Document:

EX-10.1

 Exhibit 10.1 
  

 
  

AMENDMENT NO. 3 
 dated as of 

February 26, 2018, 
 among

 CHS/COMMUNITY HEALTH SYSTEMS, INC., 

COMMUNITY HEALTH SYSTEMS, INC., 

THE LENDERS PARTY HERETO 
 and

 CREDIT SUISSE AG, 
 as
Administrative Agent 
  
  

CREDIT SUISSE SECURITIES (USA) LLC, 

CITIGROUP GLOBAL MARKETS INC. 
 and

 JPMORGAN CHASE BANK, N.A., 
 as
Joint Lead Arrangers, 
 CREDIT SUISSE SECURITIES (USA) LLC, 

CITIGROUP GLOBAL MARKETS INC., 

JPMORGAN CHASE BANK, N.A., 

DEUTSCHE BANK SECURITIES INC., 

GOLDMAN SACHS BANK USA, 
 MERRILL
LYNCH, PIERCE, FENNER & SMITH INCORPORATED, 
 RBC CAPITAL MARKETS, LLC1, 

SUNTRUST ROBINSON HUMPHREY, INC., 

WELLS FARGO SECURITIES, LLC, 

CREDIT AGRICOLE CORPORATE AND INVESTMENT BANK, 

SIEMENS FINANCIAL SERVICES, INC., 

and 
 MORGAN STANLEY SENIOR FUNDING,
INC., 
 as Joint Bookrunners, 

SCOTIA CAPITAL (USA) INC., 
 FIFTH
THIRD BANK, 
 and 
 COMPASS BANK,

 as Co-Managers 
  

 
  

 

	1 	RBC Capital Markets is a brand name for the capital markets activities of Royal Bank of Canada and its affiliates. 

 AMENDMENT NO. 3 dated as of February 26, 2018 (this
“Amendment”), to the Credit Agreement dated as of July 25, 2007, as amended and restated as of November 5, 2010, February 2, 2012, and January 27, 2014, as further amended as of March 9, 2015,
May 18, 2015, December 5, 2016 and May 30, 2017 (as heretofore amended, supplemented, amended and restated or otherwise modified, the “Credit Agreement”), among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware
corporation (the “Borrower”), COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (“Parent”), the lenders party thereto (the “Lenders”) and CREDIT SUISSE AG, as
administrative agent (in such capacity, the “Administrative Agent”) and as collateral agent for the Lenders. 

PRELIMINARY STATEMENT 

A.    Pursuant to the Credit Agreement, the Lenders have extended, and have agreed to extend, credit to the Borrower. 

B.    Parent, the Borrower and the Required Covenant Lenders desire that certain provisions of the Credit Agreement be
amended as provided herein. 
 C.    Parent, the Borrower and the Subsidiary Guarantors are party to one or more of the
Security Documents, pursuant to which, among other things, Parent and the Subsidiary Guarantors Guaranteed the Obligations of the Borrower under the Credit Agreement and provided security therefor. 

Accordingly, in consideration of the mutual agreements herein contained and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties hereto hereby agree as follows: 
 SECTION 1. Defined Terms.
(a) Capitalized terms used but not otherwise defined herein (including the Preliminary Statement hereto) shall have the meanings assigned thereto in the Credit Agreement. The provisions of Section 1.02 of the Credit Agreement are hereby
incorporated by reference herein, mutatis mutandis. This Amendment shall be a “Loan Document” for all purposes of the Credit Agreement and the other Loan Documents. 

(b) The amendment to the Credit Agreement described in Section 2 hereof, the reduction of the Extended Revolving Credit Commitments
described in Section 3 hereof and the payment of fees and expenses with respect to the foregoing, in each case on the Amendment No. 3 Effective Date, are collectively referred to herein as the “Transactions”. 

  
 2 

 SECTION 2. Amendments to the Credit Agreement. Subject to the satisfaction of the
conditions set forth in Section 5 hereof, the Credit Agreement is hereby amended as follows, effective as of the Amendment No. 3 Effective Date (as defined below): 

(a) Section 6.12 of the Credit Agreement is hereby deleted in its entirety and replaced with “[Reserved]”. 

(b) Section 6.13 of the Credit Agreement is hereby amended and restated in its entirety as follows: 

SECTION 6.13. Maximum First Lien Net Leverage Ratio. Permit the First Lien Net Leverage Ratio as of the last day
of any fiscal quarter ending during a period set forth below to be greater than the ratio set forth opposite such period below: 
  

					
	 Period
	  	Ratio	 
	 October 1, 2017 through June 30, 2018
	  	 	5.25 to 1.00	 
	 July 1, 2018 through December 31, 2018
	  	 	5.00 to 1.00	 
	 January 1, 2019 through December 31, 2019
	  	 	4.75 to 1.00	 
	 January 1, 2020 through June 30, 2020
	  	 	4.50 to 1.00	 
	 Thereafter
	  	 	4.25 to 1.00	 

 For the purposes of this Section 6.13, the following terms shall have the meanings specified: 

“First Lien Debt” shall mean, at any time the total Indebtedness of Parent, the Borrower and the Subsidiaries at such
time (excluding (i) Indebtedness of the type described in clause (h) of the definition of such term or under performance or surety bonds, in each case except to the extent of any unreimbursed drawings thereunder and (ii) Indebtedness
of the type described in clauses (c), (d), (e), (i), (j) and (k) of the definition of such term) that is secured by first priority Liens on any property or asset of Parent, the Borrower and the Subsidiaries at such time. 

