Document:

Exchange and Registration Rights Agreement

 Exhibit 10.3 
 TENET HEALTHCARE CORPORATION 
 9.0% Senior Secured Notes due 2015 and 
 10.0% Senior Secured Notes due 2018 
 unconditionally guaranteed as to the 
 payment of principal, premium, 
 if any, and interest by the 
 Guarantors named on Schedule I hereto 
  
  
 Exchange and
Registration Rights Agreement 
 March 3, 2009 
 Citigroup Global Markets Inc. 
 388 Greenwich Street 
 New York, NY 10013 
 Banc of America Securities LLC 
 One Bryant Park 
 New York, NY 10036 
 Goldman, Sachs & Co. 
 85 Broad Street 
 New York, NY 10004 
 Scotia Capital (USA) Inc. 
 165 Broadway – 25th Floor 
 One Liberty Plaza 
 New York, NY 10006 
 Ladies and Gentlemen: 
 Tenet Healthcare Corporation, a Nevada corporation (the “Company”), is exchanging, on the date hereof, certain outstanding notes of the
Company (collectively, the “Existing Notes”) for approximately $1.4 billion in aggregate principal amount of the Company’s new 9.0% Senior Secured Notes due 2015 and new 10.0% Senior Secured Notes due 2018 (the
“Exchange Offer”), which are unconditionally guaranteed by the Guarantors (as defined herein), upon the terms and conditions set forth in that certain Offering Memorandum, dated January 22, 2009, as amended and supplemented,
and that certain Dealer Manager Agreement (the “Dealer Manager Agreement”), dated as of January 22, 2009, among the Company, Citigroup Global Markets Inc., Banc of America Securities LLC, Goldman, Sachs & Co. and
Scotia Capital (USA) Inc. As an inducement to the holders of Existing Notes to tender their Existing Notes in the Exchange Offer, and in satisfaction of a condition to the obligations of the Company under the Exchange Offer, the Company and the
Guarantors agree with the Dealer Managers (as defined herein), for the benefit of the holders (as defined herein) from time to time of the Registrable Securities (as defined herein), as follows: 
 1. Certain Definitions. For purposes of this Exchange and Registration Rights Agreement (this “Agreement”), the following terms
shall have the following respective meanings: 
 “Base Interest” shall mean the interest that would otherwise accrue on the
Securities under the terms thereof and the Indenture, without giving effect to the provisions of this Agreement. 

 The term “broker-dealer” shall mean any broker or dealer registered with the Commission
under the Exchange Act. 
 “Business Day” shall mean each Monday, Tuesday, Wednesday, Thursday and Friday that is not a day
on which banking institutions in New York City are generally authorized or obligated by law or executive order to be closed. 
 “Closing Date” shall mean the date on which the Securities are initially issued. 
 “Commission”
shall mean the United States Securities and Exchange Commission, or any other federal agency at the time administering the Exchange Act or the Securities Act, whichever is the relevant statute for the particular purpose. 
 “Company” shall have the meaning assigned thereto in the preamble. 
 “Consummation Date” shall have the meaning assigned thereto in Section 2(a) hereof. 
 “Dealer Manager Agreement” shall have the meaning assigned thereto in the preamble. 
 “Dealer Managers” shall mean Citigroup Global Markets Inc., Banc of America Securities LLC, Goldman, Sachs & Co. and Scotia
Capital (USA) Inc. 
 “Effective Time” shall mean the time and date as of which the Commission declares the Exchange
Registration Statement effective or as of which the Exchange Registration Statement otherwise becomes effective. 
 “Exchange
Act” shall mean the Securities Exchange Act of 1934, or any successor thereto, as the same shall be amended from time to time. 
 “Exchange Offer” shall have the meaning assigned thereto in the preamble. 
 “Exchange
Registration” shall have the meaning assigned thereto in Section 3(c) hereof. 
 “Exchange Registration
Statement” shall have the meaning assigned thereto in Section 2(a) hereof. 
 “Exchange Securities” shall have
the meaning assigned thereto in Section 2(a) hereof. 
 “Existing Notes” shall have the meaning assigned thereto in the
preamble. 
 “FINRA” shall mean the Financial Industry Regulatory Authority, Inc. 
 “Free Trade Date” shall mean the 380th day following the Closing Date. 
 “Freely Tradable”
shall mean, with respect to the Securities at any time of determination, that (a) all outstanding Securities are eligible to be sold by a person who has not been an “affiliate” (as defined in Rule 405 under the Securities Act) of the
Company or any Guarantor during the preceding 90 days without any volume or manner of sale restrictions under the Securities Act, (b) the Company has provided a certificate to the Trustee instructing the Trustee that the restrictive legend on
the Securities no longer applies and (c) the Securities have been assigned an unrestricted CUSIP number. 
  

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 “Guarantors” shall have the meaning assigned thereto in the Indenture. 
 The term “holder” shall mean each of the persons who acquire Registrable Securities from time to time (including any successors or
assigns), in each case for so long as such person owns any Registrable Securities. 
 “Indenture” shall mean the Indenture,
dated November 6, 2001, between the Company and The Bank of New York Mellon Trust Company, N.A., as successor to The Bank of New York, as supplemented by the Ninth Supplemental Indenture, dated as of March 3, 2009, between the Company, the
Guarantors and the Trustee, as the same shall be supplemented or amended from time to time, and the Tenth Supplemental Indenture, dated as of March 3, 2009, between the Company, the Guarantors and the Trustee, as the same shall be supplemented
or amended from time to time. 
 The term “person” shall mean a corporation, association, partnership, organization,
business, individual, government or political subdivision thereof or governmental agency. 
 “Registrable Securities” shall
mean the Securities; provided, however, that a Security shall cease to be a Registrable Security when (a) in the circumstances contemplated by Section 2(a) hereof, the Security has been exchanged for an Exchange Security in a
Subsequent Exchange Offer as contemplated in Section 2(a) hereof (provided that any Exchange Security that, pursuant to the second to last and third to last sentences of Section 2(a), is included in a prospectus for use in
connection with resales by broker-dealers shall be deemed to be a Registrable Security with respect to Sections 5, 6 and 9 until resale of such Registrable Security has been effected within the 180-day period referred to in Section 2(a));
(b) the Securities become Freely Tradable or (c) such Security shall cease to be outstanding. 
 “Registration
Default” shall have the meaning assigned thereto in Section 2(b) hereof. 
 “Registration Default Period”
shall have the meaning assigned thereto in Section 2(b) hereof. 
 “Registration Expenses” shall have the meaning
assigned thereto in Section 4 hereof. 
 “Resale Period” shall have the meaning assigned thereto in Section 2(a)
hereof. 
 “Restricted Holder” shall mean (i) a holder that is an affiliate of the Company within the meaning of Rule
405, (ii) a holder who acquires Exchange Securities outside the ordinary course of such holder’s business, (iii) a holder who has arrangements or understandings with any person to participate in the Subsequent Exchange Offer for the
purpose of distributing Exchange Securities and (iv) a holder that is a broker-dealer, but only with respect to Exchange Securities received by such broker-dealer pursuant to a Subsequent Exchange Offer in exchange for Registrable Securities
acquired by the broker-dealer directly from the Company. 
 “Rule 144,” “Rule 405” and “Rule
415” shall mean, in each case, such rule promulgated under the Securities Act (or any successor provision), as the same shall be amended from time to time. 
 “Securities” shall mean, collectively, approximately $1.4 billion in aggregate principal amount of the Company’s 9.0% Senior Secured Notes due 2015 and the Company’s
10.0% Senior Secured Notes due 2018 to be issued to the holders in the Exchange Offer, and securities issued in exchange therefor or in lieu thereof pursuant to the Indenture. Each Security is entitled to the benefit of the guarantees provided for
in the Indenture (the “Guarantees”) and, unless the context otherwise requires, any reference herein to a “Security,” an “Exchange Security” or a “Registrable Security” shall include a reference to the
related Guarantees. 
  

