Document:

EX-4.1

 Exhibit 4.1 

TWELFTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2015, among CHS/COMMUNITY HEALTH SYSTEMS,
INC., a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) and REGIONS BANK, as successor Trustee under the
Indenture (the “Trustee”). 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered to the Trustee an Indenture as amended,
supplemented, waived or otherwise modified (the “Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 

WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental
Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of the Indenture,
the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture. 
 NOW THEREFORE,
in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the
Holders of the Securities as follows: 
 SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the
meanings assigned to them in the Indenture. 
 SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the
Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in
all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 

  
 1 

 SECTION 7. Effect of Headings. The Section headings herein are for convenience only and
shall not effect the construction of this Supplemental Indenture. 
 [Signature page follows] 

  
 2 

 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as
of this 30th day of September, 2015. 
  

	
	 CHS/Community Health Systems, Inc.,

a Delaware corporation

	
	By:  /s/ James W. Doucette                    
	     James W. Doucette
	     Senior Vice President and Treasurer
	
	 Lebanon HMA, LLC,

a Tennessee limited liability company

	
	By:  /s/ James W. Doucette                    
	     James W. Doucette
	     Senior Vice President and Treasurer

  
 3 

 
	
	 Regions Bank, as Trustee
  

By:  /s/ Paul
Williams                    

	     Paul Williams
	     Vice President

  
 4EX-4.2

 Exhibit 4.2 

NINTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2015, among CHS/COMMUNITY HEALTH SYSTEMS, INC.,
a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) and REGIONS BANK, as Trustee under the Indenture (the
“Trustee”). 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered to the Trustee an Indenture as amended,
supplemented, waived or otherwise modified (the “Indenture”), dated as of July 18, 2012, providing for the issuance of the 7.125% Senior Notes due 2020 (the “Securities”); 

WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental
Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of the Indenture,
the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture. 
 NOW THEREFORE,
in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the
Holders of the Securities as follows: 
 SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the
meanings assigned to them in the Indenture. 
 SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the
Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in
all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Effect of Headings. The Section
headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture.  

  
 1 

 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as
of this 30th day of September 2015. 
  

	
	 CHS/Community Health Systems, Inc.,

a Delaware corporation
  

	By:  /s/ James W. Doucette                    
	     James W. Doucette
	      Senior Vice President and Treasurer

 

	 Lebanon HMA, LLC,

a Tennessee limited liability company
  

	By:  /s/ James W. Doucette                    
	     James W. Doucette
	     Senior Vice President and Treasurer

  
 2 

 
	
	 Regions Bank, as Trustee
  

By:  /s/ Paul
Williams                    

	     Paul Williams
	     Vice President

  
 3EX-4.3

 Exhibit 4.3 

NINTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2015, among CHS/COMMUNITY HEALTH SYSTEMS, INC.,
a Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”), REGIONS BANK, as Trustee under the Indenture (the
“Trustee”) and Credit Suisse AG (the “Collateral Agent”). 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered to the Trustee an Indenture as amended,
supplemented, waived or otherwise modified (the “Indenture”), dated as of August 17, 2012, providing for the issuance of the 5.125% Senior Secured Notes due 2018 (the “Securities”); 

WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental
Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of the Indenture,
the Trustee, the Collateral Agent, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture. 

NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the
Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows: 

SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.

 SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the Issuer’s obligations under the Securities
on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in
all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Benefits Acknowledged. The New Subsidiary
Guarantor’s Note Guarantee is subject to the terms and conditions set forth in the Indenture. The New Subsidiary Guarantor acknowledges that it 

  
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will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture and that the guarantee and waivers made by it pursuant to
its Note Guarantee are knowingly made in contemplation of such benefits. 
 SECTION 8. Effect of Headings. The Section headings herein
are for convenience only and shall not effect the construction of this Supplemental Indenture. 
 [Signature page follows] 

  
 2 

 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as
of this 30th day of September, 2015. 
  

	
	 CHS/Community Health Systems, Inc.,

a Delaware corporation
  

	By:  /s/ James W. Doucette                    
	     James W. Doucette
	      Senior Vice President and Treasurer

 

	 Lebanon HMA, LLC,
  

a Tennessee limited liability company
  

	By:  /s/ James W. Doucette                    
	     James W. Doucette
	     Senior Vice President and Treasurer

  
 3 

 
	
	 Regions Bank, as Trustee
  

By:  /s/ Paul
Williams                    

	     Paul Williams
	     Vice President

  
 4 

 
	
	 Credit Suisse AG, as Collateral Agent

 

	By:  /s/ Doreen Barr                          
	     Name: Doreen Barr
	      Title: Authorized Signatory
  

By:  /s/ Michael
Moreno                    

	     Name: Michael Moreno
	     Title: Authorized Signatory

  
 5

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