“First Lien Net Leverage Ratio” shall mean, on any date, the ratio of (a) (i) First Lien Debt minus
(ii) the aggregate amount of unrestricted cash, cash equivalents and Permitted Investments that is included on the consolidated balance sheet of Parent, the Borrower and the Subsidiaries on such date, to (b) Consolidated EBITDA for the
period of four consecutive fiscal quarters most recently ended on or prior to such date for which financial statements have been delivered (or were required to be delivered) pursuant to Sections 5.04(a) or (b). In any period of four consecutive
fiscal quarters in which any Permitted Acquisition or any Significant Asset Sale occurs, the First Lien Net Leverage Ratio shall be determined on a pro forma basis in accordance with Section 1.03. 

The provisions of this Section 6.13 are solely for the benefit of the Revolving Credit Lenders and any Lenders having Other Term A Loans
and, notwithstanding the provisions of Section 9.08, the Required Covenant Lenders may (i) amend or otherwise modify Section 6.13 or, solely for the purposes of Section 6.13, the defined terms used, directly or indirectly,
therein, or (ii) waive any non-compliance with Section 6.13 or any Event of Default resulting from such non-compliance, in each case without the consent of any
other Lenders. 

  
 3 

 SECTION 3. Extended Revolving Credit Commitment Reduction. Upon the effectiveness of
this Amendment, and without any further action of any party hereto, the Extended Revolving Credit Commitments in effect immediately prior to the Amendment No. 3 Effective Date will be reduced to $650,000,000 in the aggregate with such reduction
applied on a ratable basis among the Extended Revolving Credit Lenders. Schedule I attached hereto reflects such reduction in the Extended Revolving Credit Commitments. For the avoidance of doubt, the Non-Extended Revolving Credit Commitments shall not be reduced in any way by this Amendment. 

SECTION 4. Representations and Warranties. To induce the other parties hereto to enter into this Amendment, each of Parent, the
Borrower and each Subsidiary Guarantor hereby represents and warrants to each of the Lenders party hereto (collectively, the “Consenting Lenders”), the Administrative Agent, the Issuing Banks and the Collateral Agent that,
after giving effect to this Amendment and the Transactions contemplated hereby: 
 (a) The representations and warranties set forth in
Article III of the Credit Agreement and in each other Loan Document are true and correct (i) in the case of representations and warranties qualified as to materiality, in all respects, and (ii) otherwise, in all material respects, in
each case on and as of the Amendment No. 3 Effective Date as though made on and as of such date, except to the extent that such representations and warranties expressly relate to an earlier date, in which case such representations and
warranties were so true and correct as of such earlier date (it being understood and agreed that the Transactions (as defined in this Amendment) shall be deemed to be the Subject Transactions for the purposes of the representation and warranty made
in Section 3.22 of the Credit Agreement). 
 (b) No Default or Event of Default has occurred and is continuing. 

(c) None of the Security Documents in effect on the Amendment No. 3 Effective Date will be rendered invalid, non-binding or unenforceable against any Loan Party as a result of this Amendment. The Guarantees created under such Security Documents will continue to guarantee the Obligations to the same extent as they
guaranteed the Obligations immediately prior to the Amendment No. 3 Effective Date. The Liens created under such Security Documents will continue to secure the Obligations, and will continue to be perfected, in each case, to the same extent as
they secured the Obligations or were perfected immediately prior to the Amendment No. 3 Effective Date. 

  
 4 

 SECTION 5. Effectiveness. This Amendment shall become effective on and as of the date
on which each of the following conditions precedent is satisfied (such date, the “Amendment No. 3 Effective Date”): 

(a) The Administrative Agent shall have received duly executed and delivered counterparts of this Amendment that, when taken together, bear
the signatures of Parent, the Borrower, each Subsidiary Guarantor and the Required Covenant Lenders. 
 (b) The Administrative Agent shall
have received a certificate, dated the Amendment No. 3 Effective Date and signed by a Financial Officer of the Borrower, confirming compliance with the conditions precedent set forth in paragraphs (b) and (c) of Section 4.01 of
the Credit Agreement as if the Transactions were a Credit Event. 
 (c) The Administrative Agent shall have received (i) the fees due
and payable under the Engagement Letter dated as of February 9, 2018, among Parent, the Borrower and each of the Joint Lead Arrangers party thereto (the “Engagement Letter”), in connection with this Amendment including,
with respect to each Consenting Lender that is an Extended Revolving Credit Lender, (A) an amendment fee in an amount equal to 0.10% of the aggregate amount of such Consenting Lender’s Extended Revolving Credit Commitments (whether drawn
or undrawn) as of the Amendment No. 3 Effective Date after giving effect to the reduction in such Extended Revolving Credit Commitments as set forth in Section 3 hereof and (B) an arrangement fee in an aggregate amount equal to
$1,000,000 to be allocated among the Consenting Lenders based on their respective Extended Revolving Credit Commitments (whether drawn or undrawn) as of the Amendment No. 3 Effective Date after giving effect to the reduction in such Extended
Revolving Credit Commitments as set forth in Section 3 hereof and (ii) all other amounts due and payable on or prior to the Amendment No. 3 Effective Date, including, to the extent invoiced, reimbursement or payment of all out-of-pocket expenses required to be reimbursed or paid by the Borrower hereunder, under the Engagement Letter or under any other Loan Document. 

The Administrative Agent shall notify Parent, the Borrower and the Lenders of the Amendment No. 3 Effective Date and such notice shall be
conclusive and binding. 
 SECTION 6. Effect of this Amendment. (a) Except as expressly set forth herein, this Amendment
shall not by implication or otherwise limit, impair, constitute a waiver of, or otherwise affect the rights and remedies of the Administrative Agent, the Lenders or any other Secured Party under the Credit Agreement or any other Loan Document, and
shall not alter, modify, amend or in any way affect any of the terms, conditions, obligations, covenants or agreements contained in the Credit Agreement or any other Loan Document, all of which are ratified and affirmed in all respects and shall
continue in full force and effect. Nothing herein shall be deemed to entitle any Loan Party to a consent to, or a waiver, amendment, modification or other change of, any of the terms, conditions, obligations, covenants or agreements contained in the
Credit Agreement or any other Loan Document in similar or different circumstances. This Amendment shall apply and be effective only with respect to the provisions of the Credit Agreement specifically referred to herein. 