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 “Securities Act” shall mean the Securities Act of 1933, or any successor thereto, as the
same shall be amended from time to time. 
 “Special Interest” shall have the meaning assigned thereto in Section 2(b)
hereof. 
 “Subsequent Exchange Offer” shall have the meaning assigned thereto in Section 2(a) hereof. 
 “Trustee” shall mean The Bank of New York Mellon Trust Company, N.A., as trustee under the Indenture, together with any successors in
such capacity. 
 “Trust Indenture Act” shall mean the Trust Indenture Act of 1939, or any successor thereto, and the rules,
regulations and forms promulgated thereunder, all as the same shall be amended from time to time. 
 Unless the context otherwise requires,
any reference herein to a “Section” or “clause” refers to a Section or clause, as the case may be, of this Agreement, and the words “herein,” “hereof” and “hereunder” and other words of similar
import refer to this Agreement as a whole and not to any particular Section or other subdivision. 
 2. Registration Under the Securities
Act. 
 (a) Subject to the last sentence of this Section 2(a), if the Securities have not become Freely Tradable on
or before the Free Trade Date, the Company and the Guarantors agree to use all commercially reasonable efforts to (i) file under the Securities Act a registration statement relating to an offer to exchange (such registration statement, the
“Exchange Registration Statement,” and such offer, the “Subsequent Exchange Offer”) any and all of the Securities for a like aggregate principal amount of debt securities issued by the Company and guaranteed by the
Guarantors, which debt securities and guarantees are substantially identical to the Securities and the related Guarantees, respectively (and are entitled to the benefits of a trust indenture that is substantially identical to the Indenture or is the
Indenture and that has been qualified under the Trust Indenture Act), except that they have been registered pursuant to an effective registration statement under the Securities Act and do not contain provisions for the additional interest
contemplated in Section 2(b) below (such new debt securities are hereinafter called “Exchange Securities”), (ii) cause the Exchange Registration Statement to become effective under the Securities Act, (iii) commence
the Subsequent Exchange Offer promptly after such Exchange Registration Statement has become effective, (iv) hold the Subsequent Exchange Offer open for at least 20 Business Days (or longer if required by applicable law) after the date that
notice of the Subsequent Exchange Offer is mailed to holders of the Securities, (v) exchange Exchange Securities for all Registrable Securities that have been properly tendered and not withdrawn on or prior to the expiration of the Subsequent
Exchange Offer and (vi) consummate the Subsequent Exchange Offer on the earliest practicable date after the Exchange Registration Statement has become affected, but in no event later than 30 Business Days thereafter (such 30th Business Day
being the “Consummation Date”). The Subsequent Exchange Offer will be registered under the Securities Act on the appropriate form and will comply with all applicable tender offer rules and regulations under the Exchange Act. The
Subsequent Exchange Offer will be deemed to have been “completed” only if the debt securities and related guarantees received by holders other than Restricted Holders in the Subsequent Exchange Offer for Registrable Securities are, upon
receipt, transferable by each such holder without restriction under the Securities Act and the Exchange Act and without material restrictions under the blue sky or securities laws of a substantial majority of the states of the United States of
America. The Subsequent Exchange Offer shall be deemed to have been completed upon the earlier to occur of (A) the Company having exchanged the Exchange Securities for all outstanding Registrable Securities pursuant to the Subsequent Exchange
Offer and (B) the Company having exchanged, pursuant to the Subsequent Exchange Offer, Exchange Securities for all Registrable Securities that have been properly tendered and not withdrawn before the expiration of 

  

