Document:

exv4w1

EXHIBIT 4.1

 

 

VANGUARD HEALTH HOLDING COMPANY II, LLC

VANGUARD HOLDING COMPANY II, INC.

and each of the Guarantors party hereto

8% SENIOR NOTES DUE 2018

 

INDENTURE

Dated as of January 29, 2010

 

U.S. Bank National Association

as Trustee

 

 

 

 

 

CROSS-REFERENCE TABLE*

	 	 	 	 	 	 	 	 	 
	Trust Indenture	 	 	 	 	 	Indenture
	Act Section	 	 	 	Section
	310(a)(1)

	 	 	 	 	 	7.10	 
	(a)(2)

	 	 	 	 	 	7.10	 
	(a)(3)

	 	 	 	 	 	N.A.	 
	(a)(4)

	 	 	 	 	N.A.	 
	(a)(5)

	 	 	 	 	 	7.10	 
	(b)

	 	 	 	 	 	7.10	 
	(c)

	 	 	 	 	 	N.A.	 
	311(a)

	 	 	 	 	 	7.11	 
	(b)

	 	 	 	 	7.11	 
	(c)

	 	 	 	 	 	N.A.	 
	312(a)

	 	 	 	 	 	2.05	 
	(b)

	 	 	 	 	 	12.03	 
	(c)

	 	 	 	 	 	12.03	 
	313(a)

	 	 	 	 	 	7.06	 
	(b)(1)

	 	 	 	 	 	N.A.	 
	(b)(2)

	 	 	 	 	 	7.06; 7.07	 
	(c)

	 	 	 	 	 	7.06; 12.02	 
	(d)

	 	 	 	 	 	7.06	 
	314(a)

	 	 	 	 	 	4.04; 12.02, 12.05	 
	(b)

	 	 	 	 	 	N.A.	 
	(c)(1)

	 	 	 	 	 	12.04	 
	(c)(2)

	 	 	 	 	 	12.04	 
	(c)(3)

	 	 	 	 	 	N.A.	 
	(d)

	 	 	 	 	 	N.A.	 
	(e)

	 	 	 	 	 	12.05	 
	(f)

	 	 	 	 	 	N.A.	 
	315(a)

	 	 	 	 	 	7.01	 
	(b)

	 	 	 	 	 	7.05; 12.02	 
	(c)

	 	 	 	 	 	7.01	 
	(d)

	 	 	 	 	 	7.01	 
	(e)

	 	 	 	 	 	6.11	 
	316(a) (last sentence)

	 	 	 	 	 	2.09	 
	(a)(1)(A)

	 	 	 	 	 	6.05	 
	(a)(1)(B)

	 	 	 	 	 	6.04	 
	(a)(2)

	 	 	 	 	 	N.A.	 
	(b)

	 	 	 	 	 	6.07	 
	(c)

	 	 	 	 	 	2.12	 
	317(a)(1)

	 	 	 	 	 	6.08	 
	(a)(2)

	 	 	 	 	 	6.09	 
	(b)

	 	 	 	 	 	2.04	 
	318(a)

	 	 	 	 	 	12.01	 
	(b)

	 	 	 	 	 	N.A.	 
	(c)

	 	 	 	 	 	12.01	 

N.A. means not applicable.

 

			
	*	 	This cross Reference Table is not part of this Indenture.

 

 

TABLE OF CONTENTS

	 	 	 	 	 	 	 
	 	 	 	 	Page
	 
	 	 	 	 	 	 
	ARTICLE I

	DEFINITIONS AND INCORPORATION BY REFERENCE

	Section 1.01
	 	Definitions	 	 	1	 
	Section 1.02
	 	Other Definitions	 	 	26	 
	Section 1.03
	 	Incorporation by Reference of Trust Indenture Act	 	 	26	 
	Section 1.04
	 	Rules of Construction	 	 	27	 
	 
	 	 	 	 	 	 
	ARTICLE II

	THE NOTES

	Section 2.01
	 	Form and Dating	 	 	27	 
	Section 2.02
	 	Execution and Authentication	 	 	28	 
	Section 2.03
	 	Registrar and Paying Agent	 	 	29	 
	Section 2.04
	 	Paying Agent to Hold Money in Trust	 	 	29	 
	Section 2.05
	 	Holder Lists	 	 	29	 
	Section 2.06
	 	Transfer and Exchange	 	 	29	 
	Section 2.07
	 	Replacement Notes	 	 	40	 
	Section 2.08
	 	Outstanding Notes	 	 	40	 
	Section 2.09
	 	Treasury Notes	 	 	40	 
	Section 2.10
	 	Temporary Notes	 	 	40	 
	Section 2.11
	 	Cancellation	 	 	40	 
	Section 2.12
	 	Defaulted Interest	 	 	40	 
	Section 2.13
	 	CUSIP Numbers	 	 	41	 
	Section 2.14
	 	Issuance of Additional Notes	 	 	41	 
	 
	 	 	 	 	 	 
	ARTICLE III

	REDEMPTION AND PREPAYMENT

	Section 3.01
	 	Notices to Trustee	 	 	41	 
	Section 3.02
	 	Selection of Notes to Be Redeemed or Purchased	 	 	42	 
	Section 3.03
	 	Notice of Redemption	 	 	42	 
	Section 3.04
	 	Effect of Notice of Redemption	 	 	43	 
	Section 3.05
	 	Deposit of Redemption or Purchase Price	 	 	43	 
	Section 3.06
	 	Notes Redeemed or Purchased in Part	 	 	43	 
	Section 3.07
	 	Optional Redemption	 	 	43	 
	Section 3.08
	 	Mandatory Redemption	 	 	44	 
	Section 3.09
	 	Offer to Purchase by Application of Excess Proceeds	 	 	44	 
	 
	 	 	 	 	 	 
	ARTICLE IV

	COVENANTS

	Section 4.01
	 	Payment of Notes	 	 	46	 
	Section 4.02
	 	Maintenance of Office or Agency	 	 	46	 
	Section 4.03
	 	Reports to Holders	 	 	46	 
	Section 4.04
	 	Compliance Certificate	 	 	47	 

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	 	 	 	 	Page
	 
	 	 	 	 	 	 
	Section 4.05
	 	Limitation on Restricted Payments	 	 	47	 
	Section 4.06
	 	Limitation on Dividend and Other Payment Restrictions Affecting Restricted Subsidiaries	 	 	52	 
	Section 4.07
	 	Limitation on Incurrence of Additional Indebtedness and Issuance of Preferred Stock	 	 	54	 
	Section 4.08
	 	Asset Sales	 	 	57	 
	Section 4.09
	 	Limitation on Transactions with Affiliates	 	 	59	 
	Section 4.10
	 	Limitation on Liens	 	 	61	 
	Section 4.11
	 	Offer to Repurchase Upon Change of Control	 	 	61	 
	Section 4.12
	 	Payments for Consent	 	 	62	 
	Section 4.13
	 	Additional Subsidiary Guarantees	 	 	62	 
	Section 4.14
	 	Existence of Corporate Co-Issuer	 	 	63	 
	Section 4.15
	 	Suspension of Covenants	 	 	63	 
	 
	 	 	 	 	 	 
	ARTICLE V

	SUCCESSORS

	Section 5.01
	 	Merger, Consolidation or Sale of All or Substantially All Assets of the Issuers	 	 	63	 
	Section 5.02
	 	Successor Corporation Substituted	 	 	64	 
	Section 5.03
	 	Merger, Consolidation or Sale of All or Substantially All Assets by a Guarantor	 	 	64	 
	Section 5.04
	 	Successor Guarantor Substituted	 	 	65	 
	 
	 	 	 	 	 	 
	ARTICLE VI

	DEFAULTS AND REMEDIES

	Section 6.01
	 	Events of Default	 	 	65	 
	Section 6.02
	 	Acceleration	 	 	66	 
	Section 6.03
	 	Other Remedies	 	 	66	 
	Section 6.04
	 	Waiver of Past Defaults	 	 	67	 
	Section 6.05
	 	Control by Majority	 	 	67	 
	Section 6.06
	 	Limitation on Suits	 	 	67	 
	Section 6.07
	 	Rights of Holders of Notes to Receive Payment	 	 	68	 
	Section 6.08
	 	Collection Suit by Trustee	 	 	68	 
	Section 6.09
	 	Trustee May File Proofs of Claim	 	 	68	 
	Section 6.10
	 	Priorities	 	 	68	 
	Section 6.11
	 	Undertaking for Costs	 	 	69	 
	 
	 	 	 	 	 	 
	ARTICLE VII

	TRUSTEE

	Section 7.01
	 	Duties of Trustee	 	 	69	 
	Section 7.02
	 	Rights of Trustee	 	 	70	 
	Section 7.03
	 	Individual Rights of Trustee	 	 	71	 
	Section 7.04
	 	Trustee’s Disclaimer	 	 	71	 
	Section 7.05
	 	Notice of Defaults	 	 	71	 
	Section 7.06
	 	Reports by Trustee to Holders of the Notes	 	 	71	 
	Section 7.07
	 	Compensation and Indemnity	 	 	71	 
	Section 7.08
	 	Replacement of Trustee	 	 	72	 
	Section 7.09
	 	Successor Trustee by Merger, etc.	 	 	73	 
	Section 7.10
	 	Eligibility; Disqualification	 	 	73	 
	Section 7.11
	 	Preferential Collection of Claims Against the Issuers	 	 	73	 

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	 	 	 	 	Page
	 
	 	 	 	 	 	 
	ARTICLE VIII

	LEGAL DEFEASANCE AND COVENANT DEFEASANCE

	Section 8.01
	 	Option to Effect Legal Defeasance or Covenant Defeasance	 	 	73	 
	Section 8.02
	 	Legal Defeasance and Discharge	 	 	73	 
	Section 8.03
	 	Covenant Defeasance	 	 	74	 
	Section 8.04
	 	Conditions to Legal or Covenant Defeasance	 	 	74	 
	Section 8.05
	 	Deposited Money and Government Securities to be Held in Trust; Other Miscellaneous Provisions	 	 	75	 
	Section 8.06
	 	Repayment to Issuers	 	 	75	 
	Section 8.07
	 	Reinstatement	 	 	76	 
	 
	 	 	 	 	 	 
	ARTICLE IX

	AMENDMENT, SUPPLEMENT AND WAIVER

	Section 9.01
	 	Without Consent of Holders of Notes	 	 	76	 
	Section 9.02
	 	With Consent of Holders of Notes	 	 	76	 
	Section 9.03
	 	Compliance with Trust Indenture Act	 	 	78	 
	Section 9.04
	 	Revocation and Effect of Consents	 	 	78	 
	Section 9.05
	 	Notation on or Exchange of Notes	 	 	78	 
	Section 9.06
	 	Trustee to Sign Amendments, etc.	 	 	78	 
	 
	 	 	 	 	 	 
	ARTICLE X

	GUARANTEES

	Section 10.01
	 	Guarantees	 	 	78	 
	Section 10.02
	 	Limitation on Liability	 	 	80	 
	Section 10.03
	 	Release	 	 	80	 
	Section 10.04
	 	Successors and Assigns	 	 	81	 
	Section 10.05
	 	No Waiver	 	 	81	 
	Section 10.06
	 	Modification	 	 	81	 
	Section 10.07
	 	Execution of Supplemental Indenture for Future Guarantors	 	 	81	 
	 
	 	 	 	 	 	 
	ARTICLE XI

	SATISFACTION AND DISCHARGE

	Section 11.01
	 	Satisfaction and Discharge	 	 	81	 
	Section 11.02
	 	Application of Trust Money	 	 	82	 
	 
	 	 	 	 	 	 
	ARTICLE XII

	MISCELLANEOUS

	Section 12.01
	 	Trust Indenture Act Controls	 	 	82	 
	Section 12.02
	 	Notices	 	 	83	 
	Section 12.03
	 	Communication by Holders of Notes with Other Holders of Notes	 	 	83	 
	Section 12.04
	 	Certificate and Opinion as to Conditions Precedent	 	 	84	 
	Section 12.05
	 	Statements Required in Certificate or Opinion	 	 	84	 
	Section 12.06
	 	Rules by Trustee and Agents	 	 	84	 
	Section 12.07
	 	No Personal Liability of Directors, Officers, Employees and Stockholders	 	 	84	 
	Section 12.08
	 	Governing Law	 	 	84	 

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	 	 	 	 	Page
	 
	 	 	 	 	 	 
	Section 12.09
	 	Successors	 	 	84	 
	Section 12.10
	 	Severability	 	 	84	 
	Section 12.11
	 	Counterpart Originals	 	 	85	 
	Section 12.12
	 	Table of Contents, Headings, etc.	 	 	85	 

-iv-

 

EXHIBITS

	 	 	 
	Exhibit Al

	 	FORM OF NOTE
	Exhibit A2

	 	FORM OF REGULATION S TEMPORARY GLOBAL NOTE
	Exhibit B

	 	FORM OF CERTIFICATE OF TRANSFER
	Exhibit C

	 	FORM OF CERTIFICATE OF EXCHANGE
	Exhibit D

	 	FORM OF CERTIFICATE OF ACQUIRING INSTITUTIONAL ACCREDITED INVESTOR
	Exhibit E

	 	FORM OF SUPPLEMENTAL INDENTURE

-v-

 

     INDENTURE dated as of January 29, 2010 among Vanguard Health Holding Company II, LLC, a
Delaware limited liability company (“VHS Holdco II”), Vanguard Holding Company II, Inc., a
Delaware corporation and a Wholly-Owned Subsidiary (as defined) of VHS Holdco II (the “Co-Issuer,”
and together with VHS Holdco II, the “Issuers”), Vanguard Health Holding Company I, LLC (“VHS
Holdco I”), Vanguard Health Systems, Inc. (“Vanguard”), the Subsidiary Guarantors (as defined) and
U.S. Bank National Association, a national banking association, as trustee (the “Trustee”).

     The Issuers, VHS Holdco I, Vanguard, the Subsidiary Guarantors and the Trustee agree as
follows for the benefit of each other and for the equal and ratable benefit of the Holders (as
defined) of (a) the $950,000,000 aggregate principal amount of the Issuers’ 8% Senior Notes due
2018 (the “Initial Notes”), (b) any Additional Notes (as defined) that may be issued after the date
hereof and (c) if and when issued pursuant to the Registration Rights Agreement (as defined
herein), the Issuers’ Exchange Notes (as defined herein) issued in the Registered Exchange Offer
(as defined herein) in exchange for any outstanding Initial Notes or Additional Notes (all such
securities in clauses (a), (b) and (c) being referred to collectively as the “Notes”).

ARTICLE I

DEFINITIONS AND INCORPORATION BY REFERENCE

     Section 1.01 Definitions.

     “144A Global Note” means a Global Note substantially in the form of Exhibit Al hereto bearing
the Global Note Legend and the Private Placement Legend and deposited with or on behalf of, and
registered in the name of, the Depositary or its nominee that shall be issued in a denomination
equal to the outstanding principal amount of the Notes sold in reliance on Rule 144A.

     “Acquired Debt” means, with respect to any specified Person:

     (1) Indebtedness of any other Person existing at the time such other Person is merged
with or into or became a Restricted Subsidiary of such specified Person;

     (2) Indebtedness secured by an existing Lien encumbering any asset acquired by such
specified Person; and

     (3) Indebtedness of any other Person assumed in connection with, and existing at the
time of, an acquisition by a Restricted Subsidiary of the property or assets that constitute
substantially all of a division or line of business of such Person,

but excluding in any event Indebtedness incurred in connection with, or in contemplation of, such
other Person merging with or into, or becoming a Restricted Subsidiary of, or such assets or
property being acquired by, such specified Person.

     “Additional Interest” means any additional interest then owing in respect of the Notes
pursuant to the provisions of the Registration Rights Agreement.

     “Additional Notes” means additional Notes (other than the Initial Notes) issued under this
Indenture in accordance with Sections 2.14 and 4.07 hereof, as part of the same series as the
Initial Notes.

     “Affiliate” of any specified Person means any other Person directly or indirectly controlling
or controlled by or under direct or indirect common control with such specified Person. For
purposes of this definition, “control” (including, with correlative meanings, the terms
“controlling,” “controlled by” and “under common control with”), as used with respect to any
Person, shall mean the possession, directly or indirectly, of the power to direct or cause
the direction of the management or policies of such Person, whether through the ownership of
voting securities, by agreement or otherwise.

 

 

     “Agent” means any Registrar, co-registrar, Paying Agent or additional paying agent.

     “Applicable Premium” means with respect to any Note on the applicable redemption date, the
greater of:

     (1) 1.0% of the then outstanding principal amount of the Note; and

     (2) the excess of:

     (a) the present value at such redemption date of (i) the redemption price of
the Notes at February 1, 2014 (such redemption price being set forth in the table
appearing in Section 3.07(c) hereof) plus (ii) all required interest payments due on
the Notes through February 1, 2014 (excluding accrued but unpaid interest), computed
using a discount rate equal to the Treasury Rate as of such redemption date plus 50
basis points; over

     (b) the then outstanding principal amount of the Note.

     “Applicable Procedures” means, with respect to any transfer or exchange of or for beneficial
interests in any Global Note, the rules and procedures of the Depositary, Euroclear and Clearstream
that apply to such transfer or exchange.

     “Asset Sale” means (i) the sale, conveyance, transfer or other disposition (whether in a
single transaction or a series of related transactions) of property or assets of VHS Holdco II or
any Restricted Subsidiary (each referred to in this definition as a “disposition”) or (ii) the
issuance or sale of Equity Interests of any Restricted Subsidiary, other than directors’ qualifying
Equity Interests or Equity Interests required by applicable law to be held by a Person other than
VHS Holdco II or a Restricted Subsidiary (whether in a single transaction or a series of related
transactions), in each case, other than:

     (1) a disposition of Cash Equivalents or obsolete or worn out property or equipment in
the ordinary course of business or inventory (or other assets) held for sale in the ordinary
course of business;

     (2) the disposition of all or substantially all of the assets of either of the Issuers
in a manner permitted pursuant to Article V hereof or any disposition that constitutes a
Change of Control pursuant to this Indenture;

     (3) the making of any Restricted Payment or Permitted Investment that is permitted to
be made, and is made, pursuant to Section 4.05 hereof;

     (4) any disposition of assets or issuance or sale of Equity Interests of any Restricted
Subsidiary in any transaction or series of related transactions with an aggregate fair
market value of less than $15.0 million;

     (5) any disposition of property or assets or issuance of securities by a Restricted
Subsidiary to VHS Holdco II or by VHS Holdco II or a Restricted Subsidiary to another
Restricted Subsidiary;

     (6) the lease, assignment, license or sublease of any real or personal property in the
ordinary course of business;

     (7) any sale of Equity Interests in, or Indebtedness or other securities of, an
Unrestricted Subsidiary;

     (8) sales of assets received by VHS Holdco II or any Restricted Subsidiary upon
foreclosures on a Lien;

-2-

 

     (9) sales of Securitization Assets and related assets of the type specified in the
definition of “Securitization Financing” to a Securitization Subsidiary in connection with
any Qualified Securitization Financing;

     (10) a transfer of Securitization Assets and related assets of the type specified in
the definition of “Securitization Financing” (or a fractional undivided interest therein) by
a Securitization Subsidiary in a Qualified Securitization Financing;

     (11) any exchange of assets for assets related to a Permitted Business of comparable
market value, as determined in good faith by VHS Holdco II, which in the event of an
exchange of assets with a fair market value in excess of (A) $25.0 million shall be
evidenced by a certificate of a Responsible Officer of VHS Holdco II, and (B) $50.0 million
shall be set forth in a resolution approved in good faith by at least a majority of the
Board of Directors of VHS Holdco II;

     (12) the substantially contemporaneous sale and leaseback of an asset; provided that
the sale and leaseback occurs within 180 days after the date of the acquisition of the asset
by VHS Holdco II or any Restricted Subsidiary and the Net Proceeds of such sale and
leaseback are applied in accordance with Section 4.08 hereof;

     (13) the sale or transfer, in the ordinary course of business consistent with past
practice, of receivables owing to VHS Holdco II or any Restricted Subsidiary for the purpose
of collection of outstanding balances thereunder;

     (14) the licensing or sub-licensing of intellectual property or other general
intangibles in the ordinary course of business, other than the licensing of intellectual
property on a long-term basis; and

     (15) any surrender or waiver of contract rights or the settlement, release or surrender
of contract rights or other litigation claims in the ordinary course of business.

     “Bankruptcy Law” means Title 11, U.S. Code or any similar federal or state law for the relief
of debtors.

     “Beneficial Owner” has the meaning assigned to such term in Rule 13d-3 and Rule 13d-5 under
the Exchange Act, except that in calculating the beneficial ownership of any particular “person”
(as that term is used in Section 13(d)(3) of the Exchange Act), such “person” shall be deemed to
have beneficial ownership of all securities that such “person” has the right to acquire by
conversion or exercise of other securities, whether such right is currently exercisable or is
exercisable only upon the occurrence of a subsequent condition. The terms “Beneficially Owns” and
“Beneficially Owned” have a corresponding meaning.

     “Board of Directors” means:

     (1) with respect to a corporation, the board of directors of the corporation or any
committee thereof duly authorized to act on behalf of such board;

     (2) with respect to a limited liability company, the board of directors or other
governing body, and in the absence of same, the manager or board of managers or the managing
member or members or any controlling committee thereof;

     (3) with respect to a partnership, the board of directors of the general partner or
manager of the partnership; and

     (4) with respect to any other Person, the board or committee of such Person serving a
similar function.

     “Broker-Dealer” has the meaning set forth in the Registration Rights Agreement.

-3-

 

     “Business Day” means a day other than a Saturday, Sunday or other day on which banking
institutions are authorized or required by law to close in New York State.

     “Capital Stock” means:

     (1) in the case of a corporation, corporate stock;

     (2) in the case of an association or business entity, any and all shares, interests,
participations, rights or other equivalents (however designated) of corporate stock;

     (3) in the case of a partnership or limited liability company, partnership or
membership interests (whether general or limited); and

     (4) any other interest or participation that confers on a Person the right to receive a
share of the profits and losses of, or distributions of assets of, the issuing Person.

     “Capitalized Lease Obligation” means, at the time any determination thereof is to be made, the
amount of the liability in respect of a lease that would at such time be required to be capitalized
and reflected as a liability on a balance sheet (excluding the footnotes thereto) in accordance
with GAAP.

     “Captive Insurance Subsidiary” means a Subsidiary of VHS Holdco II or any Restricted
Subsidiary established for the purpose of insuring the healthcare businesses or facilities owned or
operated by VHS Holdco II or any of its Subsidiaries or any physician employed by or on the medical
staff of any such business or facility.

     “Cash Contribution Amount” means the aggregate amount of cash contributions made to the
capital of the Issuers described in the definition of “Contribution Indebtedness.”

     “Cash Equivalents” means:

     (1) U.S. dollars or, in the case of any Foreign Subsidiary, such local currencies held
by it from time to time in the ordinary course of business;

     (2) direct obligations of the United States of America or any agency thereof or
obligations guaranteed by the United States of America or any agency thereof, in each case
with maturities not exceeding two years;

     (3) certificates of deposit and time deposits with maturities of 12 months or less from
the date of acquisition, bankers’ acceptances with maturities not exceeding 12 months and
overnight bank deposits, in each case, with any lender party to the Credit Agreement or with
any commercial bank having capital and surplus in excess of $500,000,000;

     (4) repurchase obligations for underlying securities of the types described in clauses
(2) and (3) above entered into with any financial institution meeting the qualifications
specified in clause (3) above;

     (5) commercial paper maturing within 12 months after the date of acquisition and having
a rating of at least A-1 from Moody’s or P-1 from S&P;

     (6) securities with maturities of two years or less from the date of acquisition issued
or fully guaranteed by any State or commonwealth of the United States of America, or by any
political subdivision or taxing authority thereof, and rated at least A by S&P or A-2 by
Moody’s;

     (7) investment funds at least 95% of the assets of which constitute Cash Equivalents of
the kinds described in clauses (1) through (6) of this definition; and

-4-

 

     (8) money market funds that (A) comply with the criteria set forth in Rule 2a-7 under
the Investment Company Act of 1940, (B) are rated AAA by S&P and Aaa by Moody’s and (C) have
portfolio assets of at least $500.0 million.

     “Change of Control” means the occurrence of any of the following:

     (1) the sale, lease, transfer or other conveyance, in one or a series of related
transactions, of all or substantially all of the assets of VHS Holdco II and its
Subsidiaries, taken as a whole, to any Person other than a Permitted Holder; or

     (2) any of Vanguard, VHS Holdco I or either of the Issuers becomes aware of (by way of
a report or any other filing pursuant to Section 13(d) of the Exchange Act, proxy, vote,
written notice or otherwise) the acquisition by any Person or group (within the meaning of
Section 13(d)(3) or Section 14(d)(2) of the Exchange Act, or any successor provision),
including any group acting for the purpose of acquiring, holding or disposing of securities
(within the meaning of Rule 13d-5(b)(1) under the Exchange Act), other than the Permitted
Holders, in a single transaction or in a related series of transactions, by way of merger,
consolidation or other business combination or purchase of beneficial ownership (within the
meaning of Rule 13d-3 under the Exchange Act, or any successor provision), of more than 50%
of the total voting power of the Voting Stock of either of the Issuers or any of their
respective direct or indirect parent corporations or entities.

     “Clearstream” means Clearstream Banking, S.A.

     “Code” means the United States Internal Revenue Code of 1986, as amended from time to time,
and the regulations promulgated and rulings issued thereunder.

     “Commission” means the Securities and Exchange Commission.

     “Consolidated Depreciation and Amortization Expense” means with respect to any Person for any
period, the total amount of depreciation and amortization expense, including the amortization of
deferred financing fees, of such Person and its Restricted Subsidiaries for such period on a
consolidated basis and otherwise determined in accordance with GAAP.

     “Consolidated Interest Expense” means, with respect to any Person for any period, (a) the sum,
without duplication, of: (1) consolidated interest expense of such Person and its Restricted
Subsidiaries for such period (including amortization of original issue discount, the interest
component of Capitalized Lease Obligations and net payments (if any) pursuant to interest rate
Hedging Obligations, but excluding amortization of deferred financing fees, expensing of any bridge
or other financing fees and expenses and (2) consolidated capitalized interest of such Person and
its Restricted Subsidiaries for such period, whether paid or accrued (including, without
limitation, Securitization Fees), less (b) interest income of such Person and its Restricted
Subsidiaries (other than cash interest income of the Captive Insurance Subsidiaries) for such
period.

     “Consolidated Net Income” means, with respect to any Person for any period, the aggregate of
the Net Income of such Person and its Restricted Subsidiaries for such period, on a consolidated
basis, and otherwise determined in accordance with GAAP; provided that

     (1) any net after-tax extraordinary, unusual or nonrecurring gains or losses (less all
fees and expenses relating thereto) or income or expense or charge (including, without
limitation, severance, relocation and other restructuring costs) including, without
limitation, any severance expense, and fees, expenses or charges related to any offering of
Equity Interests of such Person, any Investment, acquisition or Indebtedness permitted to be
incurred hereunder (in each case, whether or not successful), including all fees, expenses,
charges and change in control payments related to the Refinancing, in each case shall be
excluded;

     (2) the Net Income for such period shall not include the cumulative effect of a change
in accounting principles during such period;

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     (3) any net after-tax income or loss from discontinued operations and any net after-tax
gain or loss on disposal of discontinued operations shall be excluded;

     (4) any net after-tax gains or losses (less all fees and expenses or charges relating
thereto) attributable to business dispositions or asset dispositions other than in the
ordinary course of business (as determined in good faith by the Board of Directors of VHS
Holdco II) shall be excluded;

     (5) any net after-tax income or loss (less all fees and expenses or charges relating
thereto) attributable to the early extinguishment of indebtedness shall be excluded;

     (6) an amount equal to the amount of Tax Distributions under Section 4.05(b)(9)(B)
hereof actually made to VHS Holdco I, Vanguard or VHS Holdings LLC in respect of the net
taxable income allocated by VHS Holdco II to VHS Holdco I, Vanguard or VHS Holdings LLC for
such period shall be included as though such amounts had been paid as income taxes directly
by VHS Holdco II;

     (7) (A) the Net Income for such period of any Person that is not a Subsidiary, or that
is an Unrestricted Subsidiary, or that is accounted for by the equity method of accounting,
shall be included only to the extent of the amount of dividends or distributions or other
payments in respect of equity that are actually paid in cash (or to the extent converted
into cash) by the referent Person to VHS Holdco II or a Restricted Subsidiary thereof in
respect of such period and (B) without duplication, the Net Income for such period shall
include any dividend, distribution or other payments in respect of equity paid in cash by
such Person to VHS Holdco II or a Restricted Subsidiary thereof in excess of the amounts
included in clause (A);

     (8) any increase in amortization or depreciation or any one-time non-cash charges
resulting from purchase accounting in connection with any acquisition that is consummated
after the Issue Date shall be excluded;

     (9) any non-cash impairment charges resulting from the application of U.S. GAAP and the
amortization of intangibles pursuant to U.S. GAAP, shall be excluded;

     (10) any non-cash compensation expense realized from grants of stock appreciation or
similar rights, stock options or other rights to officers, directors and employees of such
Person or any of its Restricted Subsidiaries shall be excluded;

     (11) any net unrealized gain or loss (after any offset) resulting in such period from
Hedging Obligations and the application of U.S. GAAP shall be excluded; and

     (12) solely for the purpose of determining the amount available for Restricted Payments
under Section 4.05(a)(4)(C)(i) hereof, the Net Income for such period of any Restricted
Subsidiary (other than a Guarantor) shall be excluded if the declaration or payment of
dividends or similar distributions by that Restricted Subsidiary of its Net Income is not at
the date of determination permitted without any prior governmental approval (which has not
been obtained) or, directly or indirectly, by the operation of the terms of its charter or
any agreement, instrument, judgment, decree, order, statute, rule, or governmental
regulation applicable to that Restricted Subsidiary or its stockholders, unless such
restriction with respect to the payment of dividends or in similar distributions has been
legally waived; provided that Consolidated Net Income of such Person shall be increased by
the amount of dividends or distributions or other payments that are actually paid in cash
(or to the extent converted into cash) by such Person to VHS Holdco II or any Restricted
Subsidiary thereof in respect of such period, to the extent not already included therein.

     In addition, to the extent not already included in the Consolidated Net Income of such Person
and its Restricted Subsidiaries, notwithstanding anything to the contrary in the foregoing,
Consolidated Net Income shall include the amount of proceeds received from business interruption
insurance and reimbursements of any expenses and charges that are covered by indemnification or
other reimbursement provisions in connection with any Permitted Investment or any sale, conveyance,
transfer or other disposition of assets permitted under this Indenture.

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     Notwithstanding the foregoing, for the purpose of Section 4.05(a)(4)(C) only (other than
clause (iv)), there shall be excluded from Consolidated Net Income any income arising from any sale
or other disposition of Restricted Investments made by VHS Holdco II and the Restricted
Subsidiaries, any repurchases and redemptions of Restricted Investments by VHS Holdco II and the
Restricted Subsidiaries, any repayments of loans and advances which constitute Restricted
Investments by VHS Holdco II and any Restricted Subsidiary, any sale of the stock of an
Unrestricted Subsidiary or any distribution or dividend from an Unrestricted Subsidiary, in each
case only to the extent such amounts increase the amount of Restricted Payments permitted under
Section 4.05(a)(4)(C)(iv) hereof.

     “Consolidated Senior Secured Debt Ratio” as of any date of determination means the ratio of
(1) Consolidated Total Indebtedness of VHS Holdco II and its Restricted Subsidiaries that is
secured by a Lien as of the end of the most recent fiscal period for which internal financial
statements are available immediately preceding the date on which such event for which such
calculation is being made shall occur, less the Unrestricted Cash of VHS Holdco II and its
Restricted Subsidiaries at such date to (2) EBITDA of VHS Holdco II and its Restricted Subsidiaries
for the most recently ended four full fiscal quarters for which internal financial statements are
available immediately preceding the date on which such event for which such calculation is being
made shall occur, in each case with such pro forma adjustments to Consolidated Total Indebtedness
and EBITDA as are appropriate and consistent with the pro forma adjustment provisions set forth in
the definition of “Fixed Charge Coverage Ratio.”

     “Consolidated Total Indebtedness” means, as of any date of determination, the aggregate
principal amount of Indebtedness of VHS Holdco II and its Restricted Subsidiaries outstanding on
such date, determined on a consolidated basis, to the extent required to be recorded on a balance
sheet in accordance with GAAP, consisting of Indebtedness for borrowed money, Capitalized Lease
Obligations and debt obligations evidenced by promissory notes or similar instruments.

     “Contingent Obligations” means, with respect to any Person, any obligation of such Person
guaranteeing any leases, dividends or other obligations that do not constitute Indebtedness
(“primary obligations”) of any other Person (the “primary obligor”) in any manner, whether directly
or indirectly, including, without limitation, any obligation of such Person, whether or not
contingent, (a) to purchase any such primary obligation or any property constituting direct or
indirect security therefor, (b) to advance or supply funds (1) for the purchase or payment of any
such primary obligation or (2) to maintain working capital or equity capital of the primary obligor
or otherwise to maintain the net worth or solvency of the primary obligor, or (c) to purchase
property, securities or services primarily for the purpose of assuring the owner of any such
primary obligation of the ability of the primary obligor to make payment of such primary obligation
against loss in respect thereof.

     “Contribution Indebtedness” means Indebtedness of the Issuers or any Subsidiary Guarantor in
an aggregate principal amount not greater than twice the aggregate amount of cash contributions
(other than Excluded Contributions) made to the capital of the Issuers after the Issue Date;
provided that:

     (1) if the aggregate principal amount of such Contribution Indebtedness is greater than
the aggregate amount of such cash contributions to the capital of the Issuers, the amount in
excess shall be Indebtedness (other than secured Indebtedness) with a Stated Maturity later
than the Stated Maturity of the Notes, and

     (2) such Contribution Indebtedness (A) is Incurred within 180 days after the making of
such cash contribution and (B) is so designated as Contribution Indebtedness pursuant to an
Officers’ Certificate on the incurrence date thereof.

     “Corporate Trust Office of the Trustee” shall be at the address of the Trustee specified in
Section 12.02 hereof or such other address as to which the Trustee may give notice to the Issuers.