(b) From and after the Amendment No. 3 Effective Date, any reference to the Credit Agreement shall mean the Credit Agreement as modified
by this Amendment. 

  
 5 

 SECTION 7. Additional Undertakings. Each of Parent and the Borrower covenants and
agrees with each Consenting Lender that, so long as the Credit Agreement remains in effect and until (a) the Extended Revolving Credit Commitments have been terminated, (b) the principal of and interest on each Revolving Loan made in
respect of the Extended Revolving Credit Commitments has been paid in full, (c) all fees and all other expenses or amounts payable under any Loan Document in respect of the foregoing have been paid in full and (d) all Letters of Credit
have been cancelled or have expired and all amounts drawn thereunder have been reimbursed in full or other arrangements acceptable to the Issuing Banks and the Administrative Agent have been made with respect thereto, unless the Required Covenant
Lenders shall otherwise consent in writing, notwithstanding anything in the Credit Agreement or any other Loan Document to the contrary, neither Parent nor the Borrower will, nor will they cause or permit any of the Subsidiaries to, on any date on
and after the Amendment No. 3 Effective Date, reinvest any proceeds of any Asset Sale pursuant to the first proviso of the definition “Net Cash Proceeds” (for the avoidance of doubt, it being understood and agreed that the applicable
cash proceeds received in respect of any Asset Sale shall constitute Net Cash Proceeds as and when received); provided that, with respect to any Asset Sale, without limiting any obligation set forth in the Loan Modification Agreement dated as
of May 30, 2017, among Parent, the Borrower, the Lenders party thereto and the Administrative Agent, (x) to the extent that the First Lien Net Leverage Ratio (as defined in Section 6.13 of the Credit Agreement after giving effect to
this Amendment) as of the date of such Asset Sale and on a pro forma basis for the period of four consecutive fiscal quarters most recently ended on or prior to such date for which financial statements have been delivered (or were required to be
delivered) pursuant to Sections 5.04(a) or (b) of the Credit Agreement (such period, the “Test Period”) (but without giving effect to such Asset Sale or the use of proceeds thereof) is greater than or equal to 4.5 to
1.0, then the Borrower shall be permitted, in accordance with the terms of the Credit Agreement, to reinvest a portion of such Net Cash Proceeds solely to the extent that either (A) such Net Cash Proceeds are applied to repay Term Loans in
accordance with the terms of the Credit Agreement such that the First Lien Leverage Ratio for the Test Period (determined on a pro forma basis after giving effect to such Asset Sale and any prior Asset Sale but without netting any of the Net Cash
Proceeds of such Asset Sale and assuming for such pro forma purposes that the portion of Consolidated EBITDA attributable to such Asset Sale is equal to the portion attributable to the Net Cash Proceeds used to repay Term Loans) does not exceed 4.0
to 1.0 or (B) the Required Amount (as defined below) of such Net Cash Proceeds are applied to repay Term Loans in accordance with the terms of the Credit Agreement, (y) to the extent that the First Lien Net Leverage Ratio (as defined in
Section 6.13 of the Credit Agreement after giving effect to this Amendment) as of the date of such Asset Sale and on a pro forma basis for the applicable Test Period (but without giving effect to such Asset Sale or the use of proceeds thereof)
is greater than or equal to 4.0 to 1.0 but less than 4.5 to 1.0, then the Borrower shall be permitted, in accordance with the terms of the Credit Agreement, to reinvest a portion of such Net Cash Proceeds solely to the extent that either
(A) such Net Cash Proceeds are applied to repay Term Loans in accordance with the terms of the Credit Agreement such that the First Lien Leverage Ratio for the Test Period (determined on a pro forma basis after giving effect to such Asset Sale
and any prior Asset Sale but without netting any of the Net Cash Proceeds of such Asset Sale and assuming for such pro forma purposes that 

  
 6 

 
the portion of Consolidated EBITDA attributable to such Asset Sale is equal to the portion attributable to the Net Cash Proceeds used to repay Term Loans) does not exceed 4.0 to 1.0 or (B) 50% of
such Net Cash Proceeds are applied to repay Term Loans in accordance with the terms of the Credit Agreement and (z) to the extent that the First Lien Net Leverage Ratio (as defined in Section 6.13 of the Credit Agreement after giving
effect to this Amendment) as of the date of such Asset Sale and on a pro forma basis for the applicable Test Period (but without giving effect to such Asset Sale or the use of proceeds thereof) is less than 4.0 to 1.0, then the Borrower shall be
permitted, in accordance with the terms of the Credit Agreement, to reinvest all such Net Cash Proceeds. 
 For purposes of the foregoing, the
“Required Amount” of Net Cash Proceeds with respect to any Asset Sale shall mean (x) if the First Lien Leverage Ratio for the applicable Test Period (determined on a pro forma basis after giving effect to such Asset Sale
and any prior Asset Sale and assuming all of the Net Cash Proceeds of such Asset Sale have been applied to prepay Term Loans) is greater than or equal to 4.5 to 1.0, 100% of such Net Cash Proceeds or (y) if otherwise, the sum of (1) an
amount of Net Cash Proceeds such that the First Lien Leverage Ratio for the applicable Test Period (determined on a pro forma basis after giving effect to such Asset Sale and any prior Asset Sale but without netting any of the Net Cash Proceeds of
such Asset Sale and assuming for such pro forma purposes that the portion of Consolidated EBITDA attributable to such Asset Sale is equal to the portion attributable to the Net Cash Proceeds used to repay Term Loans pursuant to this clause (1))
after applying such Net Cash Proceeds to prepay Term Loans in accordance with the Credit Agreement is equal to 4.5 to 1.0 plus (2) 50% of any remaining Net Cash Proceeds after the application of the preceding clause (1). 