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the Subsequent Exchange Offer, which shall be on a date that is at least 20 Business Days following the commencement of the Subsequent Exchange Offer. The
Company and the Guarantors agree (I) to include in the Exchange Registration Statement a prospectus for use in any resales by any holder of Exchange Securities that is a broker-dealer and (II) to keep such Exchange Registration Statement
effective for a period (the “Resale Period”) beginning when Exchange Securities are first issued in the Subsequent Exchange Offer and ending upon the earlier of the expiration of the 180th day after the Subsequent Exchange Offer has
been completed or such time as such broker-dealers no longer own any Registrable Securities. With respect to such Exchange Registration Statement, such holders shall have the benefit of the rights of indemnification and contribution set forth in
Sections 6(a), (b), (c) and (d) hereof. The obligations of the Company and the Guarantors set forth in this Section 2(a) shall cease on the date on which the Securities become Freely Tradable. 
 (b) If (i) the Subsequent Exchange Offer has not been consummated prior to the Consummation Date, (ii) the Securities have not
become Freely Tradable on or before the Free Trade Date, or (iii) any Exchange Registration Statement required by this Agreement is filed and declared effective, but shall thereafter cease to be effective or fail to be usable for its intended
purpose without being succeeded by a post-effective amendment or prospectus supplement to such Exchange Registration Statement that cures such failure and that is itself declared effectively promptly (each such event referred to in clauses
(i) through (iii), a “Registration Default,” and the period during which a Registration Default has occurred and is continuing, the “Registration Default Period”), then, as liquidated damages for such
Registration Default, subject to the provisions of Section 8(b), special interest (“Special Interest”), in addition to the Base Interest, shall accrue at a per annum rate of 0.25% for the first 90 days of the Registration
Default Period, at a per annum rate of 0.50% for the second 90 days of the Registration Default Period, at a per annum rate of 0.75% for the third 90 days of the Registration Default Period and at a per annum rate of 1.0% thereafter for the
remaining portion of the Registration Default Period, provided that in no event shall the Company be required to pay Special Interest for more than one Registration Default at any given time. The Registration Default Period shall terminate on the
date on which (i) the Securities become Freely Tradable or (ii) the Exchange Registration Statement has been declared effective and the Subsequent Exchange Offer has been consummated. 
 (c) The Company shall take, and shall cause the Guarantors to take, all actions necessary or advisable to be taken to ensure that the
transactions contemplated herein are effected as so contemplated, including all actions necessary or desirable to register the Guarantees under the Exchange Registration Statement contemplated in Section 2(a) hereof. 
 (d) Any reference herein to a registration statement as of any time shall be deemed to include any document incorporated, or deemed to be
incorporated, therein by reference as of such time and any reference herein to any post-effective amendment to a registration statement as of any time shall be deemed to include any document incorporated, or deemed to be incorporated, therein by
reference as of such time. 
 3. Registration Procedures. 
 If the Company and the Guarantors file a registration statement pursuant to Section 2(a), the following provisions shall apply: 
 (a) At or before the Effective Time of the Exchange Registration, the Company and the Guarantors shall qualify the Indenture under the
Trust Indenture Act. 
 (b) In the event that such qualification would require the appointment of a new trustee under the
Indenture, the Company and the Guarantors shall appoint a new trustee thereunder pursuant to the applicable provisions of the Indenture. 
  

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 (c) In connection with the Company’s and the Guarantors’ obligations with
respect to the registration of Exchange Securities as contemplated by Section 2(a) (the “Exchange Registration”), if applicable, the Company and the Guarantors shall, as soon as practicable (or as otherwise specified):

 (i) prepare and file with the Commission an Exchange Registration Statement on any form that may be utilized by the Company
and the Guarantors and that shall permit the Subsequent Exchange Offer and resales of Exchange Securities by broker-dealers during the Resale Period to be effected as contemplated by Section 2(a), and use all commercially reasonable efforts to
cause such Exchange Registration Statement to become effective; 
 (ii) prepare and file with the Commission such amendments
and supplements to such Exchange Registration Statement and the prospectus included therein as may be necessary to effect and maintain the effectiveness of such Exchange Registration Statement for the periods and purposes contemplated in
Section 2(a) hereof and as may be required by the applicable rules and regulations of the Commission and the instructions applicable to the form of such Exchange Registration Statement, and promptly provide each broker-dealer holding Exchange
Securities with such number of copies of the prospectus included therein (as then amended or supplemented), in conformity in all material respects with the requirements of the Securities Act and the Trust Indenture Act and the rules and regulations
of the Commission thereunder, as such broker-dealer reasonably may request prior to the expiration of the Resale Period, for use in connection with resales of Exchange Securities; 
 (iii) notify each broker-dealer that has requested or received copies of the prospectus included in such Exchange Registration Statement,
and confirm such advice in writing, (A) when such Exchange Registration Statement or the prospectus included therein or any prospectus amendment or supplement or post-effective amendment has been filed, and, with respect to such Exchange
Registration Statement or any post-effective amendment, when the same has become effective, (B) of any comments by the Commission and by the blue sky or securities commissioner or regulator of any state with respect thereto or any request by
the Commission for amendments or supplements to such Exchange Registration Statement or prospectus or for additional information, (C) of the issuance by the Commission of any stop order suspending the effectiveness of such Exchange Registration
Statement or the initiation or threatening of any proceedings for that purpose, (D) if at any time the representations and warranties of the Company and the Guarantors contemplated by Section 5 cease to be true and correct in all material
respects, (E) of the receipt by the Company of any notification with respect to the suspension of the qualification of the Exchange Securities for sale in any jurisdiction or the initiation or threatening of any proceeding for such purpose, or
(F) at any time during the Resale Period when a prospectus is required to be delivered under the Securities Act, that such Exchange Registration Statement, prospectus, prospectus amendment or supplement or post-effective amendment does not
conform in all material respects to the applicable requirements of the Securities Act and the Trust Indenture Act and the rules and regulations of the Commission thereunder or contains an untrue statement of a material fact or omits to state any
material fact required to be stated therein or necessary to make the statements therein not misleading in light of the circumstances then existing; 
 (iv) in the event that the Company and the Guarantors would be required, pursuant to Section 3(c)(iii)(F) above, to notify any broker-dealers holding Exchange Securities, prepare and furnish to each such holder a
reasonable number of copies of a prospectus supplemented or amended so that, as thereafter delivered to purchasers of such Exchange Securities during the Resale Period, such prospectus shall conform in all material respects to the applicable
requirements of the Securities Act and the Trust Indenture Act and the rules and regulations of the Commission thereunder and shall not contain an untrue statement of a material fact or omit to state a material fact required to be stated therein or
necessary to make the statements therein not misleading in light of the circumstances then existing; 
  