     “Credit Agreement” means that certain Credit Agreement, dated as of the Issue Date, among the
Issuers, the Lenders party thereto, Bank of America, N.A., as administrative agent, Barclays Bank
plc, as syndication agent, the other agents named therein, and Banc of America Securities LLC and
Barclays Capital, as joint lead arrangers and book runners, together with all agreements, notes,
instruments and documents executed or delivered pursuant thereto and in connection therewith,
including, without limitation, all mortgages, other security documents and guaranties,

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in each case as amended (including any amendment and restatement), supplemented, extended,
renewed, replaced (by one or more credit facilities, debt instruments, indentures and/or related
documentation) or otherwise modified from time to time, including, without limitation, any
agreement increasing the amount of, extending the maturity of or refinancing in whole or in part
(including, but not limited to, by the inclusion of additional or different lenders or financial
institutions thereunder or additional borrowers or guarantors thereof) all or any portion of the
Indebtedness under such agreement or any successor agreement or agreements and whether by the same
or any other agent, lender or group of lenders or other financial institutions.

     “Credit Facilities” means, with respect to the Issuers or any of their Restricted
Subsidiaries, one or more debt facilities, including the Credit Agreement, or other financing
arrangements (including, without limitation, commercial paper facilities or indentures) providing
for revolving credit loans, term loans, letters of credit or other long-term indebtedness,
including any notes, mortgages, guarantees, collateral documents, instruments and agreements
executed in connection therewith, and any amendments, supplements, modifications, extensions,
renewals, restatements or refundings thereof and any indentures or credit facilities or commercial
paper facilities that replace, refund or refinance any part of the loans, notes, other credit
facilities or commitments thereunder, including any such replacement, refunding or refinancing
facility or indenture that increases the amount permitted to be borrowed thereunder or alters the
maturity thereof (provided that such increase in borrowings is permitted under Section 4.07 hereof)
or adds Restricted Subsidiaries as additional borrowers or guarantors thereunder and whether by the
same or any other agent, lender or group of lenders.

     “Custodian” means the Trustee, as custodian with respect to the Notes in global form, or any
successor entity thereto.

     “Default” means any event that is, or with the passage of time or the giving of notice or both
would be, an Event of Default.

     “Definitive Note” means a certificated Note registered in the name of the Holder thereof and
issued in accordance with Section 2.06 hereof, substantially in the form of Exhibit Al hereto
except that such Note shall not bear the Global Note Legend and shall not have the “Schedule of
Exchanges of Interests in the Global Note” attached thereto.

     “Depositary” means, with respect to the Notes issuable or issued in whole or in part in global
form, the Person specified in Section 2.03 hereof as the Depositary with respect to the Notes, and
any and all successors thereto appointed as depositary hereunder and having become such pursuant to
the applicable provision of this Indenture.

     “Designated Non-cash Consideration” means the fair market value of non-cash consideration
received by VHS Holdco II or one of its Restricted Subsidiaries in connection with an Asset Sale
that is so designated as Designated Non-cash Consideration pursuant to an Officers’ Certificate
setting forth the basis of such valuation, less the amount of cash or Cash Equivalents received in
connection with a subsequent sale of such Designated Non-cash Consideration.

     “Designated Preferred Stock” means Preferred Stock of the Issuers or any direct or indirect
parent company of the Issuers (other than Disqualified Stock), that is issued for cash (other than
to the Issuers or any of their Subsidiaries or an employee stock ownership plan or trust
established by the Issuers or any of their Subsidiaries) and is so designated as Designated
Preferred Stock, pursuant to an Officers’ Certificate, on the issuance date thereof, the cash
proceeds of which are excluded from the calculation set forth in Section 4.05(a)(4)(C) hereof.

     “Disqualified Stock” means, with respect to any Person, any Capital Stock of such Person
which, by its terms (or by the terms of any security into which it is convertible or for which it
is putable or exchangeable), or upon the happening of any event, matures or is mandatorily
redeemable (other than as a result of a Change of Control or asset sale), pursuant to a sinking
fund obligation or otherwise, or is redeemable at the option of the holder thereof (other than as a
result of a Change of Control or asset sale), in whole or in part, in each case prior to the date
91 days after the earlier of the Final Maturity Date of the Notes or the date the Notes are no
longer outstanding; provided (x) that if such Capital Stock is issued to any plan for the benefit
of employees of the Issuers or their Subsidiaries or by any such plan to such employees, such
Capital Stock shall not constitute Disqualified Stock solely because it may

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be required to be repurchased by either of the Issuers or their Subsidiaries in order to satisfy
applicable statutory or regulatory obligations and (y) any Capital Stock that would constitute
Disqualified Stock solely because the holders of the Capital Stock have the right to require either
of the Issuers or the Subsidiary that issued such Capital Stock to repurchase such Capital Stock
upon the occurrence of a Change of Control or an asset sale, shall not constitute Disqualified
Stock.

     “EBITDA” means, with respect to any Person for any period, the Consolidated Net Income of such
Person for such period (a) plus, without duplication, and in each case to the extent deducted in
calculating Consolidated Net Income for such period:

     (1) provision for taxes based on income, profits or capital of such Person for such
period, including, without limitation, state, franchise and similar taxes (including any Tax
Distribution taken into account in calculating Consolidated Net Income), plus

     (2) Consolidated Interest Expense of such Person for such period, plus

     (3) Consolidated Depreciation and Amortization Expense of such Person for such period,
plus

     (4) any reasonable expenses or charges related to the Refinancing, any Equity Offering,
Permitted Investment, acquisition, recapitalization or Indebtedness permitted to be incurred
under this Indenture (including a refinancing thereof) (whether or not successful), plus

     (5) the amount of any restructuring charges (which, for the avoidance of doubt, shall
include retention, severance, systems establishment cost or excess pension charges), plus

     (6) the non-controlling interest expense consisting of subsidiary income attributable
to minority equity interests of third parties in any non-Wholly-Owned Subsidiary in such
period or any prior period, except to the extent of dividends declared or paid on Equity
Interests held by third parties, plus

     (7) the non-cash portion of “straight-line” rent expense, plus

     (8) the amount of any expense to the extent a corresponding amount is received in cash
by VHS Holdco II and its Restricted Subsidiaries from a Person other than VHS Holdco II or
any Subsidiary of VHS Holdco II under any agreement providing for reimbursement of any such
expense; provided such reimbursement payment has not been included in determining
Consolidated Net Income or EBITDA (it being understood that if the amounts received in cash
under any such agreement in any period exceed the amount of expense in respect of such
period, such excess amounts received may be carried forward and applied against expense in
future periods), plus

     (9) the amount of management, consulting, monitoring and advisory fees and related
expenses paid to the Sponsors or any other Permitted Holder (or any accruals related to such
fees and related expenses) during such period; provided that such amount shall not exceed in
any four quarter period the greater of (A) $6.0 million and (B) 2.0% of EBITDA of VHS Holdco
II and its Restricted Subsidiaries for each period, plus

     (10) without duplication, any other non-cash charges (including any impairment charges
and the impact of purchase accounting, including, but not limited to, the amortization of
inventory step-up) (excluding any such charge that represents an accrual or reserve for a
cash expenditure for a future period), plus

     (11) any net losses resulting from Hedging Obligations entered into in the ordinary
course of business;

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and (b) less the sum of, without duplication, (1) non-cash items increasing Consolidated Net Income
for such period (excluding any items which represent the reversal of any accrual of, or cash
reserve for, anticipated cash charges or asset valuation adjustments made in any prior period); (2)
the non-controlling interest income consisting of subsidiary losses attributable to the
non-controlling equity interests of third parties in any non-Wholly-Owned Subsidiary, (3) the cash
portion of “straight-line” rent expense which exceeds the amount expensed in respect of such rent
expense and (4) any net gains resulting from Hedging Obligations entered into in the ordinary
course of business relating to intercompany loans, to the extent that the notional amount of the
related Hedging Obligation does not exceed the principal amount of the related intercompany loan.

     “Equity Interests” means Capital Stock and all warrants, options or other rights to acquire
Capital Stock (but excluding any debt security that is convertible into, or exchangeable for,
Capital Stock).

     “Equity Offering” means any public or private sale of common stock or Preferred Stock of the
Issuers or any of their direct or indirect parent corporations (excluding Disqualified Stock),
other than (a) public offerings with respect to common stock of the Issuers or of any direct or
indirect parent corporation of the Issuers registered on Form S-8 (or any successor form that
provides for registration of securities offered to employees of the registrant) and (b) any such
public or private sale that constitutes an Excluded Contribution.

     “Euroclear” means Euroclear Bank, S.A.N.V., as operator of the Euroclear system.

     “Exchange Act” means the Securities Exchange Act of 1934, as amended, and the rules and
regulations of the Commission promulgated thereunder.

     “Exchange Notes” means the Notes issued in the Registered Exchange Offer pursuant to Section
2.06(f) hereof.

     “Exchange Offer Registration Statement” has the meaning set forth in the Registration Rights
Agreement.

     “Excluded Contribution” means net cash proceeds, marketable securities or Qualified Proceeds,
in each case received after the Issue Date by VHS Holdco II and its Restricted Subsidiaries from:

     (1) contributions to its common equity capital; and

     (2) the sale (other than to a Subsidiary of VHS Holdco II or to any management equity
plan or stock option plan or any other management or employee benefit plan or agreement of
VHS Holdco II or any Subsidiary of VHS Holdco II) of Capital Stock (other than Disqualified
Stock),

in each case designated as Excluded Contributions pursuant to an Officers’ Certificate on the date
such capital contributions are made or the date such Equity Interests are sold, as the case may be,
which are excluded from the calculation set forth in Section 4.05(a)(4)(C) hereof.

     “Existing Indebtedness” means Indebtedness of VHS Holdco II and its Subsidiaries (after giving
effect to the Refinancing) in existence on the Issue Date.

     “Existing VHS Holdco I Notes” means the 11 1/4% Senior Discount Notes due 2015 issued by VHS
Holdco I and Vanguard Holding Company I, Inc. pursuant to an indenture dated as of September 23,
2004, among VHS Holdco I, Vanguard Holding Company I, Inc. and U.S. Bank National Association.

     “Existing VHS Holdco II Notes” means the 9% Senior Subordinated Notes due 2014 issued by the
Issuers pursuant to an indenture dated as of September 23, 2004, among the Issuers, the guarantors
named therein and U.S. Bank National Association.

     “Fixed Charge Coverage Ratio” means, with respect to any Person for any period consisting of
such Person’s and its Restricted Subsidiaries’ most recently ended four fiscal quarters for which
internal financial statements are available, the ratio of EBITDA of such Person for such period to
the Fixed Charges of such Person for such pe-

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riod. In the event that VHS Holdco II or any Restricted Subsidiary incurs, assumes,
guarantees or repays any Indebtedness or issues or repays Disqualified Stock or Preferred Stock
subsequent to the commencement of the period for which the Fixed Charge Coverage Ratio is being
calculated but prior to the event for which the calculation of the Fixed Charge Coverage Ratio is
made (the “Calculation Date”), then the Fixed Charge Coverage Ratio shall be calculated giving pro
forma effect to such incurrence, assumption, guarantee or repayment of Indebtedness, or such
issuance or redemption of Disqualified Stock or Preferred Stock, as if the same had occurred at the
beginning of the applicable four-quarter period. For purposes of making the computation referred
to above, Investments, acquisitions, dispositions, mergers or consolidations (as determined in
accordance with GAAP) that have been made by VHS Holdco II or any Restricted Subsidiary during the
four-quarter reference period or subsequent to such reference period and on or prior to or
simultaneously with the Calculation Date shall be calculated on a pro forma basis assuming that all
such Investments, acquisitions, dispositions, mergers, consolidations (and the change in any
associated fixed charge obligations and the change in EBITDA resulting therefrom) had occurred on
the first day of the four-quarter reference period. If since the beginning of such period any
Person (that subsequently became a Restricted Subsidiary or was merged with or into VHS Holdco II
or any Restricted Subsidiary since the beginning of such period) shall have made any Investment,
acquisition (including the Refinancing), disposition, merger, consolidation that would have
required adjustment pursuant to this definition, then the Fixed Charge Coverage Ratio shall be
calculated giving pro forma effect thereto for such period as if such Investment, acquisition
(including the Refinancing), disposition, merger or consolidation had occurred at the beginning of
the applicable four-quarter period. For purposes of this definition, whenever pro forma effect is
to be given to an acquisition (including the Refinancing) or other Investment and the amount of
income or earnings relating thereto, the pro forma calculations shall be determined in good faith
by a responsible financial or accounting Officer of VHS Holdco II and such pro forma calculations
may include operating expense reductions for such period resulting from the acquisition which is
being given pro forma effect that have been realized or for which the steps necessary for
realization have been taken or are reasonably expected to be taken within six months following any
such acquisition, including, but not limited to, the execution or termination of any contracts, the
termination of any personnel or the closing (or approval by the Board of Directors of VHS Holdco II
of any closing) of any facility, as applicable; provided that, in either case, such adjustments are
set forth in an Officers’ Certificate signed by the chief financial officer of VHS Holdco II and
another Officer which states (a) the amount of such adjustment or adjustments, (b) that such
adjustment or adjustments are based on the reasonable good faith beliefs of the Officers executing
such Officers’ Certificate at the time of such execution and (c) that any related incurrence of
Indebtedness is permitted pursuant to this Indenture. If any Indebtedness bears a floating rate of
interest and is being given pro forma effect, the interest on such Indebtedness shall be calculated
as if the rate in effect on the Calculation Date had been the applicable rate for the entire period
(taking into account any Hedging Obligations applicable to such Indebtedness). Interest on a
Capitalized Lease Obligation shall be deemed to accrue at an interest rate reasonably determined by
a responsible financial or accounting officer of VHS Holdco II to be the rate of interest implicit
in such Capitalized Lease Obligation in accordance with GAAP. For purposes of making the
computation referred to above, interest on any Indebtedness under a revolving credit facility
computed on a pro forma basis shall be computed based upon the average daily balance of such
Indebtedness during the applicable period. Interest on Indebtedness that may optionally be
determined at an interest rate based upon a factor of a prime or similar rate, a eurocurrency
interbank offered rate, or other rate, shall be deemed to have been based upon the rate actually
chosen, or, if none, then based upon such optional rate chosen as VHS Holdco II may designate.

     “Fixed Charges” means, with respect to any Person for any period, the sum of, without
duplication, (a) Consolidated Interest Expense of such Person for such period, (b) all cash
dividends paid, accrued and/or scheduled to be paid or accrued during such period (excluding items
eliminated in consolidation) on any series of Preferred Stock of such Person and (c) all cash
dividends paid, accrued and/or scheduled to be paid or accrued during such period (excluding items
eliminated in consolidation) of any series of Disqualified Stock.

     “Foreign Subsidiary” means any Subsidiary of VHS Holdco II that is an entity which is a
controlled foreign corporation under Section 957 of the Internal Revenue Code.

     “GAAP” means generally accepted accounting principles in the United States in effect on the
Issue Date. For purposes of this Indenture, the term “consolidated” with respect to any Person
means such Person consolidated with its Restricted Subsidiaries and does not include any
Unrestricted Subsidiary.

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     “Global Note Legend” means the legend set forth in Section 2.06(g)(2) hereof, which is
required to be placed on all Global Notes issued under this Indenture.

     “Global Notes” means, individually and collectively, each of the Restricted Global Notes and
the Unrestricted Global Notes deposited with or on behalf of and registered in the name of the
Depository or its nominee, substantially in the form of Exhibit Al hereto and that bears the Global
Note Legend and that has the “Schedule of Exchanges of Interests in the Global Note” attached
thereto, issued in accordance with Section 2.01, 2.06(b)(3), 2.06(b)(4), 2.06(d)(1), 2.06(d)(2) or
2.06(f) hereof.

     “Government Securities” means securities that are

     (1) direct obligations of the United States of America for the timely payment of which
its full faith and credit is pledged or

     (2) obligations of a Person controlled or supervised by and acting as an agency or
instrumentality of the United States of America the timely payment of which is
unconditionally guaranteed as a full faith and credit obligation by the United States of
America,

which, in either case, are not callable or redeemable at the option of the issuers thereof, and
shall also include a depository receipt issued by a bank (as defined in Section 3(a)(2) of the
Securities Act), as custodian with respect to any such Government Securities or a specific payment
of principal of or interest on any such Government Securities held by such custodian for the
account of the holder of such depository receipt; provided that (except as required by law) such
custodian is not authorized to make any deduction from the amount payable to the holder of such
depository receipt from any amount received by the custodian in respect of the Government
Securities or the specific payment of principal of or interest on the Government Securities
evidenced by such depository receipt.

     “guarantee” means a guarantee other than by endorsement of negotiable instruments for
collection in the ordinary course of business, direct or indirect, in any manner, including,
without limitation, through letters of credit or reimbursement agreements in respect thereof, of
all or any part of any Indebtedness or other obligations.

     “Guarantee” means the Guarantee by each Guarantor of the Issuers’ obligations under this
Indenture and the Notes, executed pursuant to the provisions of this Indenture.

     “Guarantor” means any Person, including VHS Holdco I, Vanguard (so long as it guarantees the
Notes) and the Subsidiary Guarantors, that incurs a Guarantee of the Notes; provided that upon the
release and discharge of such Person from its Guarantee in accordance with this Indenture, such
Person shall cease to be a Guarantor.

     “Hedging Obligations” means, with respect to any Person, the obligations of such Person under:

     (1) currency exchange, interest rate or commodity swap agreements, currency exchange,
interest rate or commodity cap agreements and currency exchange, interest rate or commodity
collar agreements; and

     (2) other agreements or arrangements designed to protect such Person against
fluctuations in currency exchange, interest rates or commodity prices.

     “Holder” means a Person in whose name a Note is registered on the Registrar’s books.

     “IAI Global Note” means a Global Note substantially in the form of Exhibit Al hereto bearing
the Global Note Legend and the Private Placement Legend and deposited with or on behalf of and
registered in the name of the Depositary or its nominee that shall be issued in a denomination
equal to the outstanding principal amount of the Notes sold to Institutional Accredited Investors.

     “Indebtedness” means, with respect to any Person,

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     (a) any indebtedness (including principal and premium) of such Person, whether or not
contingent,

     (1) in respect of borrowed money,

     (2) evidenced by bonds, notes, debentures or similar instruments or letters of
credit (or, without double counting, reimbursement agreements in respect thereof),

     (3) representing the balance deferred and unpaid of the purchase price of any
property (including Capitalized Lease Obligations), except (A) any such balance that
constitutes a trade payable or similar obligation to a trade creditor, in each case
accrued in the ordinary course of business and (B) reimbursement obligations in
respect of trade letters of credit obtained in the ordinary course of business with
expiration dates not in excess of 365 days from the date of issuance (i) to the
extent undrawn or (ii) if drawn, to the extent repaid in full within 20 Business
Days of any such drawing, or

     (4) representing any Hedging Obligations,

if and to the extent that any of the foregoing Indebtedness (other than letters of credit
and Hedging Obligations) would appear as a liability upon a balance sheet (excluding the
footnotes thereto) of such Person prepared in accordance with GAAP;

     (b) Disqualified Stock of such Person;

     (c) to the extent not otherwise included, any obligation by such Person to be liable
for, or to pay, as obligor, guarantor or otherwise, on the Indebtedness of another Person
(other than by endorsement of negotiable instruments for collection in the ordinary course
of business);

     (d) to the extent not otherwise included, Indebtedness of another Person secured by a
Lien on any asset owned by such Person (whether or not such Indebtedness is assumed by such
Person); and

     (e) to the extent not otherwise included, the amount then outstanding (i.e., advanced,
and received by, and available for use by, VHS Holdco II or any of its Restricted
Subsidiaries) under any Securitization Financing (as set forth in the books and records of
VHS Holdco II or any Restricted Subsidiary and confirmed by the agent, trustee or other
representative of the institution or group providing such Securitization Financing);

provided that Contingent Obligations incurred in the ordinary course of business and not in respect
of borrowed money shall be deemed not to constitute Indebtedness.

     “Indenture” means this Indenture, as amended or supplemented from time to time.

     “Independent Financial Advisor” means an accounting, appraisal or investment banking firm or
consultant to Persons engaged in a Permitted Business of nationally recognized standing that is, in
the good faith judgment of VHS Holdco II, qualified to perform the task for which it has been
engaged.

     “Indirect Participant” means a Person who holds a beneficial interest in a Global Note through
a Participant.

     “Initial Purchasers” means Banc of America Securities LLC, Barclays Capital Inc., Citigroup
Global Markets Inc., Deutsche Bank Securities, Inc., Goldman, Sachs & Co. and Morgan Stanley & Co.
Incorporated.

     “Initial Notes” has the meaning assigned to it in the preamble to this Indenture.

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     “Institutional Accredited Investor” means an institution that is an “accredited investor” as
defined in Rule 501(a)(1), (2), (3) or (7) under the Securities Act, who are not also QIBS.

     “Investment Grade Rating” means a rating equal to or higher than Baa3 (or the equivalent) by
Moody’s and BBB- (or the equivalent) by S&P, or an equivalent rating by any other Rating Agency.

     “Investment Grade Securities” means:

     (1) securities issued by the U.S. government or by any agency or instrumentality
thereof and directly and fully guaranteed or insured by the U.S. government (other than Cash
Equivalents) and in each case with maturities not exceeding two years from the date of
acquisition,

     (2) investments in any fund that invests exclusively in investments of the type
described in clause (1) which fund may also hold immaterial amounts of cash pending
investment and/or distribution, and

     (3) corresponding instruments in countries other than the United States customarily
utilized for high quality investments and in each case with maturities not exceeding two
years from the date of acquisition.

     “Investments” means, with respect to any Person, all direct or indirect investments by such
Person in other Persons (including Affiliates) in the forms of loans (including guarantees or other
obligations), advances or capital contributions (excluding accounts receivable, trade credit,
advances to customers or suppliers, commission, travel and similar advances to officers and
employees, and, to the extent recorded in conformity with GAAP on the balance sheet of VHS Holdco
II as accounts receivable, prepaid expenses or deposits, endorsements for collections or deposits,
in each case to the extent arising in the ordinary course of business), purchases or other
acquisitions for consideration of Indebtedness, Equity Interests or other securities issued by any
other Person and investments that are required by GAAP to be classified on the balance sheet
(excluding the footnotes) of such Person in the same manner as the other investments included in
this definition to the extent such transactions involve the transfer of cash or other property. If
VHS Holdco II or any Subsidiary of VHS Holdco II sells or otherwise disposes of any Equity
Interests of any direct or indirect Subsidiary of VHS Holdco II such that, after giving effect to
any such sale or disposition, such Person is no longer a Subsidiary of VHS Holdco II, VHS Holdco II
shall be deemed to have made an Investment on the date of any such sale or disposition equal to the
fair market value of the Equity Interests of such Subsidiary not sold or disposed of in an amount
determined as provided in Section 4.05(c) hereof.

     For purposes of the definition of “Unrestricted Subsidiary” and Section 4.05 hereof, (a)
“Investments” shall include the portion (proportionate to VHS Holdco II’s equity interest in such
Subsidiary) of the fair market value of the net assets of a Subsidiary of VHS Holdco II at the time
that such Subsidiary is designated an Unrestricted Subsidiary; provided that upon a redesignation
of such Subsidiary as a Restricted Subsidiary, VHS Holdco II shall be deemed to continue to have a
permanent “Investment” in an Unrestricted Subsidiary in an amount (if positive) equal to (1) VHS
Holdco II’s “Investment” in such Subsidiary at the time of such redesignation less (2) the portion
(proportionate to VHS Holdco II’s equity interest in such Subsidiary) of the fair market value of
the net assets of such Subsidiary at the time of such redesignation; (b) any property transferred
to or from an Unrestricted Subsidiary shall be valued at its fair market value at the time of such
transfer, in each case as determined in good faith by VHS Holdco II; and (c) any transfer of
Capital Stock that results in an entity which became a Restricted Subsidiary after the Issue Date
ceasing to be a Restricted Subsidiary shall be deemed to be an Investment in an amount equal to the
fair market value (as determined by the Board of Directors of VHS Holdco II in good faith as of the
date of initial acquisition) of the Capital Stock of such entity owned by VHS Holdco II and the
Restricted Subsidiaries immediately after such transfer.

     “Issue Date” means January 29, 2010, the date on which the Initial Notes are originally
issued.

     “Issuers” means Vanguard Health Holding Company II, LLC, a Delaware limited liability company,
and Vanguard Holding Company II, Inc., a Delaware corporation and a Wholly-Owned Subsidiary of
Vanguard Health Holding Company II, LLC, and any and all successors thereto.

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     “Letter of Transmittal” means the letter of transmittal to be prepared by the Issuers and sent
to all Holders of the Notes for use by such Holders in connection with the Registered Exchange
Offer.

     “Lien” means, with respect to any asset, (a) any mortgage, deed of trust, lien, hypothecation,
pledge, encumbrance, charge or security interest in or on such asset, (b) the interest of a vendor
or a lessor under any conditional sale agreement, capital lease or title retention agreement (or
any financing lease having substantially the same economic effect as any of the foregoing) relating
to such asset and (c) in the case of securities (other than securities representing an interest in
a joint venture that is not a Subsidiary), any purchase option, call or similar right of a third
party with respect to such securities.

     “LLC Agreement” means the LLC Agreement among certain of the Sponsors and VHS Holdings LLC.

     “Management Group” means the group consisting of the directors, executive officers and other
management personnel of Vanguard, VHS Holdco I and the Issuers, as the case may be, on the Issue
Date together with (a) any new directors whose election by such boards of directors or whose
nomination for election by the shareholders of Vanguard, VHS Holdco I or the Issuers, as the case
may be, was approved by a vote of a majority of the directors of Vanguard, VHS Holdco I or the
Issuers, as the case may be, then still in office who were either directors on the Issue Date or
whose election or nomination was previously so approved and (b) executive officers and other
management personnel of Vanguard, VHS Holdco I or the Issuers, as the case may be, hired at a time
when the directors on the Issue Date together with the directors so approved constituted a majority
of the directors of Vanguard, VHS Holdco I or the Issuers, as the case may be.

     “Moody’s” means Moody’s Investors Service, Inc.

     “Net Income” means, with respect to any Person, the net income (loss) of such Person,
determined in accordance with GAAP (excluding the portion of such net income attributable to
non-controlling interests of Subsidiaries) and before any reduction in respect of Preferred Stock
dividends or accretion of any Preferred Stock.

     “Net Proceeds” means the aggregate cash proceeds received by VHS Holdco II or any Restricted
Subsidiaries in respect of any Asset Sale (including, without limitation, any cash received in
respect of or upon the sale or other disposition of any Designated Non-cash Consideration received
in any Asset Sale and any cash payments received by way of deferred payment of principal pursuant
to a note or installment receivable or otherwise, but only as and when received, but excluding the
assumption by the acquiring Person of Indebtedness relating to the disposed assets or other
consideration received in any other non-cash form), net of the direct costs relating to such Asset
Sale and the sale or disposition of such Designated Non-cash Consideration (including, without
limitation, legal, accounting and investment banking fees, and brokerage and sales commissions),
and any relocation expenses Incurred as a result thereof, taxes paid or payable as a result thereof
(after taking into account any available tax credits or deductions and any tax sharing arrangements
related thereto), payments required to be made to holders of non-controlling interests in
Restricted Subsidiaries as a result of such Asset Sale, amounts required to be applied to the
repayment of principal, premium (if any) and interest on Indebtedness required (other than pursuant
to Section 4.08(b) hereof to be paid as a result of such transaction, and any deduction of
appropriate amounts to be provided by VHS Holdco II as a reserve in accordance with GAAP against
any liabilities associated with the asset disposed of in such transaction and retained by VHS
Holdco II after such sale or other disposition thereof, including, without limitation, pension and
other post-employment benefit liabilities and liabilities related to environmental matters or
against any indemnification obligations associated with such transaction; provided that any net
proceeds of an Asset Sale by a non-guarantor Subsidiary that are subject to restrictions on
repatriation to VHS Holdco II shall not be considered Net Proceeds for so long as such proceeds are
subject to such restrictions.

     “Notes” has the meaning assigned to it in the preamble to this Indenture. The Initial Notes,
any Additional Notes and any Exchange Notes shall be treated as a single class for all purposes
under this Indenture, and unless the context otherwise requires, all references to the Notes shall
include the Initial Notes, any Additional Notes and any Exchange Notes.

     “Obligations” means any principal, interest, penalties, fees, expenses, indemnifications,
reimbursements (including, without limitation, reimbursement obligations with respect to letters of
credit), damages and other liabili-

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ties, and guarantees of payment of such principal, interest, penalties, fees, expenses,
indemnifications, reimbursements, damages and other liabilities, payable under the documentation
governing any Indebtedness.

     “Offer” means (a) the offer by VHS Holdco I to purchase any and all of the Existing VHS Holdco
I Notes and (b) the offer by VHS Holdco II to purchase any and all of the Existing VHS Holdco II
Notes, in each case as described in the Offering Memorandum on the terms and conditions set forth
in the Offer to Purchase and Consent Solicitation Statement dated January 14, 2010.

     “Offering Memorandum” means that certain offering memorandum dated January 20, 2010, relating
to the initial offering of the Notes.

     “Officer” means the Chairman of the Board, the Vice Chairman (if any), the Chief Executive
Officer, the President, any Executive Vice President, Senior Vice President or Vice President, the
Treasurer or the Secretary of the Issuers.

     “Officers’ Certificate” means a certificate signed on behalf of the Issuers by two Officers of
the Issuers, one of whom is the principal executive officer, the principal financial officer, the
treasurer or the principal accounting officer of the Issuers, that meets the requirements of
Section 12.05 hereof.

     “Opinion of Counsel” means an opinion from legal counsel that meets the requirements of
Section 12.05 hereof. The counsel may be an employee of or counsel to the Issuers or any
Subsidiary of the Issuers.

     “Pari Passu Indebtedness” means any Indebtedness of the Issuers or any Guarantor that ranks
pari passu in right of payment with the Notes or the Guarantees, as applicable.

     “Participant” means, with respect to the Depositary, Euroclear, a Person who has an account
with the Depositary, Euroclear or Clearstream, respectively (and, with respect to DTC, shall
include Euroclear or Clearstream).

     “Permitted Business” means any business in the healthcare industry, including, without
limitation, the business of owning and operating acute care hospitals and other related healthcare
services and any services and any captive insurance company, activities or businesses incidental or
directly related or reasonably similar thereto and any line of business engaged in by the Issuers
or any of their direct or indirect Subsidiaries on the Issue Date or any business activity that is
a reasonable extension, development or expansion thereof or ancillary thereto.

     “Permitted Debt” is defined in Section 4.07 hereof.

     “Permitted Holders” means, at any time, each of (a) the Sponsors and their Affiliates (not
including, however, any portfolio companies of any of the Sponsors), (b) one or more of the
executive officers of Vanguard as of the Issue Date as listed in the Offering Memorandum under the
caption “Management” (excluding any representatives of the Sponsors and their Affiliates) and (c)
the Management Group, excluding those persons included in clause (ii) hereof, with respect to not
more than 5.0% of the total voting power of the Equity Interests of Vanguard, VHS Holdco I, the
Issuers or any direct or indirect parent company of any of such Persons. Any person or group whose
acquisition of beneficial ownership constitutes a Change of Control in respect of which a Change of
Control Offer is made in accordance with the requirements of this Indenture shall thereafter,
together with its Affiliates, constitute an additional Permitted Holder.

     “Permitted Investments” means

     (1) any Investment by VHS Holdco II in any Restricted Subsidiary or by a Restricted
Subsidiary in another Restricted Subsidiary;

     (2) any Investment in cash and Cash Equivalents or Investment Grade Securities;

     (3) any Investment by VHS Holdco II or any Restricted Subsidiary in a Person that is
engaged in a Permitted Business if as a result of such Investment (A) such Person becomes a
Restricted Sub-

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sidiary or (B) such Person, in one transaction or a series of related transactions, is
merged, consolidated or amalgamated with or into, or transfers or conveys substantially all
of its assets to, or is liquidated into, VHS Holdco II or a Restricted Subsidiary;

     (4) any Investment in securities or other assets not constituting cash or Cash
Equivalents and received in connection with an Asset Sale made pursuant to the provisions
described in Section 4.08 hereof or any other disposition of assets not constituting an
Asset Sale;

     (5) any Investment existing on the Issue Date or made pursuant to binding commitments
in effect on the Issue Date or an Investment consisting of any extension, modification or
renewal of any Investment existing on the Issue Date (excluding any such extension,
modification or renewal involving additional advances, contributions or other investments of
cash or property or other increases thereof unless it is a result of the accrual or
accretion of interest or original issue discount or payment-in-kind pursuant to the terms,
as of the Issue Date, of the original Investment so extended, modified or renewed);

     (6) (A) loans and advances to officers, directors and employees, not in excess of $10.0
million in the aggregate outstanding at any one time and (B) loans and advances of payroll
payments and expenses to officers, directors and employees in each case incurred in the
ordinary course of business;

     (7) any Investment acquired by VHS Holdco II or any Restricted Subsidiary (A) in
exchange for any other Investment or accounts receivable held by VHS Holdco II or any such
Restricted Subsidiary in connection with or as a result of a bankruptcy, workout,
reorganization or recapitalization of the issuer of such other Investment or accounts
receivable or (B) in satisfaction of a judgment or as a result of a foreclosure by VHS
Holdco II or any Restricted Subsidiary with respect to any secured Investment or other
transfer of title with respect to any secured Investment in default;

     (8) Hedging Obligations permitted under clause (10) of the definition of “Permitted
Debt”;

     (9) any Investment by VHS Holdco II or a Restricted Subsidiary in a Permitted Business
having an aggregate fair market value, taken together with all other Investments made
pursuant to this clause (9) that are at that time outstanding (without giving effect to the
sale of an Unrestricted Subsidiary to the extent the proceeds of such sale do not consist of
cash and/or marketable securities), not to exceed the greater of (x) $90.0 million and (y)
3.0% of Total Assets (with the fair market value of each Investment being measured at the
time made and without giving effect to subsequent changes in value); provided that if any
Investment pursuant to this clause (9) is made in any Person that is not a Restricted
Subsidiary at the date of the making of such Investment and such Person becomes a Restricted
Subsidiary after such date, such Investment shall thereafter be deemed to have been made
pursuant to clause (1) above and shall cease to have been made pursuant to this clause (9)
for so long as such Person continues to be a Restricted Subsidiary;

     (10) Investments resulting from the receipt of non-cash consideration in an Asset Sale
received in compliance with Section 4.08 hereof;

     (11) Investments the payment for which consists of Equity Interests of the Issuers or
any direct or indirect parent companies of the Issuers (exclusive of Disqualified Stock);

     (12) guarantees (including Guarantees) of Indebtedness permitted under Section 4.07
hereof and performance guarantees consistent with past practice;

     (13) any transaction to the extent it constitutes an Investment that is permitted and
made in accordance with the provisions of Section 4.09 (except transactions described in
clauses (b)(2), (6), (7) and (10) thereof);

     (14) Investments of a Restricted Subsidiary acquired after the Issue Date or of an
entity merged into the Issuers or merged into or consolidated with a Restricted Subsidiary
in accordance with

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Section 5.01 hereof after the Issue Date to the extent that such Investments were not
made in contemplation of or in connection with such acquisition, merger or consolidation and
were in existence on the date of such acquisition, merger or consolidation;

     (15) guarantees by VHS Holdco II or any Restricted Subsidiary of operating leases
(other than Capitalized Lease Obligations) or of other obligations that do not constitute
Indebtedness, in each case entered into by any Restricted Subsidiary in the ordinary course
of business;

     (16) Investments consisting of licensing or contribution of intellectual property
pursuant to joint marketing arrangements with other Persons;

     (17) Investments consisting of purchases and acquisitions of inventory, supplies,
materials and equipment or purchases of contract rights or licenses or leases of
intellectual property, in each case in the ordinary course of business;

     (18) any Investment in a Securitization Subsidiary or any Investment by a
Securitization Subsidiary in any other Person in connection with a Qualified Securitization
Financing, including Investments of funds held in accounts permitted or required by the
arrangements governing such Qualified Securitization Financing or any related Indebtedness;
provided that any Investment in a Securitization Subsidiary is in the form of a Purchase
Money Note, contribution of additional Securitization Assets or an equity interest;

     (19) additional Investments in joint ventures of VHS Holdco II or any Restricted
Subsidiaries existing on the Issue Date in an aggregate amount not to exceed $25.0 million;

     (20) Physician Support Obligations made by the Issuers or a Subsidiary Guarantor;

     (21) Investments in a Captive Insurance Subsidiary in an amount that does not exceed
the minimum amount of capital required under the laws of the jurisdiction in which such
Captive Insurance Subsidiary is formed plus the amount of any reasonable general corporate
and overhead expenses of such Captive Insurance Subsidiary, and any Investment by a Captive
Insurance Subsidiary that is a legal investment for an insurance company under the laws of
the jurisdiction in which such Captive Insurance Subsidiary is formed and made in the
ordinary course of its business and rated in one of the four highest rating categories;

     (22) Investments in prepaid expenses, negotiable instruments held for collection and
lease, utility and workers compensation, performance and similar deposits entered into as a
result of the operations of the business in the ordinary course of business; and

     (23) additional Investments by VHS Holdco II or any Restricted Subsidiaries having an
aggregate fair market value, taken together with all other Investments made pursuant to this
clause (23), not to exceed 3.0% of Total Assets at the time of such Investment (with the
fair market value of each Investment being measured at the time made and without giving
effect to subsequent changes in value).