In addition, other than in respect to the first $50,000,000 in Net Cash Proceeds in respect of Asset Sales received after the Amendment No. 3 Effective
Date, in the event that the Borrower and the Subsidiaries receive Net Cash Proceeds in respect of Asset Sales that would be required to be applied to prepay Term Loans pursuant to Section 2.13(b) but for the $50,000,000 annual threshold in
Section 2.13(b), the Borrower shall voluntarily prepay Term Loans pursuant to Section 2.12 of the Credit Agreement to the extent that Section 2.13(b) would have required Term Loans to be prepaid if such $50,000,000 annual threshold
did not apply, but giving effect to the foregoing reinvestment provisions, to the extent applicable. 
 With respect to each fiscal quarter during which any
Asset Sale occurs, the Borrower shall deliver to the Administrative Agent (for delivery to the Extended Revolving Credit Lenders) at the time the Borrower delivers to the Administrative Agent the certificate for such fiscal quarter pursuant to
Section 5.04(c) of the Credit Agreement, an additional certificate (a) specifying the amount of Net Cash Proceeds received in connection with Asset Sales during such fiscal quarter and (b) providing in reasonable detail a calculation
of the amount of Net Cash Proceeds received in connection with such Asset Sales that were (x) applied to prepay outstanding Term Loans and (y) reinvested pursuant to the first proviso of the definition of “Net Cash Proceeds”,
together with a description of such reinvestment. 

  
 7 

 The provisions of this Section 7 of this Amendment are solely for the benefit of the Extended Revolving
Credit Lenders and a majority in interest of such Extended Revolving Credit Lenders may (a) amend or otherwise modify this Section 7 or (b) waive any non-compliance with this Section 7 or
any Default or Event of Default resulting from such non-compliance. In addition, for the avoidance of doubt, any breach of this Section 7 shall constitute a breach of a covenant contained in a Loan
Document in accordance with Article VII(e) of the Credit Agreement. 
 SECTION 8. Reaffirmation. Each of Parent, the Borrower
and each of the Subsidiary Guarantors identified on the signature pages hereto (collectively, Parent, the Borrower and such Subsidiary Guarantors, the “Reaffirming Loan Parties”) hereby acknowledges that it expects to receive
substantial direct and indirect benefits as a result of this Amendment and the transactions contemplated hereby. Each Reaffirming Loan Party hereby consents to this Amendment and the transactions contemplated hereby, and hereby confirms its
respective guarantees, pledges and grants of security interests, as applicable, under each of the Loan Documents to which it is party, and agrees that, notwithstanding the effectiveness of this Amendment and the transactions contemplated hereby,
such guarantees, pledges and grants of security interests shall continue to be in full force and effect and shall accrue to the benefit of the Secured Parties. 

SECTION 9. Expenses. The Borrower agrees to reimburse the Administrative Agent for its reasonable
out-of-pocket expenses in connection with the Loan Documents (including the preparation of this Amendment), including the reasonable fees, charges and disbursements of
Cravath, Swaine & Moore LLP. 
 SECTION 10. Notices. All notices hereunder shall be given in accordance with
Section 9.01 of the Credit Agreement. 
 SECTION 11. Counterparts. This Amendment may be executed in one or more
counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. Delivery by electronic transmission (e.g., “pdf”) of an executed counterpart of a signature page to this
Amendment shall be effective as delivery of an original executed counterpart of this Amendment. 
 SECTION 12. No Novation. This
Amendment shall not extinguish the obligations for the payment of money outstanding under the Credit Agreement or discharge or release the Lien or priority of any Loan Document or any other security therefor or any guarantee thereof. Nothing herein
contained shall be construed as a substitution or novation of the Obligations outstanding under the Credit Agreement or instruments guaranteeing or securing the same, which shall remain in full force and effect, except as modified hereby or by
instruments executed concurrently herewith. Nothing expressed or implied in this Amendment or any other document contemplated hereby shall be construed as a release or other discharge of the Borrower under the Credit Agreement or any Loan Party
under any other Loan Document from any of its obligations and liabilities thereunder. The Credit Agreement and each of the other Loan Documents shall remain in full force and effect, until and except as modified hereby or thereby in connection
herewith or therewith. 

  
 8 

 SECTION 13. Governing Law. (a) THIS AMENDMENT SHALL BE GOVERNED BY, AND
CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 (b) EACH PARTY HERETO HEREBY WAIVES, TO THE FULLEST EXTENT PERMITTED BY
APPLICABLE LAW, ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN ANY LEGAL PROCEEDING DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AMENDMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY (WHETHER BASED ON CONTRACT, TORT OR ANY OTHER THEORY). EACH
PARTY HERETO (I) CERTIFIES THAT NO REPRESENTATIVE, AGENT OR ATTORNEY OF ANY OTHER PARTY HAS REPRESENTED, EXPRESSLY OR OTHERWISE, THAT SUCH OTHER PARTY WOULD NOT, IN THE EVENT OF LITIGATION, SEEK TO ENFORCE THE FOREGOING WAIVER AND
(II) ACKNOWLEDGES THAT IT AND THE OTHER PARTIES HERETO HAVE BEEN INDUCED TO ENTER INTO THIS AMENDMENT BY, AMONG OTHER THINGS, THE MUTUAL WAIVERS AND CERTIFICATIONS IN THIS SECTION. 