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 (v) use all commercially reasonable efforts to obtain the withdrawal of any order
suspending the effectiveness of such Exchange Registration Statement or any post-effective amendment thereto at the earliest practicable date; 
 (vi) use all commercially reasonable efforts to (A) register or qualify the Exchange Securities under the securities laws or blue sky laws of such jurisdictions as are contemplated by Section 2(a) no later
than the commencement of the Subsequent Exchange Offer, (B) keep such registrations or qualifications in effect and comply with such laws so as to permit the continuance of offers, sales and dealings therein in such jurisdictions until the
expiration of the Resale Period and (C) take any and all other actions as may be reasonably necessary or advisable to enable each broker-dealer holding Exchange Securities to consummate the disposition thereof in such jurisdictions;
provided, however, that neither the Company nor any of the Guarantors shall be required for any such purpose to (1) qualify as a foreign corporation in any jurisdiction wherein it would not otherwise be required to qualify but for the
requirements of this Section 3(c)(vi), (2) consent to general service of process in any such jurisdiction or (3) in the case of the Company, make any changes to its certificate of incorporation or bylaws or any agreement between it
and its stockholders, and in the case of the Guarantors, make any changes to (x) the certificate (or articles) of incorporation, certificate (or articles) of organization, certificate (or articles) of formation or certificate of limited
partnership, as the case may be, and any amendments thereto, of any Guarantor, (y) the bylaws, limited liability company agreement, operating agreement or partnership agreement, as the case may be, and any amendments thereto, of any Guarantor
or (z) any agreement between any Guarantor and its stockholders, shareholders, members or partners; 
 (vii) use all
commercially reasonable efforts to obtain the consent or approval of each governmental agency or authority, whether federal, state or local, that may be required to effect the Exchange Registration, the Subsequent Exchange Offer and the offering and
sale of Exchange Securities by broker-dealers during the Resale Period; 
 (viii) provide a CUSIP number for all Exchange
Securities, not later than the applicable Effective Time; and 
 (ix) comply with all applicable rules and regulations of the
Commission, and make generally available to its securityholders as soon as practicable but no later than 18 months after the Effective Time of such Exchange Registration Statement, an earnings statement of the Company and its subsidiaries complying
with Section 11(a) of the Securities Act (including, at the option of the Company, Rule 158 thereunder). 
 (d) Until the
expiration of one year after the Closing Date, the Company and the Guarantors will not, and will not permit any of their “affiliates” (as defined in Rule 144) to, resell any of the Securities that have been reacquired by any of them
except pursuant to an effective registration statement under the Securities Act. 
 4. Registration Expenses. 
 The Company and the Guarantors agree to bear and to pay or cause to be paid promptly all expenses incident to the Company’s and the Guarantors’
performance of or compliance with this Agreement, including (a) all Commission and any FINRA registration, filing and review fees and expenses including fees and disbursements of counsel for the placement or sales agent or underwriters in
connection with such registration, filing and review; (b) all expenses relating to the preparation, printing, 

  

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production, distribution and reproduction of each registration statement required to be filed hereunder, each prospectus included therein or prepared for
distribution pursuant hereto, each amendment or supplement to the foregoing, the expenses of preparing the Securities for delivery and the expenses of printing or producing any blue sky or legal investment memoranda and all other documents in
connection with the offering, sale or delivery of Securities to be disposed of (including certificates representing the Securities); (c) messenger, telephone and delivery expenses relating to the offering, sale or delivery of Securities and the
preparation of documents referred in clause (b) above; (d) fees and expenses of the Trustee under the Indenture, any agent of the Trustee and any counsel for the Trustee and of any collateral agent or custodian; (e) internal expenses
(including all salaries and expenses of the Company’s or Guarantors’ officers and employees performing legal or accounting duties); (f) fees, disbursements and expenses of counsel and independent certified public accountants of the
Company (including the expenses of any opinions or “cold comfort” letters required by or incident to such performance and compliance); (g) any fees charged by securities rating services for rating the Securities; and (h) fees,
expenses and disbursements of any other persons, including special experts, retained by the Company or its Guarantors in connection with this Agreement (collectively, the “Registration Expenses”). To the extent that any reasonable
fees are incurred, assumed or paid by any holder of Registrable Securities or its counsel, the Company or its Guarantors shall reimburse such person for the full amount of such reasonable fees so incurred, assumed or paid promptly after receipt of a
request therefor. Notwithstanding the foregoing, the holders of the Registrable Securities being registered shall pay all agency fees and commissions attributable to the sale of such Registrable Securities. 
 5. Representations and Warranties. 
 The Company and each of the Guarantors represents and warrants to, and agrees with, the Dealer Managers and each of the holders from time to time of Registrable Securities that: 
 (a) Each registration statement covering Registrable Securities and each prospectus (including any preliminary or summary prospectus)
contained therein or furnished pursuant to Section 3(c) hereof and any further amendments or supplements to any such registration statement or prospectus, when it becomes effective or is filed with the Commission, as the case may be, will
conform in all material respects to the requirements of the Securities Act and the Trust Indenture Act and the rules and regulations of the Commission thereunder and will not contain an untrue statement of a material fact or omit to state a material
fact required to be stated therein or necessary to make the statements therein not misleading; and at all times subsequent to the Effective Time when a prospectus would be required to be delivered under the Securities Act, other than from
(i) such time as a notice has been given to holders of Registrable Securities pursuant to Section 3(c)(iii)(F) hereof until (ii) such time as the Company furnishes an amended or supplemented prospectus pursuant to
Section 3(c)(iv) hereof, each such registration statement, and each prospectus (including any summary prospectus) contained therein or furnished pursuant to Section 3(c) hereof, as then amended or supplemented, will conform in all material
respects to the requirements of the Securities Act and the Trust Indenture Act and the rules and regulations of the Commission thereunder and will not contain an untrue statement of a material fact or omit to state a material fact required to be
stated therein or necessary to make the statements therein not misleading in the light of the circumstances then existing; provided, however, that this representation and warranty shall not apply to any statements or omissions made in
reliance upon and in conformity with information furnished in writing to the Company by a holder of Registrable Securities expressly for use therein. 
 (b) Any documents incorporated by reference in any prospectus referred to in Section 5(a) hereof, when they become or became effective or are or were filed with the Commission, as the case may be, will conform or
conformed in all material respects to the requirements of the Securities Act or the Exchange Act, as applicable, and none of such documents will contain or contained an untrue statement of a material fact or will omit or omitted to state a material
fact required to be stated therein 

  