     “Permitted Liens” means the following types of Liens:

     (1) deposits of cash or government bonds made in the ordinary course of business to
secure surety or appeal bonds to which such Person is a party;

     (2) Liens in favor of issuers of performance, surety bid, indemnity, warranty, release,
appeal or similar bonds or with respect to other regulatory requirements or letters of
credit or bankers’ acceptances issued, and completion guarantees provided for, in each case
pursuant to the request of and for the account of such Person in the ordinary course of its
business or consistent with past practice;

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     (3) Liens on property or shares of stock of a Person at the time such Person becomes a
Subsidiary of VHS Holdco II; provided that such Liens are not created or incurred in
connection with, or in contemplation of, such other Person becoming such a Subsidiary;
provided further that such Liens may not extend to any other property owned by VHS Holdco II
or any Restricted Subsidiary;

     (4) Liens on property at the time VHS Holdco II or a Restricted Subsidiary acquired the
property, including any acquisition by means of a merger or consolidation with or into VHS
Holdco II or any Restricted Subsidiary; provided that such Liens are not created or incurred
in connection with, or in contemplation of, such acquisition; provided further that such
Liens may not extend to any other property owned by VHS Holdco II or any Restricted
Subsidiary;

     (5) Liens securing Indebtedness or other obligations of a Restricted Subsidiary owing
to VHS Holdco II or another Restricted Subsidiary permitted to be incurred in accordance
with Section 4.07 hereof.

     (6) Liens securing Hedging Obligations so long as the related Indebtedness is permitted
to be incurred under this Indenture and is secured by a Lien on the same property securing
such Hedging Obligation;

     (7) Liens on specific items of inventory or other goods and proceeds of any Person
securing such Person’s obligations in respect of bankers’ acceptances issued or created for
the account of such Person to facilitate the purchase, shipment or storage of such inventory
or other goods;

     (8) Liens in favor of VHS Holdco II or any Restricted Subsidiary;

     (9) Liens to secure any refinancing, refunding, extension, renewal or replacement (or
successive refinancings, refundings, extensions, renewals or replacements) as a whole, or in
part, of any Indebtedness secured by any Liens referred to in clauses (3), (4), (25) and
(26) of this definition; provided that (A) such new Lien shall be limited to all or part of
the same property that secured the original Liens (plus improvements on such property), and
(B) the Indebtedness secured by such Lien at such time is not increased to any amount
greater than the sum of (x) the outstanding principal amount or, if greater, committed
amount of the Indebtedness described under clauses (3), (4), (25) and (26) at the time the
original Lien became a Permitted Lien under this Indenture and (y) an amount necessary to
pay any fees and expenses, including premiums, related to such refinancing, refunding,
extension, renewal or replacement;

     (10) Liens on Securitization Assets and related assets of the type specified in the
definition of “Securitization Financing” incurred in connection with any Qualified
Securitization Financing;

     (11) Liens for taxes, assessments or other governmental charges or levies of or against
VHS Holdco II or one of its Subsidiaries not yet delinquent, or which are being contested in
good faith by appropriate proceedings promptly instituted and diligently conducted or
pursuant to the agreement dated October 25, 2004, entered into under Section 7121 of the
Code between Vanguard Health Financial Company LLC and the Commissioner of Internal Revenue
with respect to the election under Section 953(d) made (or to be made) by Volunteer
Insurance, Ltd. or for property taxes on property that VHS Holdco II or one of its
Subsidiaries has determined to abandon if the sole recourse for such tax, assessment,
charge, levy or claim is to such property;

     (12) judgment Liens not giving rise to an Event of Default so long as any appropriate
legal proceedings that may have been duly initiated for the review of such judgment shall
not have been finally terminated or the period within which such legal proceedings may be
initiated shall not have expired;

     (13) (A) pledges and deposits made in the ordinary course of business in compliance
with the Federal Employers Liability Act or any other workers’ compensation, unemployment
insurance and other social security laws or regulations and deposits securing liability to
insurance carriers under insurance or self-insurance arrangements in respect of such
obligations and (B) pledges and deposits securing liability

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for reimbursement or indemnification obligations of (including obligations in respect
of letters of credit or bank guarantees for the benefit of) insurance carriers providing
property, casualty or liability insurance to Vanguard, VHS Holdco I, VHS Holdco II or any
Restricted Subsidiary;

     (14) landlord’s, carriers’, warehousemen’s, mechanics’, materialmen’s, repairmen’s,
construction or other like Liens arising in the ordinary course of business and securing
obligations that are not overdue by more than 30 days or that are being contested in good
faith by appropriate proceedings and in respect of which, if applicable, VHS Holdco II or
any Restricted Subsidiary shall have set aside on its books reserves in accordance with
GAAP;

     (15) zoning restrictions, easements, trackage rights, leases (other than Capitalized
Lease Obligations), licenses, special assessments, rights-of-way, restrictions on use of
real property and other similar encumbrances incurred in the ordinary course of business
that, in the aggregate, do not interfere in any material respect with the ordinary conduct
of the business of VHS Holdco II or any Restricted Subsidiary;

     (16) Liens that are contractual rights of set-off (A) relating to the establishment of
depository relations with banks not given in connection with the issuance of Indebtedness,
(B) relating to pooled deposit or sweep accounts of VHS Holdco II or any Restricted
Subsidiary to permit satisfaction of overdraft or similar obligations incurred in the
ordinary course of business of VHS Holdco II and the Restricted Subsidiaries or (C) relating
to purchase orders and other agreements entered into with customers of VHS Holdco II or any
Restricted Subsidiary in the ordinary course of business;

     (17) Liens arising solely by virtue of any statutory or common law provision relating
to banker’s liens, rights of set-off or similar rights;

     (18) Liens securing obligations in respect of trade-related letters of credit permitted
under Section 4.07 hereof and covering the goods (or the documents of title in respect of
such goods) financed by such letters of credit and the proceeds and products thereof;

     (19) any interest or title of a lessor under any lease or sublease entered into by VHS
Holdco II or any Restricted Subsidiary in the ordinary course of business;

     (20) licenses of intellectual property granted in a manner consistent with past
practice;

     (21) Liens in favor of customs and revenue authorities arising as a matter of law to
secure payment of customs duties in connection with the importation of goods;

     (22) Liens solely on any cash earnest money deposits made by VHS Holdco II or any
Restricted Subsidiary in connection with any letter of intent or purchase agreement
permitted hereunder;

     (23) Liens with respect to obligations of VHS Holdco II or a Restricted Subsidiary with
an aggregate fair market value (valued at the time of creation thereof) of not more than
$50.0 million at any time;

     (24) deposits or pledges in connection with bids, tenders, leases and contracts (other
than contracts for the payment of money) entered into in the ordinary course of business;

     (25) Liens securing Capitalized Lease Obligations permitted to be incurred pursuant to
Section 4.07 hereof and Indebtedness permitted to be incurred under Section 4.07(b)(5);
provided, however, that such Liens securing Capitalized Lease Obligations or Indebtedness
incurred under Section 4.07(b)(5) hereof may not extend to property owned by VHS Holdco II
or any Restricted Subsidiary other than the property being leased or acquired pursuant to
such Section 4.07(b)(5);

     (26) Liens existing on the Issue Date after giving effect to the consummation of the
Refinancing;

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     (27) Liens securing Indebtedness of the Issuers or a Restricted Subsidiary under Credit
Facilities to the extent such Indebtedness has been incurred pursuant to Section 4.07(b)(1)
hereof;

     (28) Liens securing Pari Passu Indebtedness permitted to be incurred pursuant to
Section 4.07 hereof in an amount not to exceed the maximum amount of Indebtedness such that
the Consolidated Senior Secured Debt Ratio (at the time of incurrence of such Indebtedness
after giving pro forma effect thereto in a manner consistent with the calculation of the
Fixed Charge Coverage Ratio) would not be greater than 3.50 to 1.00;

     (29) Liens arising from Uniform Commercial Code financing statement filings regarding
operating leases entered into by the Issuers and their Restricted Subsidiaries in the
ordinary course of business;

     (30) Liens on equipment of the Issuers or any of their Restricted Subsidiaries granted
in the ordinary course of business to the Issuers’ clients;

     (31) Liens (i) of a collection bank arising under Section 4-210 of the Uniform
Commercial Code on items in the course of collection, (ii) attaching to commodity trading
accounts or other commodity brokerage accounts incurred in the ordinary course of business,
and (iii) in favor of banking institutions arising as a matter of law encumbering deposits
(including the right of set-off) and which are within the general parameters customary in
the banking industry;

     (32) Liens deemed to exist in connection with Investments in repurchase agreements
permitted under Section 4.07 hereof; provided that such Liens do not extend to any assets
other than those that are the subject of such repurchase agreement; and

     (33) Liens encumbering reasonable customary initial deposits and margin deposits and
similar Liens attaching to commodity trading accounts or other brokerage accounts incurred
in the ordinary course of business and not for speculative purposes.

     “Person” means any individual, corporation, partnership, joint venture, association,
joint-stock company, trust, unincorporated organization, limited liability company or government or
other entity.

     “Physician Support Obligation” means a loan to or on behalf of, or a guarantee of indebtedness
of, (a) a physician or healthcare professional providing service to patients in the service area of
a hospital or other healthcare facility operated by VHS Holdco II or any of its Subsidiaries or (b)
any independent practice association or other entity majority-owned by any Person described in
clause (a) made or given by VHS Holdco II or any Subsidiary of VHS Holdco II, in each case:

     (1) in the ordinary course of its business; and

     (2) pursuant to a written agreement having a period not to exceed five years.

     “Preferred Stock” means any Equity Interest with preferential rights of payment of dividends
upon liquidation, dissolution or winding up.

     “Private Placement Legend” means the legend set forth in Section 2.06(g)(1) hereof to be
placed on all Notes issued under this Indenture except where otherwise permitted by the provisions
of this Indenture.

     “Purchase Money Note” means a promissory note of a Securitization Subsidiary evidencing a line
of credit, which may be irrevocable, from Vanguard or any Subsidiary of Vanguard to a
Securitization Subsidiary in connection with a Qualified Securitization Financing, which note is
intended to finance that portion of the purchase price that is not paid in cash or a contribution
of equity and which (a) shall be repaid from cash available to the Securitization Subsidiary, other
than (1) amounts required to be established as reserves, (2) amounts paid to investors in respect
of interest, (3) principal and other amounts owing to such investors and (4) amounts paid in
connection with

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the purchase of newly generated receivables and (b) may be subordinated to the payments
described in clause (a) of this definition.

     “QIB” means a “qualified institutional buyer” as defined in Rule 144A.

     “Qualified Proceeds” means assets that are used or useful in, or Capital Stock of any Person
engaged in, a Permitted Business; provided that the fair market value of any such assets or Capital
Stock shall be determined by the Board of Directors of VHS Holdco II in good faith, except that in
the event the value of any such assets or Capital Stock exceeds $25.0 million or more, the fair
market value shall be determined by an Independent Financial Advisor.

     “Qualified Securitization Financing” means any Securitization Financing of a Securitization
Subsidiary that meets the following conditions: (a) the Board of Directors of VHS Holdco II shall
have determined in good faith that such Qualified Securitization Financing (including financing
terms, covenants, termination events and other provisions) is in the aggregate economically fair
and reasonable to the Issuers and the Securitization Subsidiary, (b) all sales of Securitization
Assets and related assets to the Securitization Subsidiary are made at fair market value (as
determined in good faith by VHS Holdco II) and (c) the financing terms, covenants, termination
events and other provisions thereof shall be market terms (as determined in good faith by VHS
Holdco II) and may include Standard Securitization Undertakings. The grant of a security interest
in any Securitization Assets of VHS Holdco II or any Restricted Subsidiaries (other than a
Securitization Subsidiary) to secure Indebtedness under the Credit Agreement and any Refinancing
Indebtedness with respect thereto shall not be deemed a Qualified Securitization Financing.

     “Rating Agencies” means Moody’s and S&P or if Moody’s or S&P or both shall not make a rating
on the Notes publicly available, a nationally recognized statistical rating agency or agencies, as
the case may be, selected by any Issuer which shall be substituted for Moody’s or S&P or both, as
the case may be.

     “Refinancing” means the initial borrowings under the Credit Agreement, the offering of the
Notes and the use of proceeds therefrom and the Offers, and the payment of related fees and
expenses, in each case as described in the Offering Memorandum.

     “Registered Exchange Offer” has the meaning set forth in the Registration Rights Agreement.

     “Registration Rights Agreement” means the Registration Rights Agreement, dated as of January
29, 2010, among the Issuers, the Guarantors and the Initial Purchasers named therein, as such
agreement may be amended, modified or supplemented from time to time and, with respect to any
Additional Notes, one or more registration rights agreements among the Issuers, the Guarantors and
the other parties thereto, as such agreement(s) may be amended, modified or supplemented from time
to time, relating to rights given by the Issuers to the purchasers of Additional Notes to register
such Additional Notes under the Securities Act.

     “Regulation S” means Regulation S promulgated under the Securities Act.

     “Regulation S Global Note” means a Regulation S Temporary Global Note or Regulation S
Permanent Global Note, as appropriate.

     “Regulation S Permanent Global Note” means a permanent Global Note in the form of Exhibit Al
hereto bearing the Global Note Legend and the Private Placement Legend and deposited with or on
behalf of and registered in the name of the Depositary or its nominee, issued in a denomination
equal to the outstanding principal amount of the Regulation S Temporary Global Note upon expiration
of the Restricted Period.

     “Regulation S Temporary Global Note” means a temporary Global Note in the form of Exhibit A2
hereto deposited with or on behalf of and registered in the name of the Depositary or its nominee,
issued in a denomination equal to the outstanding principal amount of the Notes initially sold in
reliance on Rule 903 of Regulation S.

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     “Responsible Officer” of any Person means any executive officer or financial officer of such
Person and any other officer or similar official thereof responsible for the administration of the
obligations of such Person in respect of this Indenture.

     “Restricted Definitive Note” means a Definitive Note bearing the Private Placement Legend.

     “Restricted Global Note” means a Global Note bearing the Private Placement Legend.

     “Restricted Investment” means an Investment other than a Permitted Investment.

     “Restricted Period” means the 40-day distribution compliance period as defined in Regulation
S.

     “Restricted Subsidiary” means, at any time, any direct or indirect Subsidiary of VHS Holdco II
that is not then an Unrestricted Subsidiary; provided that upon the occurrence of an Unrestricted
Subsidiary ceasing to be an Unrestricted Subsidiary, such Subsidiary shall be included in the
definition of Restricted Subsidiary. Unless otherwise indicated, all references to Restricted
Subsidiaries shall mean Restricted Subsidiaries of VHS Holdco II, including the Co-Issuer.

     “Rule 144” means Rule 144 promulgated under the Securities Act.

     “Rule 144A” means Rule 144A promulgated under the Securities Act.

     “Rule 903” means Rule 903 promulgated under the Securities Act.

     “Rule 904” means Rule 904 promulgated under the Securities Act.

     “S&P” means Standard and Poor’s Ratings Services, a division of The McGraw-Hill Companies,
Inc.

     “Securities Act” means the Securities Act of 1933, as amended, and the rules and regulations
of the Commission promulgated thereunder.

     “Securitization Assets” means any accounts receivable, inventory, royalty or revenue streams
from sales of inventory subject to a Qualified Securitization Financing.

     “Securitization Fees” means reasonable distributions or payments made directly or by means of
discounts with respect to any participation interest issued or sold in connection with, and other
fees paid to a Person that is not a Securitization Subsidiary in connection with any Qualified
Securitization Financing.

     “Securitization Financing” means any transaction or series of transactions that may be entered
into by Vanguard or any of its Subsidiaries pursuant to which Vanguard or any of its Subsidiaries
may sell, convey or otherwise transfer to (a) a Securitization Subsidiary (in the case of a
transfer by Vanguard or any of its Subsidiaries) and (b) any other Person (in the case of a
transfer by a Securitization Subsidiary), or may grant a security interest in, any Securitization
Assets (whether now existing or arising in the future) of Vanguard or any of its Subsidiaries, and
any assets related thereto, including, without limitation, all collateral securing such
Securitization Assets, all contracts and all guarantees or other obligations in respect of such
Securitization Assets, proceeds of such Securitization Assets and other assets which are
customarily transferred or in respect of which security interests are customarily granted in
connection with asset securitization transactions involving Securitization Assets and any Hedging
Obligations entered into by Vanguard or any of its Subsidiaries in connection with such
Securitization Assets.

     “Securitization Repurchase Obligation” means any obligation of a seller of Securitization
Assets in a Qualified Securitization Financing to repurchase Securitization Assets arising as a
result of a breach of a representation, warranty or covenant or otherwise, including as a result of
a receivable or portion thereof becoming subject to any asserted defense, dispute, offset or
counterclaim of any kind as a result of any action taken by, any failure to take action by or any
other event relating to the seller.

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     “Securitization Subsidiary” means a Wholly-Owned Subsidiary of Vanguard (or another Person
formed for the purposes of engaging in a Qualified Securitization Financing in which Vanguard or
any of its Subsidiaries makes an Investment and to which Vanguard or any of its Subsidiaries
transfers Securitization Assets and related assets) which engages in no activities other than in
connection with the financing of Securitization Assets of Vanguard or its Subsidiaries, all
proceeds thereof and all rights (contractual and other), collateral and other assets relating
thereto, and any business or activities incidental or related to such business, and which is
designated by the Board of Directors of Vanguard or such other Person (as provided below) as a
Securitization Subsidiary and (a) no portion of the Indebtedness or any other obligations
(contingent or otherwise) of which (i) is guaranteed by Vanguard or any of its Subsidiaries
(excluding guarantees of obligations (other than the principal of, and interest on, Indebtedness)
pursuant to Standard Securitization Undertakings), (ii) is recourse to or obligates Vanguard or any
of its Subsidiaries in any way other than pursuant to Standard Securitization Undertakings or (iii)
subjects any property or asset of Vanguard or any of its Subsidiaries, directly or indirectly,
contingently or otherwise, to the satisfaction thereof, other than pursuant to Standard
Securitization Undertakings, (b) with which neither Vanguard or any of its Subsidiaries has any
material contract, agreement, arrangement or understanding other than on terms which Vanguard
reasonably believes to be no less favorable to Vanguard or any of its Subsidiaries than those that
might be obtained at the time from Persons that are not Affiliates of Vanguard and (c) to which
neither Vanguard nor any of its Subsidiaries has any obligation to maintain or preserve such
entity’s financial condition or cause such entity to achieve certain levels of operating results.
Any such designation by the Board of Directors of Vanguard or such other Person shall be evidenced
to the Trustee by filing with the Trustee a certified copy of the resolution of the Board of
Directors of Vanguard or such other Person giving effect to such designation and an Officers’
Certificate certifying that such designation complied with the foregoing conditions.

     “Shelf Registration Statement” means the Shelf Registration Statement as defined in the
Registration Rights Agreement.

     “Significant Subsidiary” means any Restricted Subsidiary that would be a “significant
subsidiary” of VHS Holdco II as defined in Article I, Rule 1-02 of Regulation S-X, promulgated
pursuant to the Securities Act, as such Regulation is in effect on the Issue Date.

     “Sponsors” means one or more investment funds controlled by The Blackstone Group and its
Affiliates and one or more investment funds controlled by Morgan Stanley Capital Partners and its
Affiliates.

     “Standard Securitization Undertakings” means representations, warranties, covenants and
indemnities entered into by Vanguard or any of its Subsidiaries which Vanguard has determined in
good faith to be customary in a Securitization Financing, including, without limitation, those
relating to the servicing of the assets of a Securitization Subsidiary, it being understood that
any Securitization Repurchase Obligation shall be deemed to be a Standard Securitization
Undertaking.

     “Stated Maturity” means, with respect to any installment of interest or principal on any
series of Indebtedness, the day on which the payment of interest or principal was scheduled to be
paid in the original documentation governing such Indebtedness, and shall not include any
contingent obligations to repay, redeem or repurchase any such interest or principal prior to the
date originally scheduled for the payment thereof.

     “Subordinated Indebtedness” means (a) with respect to the Issuers, any Indebtedness of either
of the Issuers that is by its terms subordinated in right of payment to the Notes and (b) with
respect to any Guarantor of the Notes, any Indebtedness of such Guarantor that is by its terms
subordinated in right of payment to its Guarantee of the Notes.

     “Subsidiary” means, with respect to any specified Person:

     (1) any corporation, association or other business entity, of which more than 50% of
the total voting power of shares of Capital Stock entitled (without regard to the occurrence
of any contingency) to vote in the election of directors, managers or trustees thereof is at
the time owned or controlled, directly or indirectly, by that Person or one or more of the
other Subsidiaries of that Person (or a combination thereof); and

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     (2) any partnership, joint venture, limited liability company or similar entity of
which (x) more than 50% of the capital accounts, distribution rights, total equity and
voting interests or general or limited partnership interests, as applicable, are owned or
controlled, directly or indirectly, by such Person or one or more of the other Subsidiaries
of that Person or a combination thereof whether in the form of membership, general, special
or limited partnership or otherwise and (y) such Person or any Restricted Subsidiary of such
Person is a controlling general partner or otherwise controls such entity.

     “Subsidiary Guarantor” means each Subsidiary of VHS Holdco II that incurs a Guarantee of the
Notes.

     “Tax Distribution” means any distribution pursuant to Section 4.05(b)(9) hereof.

     “TIA” means the Trust Indenture Act of 1939, as amended (15 U.S.C. Sections 77aaa-77bbbb).

     “Total Assets” means the total consolidated assets of VHS Holdco II and its Restricted
Subsidiaries, as shown on the most recent balance sheet of VHS Holdco II.

     “Treasury Rate” means, as of the applicable redemption date, the yield to maturity as of such
redemption date of United States Treasury securities with a constant maturity (as compiled and
published in the most recent Federal Reserve Statistical Release H.15 (519) that has become
publicly available at least two Business Days prior to such redemption date (or, if such
Statistical Release is no longer published, any publicly available source of similar market data))
most nearly equal to the period from such redemption date to February 1, 2014; provided that if the
period from such redemption date to February 1, 2014 is less than one year, the weekly average
yield on actually traded United States Treasury securities adjusted to a constant maturity of one
year shall be used.

     “Trustee” means U.S. Bank National Association until a successor replaces it in accordance
with the applicable provisions of this Indenture and thereafter means the successor serving
hereunder.

     “Unrestricted Definitive Note” means a Definitive Note that does not bear and is not required
to bear the Private Placement Legend.

     “Unrestricted Global Note” means a Global Note that does not bear and is not required to bear
the Private Placement Legend.

     “Unrestricted Cash” of any Person means the cash or Cash Equivalents of such Person and its
Restricted Subsidiaries that would not appear as “restricted cash” on a consolidated balance sheet
of such Person and its Restricted Subsidiaries.

     “Unrestricted Subsidiary” means (a) any Subsidiary of VHS Holdco II that at the time of
determination is an Unrestricted Subsidiary (as designated by the Board of Directors of VHS Holdco
II, as provided below) and (b) any Subsidiary of an Unrestricted Subsidiary. The Board of
Directors of VHS Holdco II may designate any Subsidiary of VHS Holdco II (including any existing
Subsidiary and any newly acquired or newly formed Subsidiary) to be an Unrestricted Subsidiary
unless such Subsidiary or any of its Subsidiaries owns any Equity Interests or Indebtedness (other
than Indebtedness represented by short-term, open account working capital rates entered into in the
ordinary course of business for cash management purposes and consistent with past practice) of, or
owns or holds any Lien on, any property of, VHS Holdco II or any Subsidiary of VHS Holdco II (other
than any Subsidiary of the Subsidiary to be so designated); provided that (1) any Unrestricted
Subsidiary must be an entity of which shares of the Capital Stock or other equity interests
(including partnership interests) entitled to cast at least a majority of the votes that may be
cast by all shares or equity interests having ordinary voting power for the election of directors
or other governing body are owned, directly or indirectly, by VHS Holdco II, (2) such designation
complies with Section 4.05 hereof, and (3) each of (A) the Subsidiary to be so designated and (B)
its Subsidiaries has not at the time of designation, and does not thereafter, create, incur, issue,
assume, guarantee or otherwise become directly or indirectly liable with respect to any
Indebtedness pursuant to which the lender has recourse to any of the assets of VHS Holdco II or any
Restricted Subsidiary. The Board of Directors of VHS Holdco II may designate any Unrestricted
Subsidiary to be a Restricted Subsidiary; provided that, immediately after giving effect to such
designation, (i) no Default or Event of Default shall have occurred and be continuing and (ii)
either (x) the Fixed Charge Coverage

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Ratio would be at least 2.00 to 1.00 or (y) the Fixed Charge Coverage Ratio would be greater
than immediately prior to such designation, in each case on a pro forma basis taking into account
such designation. Any such designation by the Board of Directors of VHS Holdco II shall be
notified by the Issuers to the Trustee by promptly filing with the Trustee a copy of the board
resolution giving effect to such designation and an Officers’ Certificate certifying that such
designation complied with the foregoing provisions.

     “U.S. Person” means a U.S. Person as defined in Rule 902(k) promulgated under the Securities
Act.

     “Voting Stock” of any Person as of any date means the Capital Stock of such Person that is at
the time entitled to vote in the election of the Board of Directors of such Person.

     “Weighted Average Life to Maturity” means, when applied to any Indebtedness at any date, the
number of years obtained by dividing:

     (1) the sum of the products obtained by multiplying (a) the amount of each then
remaining installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect of the Indebtedness, by (b) the
number of years (calculated to the nearest one-twelfth) that shall elapse between such date
and the making of such payment; by

     (2) the then outstanding principal amount of such Indebtedness.

     “Wholly-Owned Subsidiary” of any Person means a Subsidiary of such Person, 100% of the
outstanding Capital Stock or other ownership interests of which (other than directors’ qualifying
shares or nominee or other similar shares required pursuant to applicable law) shall at the time be
owned by such Person or by one or more Wholly-Owned Subsidiaries of such Person or by such Person
and one or more Wholly-Owned Subsidiaries of such Person.

     Section 1.02 Other Definitions.

	 	 	 	 	 
	 	 	Defined
	Term	 	in Section
	“Affiliate Transaction”
	 	 	4.09	 
	“Asset Sale Offer”
	 	 	3.09	 
	“Authentication Order”
	 	 	2.02	 
	“Change of Control Offer”
	 	 	4.11	 
	“Change of Control Payment”
	 	 	4.11	 
	“Change of Control Payment Date”
	 	 	4.11	 
	“Covenant Defeasance”
	 	 	8.03	 
	“DTC”
	 	 	2.03	 
	“Event of Default”
	 	 	6.01	 
	“Excess Proceeds”
	 	 	4.08	 
	“incur”
	 	 	4.07	 
	“Legal Defeasance”
	 	 	8.02	 
	“Offer Period”
	 	 	3.09	 
	“Paying Agent”
	 	 	2.03	 
	“Permitted Debt”
	 	 	4.07	 
	“Registrar”
	 	 	2.03	 
	“Restricted Payments”
	 	 	4.05	 

     Section 1.03 Incorporation by Reference of Trust Indenture Act. Whenever this Indenture refers to
a provision of the TIA, the provision is incorporated by reference in and made a part of this
Indenture.

     The following TIA terms used in this Indenture have the following meanings:

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     “indenture securities” means the Notes;

     “indenture security Holder” means a Holder of a Note;

     “indenture to be qualified” means this Indenture;

     “indenture trustee” or “institutional trustee” means the Trustee; and “obligor” on the Notes
and the Guarantees means the Issuers and the Guarantors, respectively, and any successor obligor
upon the Notes and the Guarantees, respectively.

     All other terms used in this Indenture that are defined by the TIA, defined by TIA reference
to another statute or defined by Commission rule under the TIA have the meanings so assigned to
them.

     Section 1.04 Rules of Construction. Unless the context otherwise requires:

     (1) a term has the meaning assigned to it;

     (2) an accounting term not otherwise defined has the meaning assigned to it in
accordance with GAAP;

     (3) “or” is not exclusive;

     (4) words in the singular include the plural, and in the plural include the singular;

     (5) “will” shall be interpreted to express a command;

     (6) provisions apply to successive events and transactions; and

     (7) references to Sections of or rules under the Securities Act shall be deemed to
include substitute, replacement of successor Sections or rules adopted by the Commission
from time to time.

ARTICLE II

THE NOTES

     Section 2.01 Form and Dating.

     (a) General. The Notes and the Trustee’s certificate of authentication shall be
substantially in the form of Exhibits Al and A2 hereto. The Notes may have notations, legends or
endorsements required by law, stock exchange rule or usage (provided that any such notation, legend
or endorsement required by usage is in a form reasonably acceptable to the Issuers). Each Note
shall be dated the date of its authentication. The Notes shall be in denominations of $2,000 and
integral multiples of $1,000 in excess thereof.

     The terms and provisions contained in the Notes shall constitute, and are hereby expressly
made, a part of this Indenture and the Issuers, the Guarantors and the Trustee, by their execution
and delivery of this Indenture, expressly agree to such terms and provisions and to be bound
thereby. However, to the extent any provision of any Note conflicts with the express provisions of
this Indenture, the provisions of this Indenture shall govern and be controlling.

     (b) Global Notes. Notes issued in global form shall be substantially in the form of
Exhibits Al or A2 hereto (including the Global Note Legend thereon and the “Schedule of Exchanges
of Interests in the Global Note” attached thereto). Notes issued in definitive form shall be
substantially in the form of Exhibit Al hereto (but without the Global Note Legend thereon and
without the “Schedule of Exchanges of Interests in the Global Note” attached thereto). Each Global
Note shall represent such of the outstanding Notes as shall be specified therein and each shall
provide that it represents the aggregate principal amount of outstanding Notes from time to time
endorsed thereon

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and that the aggregate principal amount of outstanding Notes represented thereby may from time
to time be reduced or increased, as appropriate, to reflect exchanges and redemptions. Any
endorsement of a Global Note to reflect the amount of any increase or decrease in the aggregate
principal amount of outstanding Notes represented thereby shall be made by the Trustee or the
custodian, at the direction of the Trustee, in accordance with instructions given by the Holder
thereof as required by Section 2.06 hereof and shall be made on the records of the Trustee and the
Depositary.

     (c) Temporary Global Notes. Notes offered and sold in reliance on Regulation S shall
be issued initially in the form of the Regulation S Temporary Global Note, which shall be deposited
on behalf of the purchasers of the Notes represented thereby with the Trustee, at its New York
office, as custodian for the Depositary, and registered in the name of the Depositary or the
nominee of the Depositary for the accounts of designated agents holding on behalf of Euroclear or
Clearstream, duly executed by the Issuers and authenticated by the Trustee as hereinafter provided.
The Restricted Period shall be terminated upon the receipt by the Trustee of:

     (1) a written certificate from the Depositary, together with copies of certificates
from Euroclear and Clearstream certifying that they have received certification of
non-United States beneficial ownership of 100% of the aggregate principal amount of the
Regulation S Temporary Global Note (except to the extent of any Beneficial Owners thereof
who acquired an interest therein during the Restricted Period pursuant to another exemption
from registration under the Securities Act and who shall take delivery of a beneficial
ownership interest in a 144A Global Note or an IAI Global Note bearing a Private Placement
Legend, all as contemplated by Section 2.06(b) hereof); and

     (2) an Officers’ Certificate from the Issuers.

     Following the termination of the Restricted Period, beneficial interests in the Regulation S
Temporary Global Note shall be exchanged for beneficial interests in the Regulation S Permanent
Global Note pursuant to the Applicable Procedures. Simultaneously with the authentication of the
Regulation S Permanent Global Note, the Trustee shall cancel the Regulation S Temporary Global
Note. The aggregate principal amount of the Regulation S Temporary Global Note and the Regulation
S Permanent Global Note may from time to time be increased or decreased by adjustments made on the
records of the Trustee and the Depositary or its nominee, as the case may be, in connection with
transfers of interest as hereinafter provided.