SECTION 14. Headings; Titles. Section headings used herein are for convenience of reference only, are not part of this Amendment
and shall not affect the construction of, or be taken into consideration in interpreting, this Amendment. None of the financial institutions listed on the front cover of this Amendment as either a “Joint Bookrunner” or a “Co-Manager” shall have any duties or responsibilities hereunder in their capacity as either a “Joint Bookrunner” or a “Co-Manager”. 

[Remainder of page intentionally left blank] 

  
 9 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly executed by their
respective authorized officers as of the date first above written. 
  

					
	CHS/COMMUNITY HEALTH SYSTEMS, INC.,
			
		 	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer
	
	COMMUNITY HEALTH SYSTEMS, INC.,
			
		 	By:	 	 /s/ Edward W. Lomicka

		 	Name:	 	Edward W. Lomicka
		 	Title:	 	Vice President and Treasurer

 [Signature Page to Amendment No. 3 to the Credit Agreement] 

 
					
	CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH, as a Lender and as Administrative Agent
			
		 	By:	 	 /s/ Christopher Day

		 	Name:	 	Christopher Day
		 	Title:	 	Authorized Officer
			
		 	By:	 	 /s/ Warren Van Heyst

		 	Name:	 	Warren Van Heyst
		 	Title:	 	Authorized Officer

 [Signature Page to Amendment No. 3 to the Credit Agreement] 

	
	ABILENE HOSPITAL, LLC
	ABILENE MERGER, LLC
	AFFINITY HEALTH SYSTEMS, LLC
	AFFINITY HOSPITAL, LLC
	BERWICK HOSPITAL COMPANY, LLC
	BILOXI H.M.A., LLC
	BIRMINGHAM HOLDINGS II, LLC
	BIRMINGHAM HOLDINGS, LLC
	BLUEFIELD HOLDINGS, LLC
	BLUEFIELD HOSPITAL COMPANY, LLC
	BLUFFTON HEALTH SYSTEM LLC
	BRANDON HMA, LLC
	BROWNWOOD MEDICAL CENTER, LLC
	BULLHEAD CITY HOSPITAL CORPORATION
	BULLHEAD CITY HOSPITAL INVESTMENT CORPORATION
	CAMPBELL COUNTY HMA, LLC
	CARLSBAD MEDICAL CENTER, LLC
	CAROLINAS HOLDINGS, LLC
	CAROLINAS JV HOLDINGS GENERAL, LLC
	CENTRAL FLORIDA HMA HOLDINGS, LLC
	CENTRAL STATES HMA HOLDINGS, LLC
	CHESTER HMA, LLC
	CHESTNUT HILL HEALTH SYSTEM, LLC
	CHHS HOLDINGS, LLC
	CHHS HOSPITAL COMPANY, LLC
	CHS PENNSYLVANIA HOLDINGS, LLC
	CHS TENNESSEE HOLDINGS, LLC
	CHS VIRGINIA HOLDINGS, LLC
	CITRUS HMA, LLC
	CLARKSVILLE HOLDINGS II, LLC
	CLARKSVILLE HOLDINGS, LLC
	CLEVELAND HOSPITAL COMPANY, LLC
	CLEVELAND TENNESSEE HOSPITAL COMPANY, LLC
	CLINTON HMA, LLC
	COATESVILLE HOSPITAL CORPORATION
	COCKE COUNTY HMA, LLC
	COLLEGE STATION MEDICAL CENTER, LLC
	COLLEGE STATION MERGER, LLC
	COMMUNITY HEALTH INVESTMENT COMPANY, LLC
	CP HOSPITAL GP, LLC
	CPLP, LLC
	CRESTWOOD HOSPITAL LP, LLC
	CRESTWOOD HOSPITAL, LLC
	CSMC, LLC
	DEACONESS HOLDINGS, LLC
	DEACONESS HOSPITAL HOLDINGS, LLC
	DESERT HOSPITAL HOLDINGS, LLC
	DETAR HOSPITAL, LLC
	DHFW HOLDINGS, LLC
	DUKES HEALTH SYSTEM, LLC
	DYERSBURG HOSPITAL COMPANY, LLC

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement] 

	
	EMPORIA HOSPITAL CORPORATION
	FLORIDA HMA HOLDINGS, LLC
	FOLEY HOSPITAL CORPORATION
	FORT SMITH HMA, LLC
	FRANKFORT HEALTH PARTNER, INC.
	FRANKLIN HOSPITAL CORPORATION
	GADSDEN REGIONAL MEDICAL CENTER, LLC
	GAFFNEY H.M.A., LLC
	GRANBURY HOSPITAL CORPORATION
	GRMC HOLDINGS, LLC
	HALLMARK HEALTHCARE COMPANY, LLC
	HEALTH MANAGEMENT ASSOCIATES, LLC
	HEALTH MANAGEMENT GENERAL PARTNER I, LLC
	HEALTH MANAGEMENT GENERAL PARTNER, LLC
	HMA FENTRESS COUNTY GENERAL HOSPITAL, LLC
	HMA SANTA ROSA MEDICAL CENTER, LLC
	HMA SERVICES GP, LLC
	HMA-TRI HOLDINGS, LLC
	HOBBS MEDCO, LLC
	HOSPITAL MANAGEMENT ASSOCIATES, LLC
	HOSPITAL OF MORRISTOWN, LLC
	JACKSON HMA, LLC
	JACKSON HOSPITAL CORPORATION
	JEFFERSON COUNTY HMA, LLC
	KAY COUNTY HOSPITAL CORPORATION
	KAY COUNTY OKLAHOMA HOSPITAL COMPANY, LLC
	KENNETT HMA, LLC
	KEY WEST HMA, LLC
	KIRKSVILLE HOSPITAL COMPANY, LLC
	KNOXVILLE HMA HOLDINGS, LLC
	LAKEWAY HOSPITAL COMPANY, LLC
	LANCASTER HOSPITAL CORPORATION
	LAS CRUCES MEDICAL CENTER, LLC
	LEA REGIONAL HOSPITAL, LLC
	LEBANON HMA, LLC
	LONGVIEW CLINIC OPERATIONS COMPANY, LLC
	LONGVIEW MERGER, LLC
	LRH, LLC
	LUTHERAN HEALTH NETWORK OF INDIANA, LLC
	MADISON HMA, LLC
	MARSHALL COUNTY HMA, LLC
	MARTIN HOSPITAL COMPANY, LLC
	MARY BLACK HEALTH SYSTEM, LLC
	MCSA, L.L.C.
	MEDICAL CENTER OF BROWNWOOD, LLC
	METRO KNOXVILLE HMA, LLC
	MISSISSIPPI HMA HOLDINGS I, LLC
	MISSISSIPPI HMA HOLDINGS II, LLC
	MOBERLY HOSPITAL COMPANY, LLC
	NAPLES HMA, LLC
	NATCHEZ HOSPITAL COMPANY, LLC