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or necessary to make the statements therein not misleading; provided, however, that this representation and warranty shall not apply to any statements
or omissions made in reliance upon and in conformity with information furnished in writing to the Company by a holder of Registrable Securities expressly for use therein. 
 (c) The compliance by the Company and the Guarantors with all of the provisions of this Agreement and the consummation of the transactions
herein contemplated will not conflict with or result in a material breach of any of the terms or provisions of, or constitute a default under, any indenture, mortgage, deed of trust, loan agreement or other agreement or instrument to which the
Company or any subsidiary of the Company is a party or by which the Company or any subsidiary of the Company is bound or to which any of the property or assets of the Company or any subsidiary of the Company is subject, nor will such action result
in any violation of the provisions of the articles of incorporation, as amended, or the bylaws of the Company; the certificate (or articles) of incorporation, certificate (or articles) of organization, certificate (or articles) of formation or
certificate of limited partnership, as the case may be, and any amendments thereto, of any Guarantor; the bylaws, limited liability company agreement, operating agreement or partnership agreement, as the case may be, and any amendments thereto, of
any Guarantor; or any material violation of any statute or any order, rule or regulation of any court or governmental agency or body having jurisdiction over the Company or any subsidiary of the Company or any of their properties; and no consent,
approval, authorization, order, registration or qualification of or with any such court or governmental agency or body is required for the consummation by the Company and the Guarantors of the transactions contemplated by this Agreement, except the
registration under the Securities Act of the Securities, qualification of the Indenture under the Trust Indenture Act and such consents, approvals, authorizations, registrations or qualifications as may be required under State securities or blue sky
laws in connection with the offering and distribution of the Securities. 
 (d) This Agreement has been duly authorized,
executed and delivered by the Company and each Guarantor. 
 6. Indemnification. 
 (a) Indemnification by the Company and the Guarantors. The Company and the Guarantors, jointly and severally, will indemnify and
hold harmless each of the holders of Registrable Securities included in an Exchange Registration Statement, and each person who participates as a placement or sales agent or as an underwriter in any offering or sale of such Registrable Securities
against any losses, claims, damages or liabilities, joint or several, to which such holder, agent or underwriter may become subject under the Securities Act or otherwise, insofar as such losses, claims, damages or liabilities (or actions in respect
thereof) arise out of or are based upon an untrue statement or alleged untrue statement of a material fact contained in any Exchange Registration Statement under which such Registrable Securities were registered under the Securities Act, or any
preliminary, final or summary prospectus contained therein or furnished by the Company to any such holder, agent or underwriter, or any amendment or supplement thereto, or arise out of or are based upon the omission or alleged omission to state
therein a material fact required to be stated therein or necessary to make the statements therein not misleading, and will reimburse such holder, such agent and such underwriter for any legal or other expenses reasonably incurred by them in
connection with investigating or defending any such action or claim as such expenses are incurred; provided, however, that neither the Company nor any Guarantor shall be liable to any such person in any such case to the extent that any such
loss, claim, damage or liability arises out of or is based upon an untrue statement or alleged untrue statement or omission or alleged omission made in any registration statement contemplated hereunder, or preliminary, final or summary prospectus,
or amendment or supplement thereto, in reliance upon and in conformity with written information furnished to the Company by such person expressly for use therein. 
  

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 (b) Notices of Claims, Etc. Promptly after receipt by an indemnified party under
subsection (a) above of written notice of the commencement of any action, such indemnified party shall, if a claim in respect thereof is to be made against an indemnifying party pursuant to the indemnification provisions of or contemplated by
this Section 6, notify such indemnifying party in writing of the commencement of such action; but the omission so to notify the indemnifying party shall not relieve it from any liability which it may have to any indemnified party otherwise than
under the indemnification provisions of or contemplated by Section 6(a) hereof. In case any such action shall be brought against any indemnified party and it shall notify an indemnifying party of the commencement thereof, such indemnifying
party shall be entitled to participate therein and, to the extent that it shall wish, jointly with any other indemnifying party similarly notified, to assume the defense thereof, with counsel reasonably satisfactory to such indemnified party (who
shall not, except with the consent of the indemnified party, be counsel to the indemnifying party), and, after notice from the indemnifying party to such indemnified party of its election so to assume the defense thereof, such indemnifying party
shall not be liable to such indemnified party for any legal expenses of other counsel or any other expenses, in each case subsequently incurred by such indemnified party, in connection with the defense thereof other than reasonable costs of
investigation. No indemnifying party shall, without the written consent of the indemnified party, effect the settlement or compromise of, or consent to the entry of any judgment with respect to, any pending or threatened action or claim in respect
of which indemnification or contribution may be sought hereunder (whether or not the indemnified party is an actual or potential party to such action or claim) unless such settlement, compromise or judgment (i) includes an unconditional release
of the indemnified party from all liability arising out of such action or claim and (ii) does not include a statement as to or an admission of fault, culpability or a failure to act by or on behalf of any indemnified party. 
 (c) Contribution. If for any reason the indemnification provisions contemplated by Section 6(a) are unavailable to or
insufficient to hold harmless an indemnified party in respect of any losses, claims, damages or liabilities (or actions in respect thereof) referred to therein, then each indemnifying party shall contribute to the amount paid or payable by such
indemnified party as a result of such losses, claims, damages or liabilities (or actions in respect thereof) in such proportion as is appropriate to reflect the relative fault of the indemnifying party and the indemnified party in connection with
the statements or omissions which resulted in such losses, claims, damages or liabilities (or actions in respect thereof), as well as any other relevant equitable considerations. The relative fault of such indemnifying party and indemnified party
shall be determined by reference to, among other things, whether the untrue or alleged untrue statement of a material fact or omission or alleged omission to state a material fact relates to information supplied by such indemnifying party or by such
indemnified party, and the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent such statement or omission. The parties hereto agree that it would not be just and equitable if contributions pursuant
to this Section 6(c) were determined by pro rata allocation (even if the holders or any agents or underwriters or all of them were treated as one entity for such purpose) or by any other method of allocation that does not take account of the
equitable considerations referred to in this Section 6(c). The amount paid or payable by an indemnified party as a result of the losses, claims, damages, or liabilities (or actions in respect thereof) referred to above shall be deemed to
include any legal or other fees or expenses reasonably incurred by such indemnified party in connection with investigating or defending any such action or claim. Notwithstanding the provisions of this Section 6(c), no holder shall be required
to contribute any amount in excess of the amount by which the dollar amount of the proceeds received by such holder from the sale of any Registrable Securities (after deducting any fees, discounts and commissions applicable thereto) exceeds the
amount of any damages that such holder has otherwise been required to pay by reason of such untrue or alleged untrue statement or omission or alleged omission, and no underwriter shall be required to contribute any amount in excess of the amount by
which the total price at which the Registrable Securities underwritten by it and distributed to the public were offered to the public exceeds the amount of any damages that such underwriter has otherwise been required to 

  