     (d) Euroclear and Clearstream Procedures Applicable. The provisions of the “Operating
Procedures of the Euroclear System” and “Terms and conditions Governing Use of Euroclear” and the
“General Terms and Conditions of Clearstream Banking” and “Customer Handbook” of Clearstream shall
be applicable to transfers of beneficial interests in the Regulation S Temporary Global Note and
the Regulation S Permanent Global Note that are held by Participants through Euroclear or
Clearstream.

     Section 2.02 Execution and Authentication. At least one officer must sign the Notes for the
Issuers by manual or facsimile signature.

     If an officer whose signature is on a Note no longer holds that office at the time a Note is
authenticated, the Note shall nevertheless be valid.

     A Note shall not be valid until authenticated by the manual signature of the Trustee. The
signature shall be conclusive evidence that the Note has been authenticated under this Indenture.

     The Trustee shall, upon receipt of a written order of the Issuers signed by two officers of
the Issuers (an “Authentication Order”), authenticate Notes for original issue that may be validly
issued under this Indenture, including any Additional Notes and any Exchange Notes. The aggregate
principal amount of Notes outstanding at any time may not exceed the aggregate principal amount of
Notes authorized for issuance by the Issuers pursuant to one or more Authentication Orders, except
as provided in Section 2.07 hereof.

     The Trustee may appoint an authenticating agent acceptable to the Issuers to authenticate
Notes. An authenticating agent may authenticate Notes whenever the Trustee may do so. Each
reference in this Indenture to au

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thentication by the Trustee includes authentication by such agent. An authenticating agent
has the same rights as an Agent to deal with Holders or an Affiliate of the Issuers.

     Section 2.03 Registrar and Paying Agent. The Issuers shall maintain an office or agency where
Notes may be presented for registration of transfer or for exchange (“Registrar”) and an office or
agency where Notes may be presented for payment (“Paying Agent”). The Registrar shall keep a
register of the Notes and of their transfer and exchange. The Issuers may appoint one or more
co-registrars and one or more additional paying agents. The term “Registrar” includes any
co-registrar and the term “Paying Agent” includes any additional paying agent. The Issuers may
change any Paying Agent or Registrar without notice to any Holder. The Issuers shall notify the
Trustee in writing of the name and address of any Agent not a party to this Indenture. If the
Issuers fail to appoint or maintain another entity as Registrar or Paying Agent, the Trustee shall
act as such. The Issuers or any of their subsidiaries may act as Paying Agent or Registrar.

     The Issuers initially appoint The Depository Trust Company (“DTC”) to act as Depositary with
respect to the Global Notes.

     The Issuers initially appoint the Trustee to act as the Registrar and Paying Agent and to act
as custodian with respect to the Global Notes.

     Section 2.04 Paying Agent to Hold Money in Trust. The Issuers shall require each Paying Agent
other than the Trustee to agree in writing that the Paying Agent shall hold in trust for the
benefit of Holders or the Trustee all money held by the Paying Agent for the payment of principal,
premium or Additional Interest, if any, or interest on the Notes, and shall notify the Trustee of
any default by the Issuers in making any such payment. While any such default continues, the
Trustee may require a Paying Agent to pay all money held by it to the Trustee. The Issuers at any
time may require a Paying Agent to pay all money held by it to the Trustee. Upon payment over to
the Trustee, the Paying Agent (if other than the Issuers or a subsidiary) shall have no further
liability for the money. If the Issuers or a Subsidiary acts as Paying Agent, it shall segregate
and hold in a separate trust fund for the benefit of the Holders all money held by it as Paying
Agent. Upon any bankruptcy or reorganization proceedings relating to the Issuers, the Trustee
shall serve as Paying Agent for the Notes.

     Section 2.05 Holder Lists. The Trustee shall preserve in as current a form as is reasonably
practicable the most recent list available to it of the names and addresses of all Holders and
shall otherwise comply with TIA Section 312(a). If the Trustee is not the Registrar, the Issuers
shall furnish to the Trustee at least seven Business Days before each interest payment date and at
such other times as the Trustee may request in writing, a list in such form and as of such date as
the Trustee may reasonably require of the names and addresses of the Holders of Notes and the
Issuers shall otherwise comply with TIA Section 312(a).

     Section 2.06 Transfer and Exchange.

     (a) Transfer and Exchange of Global Notes. A Global Note may not be transferred
except as a whole by the Depositary to a nominee of the Depositary, by a nominee of the Depositary
to the Depositary or to another nominee of the Depositary, or by the Depositary or any such nominee
to a successor Depositary or a nominee of such successor Depositary. All Global Notes shall be
exchanged by the Issuers for certificated Notes if:

     (1) the Issuers deliver in writing to the Trustee notice that the Depositary is
unwilling or unable to continue to act as Depositary or that it is no longer a clearing
agency registered under the Exchange Act and, in either case, a successor Depositary is not
appointed by the Issuers within 90 days after the date of such notice or cessation;

     (2) the Issuers in their sole discretion determine that the Global Notes (in whole but
not in part) should be exchanged for Definitive Notes and deliver a written notice to such
effect to the Trustee; provided that in no event shall the Regulation S Temporary Global
Note be exchanged by the Issuers for Definitive Notes prior to (A) the expiration of the
Restricted Period and (B) the receipt by the Registrar of any certificates required pursuant
to Rule 903(b)(3)(ii)(B) under the Securities Act; or

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     (3) there has occurred and is continuing an Event of Default and the registry has
received a request from the Depositary to issue the Certificated Notes.

     Upon the occurrence of either of the preceding events in (1) or (2) above, Definitive Notes
shall be issued in such names as the Depositary shall instruct the Trustee. Global Notes also may
be exchanged or replaced, in whole or in part, as provided in Sections 2.07 and 2.10 hereof. Every
Note authenticated and delivered in exchange for, or in lieu of, a Global Note or any portion
thereof, pursuant to this Section 2.06 or Section 2.07 or 2.10 hereof, shall be authenticated and
delivered in the form of, and shall be, a Global Note. A Global Note may not be exchanged for
another Note other than as provided in this Section 2.06(a), however, beneficial interests in a
Global Note may be transferred and exchanged as provided in Section 2.06(b), (c) or (f) hereof.

     (b) Transfer and Exchange of Beneficial Interests in the Global Notes. The transfer
and exchange of beneficial interests in the Global Notes shall be effected through the Depositary,
in accordance with the provisions of this Indenture and the Applicable Procedures. Beneficial
interests in the Restricted Global Notes shall be subject to restrictions on transfer comparable to
those set forth herein to the extent required by the Securities Act. Transfers of beneficial
interests in the Global Notes also shall require compliance with either subparagraph (1) or (2)
below, as applicable, as well as one or more of the other following subparagraphs, as applicable:

     (1) Transfer of Beneficial Interests in the Same Global Note. Beneficial
interests in any Restricted Global Note may be transferred to Persons who take delivery
thereof in the form of a beneficial interest in the same Restricted Global Note in
accordance with the transfer restrictions set forth in the Private Placement Legend;
provided, however, that prior to the expiration of the Restricted Period, transfers of
beneficial interests in the Regulation S Temporary Global Note may not be made to a U.S.
Person or for the account or benefit of a U.S. Person (other than an Initial Purchaser).
Beneficial interests in any Unrestricted Global Note may be transferred to Persons who take
delivery thereof in the form of a beneficial interest in an Unrestricted Global Note. No
written orders or instructions shall be required to be delivered to the Registrar to effect
the transfers described in this Section 2.06(b)(1).

     (2) All other Transfers and Exchanges of Beneficial Interests in Global Notes.
In connection with all transfers and exchanges of beneficial interests that are not subject
to Section 2.06(b)(1) above, the transferor of such beneficial interest must deliver to the
Registrar either:

     (A) both:

     (i) a written order from a Participant or an Indirect Participant given
to the Depositary in accordance with the Applicable Procedures directing the
Depositary to credit or cause to be credited a beneficial interest in
another Global Note in an amount equal to the beneficial interest to be
transferred or exchanged; and

     (ii) instructions given in accordance with the Applicable Procedures
containing information regarding the Participant account to be credited with
such increase; or

     (B) both:

     (i) a written order from a Participant or an Indirect Participant given
to the Depositary in accordance with the Applicable Procedures directing the
Depositary to cause to be issued a Definitive Note in an amount equal to the
beneficial interest to be transferred or exchanged; and

     (ii) instructions given by the Depositary to the Registrar containing
information regarding the Person in whose name such Definitive Note shall be
registered to effect the transfer or exchange referred to in (1) above;
provided, that in no event shall Definitive Notes be issued upon the
transfer or exchange of beneficial interests in the Regulation S Temporary
Global Note prior to (A) the expiration of the Restricted Period

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and (B) the receipt by the Registrar of any certificates required
pursuant to Rule 903 under the Securities Act.

Upon consummation of a Registered Exchange Offer by the Issuers in accordance with Section
2.06(f) hereof, the requirements of this Section 2.06(b)(2) shall be deemed to have been
satisfied upon receipt by the Registrar of the instructions contained in the Letter of
Transmittal delivered by the Holder of such beneficial interests in the Restricted Global
Notes. Upon satisfaction of all of the requirements for transfer or exchange of beneficial
interests in Global Notes contained in this Indenture and the Notes or otherwise applicable
under the Securities Act, the Trustee shall adjust the principal amount of the relevant
Global Note(s) pursuant to Section 2.06(h) hereof.

     (3) Transfer of Beneficial Interests to Another Restricted Global Note. A
beneficial interest in any Restricted Global Note may be transferred to a Person who takes
delivery thereof in the form of a beneficial interest in another Restricted Global Note if
the transfer complies with the requirements of Section 2.06(b)(2) above and the Registrar
receives the following:

     (A) if the transferee shall take delivery in the form of a beneficial interest
in the 144A Global Note, then the transferor must deliver a certificate in the form
of Exhibit B hereto, including the certifications in item (1) thereof;

     (B) if the transferee shall take delivery in the form of a beneficial interest
in the Regulation S Temporary Global Note or the Regulation S Permanent Global Note,
then the transferor must deliver a certificate in the form of Exhibit B hereto,
including the certifications in item (2) thereof; and

     (C) if the transferee shall take delivery in the form of a beneficial interest
in the IAI Global Note, then the transferor must deliver a certificate in the form
of Exhibit B hereto, including the certifications, certificates and Opinion of
Counsel required by item (3)(d) thereof, if applicable.

     (4) Transfer and Exchange of Beneficial Interests in a Restricted Global Note for
Beneficial Interests in an Unrestricted Global Note. A beneficial interest in any
Restricted Global Note may be exchanged by any holder thereof for a beneficial interest in
an Unrestricted Global Note or transferred to a Person who takes delivery thereof in the
form of a beneficial interest in an Unrestricted Global Note if the exchange or transfer
complies with the requirements of Section 2.06(b)(2) above and:

     (A) such exchange or transfer is effected pursuant to the Registered Exchange
Offer in accordance with the Registration Rights Agreement and the holder of the
beneficial interest to be transferred, in the case of an exchange, or the
transferee, in the case of a transfer, certifies in the applicable Letter of
Transmittal that it is not (i) a Broker-Dealer, (ii) a Person participating in the
distribution of the Exchange Notes or (iii) a Person who is an affiliate (as defined
in Rule 144) of the Issuers;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration statement in accordance with the Registration Rights Agreement; or

     (D) the Registrar receives the following:

     (i) if the holder of such beneficial interest in a Restricted Global
Note proposes to exchange such beneficial interest for a beneficial interest
in an Unrestricted Global Note, a certificate from such holder in the form
of Exhibit C hereto, including the certifications in item (1)(a) thereof; or

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     (ii) if the holder of such beneficial interest in a Restricted Global
Note proposes to transfer such beneficial interest to a Person who shall
take delivery thereof in the form of a beneficial interest in an
Unrestricted Global Note, a certificate from such holder in the form of
Exhibit B hereto, including the certifications in item (4) thereof;

and, in each such case set forth in subparagraph (D) above, if the Registrar so requests or if the
Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the
Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and
that the restrictions on transfer contained herein and in the Private Placement Legend are no
longer required in order to maintain compliance with the Securities Act.

     If any such transfer is effected pursuant to subparagraph (B) or (D) above at a time when an
Unrestricted Global Note has not yet been issued, the Issuers shall issue and, upon receipt of an
Authentication Order in accordance with Section 2.02 hereof, the Trustee shall authenticate one or
more Unrestricted Global Notes in an aggregate principal amount equal to the aggregate principal
amount of beneficial interests transferred pursuant to subparagraph (B) or (D) above.

     Beneficial interests in an Unrestricted Global Note cannot be exchanged for, or transferred to
Persons who take delivery thereof in the form of, a beneficial interest in a Restricted Global
Note.

     (c) Transfer or Exchange of Beneficial Interests for Definitive Notes.

     (1) Beneficial Interests in Restricted Global Notes to Restricted Definitive Notes.
If any holder of a beneficial interest in a Restricted Global Note proposes to exchange such
beneficial interest for a Restricted Definitive Note or to transfer such beneficial interest to a
Person who takes delivery thereof in the form of a Restricted Definitive Note, then, upon receipt
by the Registrar of the following documentation:

     (A) if the holder of such beneficial interest in a Restricted Global Note proposes to
exchange such beneficial interest for a Restricted Definitive Note, a certificate from such
holder in the form of Exhibit C hereto, including the certifications in item (2)(a) thereof;

     (B) if such beneficial interest is being transferred to a QIB in accordance with Rule
144A, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (1) thereof;

     (C) if such beneficial interest is being transferred to a Non-U.S. Person in an
offshore transaction in accordance with Rule 903 or Rule 904, a certificate to the effect
set forth in Exhibit B hereto, including the certifications in item (2) thereof;

     (D) if such beneficial interest is being transferred pursuant to an exemption from the
registration requirements of the Securities Act in accordance with Rule 144, a certificate
to the effect set forth in Exhibit B hereto, including the certifications in item (3)(a)
thereof;

     (E) if such beneficial interest is being transferred to an Institutional Accredited
Investor in reliance on an exemption from the registration requirements of the Securities
Act other than those listed in subparagraphs (B) through (D) above, a certificate to the
effect set forth in Exhibit B hereto, including the certifications, certificates and Opinion
of Counsel required by item (3)(d) thereof, if applicable;

     (F) if such beneficial interest is being transferred to the Issuers or any of their
Subsidiaries, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (3)(b) thereof; or

     (G) if such beneficial interest is being transferred pursuant to an effective
registration statement under the Securities Act, a certificate to the effect set forth in
Exhibit B hereto, including the certifications in item (3)(c) thereof,

the Trustee shall cause the aggregate principal amount of the applicable Global Note to be reduced
accordingly pursuant to Section 2.06(h) hereof, and the Issuers shall execute and the Trustee shall
authenticate and deliver to the

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Person designated in the instructions a Definitive Note in the appropriate principal amount. Any
Definitive Note issued in exchange for a beneficial interest in a Restricted Global Note pursuant
to this Section 2.06(c) shall be registered in such name or names and in such authorized
denomination or denominations as the holder of such beneficial interest shall instruct the
Registrar through instructions from the Depositary and the Participant or Indirect Participant.
The Trustee shall deliver such Definitive Notes to the Persons in whose names such Notes are so
registered. Any Definitive Note issued in exchange for a beneficial interest in a Restricted
Global Note pursuant to this Section 2.06(c)(1) shall bear the Private Placement Legend and shall
be subject to all restrictions on transfer contained therein.

     (2) Beneficial Interests in Regulation S Temporary Global Note to Definitive Notes.
Notwithstanding Sections 2.06(c)(1)(A) and (c) hereof, a beneficial interest in the Regulation S
Temporary Global Note may not be exchanged for a Definitive Note or transferred to a Person who
takes delivery thereof in the form of a Definitive Note prior to (A) the expiration of the
Restricted Period and (B) the receipt by the Registrar of any certificates required pursuant to
Rule 903(b)(3)(ii)(B) under the Securities Act, except in the case of a transfer pursuant to an
exemption from the registration requirements of the Securities Act other than Rule 903 or Rule 904.

     (3) Beneficial Interests in Restricted Global Notes to Unrestricted Definitive Notes.
A holder of a beneficial interest in a Restricted Global Note may exchange such beneficial interest
for an Unrestricted Definitive Note or may transfer such beneficial interest to a Person who takes
delivery thereof in the form of an Unrestricted Definitive Note only if:

     (A) such exchange or transfer is effected pursuant to the Registered Exchange Offer in
accordance with the Registration Rights Agreement and the holder of such beneficial
interest, in the case of an exchange, or the transferee, in the case of a transfer,
certifies in the applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a
Person participating in the distribution of the Exchange Notes or (iii) a Person who is an
affiliate (as defined in Rule 144) of the Issuers;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration Statement in accordance with the Registration Rights Agreement; or

     (D) the Registrar receives the following:

     (i) if the holder of such beneficial interest in a Restricted Global Note
proposes to exchange such beneficial interest for an Unrestricted Definitive Note, a
certificate from such holder in the form of Exhibit C hereto, including the
certifications in item (1)(b) thereof; or

     (ii) if the holder of such beneficial interest in a Restricted Global Note
proposes to transfer such beneficial interest to a Person who shall take delivery
thereof in the form of an Unrestricted Definitive Note, a certificate from such
holder in the form of Exhibit B hereto, including the certifications in item (4)
thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so requests or if the
Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the
Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and
that the restrictions on transfer contained herein and in the Private Placement Legend are no
longer required in order to maintain compliance with the Securities Act.

     (4) Beneficial Interests in Unrestricted Global Notes to Unrestricted Definitive
Notes. If any holder of a beneficial interest in an Unrestricted Global Note proposes to
exchange such beneficial interest for a Definitive Note or to transfer such beneficial interest to
a Person who takes delivery thereof in the form of a Definitive Note, then, upon satisfaction of
the conditions set forth in Section 2.06(b)(2) hereof, the Trustee shall cause the aggregate
principal amount of the applicable Global Note to be reduced accordingly pursuant to Section
2.06(h) hereof, and the Issuers shall execute and the Trustee shall authenticate and deliver to the
Person designated in the instructions a

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Definitive Note in the appropriate principal amount. Any Definitive Note issued in exchange
for a beneficial interest pursuant to this Section 2.06(c)(4) shall be registered in such name or
names and in such authorized denomination or denominations as the holder of such beneficial
interest requests through instructions to the Registrar from or through the Depositary and the
Participant or Indirect Participant. The Trustee shall deliver such Definitive Notes to the
Persons in whose names such Notes are so registered. Any Definitive Note issued in exchange for a
beneficial interest pursuant to this Section 2.06(c)(4) shall not bear the Private Placement
Legend.

     (d) Transfer and Exchange of Definitive Notes for Beneficial Interests.

     (1) Restricted Definitive Notes to Beneficial Interests in Restricted Global Notes.
If any Holder of a Restricted Definitive Note proposes to exchange such note for a beneficial
interest in a Restricted Global Note or to transfer such Restricted Definitive Notes to a Person
who takes delivery thereof in the form of a beneficial interest in a Restricted Global Note, then,
upon receipt by the Registrar of the following documentation:

     (A) if the Holder of such Restricted Definitive Note proposes to exchange such note for
a beneficial interest in a Restricted Global Note, a certificate from such Holder in the
form of Exhibit C hereto, including the certifications in item (2)(b) thereof;

     (B) if such Restricted Definitive Note is being transferred to a QIB in accordance with
Rule 144A, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (1) thereof;

     (C) if such Restricted Definitive Note is being transferred to a Non-U.S. Person in an
offshore transaction in accordance with Rule 903 or Rule 904, a certificate to the effect
set forth in Exhibit B hereto, including the certifications in item (2) thereof;

     (D) if such Restricted Definitive Note is being transferred pursuant to an exemption
from the registration requirements of the Securities Act in accordance with Rule 144, a
certificate to the effect set forth in Exhibit B hereto, including the certifications in
item (3)(a) thereof;

     (E) if such Restricted Definitive Note is being transferred to an Institutional
Accredited Investor in reliance on an exemption from the registration requirements of the
Securities Act other than those listed in subparagraphs (B) through (D) above, a certificate
to the effect set forth in Exhibit B hereto, including the certifications, certificates and
Opinion of Counsel required by item (3)(d) thereof, if applicable;

     (F) if such Restricted Definitive Note is being transferred to the Issuers or any of
their Subsidiaries, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (3)(b) thereof; or

     (G) if such Restricted Definitive Note is being transferred pursuant to an effective
registration statement under the Securities Act, a certificate to the effect set forth in
Exhibit B hereto, including the certifications in item (3)(c) thereof,

the Trustee shall cancel the Restricted Definitive Note, increase or cause to be increased the
aggregate principal amount of, in the case of clause (A) above, the appropriate Restricted Global
Note, in the case of clause (B) above, the 144A Global Note, in the case of clause (C) above, the
Regulation S Global Note, and in all other cases, the IAI Global Note.

     (2) Restricted Definitive Notes to Beneficial Interests in Unrestricted Global Notes.
A Holder of a Restricted Definitive Note may exchange such note for a beneficial interest in an
Unrestricted Global Note or transfer such Restricted Definitive Note to a Person who takes delivery
thereof in the form of a beneficial interest in an Unrestricted Global Note only if:

     (A) such exchange or transfer is effected pursuant to the Registered Exchange Offer in
accordance with the Registration Rights Agreement and the Holder, in the case of an
exchange, or the transferee, in the case of a transfer, certifies in the applicable Letter
of Transmittal that it is not (i) a Broker-Dealer, (ii)

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a Person participating in the distribution of the Exchange Notes or (iii) a Person who
is an affiliate (as defined in Rule 144) of the Issuers;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration statement in accordance with the Registration Rights Agreement; or

     (D) the Registrar receives the following:

     (i) if the Holder of such Definitive Notes proposes to exchange such notes for
a beneficial interest in the Unrestricted Global Note, a certificate from such
Holder in the form of Exhibit C hereto, including the certifications in item (1)(c)
thereof; or

     (ii) if the Holder of such Definitive Notes proposes to transfer such notes to
a Person who shall take delivery thereof in the form of a beneficial interest in the
Unrestricted Global Note, a certificate from such Holder in the form of Exhibit B
hereto, including the certifications in item (4) thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so requests or if the
Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the
Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and
that the restrictions on transfer contained herein and in the Private Placement Legend are no
longer required in order to maintain compliance with the Securities Act.

     Upon satisfaction of the conditions of any of the subparagraphs in this Section 2.06(d)(2),
the Trustee shall cancel the Definitive Notes and increase or cause to be increased the aggregate
principal amount of the Unrestricted Global Note.

     (3) Unrestricted Definitive Notes to Beneficial Interests in Unrestricted Global
Notes. A Holder of an Unrestricted Definitive Note may exchange such note for a beneficial
interest in an Unrestricted Global Note or transfer such Definitive Notes to a Person who takes
delivery thereof in the form of a beneficial interest in an Unrestricted Global Note at any time.
Upon receipt of a request for such an exchange or transfer, the Trustee shall cancel the applicable
Unrestricted Definitive Note and increase or cause to be increased the aggregate principal amount
of one of the Unrestricted Global Notes.

     If any such exchange or transfer from a Definitive Note to a beneficial interest is effected
pursuant to subparagraphs (2)(B), (2)(D) or (3) above at a time when an Unrestricted Global Note
has not yet been issued, the Issuers shall issue and, upon receipt of an Authentication Order in
accordance with Section 2.02 hereof, the Trustee shall authenticate one or more Unrestricted Global
Notes in an aggregate principal amount equal to the principal amount of Definitive Notes so
transferred.

     (e) Transfer and Exchange of Definitive Notes for Definitive Notes. Upon request by a
Holder of Definitive Notes and such Holder’s compliance with the provisions of this Section
2.06(e), the Registrar shall register the transfer or exchange of Definitive Notes. Prior to such
registration of transfer or exchange, the requesting Holder must present or surrender to the
Registrar the Definitive Notes duly endorsed or accompanied by a written instruction of transfer in
form satisfactory to the Registrar duly executed by such Holder or by its attorney, duly authorized
in writing. In addition, the requesting Holder must provide any additional certifications,
documents and information, as applicable, required pursuant to the following provisions of this
Section 2.06(e).

     (1) Restricted Definitive Notes to Restricted Definitive Notes. Any Restricted
Definitive Note may be transferred to and registered in the name of Persons who take
delivery thereof in the form of a Restricted Definitive Note if the Registrar receives the
following:

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     (A) if the transfer shall be made pursuant to Rule 144A, then the transferor
must deliver a certificate in the form of Exhibit B hereto, including the
certifications in item (1) thereof;

     (B) if the transfer shall be made pursuant to Rule 903 or Rule 904, then the
transferor must deliver a certificate in the form of Exhibit B hereto, including the
certifications in item (2) thereof; and

     (C) if the transfer shall be made pursuant to any other exemption from the
registration requirements of the Securities Act, then the transferor must deliver a
certificate in the form of Exhibit B hereto, including the certifications,
certificates and Opinion of Counsel required by item (3) thereof, if applicable.

     (2) Restricted Definitive Notes to Unrestricted Definitive Notes. Any
Restricted Definitive Note may be exchanged by the Holder thereof for an Unrestricted
Definitive Note or transferred to a Person or Persons who take delivery thereof in the form
of an Unrestricted Definitive Note if:

     (A) such exchange or transfer is effected pursuant to the Registered Exchange
Offer in accordance with the Registration Rights Agreement and the Holder, in the
case of an exchange, or the transferee, in the case of a transfer, certifies in the
applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a Person
participating in the distribution of the Exchange Notes or (iii) a Person who is an
affiliate (as defined in Rule 144) of the Issuers;

     (B) any such transfer is effected pursuant to the Shelf Registration Statement
in accordance with the Registration Rights Agreement;

     (C) any such transfer is effected by a Broker-Dealer pursuant to the Exchange
Offer Registration Statement in accordance with the Registration Rights Agreement;
or

     (D) the Registrar receives the following:

     (i) if the Holder of such Restricted Definitive Notes proposes to
exchange such notes for an Unrestricted Definitive Note, a certificate from
such Holder in the form of Exhibit C hereto, including the certifications in
item (1)(d) thereof; or

     (ii) if the Holder of such Restricted Definitive Notes proposes to
transfer such notes to a Person who shall take delivery thereof in the form
of an Unrestricted Definitive Note, a certificate from such Holder in the
form of Exhibit B hereto, including the certifications in item (4) thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so requests, an
Opinion of Counsel in form reasonably acceptable to the Registrar to the effect that such
exchange or transfer is in compliance with the Securities Act and that the restrictions on
transfer contained herein and in the Private Placement Legend are no longer required in
order to maintain compliance with the Securities Act.

     (3) Unrestricted Definitive Notes to Unrestricted Definitive Notes. A Holder
of Unrestricted Definitive Notes may transfer such notes to a Person who takes delivery
thereof in the form of an Unrestricted Definitive Note. Upon receipt of a request to
register such a transfer, the Registrar shall register the Unrestricted Definitive Notes
pursuant to the instructions from the Holder thereof.

     (f) Registered Exchange Offer. Upon the occurrence of the Registered Exchange Offer
in accordance with the Registration Rights Agreement, the Issuers shall issue and, upon receipt of
an Authentication Order in accordance with Section 2.02 hereof, the Trustee shall authenticate:

     (1) one or more Unrestricted Global Notes in an aggregate principal amount equal to the
principal amount of the beneficial interests in the Restricted Global Notes accepted for
exchange in the

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Registered Exchange Offer by Persons that certify in the applicable Letters of
Transmittal that (A) they are not Broker-Dealers, (B) they are not participating in a
distribution of the Exchange Notes and (C) they are not affiliates (as defined in Rule 144)
of the Issuers; and

     (2) Unrestricted Definitive Notes in an aggregate principal amount equal to the
principal amount of the Restricted Definitive Notes accepted for exchange in the Registered
Exchange Offer by Persons that certify in the applicable Letters of Transmittal that (A)
they are not Broker-Dealers, (B) they are not participating in a distribution of the
Exchange Notes and (C) they are not affiliates (as defined in Rule 144) of the Issuers.

     Concurrently with the issuance of such notes, the Trustee shall cause the aggregate principal
amount of the applicable Restricted Global Notes to be reduced accordingly, and the Issuers shall
execute and the Trustee shall authenticate and deliver to the Persons designated by the Holders of
Definitive Notes so accepted Unrestricted Definitive Notes in the appropriate principal amount.

     (g) Legends. The following legends shall appear on the face of all Global Notes and
Definitive Notes issued under this Indenture unless specifically stated otherwise in the applicable
provisions of this Indenture.

     (1) Private Placement Legend.

     (A) Except as permitted by subparagraph (B) below, each Global Note and each Definitive
Note (and all Notes issued in exchange therefor or substitution thereof) shall bear a legend
in substantially the following form:

“THIS NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE
“SECURITIES ACT”), AND MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED
EXCEPT IN ACCORDANCE WITH THE FOLLOWING SENTENCE, BY ITS ACQUISITION HEREOF OR OF A
BENEFICIAL INTEREST HEREIN, THE ACQUIRER: (1) REPRESENTS THAT: (A) IT AND ANY
ACCOUNT FOR WHICH IT IS ACTING IS A “QUALIFIED INSTITUTIONAL BUYER” (WITHIN THE
MEANING OF RULE 144A UNDER THE SECURITIES ACT) AND THAT IT EXERCISES SOLE INVESTMENT
DISCRETION WITH RESPECT TO EACH SUCH ACCOUNT, (B) IT IS AN INSTITUTIONAL “ACCREDITED
INVESTOR” (WITHIN THE MEANING OF RULE 501(a) (1), (2), (3) OR (7) UNDER THE
SECURITIES ACT) (AN “INSTITUTIONAL ACCREDITED INVESTOR”), OR (C) IT IS NOT A U.S.
PERSON (WITHIN THE MEANING OF REGULATION S UNDER THE SECURITIES ACT), AND (2) AGREES
FOR THE BENEFIT OF THE ISSUERS THAT IT SHALL NOT OFFER, SELL, PLEDGE OR OTHERWISE
TRANSFER THIS NOTE OR ANY BENEFICIAL INTEREST HEREIN, EXCEPT IN ACCORDANCE WITH THE
SECURITIES ACT AND ANY APPLICABLE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES
AND ONLY: (A) TO THE ISSUERS, (B) PURSUANT TO A REGISTRATION STATEMENT WHICH HAS
BECOME EFFECTIVE UNDER THE SECURITIES ACT, (C) TO A QUALIFIED INSTITUTIONAL BUYER IN
COMPLIANCE WITH RULE 144A UNDER THE SECURITIES ACT, (D) IN AN OFFSHORE TRANSACTION
IN COMPLIANCE WITH RULE 901 OF REGULATION S UNDER THE SECURITIES ACT, (E) IN A
PRINCIPAL AMOUNT OF NOT LESS THAN $100,000, TO AN INSTITUTIONAL ACCREDITED INVESTOR
THAT, PRIOR TO SUCH TRANSFER, DELIVERS TO THE TRUSTEE A DULY COMPLETED AND SIGNED
CERTIFICATE (THE FORM OF WHICH MAY BE OBTAINED FROM THE TRUSTEE) RELATING TO THE
RESTRICTIONS ON TRANSFER OF THIS NOTE, OR (F) PURSUANT TO AN EXEMPTION FROM
REGISTRATION PROVIDED BY RULE 144 UNDER THE SECURITIES ACT OR ANY OTHER AVAILABLE
EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT. PRIOR TO THE
REGISTRATION OF ANY TRANSFER IN ACCORDANCE WITH (2)(C) ABOVE OR (2)(D) ABOVE, A DULY
COMPLETED AND SIGNED CERTIFICATE (THE FORM OF WHICH MAY BE OBTAINED FROM THE
TRUSTEE) MUST BE DELIVERED TO THE TRUSTEE. PRIOR TO THE REGISTRATION OF ANY
TRANSFER IN ACCORDANCE

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WITH (2)(E) OR (F) ABOVE, THE ISSUERS RESERVE THE RIGHT TO REQUIRE THE DELIVERY OF
SUCH LEGAL OPINIONS, CERTIFICATIONS OR OTHER EVIDENCE AS MAY REASONABLY BE REQUIRED
IN ORDER TO DETERMINE THAT THE PROPOSED TRANSFER IS BEING MADE IN COMPLIANCE WITH
THE SECURITIES ACT AND APPLICABLE STATE SECURITIES LAWS. NO REPRESENTATION IS MADE
AS TO THE AVAILABILITY OF ANY RULE 144 EXEMPTION FROM THE REGISTRATION REQUIREMENTS
OF THE SECURITIES ACT.”

     (B) Notwithstanding the foregoing, any Global Note or Definitive Note issued pursuant
to subparagraphs (b)(4), (c)(3), (c)(4), (d)(2), (d) (3), (e)(2), (e) (3) or (f) of this
Section 2.06 (and all Notes issued in exchange therefor or substitution thereof) shall not
bear the Private Placement Legend.

     (2) Global Note Legend. Each Global Note shall bear a legend in substantially
the following form:

“THIS GLOBAL NOTE IS HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING
THIS NOTE) OR ITS NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS
HEREOF, AND IS NOT TRANSFERABLE TO ANY PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT
(1) THE TRUSTEE MAY MAKE SUCH NOTATIONS HEREON AS MAY BE REQUIRED PURSUANT TO
SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE
EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3)
THIS GLOBAL NOTE MAY BE DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO
SECTION 2.11 OF THE INDENTURE AND (4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A
SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF THE ISSUERS.

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM,
THIS NOTE MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF
THE DEPOSITARY OR BY A NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER
NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR
DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY. UNLESS THIS CERTIFICATE IS
PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY (55 WATER
STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUERS OR THEIR AGENT FOR REGISTRATION
OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE
NAME OF CEDE & CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED
REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY
AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR
OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS
THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN.”

     (3) Regulation S Temporary Global Note Legend. The Regulation S Temporary
Global Note shall bear a legend in substantially the following form:

“THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS
AND PROCEDURES GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN
THE INDENTURE (AS DEFINED HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF
THIS REGULATION S TEMPORARY GLOBAL NOTE SHALL BE ENTITLED TO RECEIVE PAYMENT OF
INTEREST HEREON.”