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement] 

	
	NATIONAL HEALTHCARE OF LEESVILLE, INC.
	NAVARRO REGIONAL, LLC
	NC-DSH, LLC
	NORTHWEST ARKANSAS HOSPITALS, LLC
	NORTHWEST HOSPITAL, LLC
	NOV HOLDINGS, LLC
	NRH, LLC
	OAK HILL HOSPITAL CORPORATION
	ORO VALLEY HOSPITAL, LLC
	PALMER-WASILLA HEALTH SYSTEM, LLC
	PASCO REGIONAL MEDICAL CENTER, LLC
	PENNSYLVANIA HOSPITAL COMPANY, LLC
	PHOENIXVILLE HOSPITAL COMPANY, LLC
	POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
	PORT CHARLOTTE HMA, LLC
	POTTSTOWN HOSPITAL COMPANY, LLC
	PUNTA GORDA HMA, LLC
	QHG GEORGIA HOLDINGS II, LLC
	QHG GEORGIA HOLDINGS, INC.
	QHG OF BLUFFTON COMPANY, LLC
	QHG OF CLINTON COUNTY, INC.
	QHG OF ENTERPRISE, INC.
	QHG OF FORREST COUNTY, INC.
	QHG OF FORT WAYNE COMPANY, LLC
	QHG OF HATTIESBURG, INC.
	QHG OF SOUTH CAROLINA, INC.
	QHG OF SPARTANBURG, INC.
	QHG OF SPRINGDALE, INC.
	REGIONAL HOSPITAL OF LONGVIEW, LLC
	RIVER OAKS HOSPITAL, LLC
	RIVER REGION MEDICAL CORPORATION
	ROH, LLC
	ROSWELL HOSPITAL CORPORATION
	RUSTON HOSPITAL CORPORATION
	RUSTON LOUISIANA HOSPITAL COMPANY, LLC
	SACMC, LLC
	SALEM HOSPITAL CORPORATION
	SAN ANGELO COMMUNITY MEDICAL CENTER, LLC
	SAN ANGELO MEDICAL, LLC
	SCRANTON HOLDINGS, LLC
	SCRANTON HOSPITAL COMPANY, LLC
	SCRANTON QUINCY HOLDINGS, LLC
	SCRANTON QUINCY HOSPITAL COMPANY, LLC
	SEMINOLE HMA, LLC
	SHELBYVILLE HOSPITAL COMPANY, LLC
	SILOAM SPRINGS ARKANSAS HOSPITAL COMPANY, LLC
	SILOAM SPRINGS HOLDINGS, LLC
	SOUTHEAST HMA HOLDINGS, LLC
	SOUTHERN TEXAS MEDICAL CENTER, LLC
	SOUTHWEST FLORIDA HMA HOLDINGS, LLC
	STATESVILLE HMA, LLC

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement] 

	
	TENNYSON HOLDINGS, LLC
	TOMBALL TEXAS HOLDINGS, LLC
	TOMBALL TEXAS HOSPITAL COMPANY, LLC
	TRIAD HEALTHCARE, LLC
	TRIAD HOLDINGS III, LLC
	TRIAD HOLDINGS IV, LLC
	TRIAD HOLDINGS V, LLC
	TRIAD NEVADA HOLDINGS, LLC
	TRIAD OF ALABAMA, LLC
	TRIAD-ARMC, LLC
	TRIAD-EL DORADO, INC.
	TRIAD-NAVARRO REGIONAL HOSPITAL SUBSIDIARY, LLC
	TULLAHOMA HMA, LLC
	TUNKHANNOCK HOSPITAL COMPANY, LLC
	VAN BUREN H.M.A., LLC
	VENICE HMA, LLC
	VHC MEDICAL, LLC
	VICKSBURG HEALTHCARE, LLC
	VICTORIA HOSPITAL, LLC
	VIRGINIA HOSPITAL COMPANY, LLC
	WEATHERFORD HOSPITAL CORPORATION
	WEATHERFORD TEXAS HOSPITAL COMPANY, LLC
	WEBB HOSPITAL CORPORATION
	WEBB HOSPITAL HOLDINGS, LLC
	WESLEY HEALTH SYSTEM LLC
	WHMC, LLC
	WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY, LLC
	WILKES-BARRE HOLDINGS, LLC
	WILKES-BARRE HOSPITAL COMPANY, LLC
	WOODLAND HEIGHTS MEDICAL CENTER, LLC
	WOODWARD HEALTH SYSTEM, LLC