 10 

 
pay by reason of such untrue or alleged untrue statement or omission or alleged omission. No person guilty of fraudulent misrepresentation (within the
meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any person who was not guilty of such fraudulent misrepresentation. The holders’ obligations in this Section 6(c) to contribute shall be several in
proportion to the principal amount of Registrable Securities registered by them and not joint. 
 (d) The obligations of the
Company and the Guarantors under this Section 6 shall be in addition to any liability which the Company or the Guarantors may otherwise have and shall extend, upon the same terms and conditions, to each officer, director and partner of each
holder, agent and underwriter and each person, if any, who controls any holder, agent or underwriter within the meaning of the Securities Act; and the obligations of the holders and any agents or underwriters contemplated by this Section 6
shall be in addition to any liability which the respective holder, agent or underwriter may otherwise have and shall extend, upon the same terms and conditions, to each officer and director of the Company or any Guarantor (including any person who,
with his consent, is named in any registration statement as about to become a director of the Company or any Guarantor) and to each person, if any, who controls the Company within the meaning of the Securities Act. 
 7. Rule 144. 
 The Company covenants
to the holders of Registrable Securities that to the extent it shall be required to do so under the Exchange Act, the Company shall timely file the reports required to be filed by it under the Exchange Act or the Securities Act (including the
reports under Section 13 and 15(d) of the Exchange Act referred to in subparagraph (c)(1) of Rule 144 adopted by the Commission under the Securities Act) and the rules and regulations adopted by the Commission thereunder, and shall take such
further action as any holder of Registrable Securities may reasonably request, all to the extent required from time to time to enable such holder to sell Registrable Securities without registration under the Securities Act within the limitations of
the exemption provided by Rule 144 under the Securities Act, as such Rule may be amended from time to time, or any similar or successor rule or regulation hereafter adopted by the Commission. Upon the request of any holder of Registrable Securities
in connection with that holder’s sale pursuant to Rule 144, the Company shall deliver to such holder a written statement as to whether it has complied with such requirements. 
 8. Miscellaneous. 
 (a) No Inconsistent Agreements. The Company and each Guarantor represents, warrants, covenants and agrees that it has not granted, and shall not grant, registration rights with respect to Registrable Securities or any other
securities which would be inconsistent with the terms contained in this Agreement. 
 (b) Specific Performance. The
parties hereto acknowledge that there would be no adequate remedy at law if the Company or any Guarantor fails to perform any of its obligations hereunder and that the Dealer Managers and the holders from time to time of the Registrable Securities
may be irreparably harmed by any such failure, and accordingly agree that the Dealer Managers and such holders, in addition to any other remedy to which they may be entitled at law or in equity, shall be entitled to seek specific performance of the
obligations of the Company and the Guarantors under this Agreement in accordance with the terms and conditions of this Agreement, in any court of the United States or any state thereof having jurisdiction. 
 (c) Notices. All notices, requests, claims, demands, waivers and other communications hereunder shall be in writing and shall be
deemed to have been duly given when delivered by hand, if delivered personally or by courier, or three days after being deposited in the mail (registered or certified mail, postage prepaid, return receipt requested) as follows: If to the Company, to
it at 13737 Noel Road, Dallas, Texas 75240, Attention: Chief Financial Officer, and if to a holder, to the address 

  

 11 

 
of such holder set forth in the security register or other records of the Company, or to such other address as the Company or any such holder may have
furnished to the other in writing in accordance herewith, except that notices of change of address shall be effective only upon receipt. 
 (d) Parties in Interest. All the terms and provisions of this Agreement shall be binding upon, shall inure to the benefit of and shall be enforceable by the parties hereto and the holders from time to time of
the Registrable Securities and the respective successors and assigns of the parties hereto and such holders. In the event that any transferee of any holder of Registrable Securities shall acquire Registrable Securities, in any manner, whether by
gift, bequest, purchase, operation of law or otherwise, such transferee shall, without any further writing or action of any kind, be deemed a beneficiary hereof for all purposes and such Registrable Securities shall be held subject to all of the
terms of this Agreement, and by taking and holding such Registrable Securities such transferee shall be entitled to receive the benefits of, and be conclusively deemed to have agreed to be bound by all of the applicable terms and provisions of this
Agreement. If the Company shall so request, any such successor, assign or transferee shall agree in writing to acquire and hold the Registrable Securities subject to all of the applicable terms hereof. 
 (e) Survival. The respective indemnities, agreements, representations, warranties and each other provision set forth in this
Agreement or made pursuant hereto shall remain in full force and effect regardless of any investigation (or statement as to the results thereof) made by or on behalf of any holder of Registrable Securities, any director, officer or partner of such
holder, any agent or underwriter or any director, officer or partner thereof, or any controlling person of any of the foregoing, and shall survive delivery of and payment for the Registrable Securities pursuant to the Dealer Manager Agreement and
the transfer and registration of Registrable Securities by such holder and the consummation of a Subsequent Exchange Offer. 
 (f) Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of New York. 
 (g) Headings. The descriptive headings of the several sections and paragraphs of this Agreement are inserted for convenience only, do not constitute a part of this Agreement and shall not affect in any way the
meaning or interpretation of this Agreement. 
 (h) Entire Agreement; Amendments. This Agreement and the other writings
referred to herein (including the Indenture, the Dealer Manager Agreement and the form of Securities) or delivered pursuant hereto which form a part hereof contain the entire understanding of the parties with respect to its subject matter. This
Agreement supersedes all prior agreements and understandings between the parties with respect to its subject matter. This Agreement may be amended and the observance of any term of this Agreement may be waived (either generally or in a particular
instance and either retroactively or prospectively) only by a written instrument duly executed by the Company, the Guarantors and the holders of at least a majority in aggregate principal amount of the Registrable Securities at the time outstanding.
Each holder of any Registrable Securities at the time or thereafter outstanding shall be bound by any amendment or waiver effected pursuant to this Section 8(h), whether or not any notice, writing or marking indicating such amendment or waiver
appears on such Registrable Securities or is delivered to such holder. 
 (i) Inspection. For so long as this Agreement
shall be in effect, this Agreement and a complete list of the names and addresses of all the holders of Registrable Securities shall be made available for inspection and copying on any Business Day by any holder of Registrable Securities for proper
purposes only (which shall include any purpose related to the rights of the holders of Registrable Securities under the Securities, the Indenture and this Agreement) at the offices of the Company at the address thereof set forth in Section 8(c)
above and at the office of the Trustee under the Indenture. 
  

 12 

 (j) Counterparts. This Agreement may be executed by the parties in counterparts,
each of which shall be deemed to be an original, but all such respective counterparts shall together constitute one and the same instrument. 
 (signature pages follow) 
  

 13 

 If the foregoing is in accordance with your understanding, please sign and return to us two counterparts
hereof, and upon the acceptance hereof by you, on behalf of each of the holders, this letter and such acceptance hereof shall constitute a binding agreement among each of the holders, the Guarantors and the Company. 
  