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     (h) Cancellation and/or Adjustment of Global Notes. At such time as all beneficial
interests in a particular Global Note have been exchanged for Definitive Notes or a particular
Global Note has been redeemed, repurchased or canceled in whole and not in part, each such Global
Note shall be returned to or retained and canceled by the Trustee in accordance with Section 2.11
hereof. At any time prior to such cancellation, if any beneficial interest in a Global Note is
exchanged for or transferred to a Person who shall take delivery thereof in the form of a
beneficial interest in another Global Note or for Definitive Notes, the principal amount of Notes
represented by such Global Note shall be reduced accordingly and an endorsement shall be made on
such Global Note by the Trustee or by the Depositary at the direction of the Trustee to reflect
such reduction; and if the beneficial interest is being exchanged for or transferred to a Person
who shall take delivery thereof in the form of a beneficial interest in another Global Note, such
other Global Note shall be increased accordingly and an endorsement shall be made on such Global
Note by the Trustee or by the Depositary at the direction of the Trustee to reflect such increase.

     (i) General Provisions Relating to Transfers and Exchanges.

     (1) To permit registrations of transfers and exchanges, the Issuers shall execute and the
Trustee shall authenticate Global Notes and Definitive Notes upon receipt of an Authentication
Order in accordance with Section 2.02 hereof or at the Registrar’s request.

     (2) No service charge shall be made to a Holder of a beneficial interest in a Global Note or
to a Holder of a Definitive Note for any registration of transfer or exchange, but the Issuers may
require payment of a sum sufficient to cover any transfer tax or similar governmental charge
payable in connection therewith (other than any such transfer taxes or similar governmental charge
payable upon exchange or transfer pursuant to Sections 2.10, 3.06, 4.08, 4.11 and 9.05 hereof).

     (3) The Registrar shall not be required to register the transfer of or exchange of any Note
selected for redemption in whole or in part, except the unredeemed portion of any Note being
redeemed in part.

     (4) All Global Notes and Definitive Notes issued upon any registration of transfer or exchange
of Global Notes or Definitive Notes shall be the valid obligations of the Issuers, evidencing the
same debt, and entitled to the same benefits under this Indenture, as the Global Notes or
Definitive Notes surrendered upon such registration of transfer or exchange.

     (5) The Issuers shall not be required:

     (A) to issue, to register the transfer of or to exchange any Notes during a period
beginning at the opening of business 15 days before the day of any selection of Notes for
redemption under Section 3.02 hereof and ending at the close of business on the day of
selection;

     (B) to register the transfer of or to exchange any Note selected for redemption in
whole or in part, except the unredeemed portion of any Note being redeemed in part; or

     (C) to register the transfer of or to exchange a Note between a record date and the
next succeeding interest payment date.

     (6) Prior to due presentment for the registration of a transfer of any Note, the Trustee, any
Agent and the Issuers may deem and treat the Person in whose name any Note is registered as the
absolute owner of such Note for the purpose of receiving payment of principal of and interest on
such Notes and for all other purposes, and none of the Trustee, any Agent or the Issuers shall be
affected by notice to the contrary.

     (7) The Trustee shall authenticate Global Notes and Definitive Notes in accordance with the
provisions of Section 2.02 hereof.

     (8) All certifications, certificates and opinions of counsel required to be submitted to the
Registrar pursuant to this Section 2.06 to effect a registration of transfer or exchange may be
submitted by facsimile.

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     Section 2.07 Replacement Notes. If any mutilated Note is surrendered to the Trustee or the Issuers
and the Trustee receives evidence to its satisfaction of the destruction, loss or theft of any
Note, the Issuers shall issue and the Trustee, upon receipt of an Authentication Order, shall
authenticate a replacement Note if the Trustee’s requirements are met. If required by the Trustee
or the Issuers, an indemnity bond must be supplied by the Holder that is sufficient in the judgment
of the Trustee and the Issuers to protect the Issuers, the Trustee, any Agent and any
authenticating agent from any loss that any of them may suffer if a Note is replaced. The Issuers
may charge for their expenses in replacing a Note.

     Every replacement Note is an additional obligation of the Issuers and shall be entitled to all
of the benefits of this Indenture equally and proportionately with all other Notes duly issued
hereunder.

     Section 2.08 Outstanding Notes. The Notes outstanding at any time are all the Notes authenticated
by the Trustee except for those canceled by it, those delivered to it for cancellation, those
reductions in the interest in a Global Note effected by the Trustee in accordance with the
provisions hereof, and those described in this Section 2.08 as not outstanding. Except as set
forth in Section 2.09 hereof, a Note does not cease to be outstanding because the Issuers or an
Affiliate of the Issuers holds the Note; however, Notes held by the Issuers or a subsidiary of the
Issuers shall not be deemed to be outstanding for purposes of Section 3.07(a) hereof.

     If a Note is replaced pursuant to Section 2.07 hereof, it ceases to be outstanding unless the
Trustee receives proof satisfactory to it that the replaced Note is held by a protected purchaser.

     If the principal amount of any Note is considered paid under Section 4.01 hereof, it ceases to
be outstanding and interest on it ceases to accrue.

     If the Paying Agent (other than the Issuers, a subsidiary or an Affiliate of any thereof)
holds, on a redemption date or maturity date, money sufficient to pay Notes payable on that date,
then on and after that date such Notes shall be deemed to be no longer outstanding and shall cease
to accrue interest.

     Section 2.09 Treasury Notes. In determining whether the Holders of the required principal amount
of Notes have concurred in any direction, waiver or consent, Notes owned by the Issuers or any
Guarantor, or by any Person directly or indirectly controlling or controlled by or under direct or
indirect common control with the Issuers or any Guarantor, shall be considered as though not
outstanding, except that for the purposes of determining whether the Trustee shall be protected in
relying on any such direction, waiver or consent, only Notes that a Responsible Officer of the
Trustee knows are so owned shall be so disregarded.

     Section 2.10 Temporary Notes. Until certificates representing Notes are ready for delivery, the
Issuers may prepare and the Trustee, upon receipt of an Authentication Order, shall authenticate
temporary Notes. Temporary Notes shall be substantially in the form of certificated Notes but may
have variations that the Issuers consider appropriate for temporary Notes and as may be reasonably
acceptable to the Trustee. Without unreasonable delay, the Issuers shall prepare and the Trustee
shall authenticate definitive Notes in exchange for temporary Notes.

     Holders of temporary Notes shall be entitled to all of the benefits of this Indenture.

     Section 2.11 Cancellation. The Issuers at any time may deliver Notes to the Trustee for
cancellation. The Registrar and Paying Agent shall forward to the Trustee any Notes surrendered to
them for registration of transfer, exchange or payment. The Trustee and no one else shall cancel
all Notes surrendered for registration of transfer, exchange, payment, replacement or cancellation
and shall dispose of such canceled Notes in its customary manner (subject to the record retention
requirement of the Exchange Act). Certification of the destruction of all canceled Notes shall be
delivered to the Issuers. The Issuers may not issue new Notes to replace Notes that they have paid
or that have been delivered to the Trustee for cancellation.

     Section 2.12 Defaulted Interest. If the Issuers default in a payment of interest on the Notes,
they shall pay the defaulted interest in any lawful manner plus, to the extent lawful, interest
payable on the defaulted interest, to the Persons who are Holders on a subsequent special record
date, in each case at the rate provided in the Notes and in Section 4.01 hereof. The Issuers shall
notify the Trustee in writing of the amount of defaulted interest pro-

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posed to be paid on each Note and the date of the proposed payment. The Issuers shall fix or
cause to be fixed each such special record date and payment date; provided that no such special
record date may be less than 10 days prior to the related payment date for such defaulted interest.
At least 15 days before the special record date, the Issuers (or, upon the written request of the
Issuers, the Trustee in the name and at the expense of the Issuers) shall mail or cause to be
mailed to Holders a notice that states the special record date, the related payment date and the
amount of such interest to be paid.

     Section 2.13 CUSIP Numbers. The Issuers in issuing the Notes may use “CUSIP” numbers (if then
generally in use), and, if so, the Trustee shall use “CUSIP” numbers in notices of redemption as a
convenience to Holders; provided that any such notice may state that no representation is made as
to the correctness of such numbers either as printed on the Notes or as contained in any notice of
a redemption and that reliance may be placed only on the other identification numbers printed on
the Notes, and any such redemption shall not be affected by any defect in or omission of such
numbers. The Issuers shall promptly notify the Trustee in writing of any change in the “CUSIP”
numbers.

     Section 2.14 Issuance of Additional Notes. The Issuers shall be entitled, from time to time,
subject to its compliance with Section 4.07 hereof, without consent of the Holders, to issue
Additional Notes under this Indenture with identical terms as the Initial Notes issued on the Issue
Date other than with respect to (a) the date of issuance, (b) the issue price, (c) the amount of
interest payable on the first interest payment date and (d) any adjustments in order to conform to
and ensure compliance with the Securities Act (or other applicable securities laws) and any
required legends. The Initial Notes issued on the Issue Date, any Additional Notes and all
Exchange Notes issued in exchange therefor shall be treated as a single class for all purposes
under this Indenture.

     With respect to any Additional Notes, the Issuers shall set forth in an Officer’s Certificate
pursuant to a resolution of the Board of Directors of the Issuers, copies of which shall be
delivered to the Trustee, the following information:

     (1) the aggregate principal amount of such Additional Notes to be authenticated and
delivered pursuant to this Indenture;

     (2) the issue price, the issue date and the CUSIP number of such Additional Notes; and

     (3) whether such Additional Notes shall be subject to transfer restrictions or shall be
issued in the form of Exchange Notes.

ARTICLE III

REDEMPTION AND PREPAYMENT

     Section 3.01 Notices to Trustee. If the Issuers elect to redeem Notes pursuant to the optional
redemption provisions of Section 3.07 hereof, it must furnish to the Trustee, at least 30 days but
not more than 60 days before a redemption date, an Officers’ Certificate setting forth:

     (1) the clause of this Indenture pursuant to which the redemption shall occur;

     (2) the redemption date;

     (3) the principal amount of Notes to be redeemed;

     (4) the redemption price; and

     (5) applicable CUSIP numbers.

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     Section 3.02 Selection of Notes to Be Redeemed or Purchased. If less than all of the Notes are to
be redeemed or purchased in an offer to purchase at any time, the Trustee shall select Notes for
redemption or purchase as follows:

     (1) if the Notes are listed on any national securities exchange, in compliance with the
requirements of the principal national securities exchange on which the Notes are listed; or

     (2) if the Notes are not listed on any national securities exchange, on a pro rata
basis, by lot or by such method as the Trustee deems fair and appropriate.

     In the event of partial redemption or purchase by lot, the particular Notes to be redeemed or
purchased shall be selected, unless otherwise provided herein, not less than 30 nor more than 60
days prior to the redemption or purchase date by the Trustee from the outstanding Notes not
previously called for redemption or purchase.

     The Trustee shall promptly notify the Issuers in writing of the Notes selected for redemption
or purchase and, in the case of any Note selected for partial redemption or purchase, the principal
amount thereof to be redeemed or purchased. Notes and portions of Notes selected shall be in
amounts of $2,000 or whole multiples of $1,000; provided that no Notes of $1,000 or less shall be
redeemed or purchased in part. Except as provided in the preceding sentence, provisions of this
Indenture that apply to Notes called for redemption or purchase also apply to portions of Notes
called for redemption.

     Section 3.03 Notice of Redemption.

     (a) At least 30 days but not more than 60 days before a redemption date, the Issuers shall
mail or cause to be mailed, by first class mail, a notice of redemption to each Holder whose Notes
are to be redeemed at its registered address, except that redemption notices may be mailed more
than 60 days prior to a redemption date if the notice is issued in connection with a defeasance of
the Notes or a satisfaction and discharge of this Indenture pursuant to Articles VIII or XI hereof.

     (b) The notice shall identify the Notes (including CUSIP numbers) to be redeemed and shall
state:

     (1) the redemption date;

     (2) the redemption price;

     (3) if any Note is being redeemed in part, the portion of the principal amount of such
Note to be redeemed and that, after the redemption date upon surrender of such Note, a new
Note or Notes in principal amount equal to the unredeemed portion of the original Note shall
be issued upon cancellation of the original Note;

     (4) the name and address of the Paying Agent;

     (5) that Notes called for redemption must be surrendered to the Paying Agent to collect
the redemption price;

     (6) that, unless the Issuers default in making such redemption payment, interest on
Notes called for redemption ceases to accrue on and after the redemption date;

     (7) the paragraph of the Notes and/or Section of this Indenture pursuant to which the
Notes called for redemption are being redeemed; and

     (8) that no representation is made as to the correctness or accuracy of the CUSIP
number, if any, listed in such notice or printed on the Notes.

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     At the Issuers’ request, the Trustee shall give the notice of redemption in the Issuers’
name and at their expense; provided, however, that the Issuers have delivered to the Trustee, at
least 45 days prior to the redemption date (unless a shorter notice period is satisfactory to the
Trustee), an Officers’ Certificate requesting that the Trustee give such notice and setting forth
the information to be stated in such notice as provided in the preceding paragraph.

     Section 3.04 Effect of Notice of Redemption. Once notice of redemption is mailed in
accordance with Section 3.03 hereof, Notes called for redemption become irrevocably due and payable
on the redemption date at the redemption price. A notice of redemption may not be conditional.

     Section 3.05 Deposit of Redemption or Purchase Price. On or before the relevant
redemption or purchase date, the Issuers shall deposit with the Trustee or with the Paying Agent
money sufficient to pay the redemption or purchase price of and accrued interest and Additional
Interest, if any, on all Notes to be redeemed or purchased on that date. The Trustee or the Paying
Agent shall promptly return to the Issuers any money deposited with the Trustee or the Paying Agent
by the Issuers in excess of the amounts necessary to pay the redemption or purchase price of, and
accrued interest and Additional Interest, if any, on, all Notes to be redeemed or purchased.

     If the Issuers comply with the provisions of the preceding paragraph, on and after the
redemption or purchase date, interest shall cease to accrue on the Notes or the portions of Notes
called for redemption or purchase. If a Note is redeemed or purchased on or after an interest
record date but on or prior to the related interest payment date, then any accrued and unpaid
interest shall be paid to the Person in whose name such Note was registered at the close of
business on such record date. If any Note called for redemption or purchase is not so paid upon
surrender for redemption or purchase because of the failure of the Issuers to comply with the
preceding paragraph, interest shall be paid on the unpaid principal, from the redemption or
purchase date until such principal is paid, and to the extent lawful on any interest not paid on
such unpaid principal, in each case at the rate provided in the Notes and in Section 4.01 hereof.

     Section 3.06 Notes Redeemed or Purchased in Part. Upon surrender of a Note that is
redeemed or purchased in part, the Issuers shall issue and, upon receipt of an Authentication
Order, the Trustee shall authenticate for the Holder at the expense of the Issuers a new Note equal
in principal amount to the unredeemed or unpurchased portion of the Note surrendered.

     Section 3.07 Optional Redemption.

     (a) At any time on or prior to February 1, 2013, the Issuers may on any one or more occasions
redeem up to 35% of the aggregate principal amount of Notes issued under this Indenture (including
additional notes issued after Issue Date) at a redemption price of 108.000% of the principal amount
thereof, plus accrued and unpaid interest and Additional Interest, if any, to, but not including,
the redemption date, in each case, with the net cash proceeds of one or more Equity Offerings (1)
by the Issuers or (2) by any direct or indirect parent of VHS Holdco II, in each case, to the
extent the net cash proceeds thereof are contributed to the common equity capital of VHS Holdco II
or used to purchase Capital Stock (other than Disqualified Stock) of VH5 Holdco II from it;
provided that:

     (1) at least 65% of the aggregate principal amount of Notes issued under this Indenture
(excluding Notes held by the Issuers and their Subsidiaries) remains outstanding immediately
after the occurrence of such redemption; and

     (2) the redemption occurs within 120 days of the date of the closing of such Equity
Offering.

     Notice of any redemption upon any Equity Offering may be given prior to the completion
thereof, and any such redemption or notice may, at the Issuers’ discretion, be subject to one or
more conditions precedent, including, but not limited to, completion of the related Equity
Offering.

     (b) Except pursuant to the preceding paragraph or as otherwise set forth below, the Notes
shall not be redeemable at the Issuers’ option prior to February 1, 2014; provided, however, the
Issuers may acquire the Notes by means other than a redemption, whether by tender offer, open
market purchases, negotiated transactions or other-

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wise, in accordance with applicable securities laws, so long as such acquisition does not
violate the terms of this Indenture.

     (c) On or after February 1, 2014, the Issuers may redeem all or a part of the Notes upon not
less than 30 nor more than 60 days’ notice, at the redemption prices (expressed as percentages of
principal amount) set forth below plus accrued and unpaid interest and Additional Interest, if any,
on the Notes redeemed to the applicable redemption date, if redeemed during the twelve-month period
beginning on February 1 of the years indicated below, subject to the rights of Holders on the
relevant record date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	 
	 	 	 	 
	2014
	 	 	104.000	%
	2015
	 	 	102.000	%
	2016 and thereafter
	 	 	100.000	%

     Unless the Issuers default in the payment of the redemption price, interest shall cease to
accrue on the Notes or portions thereof called for redemption on the applicable redemption date.

     (d) At any time prior to February 1, 2014, the Issuers may also redeem all or a part of the
Notes, upon not less than 30 nor more than 60 days’ prior notice mailed by first-class mail to each
Holder’s registered address, at a redemption price equal to 100% of the principal amount of the
Notes redeemed plus the Applicable Premium as of, and accrued and unpaid interest and Additional
Interest, if any, to, but not including, the date of redemption (subject to the rights of Holders
of Notes on the relevant record date to receive interest due on the relevant interest payment
date).

     (e) Any redemption pursuant to this Section 3.07 shall be made pursuant to the provisions of
Sections 3.01 through 3.06 hereof.

     Section 3.08 Mandatory Redemption. The Issuers are not required to make mandatory
redemption or sinking fund payments with respect to the Notes.

     Section 3.09 Offer to Purchase by Application of Excess Proceeds. In the event that,
pursuant to Section 4.08 hereof, the Issuers are required to commence an offer to all Holders to
purchase Notes (an “Asset Sale Offer”), they shall follow the procedures specified below.

     (a) The Asset Sale Offer shall be made to all Holders and if the Issuers elect (or are
required by the terms of other Pari Passu Indebtedness), all holders of other indebtedness that is
pari passu with the Notes. The Asset Sale Offer shall remain open for a period of at least 20
Business Days following its commencement and not more than 30 Business Days, except to the extent
that a longer period is required by applicable law (the “Offer Period”). No later than five
Business Days after the termination of the Offer Period (the “Purchase Date”), the Issuers shall
apply all Excess Proceeds (the “Offer Amount”) to the purchase of Notes and such other Pari Passu
Indebtedness, if any, (on a pro rata basis, if applicable) or, if less than the Offer Amount has
been tendered, all Notes and other Indebtedness tendered in response to the Asset Sale Offer.
Payment for any Notes so purchased shall be made pursuant to Section 4.01 hereof.

     (b) If the Purchase Date is on or after an interest record date and on or before the related
interest payment date, any accrued and unpaid interest and special Interest, if any, shall be paid
to the Person in whose name a Note is registered at the close of business on such record date, and
no additional interest shall be payable to Holders who tender Notes pursuant to the Asset Sale
Offer.

     (c) Upon the commencement of an Asset Sale Offer, the Issuers shall send, by first class mail,
a notice to the Trustee and each of the Holders, with a copy to the Trustee. The notice shall
contain all instructions and materials necessary to enable such Holders to tender Notes pursuant to
the Asset Sale Offer. The notice, which shall govern the terms of the Asset Sale Offer, shall
state:

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     (1) that the Asset Sale Offer is being made pursuant to this Section 3.09 and Section
4.08 hereof and the length of time the Asset Sale Offer shall remain open;

     (2) the Offer Amount, the purchase price and the Purchase Date;

     (3) that any Note not tendered or accepted for payment shall continue to accrue
interest;

     (4) that, unless the Issuers default in making such payment, any Note accepted for
payment pursuant to the Asset Sale Offer shall cease to accrue interest after the Purchase
Date;

     (5) that Holders electing to have a Note purchased pursuant to an Asset Sale Offer may
elect to have Notes purchased in denominations of $2,000 or integral multiples of $1,000 in
excess thereof;

     (6) that Holders electing to have Notes purchased pursuant to any Asset Sale Offer
shall be required to surrender the Note, with the form entitled “Option of Holder to Elect
Purchase” attached to the Notes completed, or transfer by book-entry transfer, to the
Issuers, a Depositary, if appointed by the Issuers, or a Paying Agent at the address
specified in the notice at least three days before the Purchase Date;

     (7) that Holders shall be entitled to withdraw their election if the Issuers, the
Depositary or the Paying Agent, as the case may be, receives, not later than on the
expiration of the Offer Period, a telegram, telex, facsimile transmission or letter setting
forth the name of the Holder, the principal amount of the Note the Holder delivered for
purchase and a statement that such Holder is withdrawing his election to have such Note
purchased;

     (8) that, if the aggregate principal amount of Notes and other Pari Passu Indebtedness
surrendered by Holders thereof exceeds the Offer Amount, the Issuers shall select the Notes
and other Pari Passu Indebtedness to be purchased on a pro rata basis based on the principal
amount of Notes and such other Pari Passu Indebtedness surrendered (with such adjustments as
may be deemed appropriate by the Issuers so that only Notes in denominations of $2,000, or
integral multiples of $1,000 in excess thereof, shall be purchased); and

     (9) that Holders whose Notes were purchased only in part shall be issued new Notes
equal in principal amount to the unpurchased portion of the Notes surrendered (or
transferred by book-entry transfer).

     (d) On or before the Purchase Date, the Issuers shall, to the extent lawful, accept for
payment, on a pro rata basis to the extent necessary, the Offer Amount of Notes or portions thereof
tendered pursuant to the Asset Sale Offer, or if less than the Offer Amount has been tendered, all
Notes tendered, and shall deliver or cause to be delivered to the Trustee the Notes properly
accepted together with an Officer’s Certificate stating that such Notes or portions thereof were
accepted for payment by the Issuers in accordance with the terms of this Section 3.09. The
Issuers, the Depositary or the Paying Agent, as the case may be, shall promptly (but in any case
not later than five days after the Purchase Date) mail or deliver to each tendering Holder an
amount equal to the purchase price of the Notes tendered by such Holder and accepted by the Issuers
for purchase, and the Issuers, shall promptly issue a new Note, and the Trustee, upon written
request from the Issuers shall authenticate and mail or deliver (or cause to be transferred by book
entry) such new Note to such Holder, in a principal amount equal to any unpurchased portion of the
Note surrendered. Any Note not so accepted shall be promptly mailed or delivered by the Issuers to
the Holder thereof. The Issuers shall publicly announce the results of the Asset Sale Offer on the
Purchase Date.

     Other than as specifically provided in this Section 3.09, any purchase pursuant to this
Section 3.09 shall be made pursuant to the provisions of Sections 3.01 through 3.06 hereof.

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ARTICLE IV

COVENANTS

     Section 4.01 Payment of Notes. The Issuers shall pay or cause to be paid the
principal of, premium, if any, and interest and Additional Interest, if any, on, the Notes on the
dates and in the manner provided in the Notes. Principal, premium, if any, and interest and
Additional Interest, if any shall be considered paid on the date due if the Paying Agent, if other
than the Issuers or a subsidiary thereof, holds as of 10:00 a.m. Eastern Time on the due date money
deposited by the Issuers in immediately available funds and designated for and sufficient to pay
all principal of, premium, if any, and interest and Additional Interest, if any, then due. The
Issuers shall pay all Additional Interest, if any, in the same manner on the dates and in the
amounts set forth in the Registration Rights Agreement.

     The Issuers shall pay interest on overdue principal at the rate specified therefor in the
Notes, and it shall pay interest on overdue installments of interest at the same rate borne by the
Notes to the extent lawful.

     Section 4.02 Maintenance of Office or Agency. The Issuers shall maintain in the
Borough of Manhattan, the City of New York, an office or agency (which may be an office of the
Trustee or an affiliate of the Trustee, Registrar or co-registrar) where Notes may be surrendered
for registration of transfer or for exchange and where notices and demands to or upon the Issuers
in respect of the Notes and this Indenture may be served. The Issuers shall give prompt written
notice to the Trustee of the location and any change in the location, of such office or agency. If
at any time the Issuers fail to maintain any such required office or agency or fails to furnish the
Trustee with the address thereof, such presentations, surrenders, notices and demands may be made
or served at the Corporate Trust Office of the Trustee.

     The Issuers may also from time to time designate one or more other offices or agencies where
the Notes may be presented or surrendered for any or all such purposes and may from time to time
rescind such designations; provided, however, that no such designation or rescission shall in any
manner relieve the Issuers of their obligation to maintain an office or agency in the Borough of
Manhattan, the City of New York for such purposes. The Issuers shall give prompt written notice to
the Trustee of any such designation or rescission and of any change in the location of any such
other office or agency.

     The Issuers hereby designate the Corporate Trust Office of the Trustee as one such office or
agency of the Issuers in accordance with Section 2.03 hereof.

     Section 4.03 Reports to Holders.

     (1) Whether or not required by the Commission, so long as any Notes are outstanding, VHS
Holdco II shall furnish to the Holders of Notes, within 45 days after the end of each of the first
three fiscal quarters of each fiscal year commencing with the fiscal quarter ended December 31,
2009 or (in the case of annual financial information) within 90 days after the end of each fiscal
year, all quarterly and annual financial information that would be required to be contained in a
filing with the Commission on Forms 10-Q and 10-K if VHS Holdco II were required to file such
forms, including a “Management’s Discussion and Analysis of Financial Condition and Results of
Operations” and, with respect to the annual information only, a report on the annual financial
statements by VHS Holdco II’s certified independent accountants.

     In addition, whether or not required by the Commission, VHS Holdco II shall file a copy of all
of the information and reports referred to above with the Commission for public availability within
the time periods specified above (unless the Commission shall not accept such a filing) and make
such information available to securities analysts and prospective investors upon request.

     (2) So long as any Notes remain outstanding, VHS Holdco II shall furnish to the Holders of the
Notes and to securities analysts and prospective investors, upon their request, the information
required to be delivered pursuant to Rule 144A(d)(4) under the Securities Act.

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     (3) So long as Vanguard is a Guarantor (there being no obligation of Vanguard to do so), holds
no material assets other than cash, Cash Equivalents and the Capital Stock of VHS Holdco I or the
Issuers (and performs the related incidental activities associated with such ownership) and
complies with the requirements of Rule 3-10 of Regulation S-X promulgated by the Commission (or any
successor provision), the reports, information and other documents required to be filed and
furnished to Holders of the Notes pursuant to this Section 4.03 may, at the option of VHS Holdco
II, be filed by and be those of Vanguard rather than VHS Holdco II. VHS Holdco II shall be deemed
to be in compliance with the provisions of this Section 4.03 if Vanguard shall have filed such
reports, documents and other information with the Commission using its Electronic Data Gathering,
Analysis and Referral System or any successor system.

     (4) Notwithstanding the foregoing, such requirements shall be deemed satisfied prior to the
commencement of the Registered Exchange Offer or the effectiveness of the Shelf Registration
Statement by the filing with the Commission of the Exchange Offer Registration Statement and/or
Shelf Registration Statement, and any amendments thereto, with such financial information that
satisfies Regulation S-X of the Securities Act.

     Section 4.04 Compliance Certificate.

     (a) The Issuers shall deliver to the Trustee within 120 days after the end of each fiscal year
of the Issuers an Officers’ Certificate stating that in the course of the performance by the
signers of their duties as officers of the Issuers they would normally have knowledge of any
Default and whether or not the signers know of any Default that occurred during such period. If
they do, the certificate shall describe the Default, its status and what action the Issuers are
taking or proposes to take with respect thereto. The Issuers also shall comply with Section
314(a)(4) of the TIA.

     (b) So long as any of the Notes are outstanding, the Issuers shall deliver to the Trustee,
forthwith upon any officer becoming aware of any Default or Event of Default, an Officers’
Certificate specifying such Default or Event of Default and what action the Issuers are taking or
propose to take with respect thereto.

     Section 4.05 Limitation on Restricted Payments.

     (a) VHS Holdco II shall not, and shall not permit any of its Restricted Subsidiaries to
directly or indirectly:

     (1) declare or pay any dividend or make any other payment or distribution on account of
VHS Holdco II’s or any of its Restricted Subsidiaries’ Equity Interests, including any
dividend or distribution payable in connection with any merger or consolidation (other than
(A) dividends or distributions by VHS Holdco II payable in Equity Interests (other than
Disqualified Stock) of VHS Holdco II or in options, warrants or other rights to purchase
such Equity Interests (other than Disqualified Stock) or (B) dividends or distributions by a
Restricted Subsidiary to VHS Holdco II or any other Restricted Subsidiary so long as, in the
case of any dividend or distribution payable on or in respect of any class or series of
securities issued by a Restricted Subsidiary other than a Wholly-Owned Subsidiary, VHS
Holdco II or a Restricted Subsidiary receives at least its pro rata share of such dividend
or distribution in accordance with its Equity Interests in such class or series of
securities);

     (2) purchase, redeem or otherwise acquire or retire for value any Equity Interests of
either of the Issuers or any direct or indirect parent entity of either of the Issuers,
including in connection with any merger or consolidation involving either of the Issuers or
any such parent entity;

     (3) make any principal payment on, or redeem, repurchase, defease or otherwise acquire
or retire for value, in each case prior to any scheduled repayment, sinking fund payment or
maturity, any Subordinated Indebtedness of VHS Holdco II or any Subsidiary Guarantor (other
than (A) Indebtedness permitted under clauses (8) and (9) of the definition of “Permitted
Debt” or (B) the purchase, repurchase or other acquisition of Subordinated Indebtedness, as
the case may be, purchased in anticipation of satisfying a sinking fund obligation,
principal installment or final maturity, in each case due within one year of the date of
purchase, repurchase or acquisition); or

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     (4) make any Restricted Investment (all such payments and other actions set forth in
these clauses (1) through (4) being collectively referred to as “Restricted Payments”),
unless, at the time of and after giving effect to such Restricted Payment:

     (A) no Default or Event of Default has occurred and is continuing or would
occur as a consequence of such Restricted Payment; and

     (B) VHS Holdco II would, at the time of such Restricted Payment and after
giving pro forma effect thereto as if such Restricted Payment had been made at the
beginning of the applicable four-quarter period, have been permitted to incur at
least $1.00 of additional Indebtedness pursuant to the Fixed Charge Coverage Ratio
test set forth in Section 4.07(a) hereto; and

     (C) such Restricted Payment, together with the aggregate amount of all other
Restricted Payments made by VHS Holdco II and the Restricted Subsidiaries after the
Issue Date (excluding Restricted Payments permitted by clauses (2), (3), (4), (6),
(8), (9), (11), (12), (13), (15), (16), (18), (20) and (21) of Section 4.05(b), is
less than the sum, without duplication, of

     (i) 50% of the Consolidated Net Income of VHS Holdco II for the period
(taken as one accounting period) from the beginning of the first fiscal
quarter commencing after the Issue Date, to the end of VHS Holdco II’s most
recently ended fiscal quarter for which internal financial statements are
available at the time of such Restricted Payment (or, in the case such
Consolidated Net Income for such period is a deficit, minus 100% of such
deficit), plus

     (ii) 100% of the aggregate net cash proceeds and the fair market value,
as determined in good faith by the Board of Directors of VHS Holdco II, of
property and marketable securities received by the Issuers since immediately
after the Issue Date from the issue or sale of (x) Equity Interests of VHS
Holdco II (including Retired Capital Stock (as defined below)) (other than
(a) Excluded Contributions, (b) Designated Preferred Stock, (c) cash
proceeds and marketable securities received from the sale of Equity
Interests to members of management, directors or consultants of VHS Holdco
II, any direct or indirect parent entities of VHS Holdco II and its
Subsidiaries following the Issue Date to the extent such amounts have been
applied to Restricted Payments made in accordance with clause (4) of the
next succeeding paragraph and (d) Refunding Capital Stock (as defined
below)) and, to the extent actually contributed to VHS Holdco II, Equity
Interests of any direct or indirect parent entities of VHS Holdco II and (y)
debt securities of VHS Holdco II that have been converted into such Equity
Interests of VHS Holdco II (other than Refunding Capital Stock or Equity
Interests or convertible debt securities of VHS Holdco II sold to a
Restricted Subsidiary or VHS Holdco II, as the case may be, and other than
Disqualified Stock or debt securities that have been converted into
Disqualified Stock), plus

     (iii) 100% of the aggregate amount of cash and the fair market value,
as determined in good faith by the Board of Directors of VHS Holdco II, of
property and marketable securities contributed to the capital of VHS Holdco
II following the Issue Date (other than (x) Excluded Contributions, (y) the
Cash Contribution Amount and (z) contributions by a Restricted Subsidiary),
plus

     (iv) 100% of the aggregate amount received in cash and the fair market
value, as determined in good faith by the Board of Directors of VHS Holdco
II, of property and marketable securities received after the Issue Date by
means of (x) the sale or other disposition (other than to VHS Holdco II or a
Restricted Subsidiary) of Restricted Investments made by VHS Holdco II or
its Restricted Subsidiaries and repurchases and redemptions of such
Restricted Investments from VHS Holdco II or its Restricted Subsidiaries and
repayments of loans or advances which constitute Restricted Investments by

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VHS Holdco II or its Restricted Subsidiaries or (y) the sale (other
than to VHS Holdco II or a Restricted Subsidiary) of the Capital Stock of an
Unrestricted Subsidiary or a distribution from an Unrestricted Subsidiary
(other than in each case to the extent the Investment in such Unrestricted
Subsidiary was made by a Restricted Subsidiary pursuant to clause (5) or
(14) of Section 4.05(b) hereof or to the extent such Investment constituted
a Permitted Investment) or a dividend from an Unrestricted Subsidiary, plus

     (v) in the case of the redesignation of an Unrestricted Subsidiary as a
Restricted Subsidiary or the merger or consolidation of an Unrestricted
Subsidiary into VHS Holdco II or a Restricted Subsidiary or the transfer of
assets of an Unrestricted Subsidiary to VHS Holdco II or a Restricted
Subsidiary, the fair market value of the Investment in such Unrestricted
Subsidiary, as determined by the Board of Directors of VHS Holdco II in good
faith at the time of the redesignation of such Unrestricted Subsidiary as a
Restricted Subsidiary or at the time of such merger, consolidation or
transfer of assets (other than an Unrestricted Subsidiary to the extent the
Investment in such Unrestricted Subsidiary was made by a Restricted
Subsidiary pursuant to clause (5) or (14) of the next succeeding paragraph
or to the extent such Investment constituted a Permitted Investment).

