of which is attached herewith and incorporated to the Agreement by this reference.  For the purpose of clarity, Infosys is amending this workbook to reflect the billing milestones and Year 6 pricing and discounts. 

		
	A.
	Infrastructure Services - Charges - Infosys will bill for the Infrastructure services in accordance with Schedule 3 and depicted in the new Appendix 3A dated the amendment Effective Date. 

		
	B.
	Azure Services - Charges - Infosys will bill Azure services as outlined in new Appendix 3A dated the Amendment Effective Date.

6.  Azure Foundation Charges. The parties agree on the additional charges for Azure Foundation (“Azure Foundation” as used in this Agreement means the building and securing of Azure infrastructure and PaaS services, and virtual networking resources per Molina standards, to be consumed by applications. This also includes defining and implementing access model, automation for provisioning of resources and access, cleaning up technical debts). The additional Azure Foundation Charges shall be as set forth in Schedule 1 to this Amendment.  The scope for Azure Foundation as agreed by the parties will be delivered and completed by October 31, 2019. Any additional scope or changes will be taken up as a separate contract and negotiated separately.
7. Discounts. The parties agree to apply the discounts set forth in Schedule 1 to this Amendment.

8. Amendments to Clause 58.

		
	A.
	Service Provider expressly disclaims any warranties relating to any Azure licenses or other materials licensed by Molina from Microsoft.

		
	B.
	The provisions of Section 58.1 (Indemnification by Service Provider) shall not apply to any IPR Claim arising out of any Azure licenses or other materials licensed by Molina from Microsoft.

		
	C.
	The liability caps set forth in Section 58.4 (Limitations Caps) of the Agreement shall not increase by more than $500,000 as a result of the inclusion in the calculation of the limitation of liability set out in Clause 58.4 of the MSA of Charges payable by Molina as license fees for Infosys Azure Transformation and Operations Management (“iATOM”). For the avoidance of doubt, the limitation on the amount the Service Provider’s liability may increase set out in the previous sentence shall not apply with respect to any increase in any other Charges payable by Molina in connection with the Agreement. 

		
	D.
	The liability caps set forth in Section 58.4 (Limitations Caps) of the Agreement shall not increase as a result of any separate license fees payable by Molina specifically for Microsoft products, including but not limited to Azure licenses fees payable to the Service Provider under Statement of Work #1 under this Agreement.

9. No Further Amendment. Except as expressly modified by this Amendment, the Agreement shall remain unmodified and in full force and effect. Each party to this Amendment hereby ratifies their respective obligations under the Agreement. In the event of a conflict between the terms and conditions of the Agreement and the Amendment, the provisions of this Amendment shall prevail.

IN WITNESS WHEREOF, the undersigned are duly authorized to execute this Amendment as of the
Amendment Effective Date. 

Molina Healthcare, Inc.                         INFOSYS LIMITED
By:    /s/ James Woys                        By:    /s/ Venkateshwaran Ananth
(signature)                            (signature)

Name:    James Woys                        Name:    Venkateshwaran Ananth
(printed)                                (printed)

Title:    EVP, Health Plan Services                    Title:    Senior Vice President
(printed)                                printed)

Date:     August 7, 2019                        Date:    August 7, 2019EX-4.1

 Exhibit 4.1 

NINETEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of July 1, 2019, among CHS/COMMUNITY HEALTH
SYSTEMS, INC., a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) 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, the undersigned New Subsidiary Guarantor 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 Guarantor 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 Guarantor 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. The New Subsidiary Guarantor 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 Guarantor:
	 SAN ANGELO HOSPITAL, L.P.,
 a
Delaware limited partnership

		
	By:	 	San Angelo Community Medical Center, LLC, its general partner
			
		 	By:	 	   /s/ Kevin J. Hammons

		 		 	Kevin J. Hammons
		 		 	Senior Vice President and Treasurer
	
	Acting on behalf of the New Subsidiary Guarantor set forth above

 
			
	REGIONS BANK, as Trustee
		
	By:	 	   /s/ Kristine Prall

		 	Kristine Prall
		 	Vice PresidentEX-4.2

 Exhibit 4.2 

SIXTEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of July 1, 2019, among CHS/COMMUNITY HEALTH
SYSTEMS, INC., a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) 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, the undersigned New Subsidiary Guarantor 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 Guarantor 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 Guarantor 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. The New Subsidiary Guarantor 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 Guarantor:
	 SAN ANGELO HOSPITAL, L.P.,
 a
Delaware limited partnership

		
	By:	 	 San Angelo Community Medical Center,

LLC, its general partner

			
		 	By:	 	  /s/ Kevin J. Hammons                    
		 		 	Kevin J. Hammons
		 		 	Senior Vice President and Treasurer
	
	Acting on behalf of the New Subsidiary Guarantor set forth above

 
			
	REGIONS BANK, as Trustee
		
	By:	 	   /s/ Kristine Prall

		 	Kristine Prall
		 	Vice President

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