			
	Very truly yours,
	
	TENET HEALTHCARE CORPORATION
		
	By:	 	 /s/    Biggs C. Porter

	Name:	 	Biggs C. Porter
	Title:	 	Chief Financial Officer

			
	CORAL GABLES HOSPITAL, INC., as:
	General Partner of CGH HOSPITAL, LTD.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	FMC ACQUISITION, INC., as:
	General Partner of FMC HOSPITAL, LTD.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	TENET PHYSICIAN SERVICES—HILTON HEAD, INC., as:
	General Partner of HILTON HEAD HEALTH SYSTEM, L.P.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	CYPRESS FAIRBANKS MEDICAL CENTER, INC., as:
	General Partner of NEW MEDICAL HORIZONS II, LTD.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	TENET LOUISIANA, INC., as:
	Sole and Managing Member of NORTHSHORE
	REGIONAL MEDICAL CENTER, L.L.C.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer

			
	TENET TEXAS, INC., as:
	General Partner of TENET FRISCO, LTD.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	TENET HEALTHSYSTEM PHILADELPHIA,
INC., as:
	Managing Member of TENET HEALTHSYSTEM
	HAHNEMANN, LLC
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	TENET HEALTHSYSTEM PHILADELPHIA,
INC., as:
	Managing Member of TENET HEALTHSYSTEM
	ST. CHRISTOPHER’S HOSPITAL FOR
	CHILDREN, L.L.C.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	TENET TEXAS, INC., as:
	General Partner of TENET HOSPITALS LIMITED
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer
	
	LIFEMARK HOSPITALS, INC., as:
	General Partner of TH HEALTHCARE, LTD.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer

	
	 AMERICAN MEDICAL (CENTRAL), INC.

	 AMI INFORMATION SYSTEMS GROUP, INC.

	 AMISUB (HEIGHTS), INC.

	 AMISUB (HILTON HEAD), INC.

	 AMISUB (SFH), INC.

	 AMISUB (TWELVE OAKS), INC.

	 AMISUB OF NORTH CAROLINA, INC.

	 AMISUB OF SOUTH CAROLINA, INC.

	 AMISUB OF TEXAS, INC.

	 BROOKWOOD HEALTH SERVICES, INC.

	 COASTAL CAROLINA MEDICAL CENTER, INC.

	 COMMUNITY HOSPITAL OF LOS GATOS, INC.

	 CORAL GABLES HOSPITAL, INC.

	 CYPRESS FAIRBANKS MEDICAL CENTER, INC.

	 DELRAY MEDICAL CENTER, INC.

	 DOCTORS HOSPITAL OF MANTECA, INC.

	 DOCTORS MEDICAL CENTER OF MODESTO, INC.

	 EAST COOPER COMMUNITY HOSPITAL, INC.

	 FMC ACQUISITION, INC.

	 FMC MEDICAL, INC.

	 FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER

	 FRYE REGIONAL MEDICAL CENTER, INC.

	 JFK MEMORIAL HOSPITAL, INC.

	 LAKEWOOD REGIONAL MEDICAL CENTER, INC.

	 LIFEMARK HOSPITALS OF FLORIDA, INC.

	 LIFEMARK HOSPITALS, INC.

	 LOS ALAMITOS MEDICAL CENTER, INC.

	 MCF, INC., A FLORIDA CORPORATION

	 NORTH FULTON MEDICAL CENTER, INC.

	 ORNDA HOSPITAL CORPORATION

	 PALM BEACH GARDENS COMMUNITY HOSPITAL, INC.

	 PLACENTIA-LINDA HOSPITAL, INC.

	 SAN RAMON REGIONAL MEDICAL CENTER, INC.

	 SIERRA VISTA HOSPITAL, INC.

	 TENET CALIFORNIA, INC.

	 TENET FLORIDA, INC.

	 TENET GOOD SAMARITAN, INC.

	 TENET HEALTHSYSTEM BARTLETT, INC.

	 TENET HEALTHSYSTEM CFMC, INC.

	 TENET HEALTHSYSTEM DESERT, INC.

	 TENET HEALTHSYSTEM DI, INC.

	 TENET HEALTHSYSTEM GB, INC.

	 TENET HEALTHSYSTEM HEALTHCORP

	 TENET HEALTHSYSTEM HOLDINGS, INC.

	 TENET HEALTHSYSTEM MEDICAL, INC.

	 TENET HEALTHSYSTEM NORRIS, INC.

	 TENET HEALTHSYSTEM NORTH SHORE, INC.

	 TENET HEALTHSYSTEM PHILADELPHIA, INC.

	 TENET HEALTHSYSTEM SGH, INC.

	 TENET HEALTHSYSTEM SL, INC.

	 TENET HEALTHSYSTEM SPALDING, INC.

			
	TENET HIALEAH HEALTHSYSTEM, INC.
	TENET HOSPITALS, INC.
	TENET LOUISIANA, INC.
	TENET MISSOURI, INC.
	TENET PHYSICIAN SERVICES—HILTON     HEAD, INC.
	TENET SOUTH FULTON, INC.
	TENET ST. MARY’S, INC.
	TENET TEXAS, INC.
	TENETSUB TEXAS, INC.
	TWIN CITIES COMMUNITY HOSPITAL, INC.
	USC UNIVERSITY HOSPITAL, INC.
	WEST BOCA MEDICAL CENTER, INC.
	
	 /s/    Jeffrey S. Sherman

	Name:	 	Jeffrey S. Sherman
	Title:	 	Treasurer

			
	The foregoing Agreement is hereby confirmed
	and accepted as of the date first above written.
	
	CITIGROUP GLOBAL MARKETS INC.
	(on behalf of the holders)
		
	By:	 	 /s/    Richard Hardy

	Name:	 	Richard Hardy
	Title:	 	Director
	
	BANC OF AMERICA SECURITIES LLC
	(on behalf of the holders)
		
	By:	 	 /s/    R. Sean Snipes

	Name:	 	R. Sean Snipes
	Title:	 	Managing Director
	
	GOLDMAN, SACHS & CO.
	(on behalf of the holders)
		
	By:	 	 /s/    Goldman, Sachs & Co.

		 	Goldman, Sachs & Co.
	