     (b) The preceding provisions of Section 4.05(a) hereof shall not prohibit:

     (1) the payment of any dividend or other distribution or the consummation of any
irrevocable redemption within 60 days after the date of declaration of the dividend or
distribution or giving of the irrevocable redemption notice, as the case may be, if, at the
date of declaration or notice, such dividend, distribution or redemption payment, as the
case may be, would have complied with the provisions of this Indenture;

     (2) (A) the redemption, repurchase, retirement or other acquisition of any Equity
Interests of the Issuers or any direct or indirect parent corporation of the Issuers
(“Retired Capital Stock”) or Subordinated Indebtedness, as the case may be, in exchange for
or out of the proceeds of the substantially concurrent sale (other than to a Restricted
Subsidiary or the Issuers) of Equity Interests of the Issuers or any direct or indirect
parent of the Issuers or contributions to the equity capital of the Issuers (in each case,
other than Disqualified Stock) (“Refunding Capital Stock”) and (B) the declaration and
payment of accrued dividends on the Retired Capital Stock out of the proceeds of the
substantially concurrent sale (other than to a Restricted Subsidiary or the Issuers) of
Refunding Capital Stock;

     (3) the redemption, repurchase or other acquisition or retirement for value of
Subordinated Indebtedness of VHS Holdco II or any Subsidiary Guarantor made by exchange for,
or out of the proceeds of the substantially concurrent sale of, new Indebtedness of the
borrower thereof, which is incurred in compliance with Section 4.07 hereof, so long as (A)
the principal amount of such new Indebtedness does not exceed the principal amount of the
Subordinated Indebtedness being so redeemed, repurchased, acquired or retired for value plus
the amount of any reasonable premium required to be paid under the terms of the instrument
governing the Subordinated Indebtedness being so redeemed, repurchased, acquired or retired
for value, (B) such new Indebtedness is subordinated to the Notes and any such applicable
Guarantees at least to the same extent as such Subordinated Indebtedness being so redeemed,
repurchased, acquired or retired for value is subordinated to the Notes and/or Guarantees,
(C) such new Indebtedness has a final scheduled maturity date equal to or later than the
final scheduled maturity date of the Subordinated Indebtedness being so redeemed,
repurchased, acquired or retired for value and (D) such new Indebtedness has a Weighted
Average Life to Maturity equal to or greater than the remaining Weighted Average Life to
Maturity of the Subordinated Indebtedness being so redeemed, repurchased, acquired or
retired for value;

     (4) a Restricted Payment to pay for the repurchase, retirement or other acquisition or
retirement for value of common Equity Interests of the Issuers or any of their direct or
indirect parent entities held by any future, present or former employee, director or
consultant of VHS Holdco II, any of its Subsidiaries or (to the extent such person renders
services to the businesses of VHS Holdco II and its Subsidiaries) VHS Holdco II’s direct or
indirect parent entities, pursuant to any management equity plan or stock

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option plan or any other management or employee benefit plan or agreement or
arrangement; provided that the aggregate amount of all such Restricted Payments made under
this clause (4) does not exceed in any calendar year $12.5 million (which shall increase to
$25.0 million subsequent to the consummation of an underwritten public Equity Offering by
VHS Holdco II or any of its direct or indirect parent entities) (with unused amounts in any
calendar year being carried over to the next two succeeding calendar years); and provided,
further, that such amount in any calendar year may be increased by an amount not to exceed
(A) the cash proceeds from the sale of Equity Interests of VHS Holdco II and, to the extent
contributed to VHS Holdco II, Equity Interests of any of its direct or indirect parent
entities, in each case to members of management, directors or consultants of VHS Holdco II,
any of its Subsidiaries or (to the extent such person renders services to the businesses of
VHS Holdco II and its Subsidiaries) VHS Holdco II’s direct or indirect parent entities, that
occurs after the Issue Date plus (B) the cash proceeds of key man life insurance policies
received by VHS Holdco II or its Restricted Subsidiaries, or by any direct or indirect
parent entity to the extent contributed to VHS Holdco II, after the Issue Date (provided
that VHS Holdco II may elect to apply all or any portion of the aggregate increase
contemplated by clauses (A) and (B) above in any calendar year) less (C) the amount of any
Restricted Payments previously made pursuant to clauses (A) and (B) of this clause (4); and
provided, further, that cancellation of Indebtedness owing to the Issuers from members of
management of the Issuers, any of the Issuers’ direct or indirect parent companies or any of
the Issuers’ Restricted Subsidiaries in connection with a repurchase of Equity Interests of
the Issuers or any of their direct or indirect parent companies shall not be deemed to
constitute a Restricted Payment for purposes of this Section 4.05 or any other provision of
this Indenture;

     (5) Investments in Unrestricted Subsidiaries having an aggregate fair market value,
taken together with all other Investments made pursuant to this clause (5) that are at the
time outstanding, without giving effect to the sale of an Unrestricted Subsidiary to the
extent the proceeds of such sale do not consist of cash and/or marketable securities, not to
exceed $50.0 million at the time of such Investment (with the fair market value of each
Investment being measured at the time made and without giving effect to subsequent changes
in value);

     (6) repurchases of Equity Interests deemed to occur upon exercise of stock options or
warrants if such Equity Interests represent a portion of the exercise price of such options
or warrants;

     (7) the payment of dividends on the common equity interests of the Issuers (or the
payment of dividends to any direct or indirect parent of the Issuers to fund a payment of
dividends on such entity’s common stock) following the first public offering of the common
stock of the Issuers, or the common equity interests of any of their direct or indirect
parent entities after the Issue Date, of up to 6.0% per annum or the net proceeds received
by or contributed to the Issuers in any public offering, other than public offerings with
respect to common equity interests registered on Form S-8 (or any successor form that
provides for registration of securities offered to employees of the registrant) and other
than any public sale constituting an Excluded Contribution;

     (8) Restricted Payments equal to the amount of Excluded Contributions;

     (9) the declaration and payment of dividends to, or the making of loans to, VHS
Holdings LLC, a Delaware limited liability company, VHS Holdco I, or Vanguard in amounts
required for VHS Holdings LLC, VHS Holdco I, or Vanguard to pay:

     (A) (i) overhead (including salaries and other compensation expenses) and
franchise or similar tax liabilities, legal, accounting and other professional fees
and expenses in connection with, and to the extent attributable, to the maintenance
of VHS Holdings LLC’s, VHS Holdco I’s or Vanguard’s existence and its ownership of
VHS Holdco I, Vanguard, the Issuers or any of their Subsidiaries, as applicable,
(ii) fees and expenses related to any equity offering, investment or acquisition
permitted hereunder (whether or not successful) and (iii) other fees and expenses in
connection with, and to the extent attributable to, the maintenance of VHS Holdings
LLC’s, VHS Holdco I’s or Vanguard’s existence and its ownership of VHS Holdco I,
Vanguard, the Issuers or any of their Subsidiaries, as applicable; and

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     (B) with respect to each tax year (or portion thereof), federal, state or local
income taxes (as the case may be) imposed directly on or allocated to VHS Holdings
LLC, VHS Holdco I or Vanguard or which are due and payable by VHS Holdings LLC, VHS
Holdco I or Vanguard as part of a consolidated group, to the extent such income
taxes are attributable to the income of VHS Holdco I, the Issuers or any of their
Subsidiaries;

     (10) [Reserved];

     (11) distributions or payments of Securitization Fees;

     (12) cash dividends or other distributions on Capital Stock of VHS Holdco II or any of
its Restricted Subsidiaries used to, or the making of loans, the proceeds of which shall be
used to, fund the payment of fees and expenses incurred in connection with the Refinancing,
this offering or owed to Affiliates, in each case to the extent permitted by Section 4.09
hereof;

     (13) declaration and payment of dividends to holders of any class or series of
Disqualified Stock of VHS Holdco II or any Restricted Subsidiary or any class of Preferred
Stock of any Restricted Subsidiary issued in accordance with Section 4.07 hereof to the
extent such dividends are included in the definition of Fixed Charges;

     (14) other Restricted Payments in an aggregate amount not to exceed $100.0 million;

     (15) the declaration and payment of dividends or distributions to holders of any class
or series of Designated Preferred Stock issued after the Issue Date and the declaration and
payment of dividends to any direct or indirect parent company of VHS Holdco II, the proceeds
of which shall be used to fund the payment of dividends to holders of any class or series of
Designated Preferred Stock of any direct or indirect parent company of VHS Holdco II issued
after the Issue Date; provided that (A) for the most recently ended four full fiscal
quarters for which internal financial statements are available immediately preceding the
date of issuance of such Designated Preferred Stock, after giving effect to such issuance on
the first day of such period (and the payment of dividends or distributions) on a pro forma
basis, VHS Holdco II would have had a Fixed Charge Coverage Ratio of at least 2.00 to 1.00
and (B) the aggregate amount of dividends declared and paid pursuant to this clause (15)
does not exceed the net cash proceeds actually received by the Issuers from any such sale of
Designated Preferred Stock issued after the Issue Date;

     (16) the distribution, as a dividend or otherwise, of shares of Capital Stock of, or
Indebtedness owed to VHS Holdco II or a Restricted Subsidiary by, Unrestricted Subsidiaries;

     (17) the repurchase, redemption or other acquisition or retirement for value of any
Subordinated Indebtedness pursuant to the provisions similar to those described in Section
4.08 and Section 4.11 hereof; provided that all Notes tendered by Holders of the Notes in
connection with the related Change of Control Offer or Asset Sale Offer, as applicable, have
been repurchased, redeemed or acquired for value;

     (18) payments to VHS Holdco I to enable VHS Holdco I to purchase Existing VHS Holdco I
Notes validly tendered, and not validly withdrawn, in the Offer in accordance with the terms
thereof or to redeem VHS Holdco I Notes that are not validly tendered; provided that such
amounts are used by VHS Holdco I to purchase such Existing VHS Holdco I Notes in accordance
with this clause (18) promptly after receipt of such payment;

     (19) payments or distributions to dissenting stockholders pursuant to applicable law,
pursuant to or in connection with a consolidation, merger or transfer of all or
substantially all of the assets of VHS Holdco II or any direct or indirect parent entity of
VHS Holdco II that complies with the provisions of this Indenture applicable to mergers,
consolidations and transfers of all or substantially all of the property and assets of VHS
Holdco II; provided that, as a result of such consolidation, merger or transfer of assets,
the Issuers have made a Change of Control Offer pursuant to Section 4.11 hereof and any
Notes tendered in connection therewith have been purchased;

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     (20) cash payments in lieu of fractional shares issuable as dividends on preferred
stock or upon the conversion of any convertible debt securities of either Issuer or any of
their Restricted Subsidiaries; provided that the Board of Directors of VHS Holdco II shall
have determined in good faith that such payments are not made for the purpose of evading the
limitations of this Section 4.05; and

     (21) any Restricted Payment with the net proceeds of the offering of Notes on the Issue
Date as described under the caption “Use of Proceeds” in the Offering Memorandum.

provided that at the time of, and after giving effect to, any Restricted Payment permitted under
clauses 4.05(b)(2) (with respect to the payment of dividends on Refunding Capital Stock pursuant to
clause (B) thereof), (5), (7), (11), (13), (14), (15), (16), (17) and (20) above, no Default or
Event of Default shall have occurred and be continuing or would occur as a consequence thereof.

     (c) The amount of all Restricted Payments (other than cash) shall be the fair market value on
the date of the Restricted Payment of the asset(s) or securities proposed to be transferred or
issued by VHS Holdco II or such Subsidiary, as the case may be, pursuant to the Restricted Payment.
The fair market value of any assets or securities that are required to be valued by this Section
4.05 shall be determined in good faith by the Board of Directors of VHS Holdco II.

     (d) VHS Holdco II shall not permit any Unrestricted Subsidiary to become a Restricted
Subsidiary except pursuant to the second to last sentence of the definition of Unrestricted
Subsidiary. For purposes of designating any Restricted Subsidiary as an Unrestricted Subsidiary,
all outstanding investments by VHS Holdco II and the Restricted Subsidiaries (except to the extent
repaid) in the Subsidiary so designated shall be deemed to be Restricted Payments in an amount
determined as set forth in the second paragraph of the definition of Investments. Such designation
shall be permitted only if a Restricted Payment in such amount would be permitted at such time
under this Section 4.05 or the definition of Permitted Investments and if such Subsidiary otherwise
meets the definition of an Unrestricted Subsidiary.

     Section 4.06 Limitation on Dividend and Other Payment Restrictions Affecting Restricted
Subsidiaries.

     (a) VHS Holdco II shall not, and shall not permit any of its Restricted Subsidiaries to,
directly or indirectly, create or permit to exist or become effective any consensual encumbrance or
restriction on the ability of any such Restricted Subsidiary to:

     (1) pay dividends or make any other distributions on its Capital Stock to VHS Holdco II
or any of its Restricted Subsidiaries, or with respect to any other interest or
participation in, or measured by, its profits, or pay any Indebtedness owed to VHS Holdco II
or any of its Restricted Subsidiaries;

     (2) make loans or advances to VHS Holdco II or any of its Restricted Subsidiaries; or

     (3) sell, lease or transfer any of its properties or assets to VHS Holdco II or any of
its Restricted Subsidiaries.

     (b) The restrictions in Section 4.06(a) hereof shall not apply to encumbrances or restrictions
existing under or by reason of:

     (1) contractual encumbrances or restrictions in effect on the Issue Date, including,
without limitation, pursuant to Existing Indebtedness, the Credit Agreement and related
documentation, Hedging Obligations, this Indenture and the Notes;

     (2) [Reserved];

     (3) purchase money obligations for property acquired in the ordinary course of business
that impose restrictions of the nature described in Section 4.06(a)(3) hereof;

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     (4) applicable law or any applicable rule, regulation or order;

     (5) any agreement or other instrument of a Person acquired by VHS Holdco II or any
Restricted Subsidiary in existence at the time of such acquisition (but not created in
contemplation thereof), which encumbrance or restriction is not applicable to any Person, or
the properties or assets of any Person, other than the Person, or the property or assets of
the Person, so acquired;

     (6) contracts for the sale of assets, including, without limitation, customary
restrictions with respect to a Subsidiary pursuant to an agreement that has been entered
into for the sale or disposition of all or substantially all of the Capital Stock or assets
of such Subsidiary;

     (7) secured Indebtedness otherwise permitted to be incurred pursuant to Sections 4.07
and 4.10 hereof that limits the right of the debtor to dispose of the assets securing such
Indebtedness;

     (8) restrictions on cash or other deposits or net worth imposed by customers under
contracts entered into in the ordinary course of business;

     (9) other Indebtedness of Restricted Subsidiaries that are Guarantors which
Indebtedness is permitted to be incurred pursuant to an agreement entered into subsequent to
the Issue Date in accordance with Section 4.07 hereof;

     (10) customary provisions in joint venture agreements and other similar agreements
entered into in the ordinary course of business, including, without limitation, provisions
limiting the disposition or distribution of assets or property; provided that such
limitations are applicable only to the assets or property that are the subject of such joint
venture agreements and are owned by such joint venture;

     (11) customary provisions restricting dispositions of real property interests set forth
in any reciprocal easement agreements of VHS Holdco II or any Restricted Subsidiary;

     (12) customary provisions contained in licenses of intellectual property and other
similar agreements entered into in the ordinary course of business;

     (13) customary provisions restricting subletting or assignment of any lease governing a
leasehold interest;

     (14) customary provisions restricting assignment of any agreement entered into in the
ordinary course of business;

     (15) contracts entered into in the ordinary course of business, not related to any
Indebtedness, and that do not, individually or in the aggregate, detract from the value of
property or assets of VHS Holdco II or any Restricted Subsidiary in any manner material to
VHS Holdco II or any Restricted Subsidiary;

     (16) any encumbrances or restrictions of the type referred to in Section 4.06(a)(1),
(2) and (3) imposed by any amendments, modifications, restatements, renewals, increases,
supplements, refundings, replacements or refinancings of the contracts, instruments or
obligations referred to in Sections 4.06(b)(1) and (5); provided that such amendments,
modifications, restatements, renewals, increases, supplements, refundings, replacements or
refinancings are, in the good faith judgment of the Board of Directors of VHS Holdco II, not
materially more restrictive with respect to such dividend and other payment restrictions
than those contained in the dividend or other payment restrictions prior to such amendment,
modification, restatement, renewal, increase, supplement, refunding, replacement or
refinancing; or

     (17) any encumbrance or restriction of a Securitization Subsidiary effected in
connection with a Qualified Securitization Financing; provided that such restrictions apply
only to such Securitization Subsidiary.

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     Section 4.07 Limitation on Incurrence of Additional Indebtedness and Issuance of Preferred
Stock.

     (a) VHS Holdco II shall not, and shall not permit any of its Restricted Subsidiaries to,
directly or indirectly, create, incur, issue, assume, guarantee or otherwise become directly or
indirectly liable, contingently or otherwise, with respect to (collectively, “incur”) any
Indebtedness (including Acquired Debt), and VHS Holdco II shall not permit any of its Restricted
Subsidiaries to issue any shares of Preferred Stock; provided that VHS Holdco II and any Restricted
Subsidiary may incur Indebtedness (including Acquired Debt) and any Restricted Subsidiary may issue
Preferred Stock if the Fixed Charge Coverage Ratio for VHS Holdco II’s most recently ended four
full fiscal quarters for which internal financial statements are available immediately preceding
the date on which such additional Indebtedness is incurred or such Preferred Stock is issued would
have been at least 2.00 to 1.00, determined on a pro forma basis (including a pro forma application
of the net proceeds therefrom), as if the additional Indebtedness had been incurred or the
Preferred Stock had been issued, as the case may be, and the application of proceeds therefrom had
occurred at the beginning of such four-quarter period.

     (b) The provisions of Section 4.07(a) hereof shall not prohibit the incurrence of any of the
following (collectively, “Permitted Debt”):

     (1) Indebtedness under Credit Facilities together with the incurrence of the guarantees
thereunder and the issuance and creation of letters of credit and bankers’ acceptances
thereunder (with letters of credit and bankers’ acceptances being deemed to have a principal
amount equal to the face amount thereof), up to an aggregate principal amount of $1,275.0
million outstanding at any one time less the amount of all permanent reductions of
Indebtedness thereunder as a result of principal payments actually made with Net Proceeds
from Asset Sales;

     (2) Indebtedness represented by the Existing VHS Holdco II Notes after giving effect to
the consummation of the Offer (including any guarantee thereof existing on the Issue Date);
provided that any such Existing VHS Holdco II Notes shall be redeemed within 45 days of the
Issue Date;

     (3) Indebtedness represented by the Notes and the Guarantees and the Notes and related
Guarantees to be issued in exchange therefor pursuant to the Registration Rights Agreement;

     (4) Existing Indebtedness (other than Indebtedness described in Sections 4.07(b)(1),
(2) and (3));

     (5) Indebtedness (including Capitalized Lease Obligations) incurred or issued by VHS
Holdco II or any Restricted Subsidiary to finance the purchase, lease or improvement of
property (real or personal) or equipment that is used by or useful to VHS Holdco II or any
Restricted Subsidiary in a Permitted Business (whether through the direct purchase of assets
or the Capital Stock of any Person owning such assets) in an aggregate principal amount
that, when aggregated with the principal amount of all other Indebtedness then outstanding
and incurred pursuant to this clause (5) of Section 4.07(b) does not exceed the greater of
$75.0 million and 3.0% of Total Assets;

     (6) Indebtedness incurred by VHS Holdco II or any Restricted Subsidiary constituting
reimbursement obligations with respect to letters of credit issued in the ordinary course of
business, including, without limitation, letters of credit in respect of workers’
compensation claims, health, disability or other employee benefits or property, casualty or
liability insurance or self-insurance or other Indebtedness with respect to
reimbursement-type obligations regarding workers’ compensation claims;

     (7) Indebtedness arising from agreements of VHS Holdco II or a Restricted Subsidiary
providing for indemnification, adjustment of purchase price or similar obligations, in each
case, incurred or assumed in connection with the disposition of any business, assets or a
Subsidiary, other than guarantees of Indebtedness incurred by any Person acquiring all or
any portion of such business, assets or a Subsidiary for the purpose of financing such
acquisition; provided that (A) such Indebtedness is not reflected on the balance sheet
(other than by application of FASB ASL 460, Guarantees as a result of an amendment to an
obligation in existence on the Issue Date) of VHS Holdco II or any Restricted Subsidiary
(contingent obli-

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gations referred to in a footnote to financial statements and not otherwise reflected
on the balance sheet shall not be deemed to be reflected on such balance sheet for purposes
of this clause (A) of Section 4.07(b)(7) and (B) the maximum assumable liability in respect
of all such Indebtedness shall at no time exceed the gross proceeds including non-cash
proceeds (the fair market value of such non-cash proceeds being measured at the time
received and without giving effect to any subsequent changes in value) actually received by
VHS Holdco II and any Restricted Subsidiaries in connection with such disposition;

     (8) Indebtedness of VHS Holdco II owed to and held by any Restricted Subsidiary or
Indebtedness of a Restricted Subsidiary owed to and held by VHS Holdco II or any Restricted
Subsidiary; provided that (A) any subsequent issuance or transfer of any Capital Stock or
any other event that results in any such Restricted Subsidiary ceasing to be a Restricted
Subsidiary or any subsequent transfer of any such Indebtedness (except to VHS Holdco II or a
Restricted Subsidiary) shall be deemed, in each case, to constitute the incurrence of such
Indebtedness by the issuer thereof and (B) if either of the Issuers or any Guarantor is the
obligor on such Indebtedness owing to a Restricted Subsidiary that is not a Guarantor, other
than Indebtedness represented by short-term, open account working capital notes entered into
in the ordinary course of business for cash management purposes and consistent with past
practice, such Indebtedness is expressly subordinated to the prior payment in full in cash
of all obligations of such Issuer with respect to the Notes or of such Guarantor with
respect to its Guarantee;

     (9) shares of Preferred Stock of a Restricted Subsidiary issued to VHS Holdco II or a
Restricted Subsidiary; provided that any subsequent issuance or transfer of any Capital
Stock or any other event which results in any such Restricted Subsidiary ceasing to be a
Restricted Subsidiary or any other subsequent transfer of any such shares of Preferred Stock
(except to VHS Holdco II or a Restricted Subsidiary) shall be deemed in each case to be an
issuance of such shares of Preferred Stock;

     (10) Hedging Obligations of VHS Holdco II or any Restricted Subsidiary (excluding
Hedging Obligations entered into for speculative purposes) for the purpose of limiting (A)
interest rate risk with respect to any Indebtedness that is permitted by the terms of this
Indenture to be outstanding or (B) exchange rate risk with respect to any currency exchange
or (C) commodity risk;

     (11) obligations in respect of performance, bid, appeal and surety bonds and
performance and completion guarantees provided by VHS Holdco II or any Restricted Subsidiary
or obligations in respect of letters of credit related thereto, in each case in the ordinary
course of business or consistent with past practice;

     (12) Preferred Stock that is not Disqualified Stock and is issued by a Restricted
Subsidiary of VHS Holdco II to a Person holding a minority Equity Interest in such
Restricted Subsidiary (after giving effect to such issuance); provided that such Preferred
Stock is not exchangeable or convertible into Indebtedness of VHS Holdco II or any of its
Restricted Subsidiaries and does not require any cash payment of dividends or distributions
at any time that such cash payment would result in a Default or an Event of Default;
provided, further, that the aggregate liquidation preference of all Preferred Stock issued
pursuant to this clause (12) of Section 4.07(b) shall not exceed $25.0 million;

     (13) Indebtedness of VHS Holdco II or any Restricted Subsidiary or Preferred Stock of
any Restricted Subsidiary not otherwise permitted hereunder in an aggregate principal amount
or liquidation preference which, when aggregated with the principal amount and liquidation
preference of all other Indebtedness and Preferred Stock then outstanding and incurred
pursuant to this clause (13) of Section 4.07(b), does not at any one time outstanding, when
taken together with any Refinancing Indebtedness in respect thereof, exceed the greater of
(x) $150.0 million and (y) 5.0% of Total Assets (it being understood that any Indebtedness
or Preferred Stock incurred pursuant to this clause (13) of Section 4.07(b) shall cease to
be deemed incurred or outstanding for purposes of this clause (13) of Section 4.07(b) but
shall be deemed incurred for the purposes of the first paragraph of this covenant from and
after the first date on which VHS Holdco II or such Restricted Subsidiary could have
incurred such Indebtedness or Preferred Stock under the first paragraph of this covenant
without reliance on this clause (13) of Section 4.07(b));

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     (14) any guarantee by either of the Issuers or a Guarantor of Indebtedness or other
obligations of VHS Holdco II or any Restricted Subsidiary so long as the incurrence of such
Indebtedness by VHS Holdco II or such Restricted Subsidiary is permitted under the terms of
this Indenture; provided that if such Indebtedness is by its express terms subordinated in
right of payment to the Notes or a Guarantee, as applicable, any such guarantee with respect
to such Indebtedness shall be subordinated in right of payment to the Notes or such
Guarantee with respect to the Notes substantially to the same extent as such Indebtedness is
subordinated to the Notes or such Guarantee, as applicable;

     (15) the incurrence by VHS Holdco II or any Restricted Subsidiary of Indebtedness or
Preferred Stock that serves to refund or refinance any Indebtedness incurred as permitted
under Section 4.07(a) hereof and clauses (2), (3), (4) and (13) of Section 4.07(b) hereof,
this clause (15) and clause (16) of Section 4.07(b) hereof or any Indebtedness issued to so
refund or refinance such Indebtedness including additional Indebtedness incurred to pay
premiums and fees in connection therewith (the “Refinancing Indebtedness”) prior to its
respective maturity; provided that such Refinancing Indebtedness (A) has a Weighted Average
Life to Maturity at the time such Refinancing Indebtedness is incurred which is not less
than the remaining Weighted Average Life to Maturity of the Indebtedness being refunded or
refinanced, (B) to the extent such Refinancing Indebtedness refinances Indebtedness
subordinated to the Notes, such Refinancing Indebtedness is subordinated to the Notes at
least to the same extent as the Indebtedness being refinanced or refunded, (C) shall not
include (x) Indebtedness or Preferred Stock of a Restricted Subsidiary that is not the
Co-Issuer or a Guarantor that refinances Indebtedness or Preferred Stock of either Issuer or
a Guarantor or (y) Indebtedness or Preferred Stock of VHS Holdco II or a Restricted
Subsidiary that refinances Indebtedness or Preferred Stock of an Unrestricted Subsidiary,
(D) shall not be in a principal amount in excess of the principal amount of, premium, if
any, accrued interest on, and related fees and expenses of, the Indebtedness being refunded
or refinanced and (E) shall not have a stated maturity date prior to the Stated Maturity of
the Indebtedness being refunded or refinanced;

     (16) Indebtedness or Preferred Stock of Persons that are acquired by VHS Holdco II or
any Restricted Subsidiary or merged into VHS Holdco II or a Restricted Subsidiary in
accordance with the terms of this Indenture; provided that such Indebtedness or Preferred
Stock is not incurred in connection with or in contemplation of such acquisition or merger;
and provided, further, that after giving effect to such acquisition or merger, either (A)
VHS Holdco II or such Restricted Subsidiary would be permitted to incur at least $1.00 of
additional Indebtedness pursuant to the Fixed Charge Coverage Ratio test set forth in the
first paragraph of this covenant or (B) the Fixed Charge Coverage Ratio would be greater
than immediately prior to such acquisition;

     (17) Indebtedness arising from the honoring by a bank or financial institution of a
check, draft or similar instrument drawn against insufficient funds in the ordinary course
of business; provided that such Indebtedness, other than credit or purchase cards, is
extinguished within five Business Days of its incurrence;

     (18) Indebtedness of VHS Holdco II or any Restricted Subsidiary supported by a letter
of credit issued pursuant to the Credit Agreement in a principal amount not in excess of the
stated amount of such letter of credit;

     (19) Contribution Indebtedness;

     (20) Indebtedness consisting of the financing of insurance premiums;

     (21) Indebtedness incurred on behalf of or representing Guarantees of Indebtedness of
joint ventures of VHS Holdco II or any Restricted Subsidiary not in excess of $25.0 million
at any time outstanding;

     (22) Indebtedness incurred by a Securitization Subsidiary in a Qualified Securitization
Financing that is not recourse to VHS Holdco II or any Restricted Subsidiary other than a
Securitization Subsidiary (except for Standard Securitization Undertakings);

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     (23) Physician Support Obligations incurred by VHS Holdco II or any Restricted
Subsidiary;

     (24) Indebtedness consisting of Indebtedness issued by the Issuers or any of their
Restricted Subsidiaries to current or former officers, directors and employees thereof,
their respective estates, spouses or former spouses, in each case to finance the purchase or
redemption of Equity Interests of the Issuers or any direct or indirect parent company of
the Issuers to the extent described in Section 4.05(b)(4);

     (25) customer deposits and advance payments received in the ordinary course of business
from customers for goods purchased in the ordinary course of business;

     (26) Indebtedness owed on a short-term basis of no longer than 30 days to banks and
other financial institutions incurred in the ordinary course of business of the Issuers and
their Restricted Subsidiaries with such banks or financial institutions that arises in
connection with ordinary banking arrangements to manage cash balances of the Issuers and
their Restricted Subsidiaries;

     (27) Indebtedness incurred by a Restricted Subsidiary in connection with bankers’
acceptances, discounted bills of exchange or the discounting or factoring of receivables for
credit management purposes, in each case incurred or undertaken in the ordinary course of
business on arm’s length commercial terms on a recourse basis; and

     (28) all premium (if any), interest (including post-petition interest), fees, expenses,
charges and additional or contingent interest on obligations described in paragraphs (1)
through (27) of Section 4.07(b) hereof.

     For purposes of determining compliance with this Section 4.07, in the event that an item of
proposed Indebtedness meets the criteria of more than one of the categories of Permitted Debt
described in clauses (1) through (28) of Section 4.07(b) hereof, or is entitled to be incurred
pursuant to Section 4.07(a) hereof, VHS Holdco II shall be permitted to classify and later
reclassify such item of Indebtedness in any manner that complies with this covenant, and such item
of Indebtedness shall be treated as having been incurred pursuant to only one of such categories.
Accrual of interest, the accretion of accreted value and the payment of interest in the form of
additional Indebtedness shall not be deemed to be an incurrence of Indebtedness for purposes of
this Section 4.07. Indebtedness under the Credit Agreement outstanding on the date on which Notes
are first issued and authenticated under this Indenture shall be deemed to have been incurred on
such date in reliance on the exception provided by clause (1) of the definition of Permitted Debt.
The maximum amount of Indebtedness that VHS Holdco II and its Restricted Subsidiaries may incur
pursuant to this Section 4.07 shall not be deemed to be exceeded, with respect to any outstanding
Indebtedness, solely as a result of fluctuations in the exchange rate of currencies.

     Section 4.08 Asset Sales.

     (a) VHS Holdco II shall not, and shall not permit any of its Restricted Subsidiaries to,
consummate an Asset Sale unless:

     (1) VHS Holdco II (or such Restricted Subsidiary, as the case may be) receives
consideration at the time of the Asset Sale at least equal to the fair market value (as
determined in good faith by the principal financial officer of VHS Holdco II or, in the case
of assets and Equity Interests having a value in excess of $25.0 million, by the Board of
Directors of VHS Holdco II) of the assets or Equity Interests issued or sold or otherwise
disposed of; and

     (2) at least 75% of the consideration received in the Asset Sale by VHS Holdco II or
such Restricted Subsidiary is in the form of cash or Cash Equivalents.

     The amount of (A) any liabilities (as shown on VHS Holdco II’s or such Restricted Subsidiary’s
most recent balance sheet or in the notes thereto) of VHS Holdco II or any Restricted Subsidiary
(other than liabilities that are by their terms subordinated to the Notes) that are assumed by the
transferee of any such assets and for which VHS Holdco II and all Restricted Subsidiaries have been
validly released by all creditors in writing, (B) any securi-

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ties received by VHS Holdco II or such Restricted Subsidiary from such transferee that are
converted by VHS Holdco II or such Restricted Subsidiary into cash (to the extent of the cash
received) within 180 days following the receipt thereof and (C) any Designated Non-cash
Consideration received by VHS Holdco II or any of its Restricted Subsidiaries in such Asset Sale
having an aggregate fair market value (as determined in good faith by VHS Holdco II), taken
together with all other Designated Non-cash Consideration received pursuant to this clause (C) that
is at that time outstanding, not to exceed the greater of (i) $50.0 million and (ii) 2.0% of Total
Assets at the time of the receipt of such Designated Non-cash Consideration (with the fair market
value of each item of Designated Non-cash Consideration being measured at the time received without
giving effect to subsequent changes in value) shall be deemed to be cash for purposes of Section
4.08(a)(2) and for no other purpose.

     Notwithstanding the foregoing, the 75% limitation referred to in this clause (2) of Section
4.08(a) shall not apply to any Asset Sale in which the amount of consideration of the type referred
to this clause (2) of Section 4.08(a) received therefrom, determined in accordance with the
foregoing provision, is equal to or greater than what the after-tax proceeds would have been had
such Asset Sale complied with the aforementioned 75% limitation.