 Acting on behalf of each of the Subsidiary Guarantors set forth above 

 

			
	By:	 	 /s/ Edward W. Lomicka

	Name:	 	Edward W. Lomicka
	Title:	 	Vice President and Treasurer

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement] 

 
			
	HEALTH MANAGEMENT ASSOCIATES, LP
	By:	 	Health Management General Partner, LLC, its general partner
	
	TENNESSEE HMA HOLDINGS, LP
	By:	 	Health Management General Partner I, LLC, its general parter
	
	QHG GEORGIA, LP
	By:	 	QHG Georgia Holdings II, LLC, its general partner
	
	HOSPITAL MANAGEMENT SERVICES OF FLORIDA, LP
	By:	 	HMA Services GP, LLC, its general partner
	
	HMA HOSPITALS HOLDINGS, LP
	By:	 	Health Management General Partner, LLC, its general partner
	
	BROWNWOOD HOSPITAL, L.P.
	By:	 	Brownwood Medical Center, LLC, its general partner
	
	CAROLINAS JV HOLDINGS, L.P.
	By:	 	Carolina JV Holdings General, LLC, its general partner
	
	COLLEGE STATION HOSPITAL, L.P.
	By:	 	College Station Medical Center, LLC, its general partner
	
	CRESTWOOD HEALTHCARE, L.P.
	By:	 	Crestwood Hospital, LLC
	
	LAREDO TEXAS HOSPITAL COMPANY, L.P.
	By:	 	Webb Hospital Corporation, its general partner
	
	LONGVIEW MEDICAL CENTER, L.P.
	By:	 	Regional Hospital of Longview, LLC, its general partner
	
	NAVARRO HOSPITAL, L.P.
	By:	 	Navarro Regional, LLC, its general partner
	
	VICTORIA OF TEXAS, L.P.
	By:	 	Detar Hospital, LLC, its general partner

 Acting on behalf of each of the Subsidiary Guarantors set forth above 

 

			
	By:	 	 /s/ Edward W. Lomicka

	Name:	 	Edward W. Lomicka
	Title:	 	Vice President and Treasurer

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement] 

 [Name of Revolving Credit Lender:1 

 

			
	By:	 	  

	Name:	 	
	Title:	 	

 For any Revolving Credit Lender requiring a second signature block: 

 

			
	By:	 	  

	Name:	 	
	Title:]	 	

 1 On file with Agent. 

  
 [Signature Page to
Amendment No. 3 to the Credit Agreement]Exhibit

Exhibit 10.1

CROWN CASTLE INTERNATIONAL CORP.
2018 EMT ANNUAL INCENTIVE PLAN
(Effective January 1, 2018)

Overview
This Plan Document is designed to outline the provisions of the Crown Castle International Corp. (“CCIC” or “Company”) 2018 Executive Management Team (EMT) Annual Incentive Plan (the “Plan”) effective as of the 1st day of January 2018, in accordance with the terms provided herein.

The Company hereby adopts the terms of the Plan as follows:

		
	I.
	Objectives

The Company’s main objectives for the Plan are:
		
	•
	To provide a compensation package that is competitive with the market.

		
	•
	To motivate executives by providing an appropriate reward (“Incentive Award”) for corporate performance based on Company goals and objectives.

		
	•
	To focus executives on maximizing results and reinforce the importance of teamwork at the corporate level.

		
	•
	To link the Plan’s financial measures with investor expectations.

		
	II.
	Plan Year

The effective date of this Plan is January 1, 2018.  The Plan will remain in effect from January 1, 2018 to December 31, 2018 (the “Plan Year”).

		
	III.
	Administration

The Plan shall be administered by the Compensation Committee (the “Committee”) of the Board of Directors (the “Board”) with oversight by the Board.  The Committee shall have the authority to review and approve: (a) the Participants as defined in Section IV, (b) the incentive opportunities for each Participant as defined in Section VI, (c) the methodology for determining the Performance Goals as defined in Section VII, (d) the minimum performance requirements as described in Section VIII, and (e) the final calculation of Incentive Awards for the Participants as described in Section IX.  The Committee shall also have the authority to review and approve any proposed amendments to the Plan throughout the Plan Year.  The Committee retains the right to discontinue or amend this Plan at any time.  The Committee may use discretion to adjust the Incentive Award levels to account for events that impact the ability to meet the Performance Goals described in Section VII.

The President and Chief Executive Officer of the Company (the “CEO”) will be responsible for the interpretation and the day-to-day management of the Plan.  The CEO shall also make recommendations to the Committee for review and approval.

Nothing in this Plan is to be construed as a guarantee of an Incentive Award.

1

		
	IV.
	Eligibility

Executive employees who are selected by the CEO and approved by the Committee will be eligible to participate in the Plan (the “Participants”).

		
	V.
	Change in Eligibility Status

In making decisions regarding employees’ participation in the Plan, the CEO may consider any factors that he or she may consider relevant.  The following guidelines are provided as general information regarding employee status changes upon the occurrence of the events described below, provided that recommendation to include an employee in the Plan originates from the CEO, and the Committee may, in its sole discretion, exercise its authority to apply alternate treatment to any Participant experiencing a change in eligibility status during the Plan Year:

		
	(a)
	New Hires.  A newly hired employee selected and approved as a Participant in the Plan prior to March 1 of the Plan Year may participate in the Plan based on a full Plan Year.  A newly hired employee selected and approved as a Participant in the Plan on or after March 1 and before November 1 of the Plan Year may participate in the Plan on a pro rata basis as of the date the Participant was first approved as a Participant in the Plan with respect to the Plan Year.  A newly hired employee selected and approved as a Participant in the Plan on or after November 1 of the Plan Year will not be eligible to participate in the Plan until a new Plan Year begins the following January 1.