	SCOTIA CAPITAL (USA) INC.
	(on behalf of the holders)
		
	By:	 	 /s/    Greg Greer

	Name:	 	Greg Greer
	Title:	 	Managing Director

 Schedule I 
 Guarantors 
 American Medical (Central), Inc. 
 AMI Information Systems Group, Inc. 
 Amisub (Heights), Inc. 
 Amisub (Hilton Head), Inc. 
 Amisub (SFH), Inc. 
 Amisub (Twelve Oaks), Inc. 
 Amisub of North Carolina, Inc. 
 Amisub of South Carolina, Inc. 
 Amisub of Texas, Inc. 
 Brookwood Health Services, Inc. 
 CGH Hospital, Ltd. 
 Coastal Carolina Medical Center, Inc. 
 Community Hospital of Los Gatos, Inc. 
 Coral Gables Hospital, Inc. 
 Cypress Fairbanks Medical Center, Inc.

 Delray Medical Center, Inc. 
 Doctors Hospital of Manteca, Inc.

 Doctors Medical Center of Modesto, Inc. 
 East Cooper Community
Hospital, Inc. 
 FMC Acquisition, Inc. 
 FMC Hospital, Ltd.

 FMC Medical, Inc. 
 Fountain Valley Regional Hospital and
Medical Center 
 Frye Regional Medical Center, Inc. 
 Hilton Head
Health System, L.P. 
 JFK Memorial Hospital, Inc. 
 Lakewood
Regional Medical Center, Inc. 
 Lifemark Hospitals of Florida, Inc. 
 Lifemark Hospitals, Inc. 
 Los Alamitos Medical Center, Inc. 
 MCF, Inc., a Florida corporation 
 New Medical Horizons II, Ltd. 
 North Fulton Medical Center, Inc. 
 NorthShore Regional Medical Center, L.L.C. 
 OrNda Hospital Corporation 
 Palm Beach Gardens Community Hospital, Inc.

 Placentia-Linda Hospital, Inc. 
 San Ramon Regional Medical
Center, Inc. 
 Sierra Vista Hospital, Inc. 
 Tenet California,
Inc. 
 Tenet Florida, Inc. 
 Tenet Frisco, Ltd. 
 Tenet Good Samaritan, Inc. 
 Tenet HealthSystem Bartlett, Inc. 
 Tenet HealthSystem CFMC, Inc. 
 Tenet HealthSystem Desert, Inc. 
 Tenet HealthSystem DI, Inc. 
 Tenet HealthSystem GB, Inc. 

 Tenet HealthSystem Hahnemann, LLC 
 Tenet HealthSystem HealthCorp 
 Tenet HealthSystem Holdings, Inc. 
 Tenet HealthSystem Medical, Inc. 
 Tenet HealthSystem Norris, Inc. 
 Tenet HealthSystem North Shore, Inc. 
 Tenet HealthSystem Philadelphia, Inc.

 Tenet HealthSystem SGH, Inc. 
 Tenet HealthSystem SL, Inc.

 Tenet HealthSystem Spalding, Inc. 
 Tenet HealthSystem St.
Christopher’s Hospital for Children, L.L.C. 
 Tenet Hialeah HealthSystem, Inc. 
 Tenet Hospitals, Inc. 
 Tenet Hospitals Limited 
 Tenet Louisiana, Inc. 
 Tenet Missouri, Inc. 
 Tenet Physician Services—Hilton Head, Inc. 
 Tenet South Fulton, Inc. 
 Tenet St. Mary’s, Inc. 
 Tenet Texas, Inc. 
 Tenetsub Texas, Inc. 
 TH Healthcare, Ltd. 
 Twin Cities Community Hospital, Inc. 
 USC University Hospital, Inc.

 West Boca Medical Center, Inc.Amendment to Employment Agreement

 Exhibit 10.19 
 AMENDMENT TO 
 EMPLOYMENT AGREEMENT 
 THIS AMENDMENT TO EMPLOYMENT AGREEMENT is entered into as of January 28, 2009, by and between Heritage Bankshares, Inc., a Virginia corporation
(hereinafter referred to as “Bankshares”), Heritage Bank, a Virginia corporation, and Michael S. Ives (the “Executive”). 
 RECITALS 
 Bankshares and Executive previously entered into an Employment Agreement as of February 7, 2005 (“Employment
Agreement”), which has been amended subsequently; and 
 Bankshares and Executive desire to amend the Employment Agreement as further
provided herein. 
 NOW, THEREFORE, in consideration of the mutual promises of the parties hereto and for other good and valuable
consideration, the receipt and adequacy whereof each party hereby acknowledges, Bankshares and Executive hereby agree that effective January 28, 2009, Sections 3 and 4 of the Employment Agreement are amended, and Section 5 is added to the
Employment Agreement, to read as follows: 
 3. TERM. The amended Term of this Agreement shall begin on January 1, 2009 and end on
December 31, 2013. Executive and Bankshares shall commence confidential discussions in 2011 for the purpose of determining whether, and if so, for what period and on what terms, to renew this Agreement for a period following the end of the
amended Term. 
 4. BASE SALARY. Executive shall receive Base Salary at the rate of $200,000 per year during 2009 and at the rate of
$250,000 per year beginning January 1, 2010, payable in substantially equal installments no less frequently than monthly (less any amounts withheld as required by law or pursuant to any benefits plan). At least annually after 2009, Bankshares
shall review and, in its sole discretion, may increase Executive’s Base Salary. If Executive’s Base 

 
Salary is increased by Bankshares, such increased Base Salary shall then constitute the Base Salary for all purposes of this Agreement and such Base Salary
shall not be reduced during the Term of this Agreement. 
 5. ANNUAL INCENTIVE BONUS. Executive shall have the opportunity to earn an
annual incentive bonus during each calendar year in the Term. Executive’s bonus, if any, shall be based upon Executive’s performance during the applicable year as determined by the Board of Directors of Bankshares in its sole discretion on
the basis of such performance factors as it deems appropriate, and any such bonus shall be no greater than 35% of Executive’s Base Salary paid during the applicable year. 
 IN WITNESS WHEREOF, the parties have executed this Amendment effective as specified above. 
  

							
		 		 	EXECUTIVE
			
	 Date: March 4, 2009
	 		 	 /s/ Michael S. Ives

		 		 	Michael S. Ives
			
		 		 	HERITAGE BANKSHARES, INC.
				
	 Date: March 4, 2009
	 		 	By:	 	 /s/ Peter M. Meredith, Jr.

		 		 		 	Chairman of the Board
			
		 		 	HERITAGE BANK
				
	 Date: March 4, 2009
	 		 	By:	 	 /s/ Peter M. Meredith, Jr.

		 		 		 	Chairman of the Board

  

 2

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