     (b) Within 365 days after the receipt of any Net Proceeds by VHS Holdco II or any Restricted
Subsidiary from an Asset Sale, VHS Holdco II or such Restricted Subsidiary may apply those Net
Proceeds at its option to:

     (1) permanently reduce Obligations under the Credit Agreement and, in the case of
revolving Obligations thereunder, to correspondingly reduce commitments with respect thereto
(or other Indebtedness of the Issuers or a Guarantor secured by a Lien) or Pari Passu
Indebtedness or Indebtedness of a Restricted Subsidiary that is not a Guarantor; provided
that if the Issuers or a Guarantor shall so reduce Obligations under such Pari Passu
Indebtedness, it shall equally and ratably reduce Obligations under the Notes by making an
offer (in accordance with the procedures set forth below for an Asset Sale Offer) to all
Holders of Notes to purchase at a purchase price equal to 100% of the principal amount
thereof, plus accrued and unpaid interest and Additional Interest, if any, the pro rata
principal amount of Notes) or Indebtedness of a Restricted Subsidiary that is not a
Guarantor, in each case other than Indebtedness owed to either of the Issuers or an
Affiliate of the Issuers (provided that in the case of any reduction of any revolving
obligations, the Issuers or such Restricted Subsidiary shall effect a corresponding
reduction of commitments with respect thereto);

     (2) make an investment in (A) any one or more businesses; provided that such investment
in any business is in the form of the acquisition of Capital Stock and results in VHS Holdco
II or a Restricted Subsidiary owning an amount of the Capital Stock of such business such
that it constitutes a Restricted Subsidiary, (B) capital expenditures or (C) other assets,
in each of (A), (B) and (C), used or useful in a Permitted Business; and/or

     (3) make an investment in (A) any one or more businesses; provided that such investment
in any business is in the form of the acquisition of Capital Stock and it results in VHS
Holdco II or a Restricted Subsidiary owning an amount of the Capital Stock of such business
such that it constitutes a Restricted Subsidiary, (B) properties or (C) assets that, in each
of (A), (B) and (C), replace the businesses, properties and assets that are the subject of
such Asset Sale;

provided that the 365-day period provided above to apply any portion of Net Proceeds in accordance
with clause (2) or (3) of this Section 4.08(b) shall be extended by an additional 180 days if by
not later than the 365th day after receipt of such Net Proceeds, VHS Holdco II or a Restricted
Subsidiary, as applicable, has entered into a bona fide binding commitment with a Person other than
an Affiliate of the Issuers to make an investment of the type referred to in either such clause in
the amount of such Net Proceeds.

     (c) When the aggregate amount of Net Proceeds not applied or invested in accordance with the
preceding paragraph (“Excess Proceeds”) exceeds $30.0 million, the Issuers shall make an Asset Sale
Offer to all Holders of Notes and any other Pari Passu Indebtedness requiring the making of such an
offer to purchase on a pro rata basis the maximum principal amount of Notes and such other Pari
Passu Indebtedness that may be purchased out of

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the Excess Proceeds. The offer price in any Asset Sale Offer shall be equal to 100% of the
principal amount plus accrued and unpaid interest and Additional Interest, if any, to the date of
purchase, and shall be payable in cash.

     (d) Pending the final application of any Net Proceeds, VHS Holdco II or such Restricted
Subsidiary may temporarily reduce revolving credit borrowings or otherwise invest the Net Proceeds
in any manner that is not prohibited by this Indenture.

     (e) If any Excess Proceeds remain after consummation of an Asset Sale Offer, the Issuers may
use those Excess Proceeds for any purpose not otherwise prohibited by this Indenture. If the
aggregate principal amount of Notes and such other Pari Passu Indebtedness tendered into such Asset
Sale Offer exceeds the amount of Excess Proceeds, the Trustee shall select the Notes and such other
Pari Passu Indebtedness to be purchased on a pro rata basis. Upon completion of each Asset Sale
Offer, the amount of Excess Proceeds shall be reset at zero.

     (f) The Issuers shall comply with the requirements of Rule 14e-1 under the Exchange Act and
any other securities laws and regulations thereunder to the extent those laws and regulations are
applicable in connection with each repurchase of Notes pursuant to an Asset Sale Offer. To the
extent that the provisions of any securities laws or regulations conflict with the Asset Sale
provisions of this Indenture, the Issuers shall comply with the applicable securities laws and
regulations and shall not be deemed to have breached their obligations under the Asset Sale
provisions of this Indenture by virtue of such conflict.

     Section 4.09 Limitation on Transactions with Affiliates.

     (a) VHS Holdco II shall not, and shall not permit any of its Restricted Subsidiaries to, make
any payment to, or sell, lease, transfer or otherwise dispose of any of its properties or assets
to, or purchase any property or assets from, or enter into or make or amend any transaction,
contract, agreement, understanding, loan, advance or guarantee with, or for the benefit of, any
Affiliate (each, an “Affiliate Transaction”) involving aggregate consideration in excess of $10.0
million, unless:

     (1) the Affiliate Transaction is on terms that are not materially less favorable, taken
as a whole, to VHS Holdco II or the relevant Restricted Subsidiary than those that would
have been obtained in a comparable transaction by VHS Holdco II or such Restricted
Subsidiary with an unrelated Person on an arms length basis; and

     (2) VHS Holdco II delivers to the Trustee, with respect to any Affiliate Transaction or
series of related Affiliate Transactions involving aggregate consideration in excess of
$20.0 million, a resolution of the Board of Directors of VHS Holdco II set forth in an
Officers’ Certificate certifying that such Affiliate Transaction complies with this covenant
and that such Affiliate Transaction has been approved by a majority of the disinterested
members, if any, of the Board of Directors of VHS Holdco II.

     (b) The following items shall not be deemed to be Affiliate Transactions and, therefore, shall
not be subject to the provisions of Section 4.09(a) hereof:

     (1) transactions between or among VHS Holdco II and/or any Restricted Subsidiary or any
entity that becomes a Restricted Subsidiary as a result of such transaction;

     (2) Restricted Payments and Permitted Investments permitted by this Indenture;

     (3) the payment to Sponsors of annual management, consulting, monitoring and advisory
fees in an aggregate amount in any fiscal year not in excess of the greater of (A) $6.0
million and (B) 2.0% of EBITDA of VHS Holdco II and its Restricted Subsidiaries for the
immediately preceding fiscal year, plus reasonable out-of-pocket costs and expenses in
connection therewith and unpaid amounts accrued for prior periods (but after the Issue
Date), and the execution of any management or monitoring agreement subject to the same
limitations;

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     (4) the payment of reasonable and customary fees paid to, and indemnities provided on
behalf of, officers, directors, employees or consultants of VHS Holdco II, any Restricted
Subsidiary or (to the extent such person renders services to the businesses of VHS Holdco II
and its Subsidiaries) any of VHS Holdco II’s direct or indirect parent entities;

     (5) payments by VHS Holdco II or any Restricted Subsidiary to the Sponsors and any of
their Affiliates made for any financial advisory, financing, underwriting or placement
services or in respect of other investment banking activities, including, without
limitation, in connection with acquisitions or divestitures, which payments are approved by
a majority of the members of the Board of Directors of VHS Holdco II in good faith;

     (6) transactions in which VHS Holdco II or any Restricted Subsidiary delivers to the
Trustee a letter from an Independent Financial Advisor stating that such transaction is fair
to VHS Holdco II or such Restricted Subsidiary from a financial point of view;

     (7) payments or loans (or cancellations of loans) to employees or consultants of VHS
Holdco II, any Restricted Subsidiary or (to the extent such person renders services to the
businesses of VHS Holdco II and its Subsidiaries) any of VHS Holdco II’s direct or indirect
parent entities, which are approved by a majority of the Board of Directors of VHS Holdco II
in good faith and which are otherwise permitted under this Indenture;

     (8) payments made or performance under any agreement as in effect on the Issue Date or
any amendment thereto (so long as any such amendment is not less advantageous to the Holders
in any material respect than the original agreement as in effect on the Issue Date);

     (9) the existence of, or the performance by VHS Holdco II or any of its Restricted
Subsidiaries of its obligations under the terms of, the LLC Agreement (including any
registration rights agreement or purchase agreements related thereto to which it is party on
the Issue Date and any similar agreement that it may enter into thereafter); provided that
the existence of, or the performance by VHS Holdco II or any of its Restricted Subsidiaries
of its obligations under any future amendment to the LLC Agreement or under any similar
agreement or amendment thereto entered into after the Issue Date shall only be permitted by
this clause (9) to the extent that the terms of any such amendment or new agreement are not
otherwise disadvantageous to Holders of the Notes in any material respect;

     (10) transactions with customers, clients, suppliers, or purchasers or sellers of goods
or services, in each case in the ordinary course of business and otherwise in compliance
with the terms of this Indenture that are fair to VHS Holdco II and or the Restricted
Subsidiaries, in the reasonable determination of the members of the Board of Directors of
VHS Holdco II or the senior management thereof, or are on terms at least as favorable as
might reasonably have been obtained at such time from an unaffiliated party;

     (11) if otherwise permitted hereunder, the issuance of Equity Interests (other than
Disqualified Stock) of the Issuers to VHS Holdco I, to any direct or indirect parent of VHS
Holdco I, or to any Permitted Holder;

     (12) any transaction effected as part of a Qualified Securitization Financing;

     (13) any transaction with a Captive Insurance Subsidiary in the ordinary course of
operations of such Captive Insurance Subsidiary;

     (14) payments or loans (or cancellation of loans) to employees or consultants of the
Issuers, any of their direct or indirect parent companies or any of their Restricted
Subsidiaries and any employment agreements entered into by VHS Holdco II or any of the
Restricted Subsidiaries in the ordinary course of business;

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     (15) transactions with joint ventures in Permitted Businesses entered into in the
ordinary course of business and in a manner consistent with past practice;

     (16) any issuance of securities, or other payments, awards or grants in cash,
securities or otherwise pursuant to, or the funding of, employment arrangements, stock
options and stock ownership plans approved by the Board of Directors of VHS Holdco II; and

     (17) Investments by any of the Sponsors in securities of the Issuers or any of their
Restricted Subsidiaries (and payment of reasonable out-of-pocket expenses incurred by such
investors in connection therewith) so long as (i) the investment is being offered generally
to other investors on the same or more favorable terms and (ii) the investment constitutes
less than 5% of the proposed or outstanding issue amount of such class of securities.

     Section 4.10 Limitation on Liens. VHS Holdco II shall not, and shall not permit any
Restricted Subsidiary to, directly or indirectly, create, incur, assume or suffer to exist any Lien
that secures obligations under any Indebtedness (other than Permitted Liens) on any asset or
property of VHS Holdco II or any Restricted Subsidiary, or any income or profits therefrom, or
assign or convey any right to receive income therefrom, unless:

     (1) in the case of Liens securing Subordinated Indebtedness, the Notes and any
applicable Guarantees are secured by a Lien on such property, assets or proceeds that is
senior in priority to such Liens; or

     (2) in all other cases, the Notes or the applicable Guarantee or Guarantees are equally
and ratably secured.

     Section 4.11 Offer to Repurchase Upon Change of Control.

     (a) Upon the occurrence of a Change of Control, the Issuers shall make an offer (a “Change of
Control Offer”) to each Holder of the Notes to repurchase all or any part (equal to $2,000 or an
integral multiple of $1,000) of that Holder’s Notes repurchased at a purchase price in cash equal
to 101% of the aggregate principal amount thereof plus accrued and unpaid interest and Additional
Interest, if any, on the Notes repurchased to, but not including, the date of purchase, subject to
the rights of Holders on the relevant record date to receive interest due on the relevant interest
payment date (the “Change of Control Payment”). Within 30 days following any Change of Control,
except to the extent that the Issuers have exercised their right to redeem the Notes in accordance
with Article III of this Indenture, the Issuers shall mail a notice to each Holder describing the
transaction or transactions that constitute the Change of Control and stating:

     (1) that the Change of Control is being made pursuant to this Section 4.11 and that all
Notes properly tendered pursuant to such Change of Control Offer shall be accepted for
payment;

     (2) the purchase price and the purchase date, which shall be no earlier than 30 days
and no later than 60 days from the date such notice is mailed (the “Change of Control
Payment Date”);

     (3) that any Note not tendered shall continue to accrue interest;

     (4) that, unless the Issuers default in the payment of the Change of Control Payment,
all Notes accepted for payment pursuant to the Change of Control Offer shall cease to accrue
interest after the Change of Control Payment Date;

     (5) that Holders electing to have any Notes purchased pursuant to a Change of Control
Offer shall be required to surrender the Notes completed, or transfer by book entry
transfer, to the Paying Agent at the address specified in the notice prior to the close of
business on the third Business Day preceding the Change of Control Payment Date;

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     (6) that Holders shall be entitled to withdraw their election if the Paying Agent
receives, not later than the close of business on the second Business Day preceding the
Change of Control Payment Date, a telegram, telex, facsimile transmission or letter setting
forth the name of the Holder, the principal amount of Notes delivered for purchase, and a
statement that such Holder is withdrawing his election to have the Notes purchased;

     (7) that Holders whose Notes are being purchased only in part shall be issued new Notes
equal in principal amount or an integral multiple thereof.

The Issuers shall comply with the requirements of Rule 14e-1 under the Exchange Act and any other
securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Notes as a result of a Change of Control. To the extent
that the provisions of any securities laws or regulations conflict with this Section 4.11, the
Issuers shall comply with the applicable securities laws and regulations and shall not be deemed to
have breached their obligations under this Section 4.11 by virtue of such conflict.

     (b) On the Change of Control Payment Date, the Issuers shall, to the extent lawful:

     (1) accept for payment all Notes or portions of Notes properly tendered pursuant to the
Change of Control Offer;

     (2) deposit with the paying agent an amount equal to the Change of Control Payment in
respect of all Notes or portions of Notes properly tendered; and

     (3) deliver or cause to be delivered to the Trustee the Notes properly accepted
together with an Officers’ Certificate stating the aggregate principal amount of Notes or
portions of Notes being purchased by the Issuers.

     The paying agent shall promptly mail to each Holder of Notes properly tendered the Change of
Control Payment for such Notes, and the Trustee shall promptly authenticate and mail (or cause to
be transferred by book entry) to each Holder a new Note equal in principal amount to any
unpurchased portion of the Notes surrendered, if any; provided that each new Note shall be in a
principal amount of $2,000 or an integral multiple of $1,000 in excess thereof.

     The Issuers shall publicly announce the results of the Change of Control Offer on or as soon
as practicable after the Change of Control Payment Date.

     (c) Notwithstanding anything to the contrary in this Section 4.11, the Issuers shall not be
required to make a Change of Control Offer upon a Change of Control if a third party makes the
Change of Control Offer in the manner, at the times and otherwise in compliance with the
requirements set forth in this Section 4.11 applicable to a Change of Control Offer made by the
Issuers and purchases all Notes properly tendered and not withdrawn under the Change of Control
Offer. A Change of Control Offer may be made in advance of a Change of Control if a definitive
agreement is in place for the Change of Control at the time of the making of the Change of Control
Offer, and such Change of Control Offer is otherwise made in compliance with the provisions of this
Section 4.11.

     Section 4.12 Payments for Consent. VHS Holdco II shall not, and shall not permit any
of its Subsidiaries to, directly or indirectly, pay or cause to be paid any consideration to or for
the benefit of any Holder of Notes for or as an inducement to any consent, waiver or amendment of
any of the terms or provisions of this Indenture or the Notes unless such consideration is offered
to be paid and is paid to all Holders of the Notes that consent, waive or agree to amend in the
time frame set forth in the solicitation documents relating to such consent, waiver or agreement.

     Section 4.13 Additional Subsidiary Guarantees. Upon the occurrence of the guarantee
by any Restricted Subsidiary of the obligations of any borrower under the Credit Agreement, VHS
Holdco II shall cause each such Restricted Subsidiary (other than a Securitization Subsidiary) to
execute a Guarantee satisfactory in form and substance to the Trustee (and with such documentation
relating thereto as the Trustee may require, including, with-

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out limitation, opinions of counsel as to the enforceability of such guarantee), pursuant
to which such Restricted Subsidiary shall become a Guarantor. Such Guarantee is contained in the
form of the supplemental indenture attached as Exhibit E hereto.

     Section 4.14 Existence of Corporate Co-Issuer. VHS Holdco II shall always maintain a
Wholly-Owned Subsidiary that is a Restricted Subsidiary of VHS Holdco II organized as a corporation
under the laws of the United States of America, any state thereof or the District of Columbia that
shall serve as a co-issuer of the Notes unless VHS Holdco II is itself a corporation under the laws
of the United States of America, any state thereof or the District of Columbia.

     Section 4.15 Suspension of Covenants.

     (a) If on any date (i) the Notes have Investment Grade Ratings from both Rating Agencies, and
(ii) no Default has occurred and is continuing under this Indenture then, beginning on that day
(the occurrence of the events described in the foregoing clauses (i) and (ii) being collectively
referred to as a “Covenant Suspension Event”), Sections 4.05 hereof, 4.06 hereof, 4.07 hereof, 4.08
hereof, 4.09 hereof and 5.01(4) hereof shall not be applicable to the Notes (collectively, the
“Suspended Covenants”).

     (b) During any period that the foregoing covenants have been suspended, the Issuers may not
designate any of its Subsidiaries as Unrestricted Subsidiaries pursuant to clause (ii) of the
definition of “Unrestricted Subsidiary.”

     (c) In the event that the Issuers and their Restricted Subsidiaries are not subject to the
Suspended Covenants for any period of time as a result of the foregoing, and on any subsequent date
(the “Reversion Date”) one or both of the Rating Agencies withdraw their Investment Grade Rating or
downgrade the rating assigned to the Notes below an Investment Grade Rating, then the Issuers and
their Restricted Subsidiaries shall thereafter again be subject to the Suspended Covenants with
respect to future events. The period of time between the Suspension Date and the Reversion Date is
referred to as the “Suspension Period.” The Guarantees of the Guarantors shall be suspended during
the Suspension Period. Additionally, upon the occurrence of a Covenant Suspension Event, the
amount of Excess Proceeds from Asset Sales shall be reset to zero.

     (d) Notwithstanding the foregoing, in the event of any such reinstatement, no action taken or
omitted to be taken by the Issuers or any of their Restricted Subsidiaries prior to such
reinstatement shall give rise to a Default or Event of Default under this Indenture with respect to
the Notes; provided that (1) with respect to Restricted Payments made after such reinstatement, the
amount of Restricted Payments made shall be calculated as though the limitations contained in
Section 4.05 had been in effect prior to, but not during, the Suspension Period; and (2) all
Indebtedness incurred, or Disqualified Stock or Preferred Stock issued, during the Suspension
Period shall be deemed to have been incurred or issued pursuant to Section 4.07(b)(4).

ARTICLE V

SUCCESSORS

     Section 5.01 Merger, Consolidation or Sale of All or Substantially All Assets of the
Issuers. Neither Issuer may, directly or indirectly: (a) consolidate or merge with or into or
wind up into another Person (whether or not such Issuer is the surviving corporation); or (b) sell,
assign, transfer, convey or otherwise dispose of all or substantially all of its properties or
assets, in one or more related transactions, to another Person; unless:

     (1) either: (A) such Issuer is the surviving corporation; or (B) the Person formed by
or surviving any such consolidation or merger (if other than such Issuer) or to which such
sale, assignment, transfer, conveyance or other disposition has been made is a Person
organized or existing under the laws of the jurisdiction of organization of such Issuer or
the United States, any state of the United States or the District of Columbia (such Issuer
or such Person, as the case may be, hereinafter referred to as the “Successor Company”);

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     (2) the Successor Company (if other than such Issuer) expressly assumes all the
obligations of such Issuer under the Notes, this Indenture and the Registration Rights
Agreement pursuant to agreements reasonably satisfactory to the Trustee; provided that at
all times, a corporation organized and existing under the laws of the United States of
America, any state thereof or the District of Columbia must be a co-issuer or the issuer of
the Notes;

     (3) immediately after such transaction no Default or Event of Default exists;

     (4) after giving pro forma effect thereto and any related financing transactions as if
the same had occurred at the beginning of the applicable four-quarter period, either (A) the
Successor Company (if other than such Issuer), would have been permitted to incur at least
$1.00 of additional Indebtedness pursuant to the Fixed Charge Coverage Ratio test set forth
in Section 4.07(a) hereof determined on a pro forma basis (including pro forma application
of the net proceeds therefrom), as if such transaction had occurred at the beginning of such
four-quarter period, or (B) the Fixed Charge Coverage Ratio for the Successor Company and
its Restricted Subsidiaries would be greater than such ratio for VHS Holdco II and its
Restricted Subsidiaries immediately prior to such transaction;

     (5) each Guarantor, unless it is the other party to the transactions described above,
in which case clause (2) of this Section 5.01 shall apply, shall have confirmed in writing
that its Guarantee shall apply to such Person’s obligations under the Notes, this Indenture
and the Registration Rights Agreement; and

     (6) such Issuer shall have delivered to the Trustee a certificate from a Responsible
Officer and an Opinion of Counsel, each stating that such consolidation, merger or transfer
and such amendment or supplement (if any) comply with this Indenture.

     Section 5.02 Successor Corporation Substituted. The Successor Company shall succeed
to, and be substituted for, such Issuer under this Indenture and the Notes. Notwithstanding the
provisions of clauses (3) and (4) of Section 5.01 hereof, (a) any Restricted Subsidiary may
consolidate with, merge into or transfer all or part of its properties and assets to VHS Holdco II
or to another Restricted Subsidiary and (b) either Issuer may merge with an Affiliate incorporated
solely for the purpose of reincorporating such Issuer in another state of the United States, so
long as the amount of Indebtedness of VHS Holdco II and its Restricted Subsidiaries is not
increased thereby.

     If a direct or indirect parent organized or existing under the laws of the United States, any
state of the United States or the District of Columbia (“Parent”) of VHS Holdco II assumes the
obligations under this Indenture in a transaction which meets the requirements of Section 5.01
hereof, treating Parent as the Successor Company for purposes of such covenant, all obligations of
VHS Holdco II under this Indenture shall be discharged except to the extent that VHS Holdco II is
or becomes a Subsidiary, Restricted Subsidiary or Subsidiary Guarantor of the Notes. In such
event, Parent shall succeed to, and be substituted for, VHS Holdco II under this Indenture and the
Notes.

     Section 5.03 Merger, Consolidation or Sale of All or Substantially All Assets by a
Guarantor. Subject to the provisions described in Sections 10.02 and 10.03 hereof, no
Guarantor (other than Vanguard) shall consolidate or merge with or into or wind up into (whether or
not such Guarantor is the surviving corporation), or sell, assign, transfer, lease, convey or
otherwise dispose of all or substantially all of its properties or assets in one or more related
transactions to, any Person, unless:

     (1) such Guarantor is the surviving Person or the Person formed by or surviving any
such consolidation or merger (if other than such Guarantor) or to which such sale,
assignment, transfer, lease, conveyance or other disposition shall have been made is a
Person organized or existing under the laws of the United States, any state thereof or the
District of Columbia (such Guarantor or such Person, as the case may be, being herein called
the “Successor Guarantor”);

     (2) the Successor Guarantor (if other than such Guarantor) expressly assumes all the
obligations of such Guarantor under this Indenture pursuant to supplemental indentures or
other documents or instruments in form reasonably satisfactory to the Trustee;

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     (3) immediately after such transaction no Default or Event of Default exists; and

     (4) the Issuers shall have delivered to the Trustee a certificate from a Responsible
Officer and an Opinion of Counsel, each stating that such consolidation, merger or transfer
and such amendment or supplement (if any) comply with this Agreement

     Section 5.04 Successor Guarantor Substituted.

     (a) The Successor Guarantor shall succeed to, and be substituted for, such Guarantor under
this Indenture and the Registration Rights Agreement.

     (b) Notwithstanding the foregoing, (1) a Guarantor may merge with an Affiliate incorporated
solely for the purpose of reincorporating such Guarantor in another state of the United States or
the District of Columbia, so long as the amount of Indebtedness of the Guarantor is not increased
thereby, and (2) any Subsidiary Guarantor may merge into or transfer all or part of its properties
and assets to either of the Issuers or another Subsidiary Guarantor.

     (c) Notwithstanding anything to the contrary herein, except as expressly permitted under this
Indenture no Guarantor shall be permitted to consolidate with, merge into or transfer all or part
of its properties and assets to VHS Holdco I or Vanguard.

ARTICLE VI

DEFAULTS AND REMEDIES

     Section 6.01 Events of Default. An “Event of Default” is defined as any of the
following:

     (1) the Issuers default in payment when due and payable, upon redemption, acceleration
or otherwise, of principal of, or premium, if any, on the Notes issued under this Indenture;

     (2) the Issuers default in the payment when due of interest or Additional Interest, if
any, on or with respect to the Notes issued under this Indenture and such default continues
for a period of 30 days;

     (3) either of the Issuers defaults in the performance of, or breaches any covenant,
warranty or other agreement contained in this Indenture (other than a default in the
performance or breach of a covenant, warranty or agreement which is specifically dealt with
in clauses (1) or (2) above) and such default or breach continues for a period of 60 days
after written notice specifying the default (and demanding that such default be remedied)
from the Trustee or the Holders of 25% or more in aggregate principal amount of the Notes;

     (4) either of the Issuers or any Significant Subsidiary defaults under any mortgage,
indenture or instrument under which there is issued or by which there is secured or
evidenced any Indebtedness for money borrowed by VHS Holdco II or any Restricted Subsidiary
or the payment of which is guaranteed by VHS Holdco II or any Restricted Subsidiary (other
than Indebtedness owed to VHS Holdco II or a Restricted Subsidiary), whether such
Indebtedness or guarantee now exists or is created after the Issue Date, if (A) such default
either (i) results from the failure to pay any such Indebtedness at its Stated Maturity
(after giving effect to any applicable grace periods) or (ii) relates to an obligation other
than the obligation to pay principal of any such Indebtedness at its Stated Maturity and
results in the Holder or Holders of such Indebtedness causing such Indebtedness to become
due prior to its Stated Maturity and (B) the principal amount of such Indebtedness, together
with the principal amount of any other such Indebtedness in default for failure to pay
principal at Stated Maturity (after giving effect to any applicable grace periods), or the
maturity of which has been so accelerated, aggregate $30.0 million or more at any one time
outstanding;

     (5) either of the Issuers or any Significant Subsidiary fails to pay final judgments
(other than any judgments covered by insurance policies issued by reputable and creditworthy
insurance companies)

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aggregating in excess of $30.0 million, which final judgments remain unpaid,
undischarged and unstayed for a period of more than 60 consecutive days after such judgment
becomes final, and an enforcement proceeding has been commenced by any creditor upon such
judgment or decree which is not promptly stayed;

     (6) either of the Issuers or any Significant Subsidiary pursuant to or within the
meaning of Bankruptcy Law:

     (A) commences a voluntary case,

     (B) consents to the entry of an order for relief against it in an involuntary
case,

     (C) consents too the appointment of a custodian of it or for all or
substantially all of its property, or

     (D) makes a general assignment for the benefit of its creditors.

     (7) a court of competent jurisdiction interest an order or decree under Bankruptcy Law
that:

     (A) is for relief against either of the Issuers or any Significant Subsidiary
or any group of Restricted Subsidiaries that, taken together, would constitute a
Significant Subsidiary in an involuntary case;

     (B) appoints a custodian of either of the Issuers or any Significant Subsidiary
or any group of Restricted Subsidiaries that, taken together, would constitute a
Significant Subsidiary or for all or substantially all of the property of either of
the Issuers or any of their Restricted Subsidiaries that is a Significant Subsidiary
or any group of Restricted Subsidiaries that, taken together, would constitute a
Significant Subsidiary; or

     (C) orders the liquidation of either the Issuers or any Significant Subsidiary
or any group of Restricted Subsidiaries that, taken together, would constitute a
Significant Subsidiary; and the order of decree remains unstayed and in effect for
60 consecutive days and

     (8) the Guarantee of VHS Holdco I or any Guarantee of a Significant Subsidiary fails to
be in full force and effect (except as contemplated by the terms thereof) or any Guarantor
(other than Vanguard) denies or disaffirms its obligations under its Guarantee and such
Default continues for 10 days.

     Section 6.02 Acceleration. If an Event of Default (other than an Event of Default
specified in Section 6.01(6) or (7) above with respect to either of the Issuers) shall occur and be
continuing, the Trustee or the Holders of at least 25% in principal amount of outstanding Notes
under this Indenture may declare the principal of and accrued interest on such Notes to be due and
payable by notice in writing to the Issuers and the Trustee specifying the respective Event of
Default and that it is a “notice of acceleration” (the “Acceleration Notice”), and the same shall
become immediately due and payable.

     Notwithstanding the foregoing, if an Event of Default specified in Section 6.01(6) or (7)
above with respect to either of the Issuers occurs and is continuing, then all unpaid principal of,
and premium, if any, and accrued and unpaid interest on all of the outstanding Notes shall ipso
facto become and be immediately due and payable without any declaration or other act on the part of
the Trustee or any Holder of the Notes.

     Section 6.03 Other Remedies. If an Event of Default occurs and is continuing, the
Trustee may pursue any available remedy to collect the payment of principal, premium and Additional
Interest, if any, and interest on the Notes or to enforce the performance of any provision of the
Notes or this Indenture.

     The Trustee may maintain a proceeding even if it does not possess any of the Notes or does not
produce any of them in the proceeding. A delay or omission by the Trustee or any Holder of a Note
in exercising any right

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or remedy accruing upon an Event of Default shall not impair the right or remedy or constitute
a waiver of or acquiescence in the Event of Default. All remedies are cumulative to the extent
permitted by law.

     Section 6.04 Waiver of Past Defaults.

     (a) At any time after a declaration of acceleration with respect to the Notes issued under
this Indenture as described in the preceding paragraph, the Holders of a majority in principal
amount of the outstanding Notes issued under this Indenture may rescind and cancel such declaration
and its consequences:

     (1) if the rescission would not conflict with any judgment or decree;

     (2) if all existing Events of Default have been cured or waived except nonpayment of
principal or interest that has become due solely because of the acceleration;

     (3) to the extent the payment of such interest is lawful, interest on overdue
installments of interest and overdue principal, which has become due otherwise than by such
declaration of acceleration, has been paid;

     (4) if the Issuers have paid the Trustee its reasonable compensation and reimbursed the
Trustee for its expenses, disbursements and advances; and

     (5) in the event of the cure or waiver of an Event of Default of the type described in
Section 6.01(5), the Trustee shall have received an Officers’ Certificate and an Opinion of
Counsel that such Event of Default has been cured or waived.

     No such rescission shall affect any subsequent Default or impair any right consequent thereto.

     The Holders of a majority in principal amount of the Notes issued under this Indenture may
waive any existing Default or Event of Default under this Indenture, and its consequences, except a
default in the payment of the principal of or interest on such Notes.

     (b) In the event of any Event of Default specified in clause (4) of Section 6.01 hereof, such
Event of Default and all consequences thereof (excluding, however, any resulting payment default)
shall be annulled, waived and rescinded, automatically and without any action by the Trustee or the
Holders of the Notes, if within 20 days after such Event of Default arose the Issuers deliver an
Officers’ Certificate to the Trustee stating that (1) the Indebtedness or guarantee that is the
basis for such Event of Default has been discharged or (2) the Holders thereof have rescinded or
waived the acceleration, notice or action (as the case may be) giving rise to such Event of Default
or (3) the default that is the basis for such Event of Default has been cured, it being understood
that in no event shall an acceleration of the principal amount of the Notes as described above be
annulled, waived or rescinded upon the happening of any such events.

     Section 6.05 Control by Majority. Holders of a majority in aggregate principal amount
of the then outstanding Notes have the right to direct the time, method and place of conducting any
proceeding for any remedy available to the Trustee or exercising any trust or power conferred on
it. However, the Trustee may refuse to follow any direction that conflicts with law or this
Indenture that the Trustee determines may be unduly prejudicial to the rights of other Holders of
Notes or that may involve the Trustee in personal liability.

     Section 6.06 Limitation on Suits. A Holder may pursue a remedy with respect to this
Indenture or the Notes only if:

     (1) such Holder has previously given the Trustee written notice that an Event of
Default is continuing;

     (2) Holders of at least 25% in aggregate principal amount of the then outstanding Notes
make a written request to the Trustee to pursue the remedy;

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     (3) such Holder or Holders offer and, if requested, provide to the Trustee security or
indemnity reasonably satisfactory to the Trustee against any loss, liability or expense;

     (4) the Trustee does not comply with the request within 60 days after receipt of the
request and the offer of security or indemnity; and

     (5) during such 60-day period, Holders of a majority in aggregate principal amount of
the then outstanding Notes do not give the Trustee a direction inconsistent with such
request.

     A Holder of a Note may not use this Indenture to prejudice the rights of another Holder of a
Note or to obtain a preference or priority over another Holder of a Note.

     Section 6.07 Rights of Holders of Notes to Receive Payment. Notwithstanding any other
provision of this Indenture, the right of any Holder of a Note to receive payment of principal,
premium and Additional Interest, if any, and interest on the Note, on or after the respective due
dates expressed in the Note (including in connection with an offer to purchase), or to bring suit
for the enforcement of any such payment on or after such respective dates, shall not be impaired or
affected without the consent of such Holder.

     Section 6.08 Collection Suit by Trustee. If an Event of Default specified in Section
6.01(1) or (2) hereof occurs and is continuing, the Trustee is authorized to recover judgment in
its own name and as trustee of an express trust against the Issuers for the whole amount of
principal of, premium and Additional Interest, if any, and interest remaining unpaid on, the Notes
and interest on overdue principal and, to the extent lawful, interest and such further amount as
shall be sufficient to cover the costs and expenses of collection, including the reasonable
compensation, expenses, disbursements and advances of the Trustee, its agents and counsel.

     Section 6.09 Trustee May File Proofs of Claim. The Trustee is authorized to file such
proofs of claim and other papers or documents as may be necessary or advisable in order to have the
claims of the Trustee (including any claim for the reasonable compensation, expenses, disbursements
and advances of the Trustee, its agents and counsel) and the Holders of the Notes allowed in any
judicial proceedings relative to the Issuers (or any other obligor upon the Notes), its creditors
or its property and shall be entitled and empowered to collect, receive and distribute any money or
other property payable or deliverable on any such claims and any custodian in any such judicial
proceeding is hereby authorized by each Holder to make such payments to the Trustee, and in the
event that the Trustee shall consent to the making of such payments directly to the Holders, to pay
to the Trustee any amount due to it for the reasonable and documented compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel, and any other amounts due the
Trustee under Section 7.07 hereof. To the extent that the payment of any such compensation,
expenses, disbursements and advances of the Trustee, its agents and counsel, and any other amounts
due the Trustee under Section 7.07 hereof out of the estate in any such proceeding, shall be denied
for any reason, payment of the same shall be secured by a Lien on, and shall be paid out of, any
and all distributions, dividends, money, securities and other properties that the Holders may be
entitled to receive in such proceeding whether in liquidation or under any plan of reorganization
or arrangement or otherwise. Nothing herein contained shall be deemed to authorize the Trustee to
authorize or consent to or accept or adopt on behalf of any Holder any plan of reorganization,
arrangement, adjustment or composition affecting the Notes or the rights of any Holder, or to
authorize the Trustee to vote in respect of the claim of any Holder in any such proceeding.