		
	(b)
	Transfer, Promotion.  A Participant that experiences a transfer or promotion during the Plan Year may participate in the Plan on a pro rata basis, with a portion of the Incentive Award tied to time spent in the former position and the balance of the Incentive Award tied to time spent in the latter position.   

		
	(c)
	Demotion.  An Incentive Award will generally not be made to an employee who has been demoted during the Plan Year due to performance.

		
	(d)
	Termination.  An Incentive Award will generally not be made to any Participant whose services are terminated prior to the payment of the Incentive Award for reasons of misconduct, failure to perform or other cause.

		
	(e)
	Resignation.  An Incentive Award will generally not be made to any Participant who resigns for any reason before the Incentive Award is paid.  However, if the Participant has voluntarily terminated his or her employment with the Company’s consent, the Participant may be considered for a pro rata Incentive Award, provided the Participant otherwise qualifies for the Incentive Award.

		
	(f)
	Death and Disability.  A Participant whose status as an active employee is changed prior to the payment of the Incentive Award for any reason other than the reasons cited above may be considered for a pro rata Incentive Award, provided the Participant otherwise qualifies for the Incentive Award.  In the event that an Incentive Award is made on behalf of an employee who has terminated employment by reason of death, any such payments or other amounts due will generally be paid to the Participant’s estate.

The above guidelines are subject to the terms of any applicable severance or similar agreements. Nothing in the Plan shall confer any right to any employee to continue in the employ of the Company.

2

		
	VI.
	Incentive Opportunity

The CEO will determine, and recommend for approval by the Committee, incentive opportunities for each Participant.  The incentive opportunities will be defined as Incentive Opportunity Zones that represent a range of threshold, target and maximum performance outcomes for which incremental increases in performance will result in incremental increases in the Incentive Award.

Each Incentive Opportunity Zone will include threshold, target and maximum incentive opportunities.  The Participant’s target incentive opportunity will be based on the Participant’s role and responsibilities, and will be expressed as a percentage of the Participant’s base salary.  The Participant’s threshold and maximum incentive opportunities will be expressed as a Payout Multiple of the target incentive opportunity and will also be based on the Participant’s role and responsibilities.  The tables set forth on Exhibit A outline the target Payout Multiples for certain Participant categories. 

The target incentive opportunity as a multiple of base salary, and the resulting threshold and maximum opportunities will be determined and approved in writing and kept on file for each Participant in the Business Support department.

		
	VII.
	Performance Goals

Each Participant shall have specific performance goals (the “Performance Goals”) determined for his or her position for the Plan Year.  These Performance Goals will be based on certain financial performance measures that support the approved business plan of the Company.

Corporate performance will be assessed utilizing one or more performance measures with equal or different weighting, including without limitation any one or more of the performance criteria described below:
		
	•
	Corporate Adjusted EBITDA – calculated as CCIC EBITDA adjusted for non-cash compensation and amortization of prepaid lease purchase price adjustments.

		
	•
	Corporate Adjusted Funds From Operations per Share – calculated as CCIC Adjusted Funds From Operations divided by weighted average CCIC common shares outstanding with respect to the Plan Year.

The Performance Goals for these financial measures will generally be based on the Company’s 2018 financial budget/forecasts as approved by the Board.

The target mix and weighting of the Performance Goals for each Participant will vary depending on the Participant’s role and responsibilities, as set forth on Exhibit B.

For the financial performance measures, threshold, target, and maximum Performance Goals will be established and aligned within the Participant’s applicable Incentive Opportunity Zone as defined above in Section VI.  The threshold, target, and maximum Performance Goals for these financial measures, based on the Company’s budget/forecast for 2018 are set forth on Exhibit C.

3

		
	VIII.
	Minimum Performance Requirements

There are two minimum performance requirements in order to receive a full Annual Incentive in accordance with the Plan:

		
	1.
	The Minimum Financial Performance Target level set forth on Exhibit C must be achieved for Participants to be eligible for the Annual Incentive.

		
	2.
	The business units or departments for which the Participants are responsible must receive an acceptable 404 assessment of applicable internal controls.  The receipt of a 404 assessment with a material weakness may result in a reduction or elimination of the potential 2018 Annual Incentive for the responsible Participants and potentially all Participants.

		
	IX.
	Incentive Award Calculation

The Incentive Awards will be calculated based on the Incentive Opportunity Zones established for each Participant at the beginning of the Plan Year.  The Incentive Opportunity Zones can be depicted as target Incentive Opportunity Curves that correlate the incentive Payout Multiples with each of the Performance Goals.

The target Incentive Opportunity Curve for each of the Performance Goals are set forth on Exhibit D.

At Plan Year-end, the following steps will occur to calculate each Participant’s final Incentive Award:
		
	•
	The actual performance results will be plotted on each applicable Incentive Opportunity Curve for the Participant.

		
	◦
	    If actual performance results fall between the threshold and target, or the target and maximum Performance Goals, the Payout Multiples will be calculated by interpolating the actual performance results with the threshold, target, and maximum Payout Multiples.  However, no incentive will be paid if actual results fall below the threshold Performance Goal. 

		
	•
	Each of the resulting Payout Multiples will then be multiplied by the weighted percentage for the applicable Performance Goal.

		
	•
	The products of each will then be added together to determine the total Payout Multiple for the Participant.

		
	•
	The total Payout Multiple will then be applied to the Participant’s target Incentive Award as a percentage of base salary to determine the total Incentive Award.

An illustration of how this calculation is performed is set forth on Exhibit E.

		
	X.
	Incentive Award Payments

Incentive Award payments in accordance with this Plan will be processed by March 15, 2019 following the Board of Directors’ approval of the Plan Year’s financial statements.

4

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