     Section 6.10 Priorities. If the Trustee collects any money pursuant to this Article
VI, it shall pay out the money in the following order:

     First: to the Trustee, its agents and attorneys for amounts due under Section 7.07
hereof, including payment of all compensation, expenses and liabilities incurred, and all
advances made, by the Trustee and the costs and expenses of collection;

     Second: to Holders of Notes for amounts due and unpaid on the Notes for principal,
premium and Additional Interest, if any, and interest, ratably, without preference or
priority of any kind, according to the amounts due and payable on the Notes for principal,
premium and Additional Interest, if any and interest, respectively; and

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     Third: to the Issuers or to such party as a court of competent jurisdiction shall
direct in writing.

     The Trustee may fix a record date and payment date for any payment to Holders of Notes
pursuant to this Section 6.10.

     Section 6.11 Undertaking for Costs. In any suit for the enforcement of any right or
remedy under this Indenture or in any suit against the Trustee for any action taken or omitted by
it as a Trustee, a court in its discretion may require the filing by any party litigant in the suit
of an undertaking to pay the costs of the suit, and the court in its discretion may assess
reasonable costs, including reasonable and documented attorneys’ fees and expenses against any
party litigant in the suit, having due regard to the merits and good faith of the claims or
defenses made by the party litigant. This Section 6.11 does not apply to a suit by the Trustee, a
suit by a Holder of a Note pursuant to Section 6.07 hereof, or a suit by Holders of more than 10%
in aggregate principal amount of the then outstanding Notes.

ARTICLE VII

TRUSTEE

     Section 7.01 Duties of Trustee.

     (a) If an Event of Default has occurred and is continuing, the Trustee shall exercise such of
the rights and powers vested in it by this Indenture, and use the same degree of care and skill in
its exercise, as a prudent person would exercise or use under the circumstances in the conduct of
such person’s own affairs.

     (b) Except during the continuance of an Event of Default:

     (1) the duties of the Trustee shall be determined solely by the express provisions of
this Indenture and the Trustee need perform only those duties that are specifically set
forth in this Indenture and no others, and no implied covenants or obligations shall be read
into this Indenture against the Trustee; and

     (2) in the absence of bad faith on its part, the Trustee may conclusively rely, as to
the truth of the statements and the correctness of the opinions expressed therein, upon
certificates or opinions furnished to the Trustee and conforming to the requirements of this
Indenture. However, with respect to certificates or opinions specifically required by any
provision hereof to be furnished to it, the Trustee shall examine the certificates and
opinions to determine whether or not they conform to the requirements of this Indenture.

     (c) The Trustee may not be relieved from liabilities for its own negligent action, its own
negligent failure to act, or its own willful misconduct, except that:

     (1) this paragraph does not limit the effect of paragraph (b) of this Section 7.01;

     (2) the Trustee shall not be liable for any error of judgment made in good faith by a
Responsible Officer, unless it is proved that the Trustee was negligent in ascertaining the
pertinent facts; and

     (3) the Trustee shall not be liable with respect to any action it takes or omits to
take in good faith in accordance with a direction received by it pursuant to Section 6.05
hereof.

     (d) whether or not therein expressly so provided, every provision of this Indenture that in
any way relates to the Trustee is subject to paragraphs (a), (b), and (c) of this Section 7.01.

     (e) No provision of this Indenture shall require the Trustee to expend or risk its own funds
or incur any liability.

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     (f) The Trustee shall not be liable for interest on any money received by it except as the
Trustee may agree in writing with the Issuers. Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

     Section 7.02 Rights of Trustee.

     (a) The Trustee may conclusively rely upon any document believed by it to be genuine and to
have been signed or presented by the proper Person. The Trustee need not investigate any fact or
matter stated in the document.

     (b) Before the Trustee acts or refrains from acting, it may require an Officers’ Certificate
or an Opinion of Counsel or both. The Trustee shall not be liable for any action it takes or omits
to take in good faith in reliance on such Officers’ Certificate or Opinion of Counsel. The Trustee
may consult with counsel of its own selection and the advice of such counsel or any Opinion of
Counsel shall be full and complete authorization and protection from liability in respect of any
action taken, suffered or omitted by it hereunder in good faith and in reliance thereon.

     (c) The Trustee may act through its attorneys and agents and shall not be responsible for the
misconduct or negligence of any agent appointed with due care.

     (d) The Trustee shall not be liable for any action it takes or omits to take in good faith
that it believes to be authorized or within the rights or powers conferred upon it by this
Indenture.

     (e) Unless otherwise specifically provided in this Indenture, any demand, request, direction
or notice from the Issuers shall be sufficient if signed by an Officer of the Issuers.

     (f) The Trustee shall be under no obligation to exercise any of the rights or powers vested in
it by this Indenture at the request, order or direction of any of the Holders unless such Holders
have offered to the Trustee reasonable indemnity or security satisfactory to it against any losses,
liabilities or expenses.

     (g) In no event shall the Trustee be responsible or liable for special, indirect, or
consequential loss or damage of any kind whatsoever (including, but not limited to, loss of profit)
irrespective of whether the Trustee has been advised of the likelihood of such loss or damage and
regardless of the form of action.

     (h) Except with respect to Section 4.01, the Trustee shall have no duty to inquire as to the
performance of the Issuers with respect to the covenants contained in Article IV. In addition, the
Trustee shall not be deemed to have knowledge of an Event of Default except (i) any Default or
Event of Default occurring pursuant to Sections 4.01, 6.01(1) or 6.01(2) or (ii) any Default or
Event of Default of which the Trustee shall have received written notification or obtained actual
knowledge.

     (i) The rights, privileges, protections, immunities and benefits given to the Trustee,
including, without limitation, its right to be indemnified, are extended to, and shall be
enforceable by, the Trustee in each of its capacities hereunder, and each agent, custodian and
other Person employed to act hereunder.

     (j) The Trustee may request that the Issuers deliver an Officers’ Certificate setting forth
the names of individuals and/or titles of officers authorized at such time to take specified
actions pursuant to this Indenture, which Officers’ Certificate may be signed by any person
authorized to sign an Officers’ Certificate, including any person specified as so authorized in any
such certificate previously delivered and not superseded.

     (k) Delivery of reports, information and documents to the Trustee under Section 4.03 is for
informational purposes only and the Trustee’s receipt of the foregoing shall not constitute
constructive notice of any information contained therein or determinable from information contained
therein, including the Issuers’ compliance with any of their covenants hereunder (as to which the
Trustee is entitled to rely exclusively on Officers’ Certificates).

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     Section 7.03 Individual Rights of Trustee. The Trustee in its individual or any other
capacity may become the owner or pledgee of Notes and may otherwise deal with the Issuers or any
Affiliate of the Issuers with the same rights it would have if it were not Trustee. However, in
the event that the Trustee acquires any conflicting interest it must eliminate such conflict within
90 days, apply to the Commission for permission to continue as trustee or resign. Any Agent may do
the same with like rights and duties. The Trustee is also subject to Sections 7.10 and 7.11
hereof.

     Section 7.04 Trustee’s Disclaimer. The Trustee shall not be responsible for and makes
no representation as to the validity or adequacy of this Indenture or the Notes, it shall not be
accountable for the Issuers’ use of the proceeds from the Notes or any money paid to the Issuers or
upon the Issuers’ direction under any provision of this Indenture, it shall not be responsible for
the use or application of any money received by any Paying Agent other than the Trustee, and it
shall not be responsible for any statement or recital herein or any statement in the Notes or any
other document in connection with the sale of the Notes or pursuant to this Indenture other than
its certificate of authentication.

     Section 7.05 Notice of Defaults. If a Default or Event of Default occurs and is
continuing and if it is known to the Trustee, the Trustee shall mail to Holders of Notes a notice
of the Default or Event of Default within 90 days after it occurs. Except in the case of a Default
or Event of Default in payment of principal of, premium or Additional Interest, if any, or interest
on, any Note, the Trustee may withhold the notice if and so long as a committee of its Responsible
Officers in good faith determines that withholding the notice is in the interests of the Holders of
the Notes.

     Section 7.06 Reports by Trustee to Holders of the Notes.

     (a) Within 60 days after each May 15 beginning with the May 15 following the date of this
Indenture, and for so long as Notes remain outstanding, the Trustee shall mail to the Holders of
the Notes a brief report dated as of such reporting date that complies with TIA Section 313(a) (but
if no event described in TIA Section 313(a) has occurred within the twelve months preceding the
reporting date, no report need be transmitted).

     The Trustee also shall comply with TIA Section 313(b)(2). The Trustee shall also transmit by
mail all reports as required by TIA Section 313(c).

     (b) A copy of each report at the time of its mailing to the Holders of Notes shall be mailed
by the Trustee to the Issuers and filed by the Trustee with the Commission and each stock exchange
on which the Notes are listed in accordance with TIA Section 313(d). The Issuers shall promptly
notify the Trustee when the Notes are listed on any stock exchange or delisted therefrom.

     Section 7.07 Compensation and Indemnity.

     (a) The Issuers shall pay to the Trustee from time to time reasonable compensation for its
acceptance of this Indenture and services hereunder. The Trustee’s compensation shall not be
limited by any law on compensation of a trustee of an express trust. The Issuers shall reimburse
the Trustee promptly upon request for all reasonable and documented disbursements, advances and
expenses incurred or made by it in addition to the compensation for its services. Such expenses
shall include the reasonable and documented compensation, disbursements and expenses of the
Trustee’s agents and counsel.

     (b) The Issuers and each Guarantor, jointly and severally, shall indemnify the Trustee against
any and all losses, liabilities, claims, damages or expenses incurred by it arising out of or in
connection with the acceptance or administration of its duties under this Indenture, including the
reasonable and documented costs and expenses of enforcing this Indenture against the Issuers and
the Guarantors (including this Section 7.07) and defending itself against any claim (whether
asserted by the Issuers, the Guarantors, any Holder or any other Person) or liability in connection
with the exercise or performance of any of its powers or duties hereunder, except to the extent any
such loss, liability or expense may be attributable to its own negligence, bad faith or willful
misconduct. The Trustee shall notify the Issuers promptly of any claim of which a Responsible
Officer has received written notice for which it may seek indemnity. Failure by the Trustee to so
notify the Issuers shall not relieve the Issuers or any of the

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Guarantors of their obligations hereunder. The Issuers or such Guarantor shall defend the
claim and the Trustee shall cooperate in the defense. The Trustee may have separate counsel and
the Issuers and the Guarantors, as applicable, shall pay the reasonable and documented fees and
expenses of such counsel; provided, however, that the Issuers and any Guarantor shall not be
required to pay such fees and expenses if it assumes such indemnified parties’ defense and, in such
indemnified parties’ reasonable judgment, there is no conflict of interest between the Issuers and
the Guarantors, as applicable, and such parties in connection with such defense. Neither the
Issuers nor any Guarantor need pay for any settlement made without its consent, which consent shall
not be unreasonably withheld.

     (c) The obligations of the Issuers and the Guarantors under this Section 7.07 shall survive
the satisfaction and discharge of this Indenture.

     (d) To secure the Issuers’ and the Guarantors’ payment obligations in this Section 7.07, the
Trustee shall have a Lien prior to the Notes on all money or property held or collected by the
Trustee, except that held in trust to pay principal and interest on particular Notes. Such Lien
shall survive the satisfaction and discharge of this Indenture.

     (e) When the Trustee incurs expenses or renders services after an Event of Default specified
in Section 6.01(7) or (8) hereof occurs, the expenses and the compensation for the services
(including the fees and expenses of its agents and counsel) are intended to constitute expenses of
administration under any Bankruptcy Law.

     (f) The Trustee shall comply with the provisions of TIA Section 313(b)(2) to the extent
applicable.

     Section 7.08 Replacement of Trustee.

     (a) A resignation or removal of the Trustee and appointment of a successor Trustee shall
become effective only upon the successor Trustee’s acceptance of appointment as provided in this
Section 7.08.

     (b) The Trustee may resign in writing at any time and be discharged from the trust hereby
created by so notifying the Issuers. The Holders of a majority in aggregate principal amount of
the then outstanding Notes may remove the Trustee by so notifying the Trustee and the Issuers in
writing. The Issuers may remove the Trustee if:

     (1) the Trustee fails to comply with Section 7.10 hereof;

     (2) the Trustee is adjudged a bankrupt or an insolvent or an order for relief is
entered with respect to the Trustee under any Bankruptcy Law;

     (3) a custodian or public officer takes charge of the Trustee or its property; or

     (4) the Trustee becomes incapable of acting.

     (c) If the Trustee resigns or is removed or if a vacancy exists in the office of Trustee for
any reason, the Issuers shall promptly appoint a successor Trustee. Within one year after the
successor Trustee takes office, the Holders of a majority in principal amount of the then
outstanding Notes may appoint a successor Trustee to replace the successor Trustee appointed by the
Issuers.

     (d) If a successor Trustee does not take office within 60 days after the retiring Trustee
resigns or is removed, the retiring Trustee, the Issuers, or the Holders of at least 10% in
principal amount of the then outstanding Notes may petition, at the expense of the Issuers, any
court of competent jurisdiction for the appointment of a successor Trustee.

     (e) If the Trustee, after written request by any Holder who has been a Holder for at least six
months, fails to comply with Section 7.10 hereof, such Holder may petition, at the expense of the
Issuers, any court of competent jurisdiction for the removal of the Trustee and the appointment of
a successor Trustee.

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     (f) A successor Trustee shall deliver a written acceptance of its appointment to the retiring
Trustee and to the Issuers. Thereupon, the resignation or removal of the retiring Trustee shall
become effective, and the successor Trustee shall have all the rights, powers and duties of the
Trustee under this Indenture. The successor Trustee shall mail a notice of its succession to
Holders. The retiring Trustee shall promptly transfer all property held by it as Trustee to the
successor Trustee; provided all sums owing to the Trustee hereunder have been paid and subject to
the Lien provided for in Section 7.07 hereof. Notwithstanding replacement of the Trustee pursuant
to this Section 7.08, the Issuers’ obligations under Section 7.07 hereof shall continue for the
benefit of the retiring Trustee.

     Section 7.09 Successor Trustee by Merger, etc. If the Trustee consolidates, merges or
converts into, or transfers all or substantially all of its corporate trust business to, another
corporation, the successor corporation without any further act shall be the successor Trustee.

     Section 7.10 Eligibility; Disqualification. There shall at all times be a Trustee
hereunder that is a corporation organized and doing business under the laws of the United States of
America or of any state thereof that is authorized under such laws to exercise corporate trustee
power, that is subject to supervision or examination by federal or state authorities and that has a
combined capital and surplus of at least $50.0 million as set forth in its most recent published
annual report of condition.

     This Indenture shall always have a Trustee who satisfies the requirements of TIA Section
310(a)(1), (2) and (5). The Trustee is subject to TIA Section 310(b).

     Section 7.11 Preferential Collection of Claims Against the Issuers. The Trustee is
subject to TIA Section 311(a), excluding any creditor relationship listed in TIA Section 311(b). A
Trustee who has resigned or been removed shall be subject to TIA Section 311(a) to the extent
indicated therein.

ARTICLE VIII

LEGAL DEFEASANCE AND COVENANT DEFEASANCE

     Section 8.01 Option to Effect Legal Defeasance or Covenant Defeasance. The Issuers
may at any time, at the option of its Board of Directors evidenced by a resolution set forth in an
Officers’ Certificate, elect to have either Section 8.02 or 8.03 hereof be applied to all
outstanding Notes and Guarantees upon compliance with the conditions set forth below in this
Article VIII.

     Section 8.02 Legal Defeasance and Discharge. Upon the Issuers’ exercise under Section
8.01 hereof of the option applicable to this Section 8.02, the Issuers and each of the Guarantors
shall, subject to the satisfaction of the conditions set forth in Section 8.04 hereof, be deemed to
have been discharged from their obligations with respect to all outstanding Notes (including the
Guarantees) on the date the conditions set forth below are satisfied (hereinafter, “Legal
Defeasance”). For this purpose, Legal Defeasance means that the Issuers and the Guarantors shall
be deemed to have paid and discharged the entire Indebtedness represented by the outstanding Notes
(including the Guarantees), which shall thereafter be deemed to be “outstanding” only for the
purposes of Section 8.05 hereof and the other Sections of this Indenture referred to in clauses (1)
and (2) below, and to have satisfied all their other obligations under such Notes, the Guarantees
and this Indenture (and the Trustee, on demand of and at the expense of the Issuers, shall execute
proper instruments acknowledging the same), except for the following provisions which shall survive
until otherwise terminated or discharged hereunder:

     (1) the rights of Holders of outstanding Notes issued hereunder to receive payments in
respect of the principal of, or interest or premium and Additional Interest, if any, on,
such Notes when such payments are due from the trust referred to in Section 8.04 hereof;

     (2) the Issuers’ obligations with respect to such Notes under Article II and Section
4.02 hereof;

     (3) the rights, powers, trusts, duties and immunities of the Trustee hereunder and the
Issuers’ and the Guarantors’ obligations in connection therewith; and

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     (4) this Article VIII.

     Subject to compliance with this Article VIII, the Issuers may exercise their option under this
Section 8.02 notwithstanding the prior exercise of its option under Section 8.03 hereof.

     Section 8.03 Covenant Defeasance. Upon the Issuers’ exercise under Section 8.01
hereof of the option applicable to this Section 8.03, the Issuers and each of the Guarantors shall,
subject to the satisfaction of the conditions set forth in Section 8.04 hereof, be released from
each of their obligations under the covenants contained in Sections 4.03, 4.05, 4.06, 4.07, 4.08,
4.09, 4.10, 4.11, 4.12 and 4.13 and clauses (3) and (4) of Section 5.01 hereof with respect to the
outstanding Notes on and after the date the conditions set forth in Section 8.04 hereof are
satisfied (hereinafter, “Covenant Defeasance”), and the Notes shall thereafter be deemed not
“outstanding” for the purposes of any direction, waiver, consent or declaration or act of Holders
(and the consequences of any thereof) in connection with such covenants, but shall continue to be
deemed “outstanding” for all other purposes hereunder (it being understood that such Notes shall
not be deemed outstanding for accounting purposes). For this purpose, Covenant Defeasance means
that, with respect to the outstanding Notes and Guarantees, the Issuers and the Guarantors may omit
to comply with and shall have no liability in respect of any term, condition or limitation set
forth in any such covenant, whether directly or indirectly, by reason of any reference elsewhere
herein to any such covenant or by reason of any reference in any such covenant to any other
provision herein or in any other document and such omission to comply shall not constitute a
Default or an Event of Default under Section 6.01 hereof, but, except as specified above, the
remainder of this Indenture and such Notes and Guarantees shall be unaffected thereby. In
addition, upon the Issuers’ exercise under Section 8.01 hereof of the option applicable to this
Section 8.03, subject to the satisfaction of the conditions set forth in Section 8.04 hereof,
Sections 6.01(3) through 6.01(5) hereof shall not constitute Events of Default.

     Section 8.04 Conditions to Legal or Covenant Defeasance. In order to exercise either
Legal Defeasance or Covenant Defeasance under either Section 8.02 or 8.03 hereof:

     (1) the Issuers must irrevocably deposit with the Trustee, in trust, for the benefit of
the Holders of the Notes issued hereunder, cash in U.S. dollars, non-callable Government
Securities, or a combination of cash in U.S. dollars and non-callable Government Securities,
in such amounts as shall be sufficient, in the opinion of a nationally recognized firm of
independent public accountants, to pay the principal of, or interest and premium and
Additional Interest, if any, on, the outstanding Notes issued hereunder on the stated
maturity thereof or on the applicable redemption date, as the case may be, and the Issuers
must specify whether the Notes are being defeased to such stated maturity or to a particular
redemption date;

     (2) in the case of an election under Section 8.02 hereof, the Issuers must deliver to
the Trustee an Opinion of Counsel reasonably acceptable to the Trustee confirming that:

     (A) the Issuers have received from, or there has been published by, the
Internal Revenue Service a ruling; or

     (B) since the Issue Date, there has been a change in the applicable federal
income tax law, in either case to the effect that, and based thereon such Opinion of
Counsel shall confirm that, subject to customary assumptions and exclusions, the
Holders of the respective outstanding Notes shall not recognize income, gain or loss
for federal income tax purposes as a result of such Legal Defeasance and shall be
subject to federal income tax on the same amounts, in the same manner and at the
same times as would have been the case if such Legal Defeasance had not occurred;

     (3) in the case of an election under Section 8.03 hereof, the Issuers must deliver to
the Trustee an Opinion of Counsel reasonably acceptable to the Trustee confirming that,
subject to customary assumptions and exclusions, the Holders of the respective outstanding
Notes shall not recognize income, gain or loss for federal income tax purposes as a result
of such Covenant Defeasance and shall be subject to federal income tax on the same amounts,
in the same manner and at the same times as would have been the case if such Covenant
Defeasance had not occurred;

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     (4) no Default or Event of Default shall have occurred and be continuing on the date of
such deposit (other than a Default or Event of Default resulting from the borrowing of funds
to be applied to such deposit and the grant of Liens in connection therewith) or insofar as
Events of Default (other than Events of Default resulting from the borrowing of funds to be
applied to such deposit and the granting of Liens in connection therewith) resulting from
the borrowing of funds or insolvency events are concerned, at any time in the period ending
on the 91st day after the date of deposit;

     (5) such Legal Defeasance or Covenant Defeasance shall not result in a breach or
violation of, or constitute a default under the Credit Agreement or any other material
agreement or instrument (other than this Indenture) to which VHS Holdco II or any of its
Restricted Subsidiaries is a party or by which VHS Holdco II or any of its Restricted
Subsidiaries is bound;

     (6) the Issuers must deliver to the Trustee an Officers’ Certificate stating that the
deposit was not made by the Issuers with the intent of preferring the Holders of Notes over
the other creditors of the Issuers with the intent of defeating, hindering, delaying or
defrauding creditors of the Issuers or others; and

     (7) the Issuers must deliver to the Trustee an Officers’ Certificate and an Opinion of
Counsel, subject to customary assumptions and exclusions, each stating that all conditions
precedent relating to the Legal Defeasance or the Covenant Defeasance have been complied
with.

     Section 8.05 Deposited Money and Government Securities to be Held in Trust; Other
Miscellaneous Provisions. Subject to Section 8.06 hereof, all money and non-callable
Government Securities (including the proceeds thereof) deposited with the Trustee (or other
qualifying trustee, collectively for purposes of this Section 8.05, the “Trustee”) pursuant to
Section 8.04 hereof in respect of the outstanding Notes shall be held in trust and applied by the
Trustee, in accordance with the provisions of such Notes and this Indenture, to the payment, either
directly or through any Paying Agent (including the Issuers acting as Paying Agent) as the Trustee
may determine, to the Holders of such Notes of all sums due and to become due thereon in respect of
principal, premium and Additional Interest, if any, and interest, but such money need not be
segregated from other funds except to the extent required by law.

     The Issuers shall pay and indemnify the Trustee against any tax, fee or other charge imposed
on or assessed against the cash or non-callable Government Securities deposited pursuant to Section
8.04 hereof or the principal and interest received in respect thereof other than any such tax, fee
or other charge which by law is for the account of the Holders of the outstanding Notes.

     Notwithstanding anything in this Article VIII to the contrary, the Trustee shall deliver or
pay to the Issuers from time to time upon the request of the Issuers any money or non-callable
Government Securities held by it as provided in Section 8.04 hereof which, in the opinion of a
nationally recognized firm of independent public accountants expressed in a written certification
thereof delivered to the Trustee (which may be the opinion delivered under Section 8.04(1) hereof),
are in excess of the amount thereof that would then be required to be deposited to effect an
equivalent Legal Defeasance or Covenant Defeasance.

     Section 8.06 Repayment to Issuers. Any money deposited with the Trustee or any Paying
Agent, or then held by the Issuers, in trust for the payment of the principal of, premium or
Additional Interest, if any, or interest on, any Note and remaining unclaimed for two years after
such principal, premium or Additional Interest, if any, or interest has become due and payable
shall be paid to the Issuers on their request or (if then held by the Issuers) shall be discharged
from such trust; and the Holder of such Note shall thereafter be permitted to look only to the
Issuers for payment thereof, and all liability of the Trustee or such Paying Agent with respect to
such trust money, and all liability of the Issuers as trustee thereof, shall thereupon cease;
provided, however, that the Trustee or such Paying Agent, before being required to make any such
repayment, may at the expense of the Issuers causes to be published once, in the New York Times and
The Wall Street Journal (national edition), notice that such money remains unclaimed and that,
after a date specified therein, which shall not be less than 30 days from the date of such
notification or publication, any unclaimed balance of such money then remaining shall be repaid to
the Issuers.

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     Section 8.07 Reinstatement. If the Trustee or Paying Agent is unable to apply any
U.S. dollars or non-callable Government Securities in accordance with Section 8.02 or 8.03 hereof,
as the case may be, by reason of any order or judgment of any court or governmental authority
enjoining, restraining or otherwise prohibiting such application, then the Issuers’ and the
Guarantors’ obligations under this Indenture, the Notes and the Guarantees shall be revived and
reinstated as though no deposit had occurred pursuant to Section 8.02 or 8.03 hereof until such
time as the Trustee or Paying Agent is permitted to apply all such money in accordance with Section
8.02 or 8.03 hereof, as the case may be; provided, however, that, if the Issuers make any payment
of principal of, premium or Additional Interest, if any, or interest on, any Note following the
reinstatement of its obligations, the Issuers shall be subrogated to the rights of the Holders of
such Notes to receive such payment from the money held by the Trustee or Paying Agent.

ARTICLE IX

AMENDMENT, SUPPLEMENT AND WAIVER

     Section 9.01 Without Consent of Holders of Notes. Notwithstanding Section 9.02 of
this Indenture, the Issuers and the Trustee may amend or supplement this Indenture or the Notes or
the Guarantees without the consent of any Holder of Notes:

     (1) to cure any ambiguity, defect or inconsistency;

     (2) to provide for uncertificated Notes in addition to or in place of certificated
Notes;

     (3) to provide for the assumption of either Issuer’s obligations to Holders of the
Notes by a successor to the Issuers pursuant to Article V;

     (4) to make any change that would provide any additional rights or benefits to the
Holders of Notes or that does not adversely affect the legal rights hereunder of any such
Holder;

     (5) to comply with requirements of the Commission in order to effect or maintain the
qualification of this Indenture under the TIA;

     (6) to add a Guarantee with respect to the Notes or to release the Guarantee of
Vanguard;

     (7) to conform the text of this Indenture, the Notes or the Guarantees to any provision
of the “Description of Notes” in the Offering Memorandum to the extent that such provision
in the Description of Notes in the Offering Memorandum was intended to be a verbatim
recitation of a provision of this Indenture, the Notes or the Guarantees; or

     (8) to evidence and provide for the acceptance and appointment under this Indenture of
a successor Trustee thereunder pursuant to the requirements thereof.

     Upon the request of the Issuers accompanied by a resolution of their Board of Directors
authorizing the execution of any such amended or supplemental indenture, and upon receipt by the
Trustee of the documents described in Section 7.02 hereof, the Trustee shall join with the Issuers
in the execution of any amended or supplemental indenture authorized or permitted by the terms of
this Indenture and to make any further appropriate agreements and stipulations that may be therein
contained, but the Trustee shall not be obligated to enter into such amended or supplemental
indenture that affects its own rights, duties or immunities under this Indenture or otherwise.

     Section 9.02 With Consent of Holders of Notes.

     (a) Except as provided below in this Section 9.02, the Issuers and the Trustee may amend or
supplement this Indenture (including, without limitation, Sections 4.08 and 4.11 hereof) and the
Notes or the Guarantees with the consent of the Holders of at least a majority in aggregate
principal amount of the then outstanding Notes voting as a single class (including, without
limitation, consents obtained in connection with a tender offer or ex-

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change offer for, or purchase of, the Notes), and, subject to Sections 6.04 and 6.07 hereof,
any existing Default or Event of Default (other than a Default or Event of Default in the payment
of the principal of, premium or Additional Interest, if any, or interest on, the Notes, except a
payment default resulting from an acceleration that has been rescinded) or compliance with any
provision of this Indenture or the Notes or the Guarantees may be waived with the consent of the
Holders of a majority in aggregate principal amount of the then outstanding Notes (including,
without limitation, Additional Notes, if any) voting as a single class (including, without
limitation, consents obtained in connection with a tender offer or exchange offer for, or purchase
of, the Notes). Section 2.08 hereof shall determine which Notes are considered to be “outstanding”
for purposes of this Section 9.02.

     (b) Upon the request of the Issuers accompanied by a resolution of their Board of Directors
authorizing the execution of any such amended or supplemental indenture, and upon the filing with
the Trustee of evidence satisfactory to the Trustee of the consent of the Holders of Notes as
aforesaid, and upon receipt by the Trustee of the documents described in Section 7.02 hereof, the
Trustee shall join with the Issuers in the execution of such amended or supplemental indenture
unless such amended or supplemental indenture directly affects the Trustee’s own rights, duties or
immunities under this Indenture or otherwise, in which case the Trustee may in its discretion, but
shall not be obligated to, enter into such amended or supplemental Indenture.

     (c) It is not be necessary for the consent of the Holders under this Section 9.02 to approve
the particular form of any proposed amendment, supplement or waiver, but it is sufficient if such
consent approves the substance thereof.

     (d) After an amendment, supplement or waiver under this Section 9.02 becomes effective, the
Issuers shall mail to the Holders of Notes affected thereby a notice briefly describing the
amendment, supplement or waiver. Any failure of the Issuers to mail such notice, or any defect
therein, shall not, however, in any way impair or affect the validity of any such amendment,
supplement or waiver. Subject to Sections 6.04 and 6.07 hereof, the Holders of a majority in
aggregate principal amount of the Notes then outstanding voting as a single class may waive
compliance in a particular instance by the Issuers with any provision of this Indenture or the
Notes or the Guarantees. However, without the consent of each Holder affected, an amendment,
supplement or waiver under this Section 9.02 may not (with respect to any Notes held by a
non-consenting Holder):

     (1) reduce the principal amount of Notes issued hereunder whose Holders must consent to
an amendment, supplement or waiver;

     (2) reduce the principal of or change the fixed maturity of any Note or alter the
provisions with respect to the redemption of the Notes issued hereunder (other than
provisions relating to Sections 4.08 and 4.11 hereof);

     (3) reduce the rate of or change the time for payment of interest on any Note issued
hereunder;

     (4) waive a Default or Event of Default in the payment of principal of, or interest or
premium or Additional Interest, if any, on the Notes issued hereunder (except a rescission
of acceleration of the Notes by the Holders of at least a majority in aggregate principal
amount of the Notes issued hereunder and a waiver of the payment default that resulted from
such acceleration);

     (5) make any Note payable in money other than that stated in the Notes;

     (6) make any change in the provisions of this Indenture relating to waivers of past
Defaults or the rights of Holders of Notes to receive payments of principal of, or interest
or premium or Additional Interest, if any, on, the Notes issued hereunder;

     (7) waive a redemption payment with respect to any Note issued hereunder (other than a
payment required by Section 4.08 or 4.11 hereof);

     (8) modify the Guarantees in any manner adverse to the Holders of the Notes;

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     (9) make any change in the preceding amendment and waiver provisions; or

     (10) modify or change any provision of this Indenture or the related definitions
affecting the ranking of the Notes in a manner that would materially adversely affect the
Holders of the Notes.

     Section 9.03 Compliance with Trust Indenture Act. Every amendment or supplement to
this Indenture or the Notes shall be set forth in an amended or supplemental indenture that
complies with the TIA as then in effect.

     Section 9.04 Revocation and Effect of Consents. Until an amendment, supplement or
waiver becomes effective, a consent to it by a Holder of a Note is a continuing consent by the
Holder of a Note and every subsequent Holder of a Note or portion of a Note that evidences the same
debt as the consenting Holder’s Note, even if notation of the consent is not made on any Note.
However, any such Holder of a Note or subsequent Holder of a Note may revoke the consent as to its
Note if the Trustee receives written notice of revocation before the date the amendment, supplement
or waiver becomes effective. After an amendment, supplement or waiver becomes effective in
accordance with its terms, it thereafter binds every Holder.

     Section 9.05 Notation on or Exchange of Notes. The Trustee may place an appropriate
notation about an amendment, supplement or waiver on any Note thereafter authenticated. The
Issuers in exchange for all Notes may issue and the Trustee shall, upon receipt of an
Authentication Order, authenticate new Notes that reflect the amendment, supplement or waiver.
Failure to make the appropriate notation or issue a new Note shall not affect the validity and
effect of such amendment, supplement or waiver.

     Section 9.06 Trustee to Sign Amendments, etc. The Trustee shall sign any amended or
supplemental indenture authorized pursuant to this Article IX if the amendment or supplement does
not adversely affect the rights, duties, liabilities or immunities of the Trustee. The Issuers may
not sign an amended or supplemental indenture until the Boards of Directors of the Issuers approve
it. In executing any amended or supplemental indenture, the Trustee shall be provided with and
(subject to Section 7.01 hereof) shall be fully protected in relying upon, in addition to the
documents required by Section 12.04 hereof, an Officers’ Certificate and an Opinion of Counsel
stating that the execution of such amended or supplemental indenture is authorized or permitted by
this Indenture.

ARTICLE X

GUARANTEES

     Section 10.01 Guarantees.

     (a) Subject to this Article X, each Guarantor hereby jointly and severally, irrevocably and
unconditionally guarantees on a senior unsecured basis as a primary obligor and not merely as a
surety, to each Holder and to the Trustee and its successors and assigns:

     (1) the full and punctual payment when due, whether at Stated Maturity, by
acceleration, by redemption or otherwise, of all obligations of the Issuers under this
Indenture (including obligations to the Trustee) and the Notes, whether for payment of
principal of, premium, if any, or interest on in respect of the Notes and all other monetary
obligations of the Issuers under this Indenture and the Notes; and

     (2) the full and punctual performance within applicable grace periods of all other
obligations of the Issuers whether for fees, expenses, indemnification or otherwise under
this Indenture and the Notes (all the foregoing being hereinafter collectively called the
“Guaranteed Obligations”).

     Each Guarantor further agrees that the Guaranteed Obligations may be extended or renewed, in
whole or in part, without notice or further assent from each such Guarantor, and that each such
Guarantor shall remain bound under this Article X notwithstanding any extension or renewal of any
Guaranteed Obligation.

     (b) The Guarantors hereby agree that their obligations hereunder are unconditional,
irrespective of the validity, regularity or enforceability of the Notes or this Indenture, the
absence of any action to enforce the same,

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any waiver or consent by any Holder of the Notes with respect to any provisions hereof or
thereof, the recovery of any judgment against the Issuers, any action to enforce the same or any
other circumstance which might otherwise constitute a legal or equitable discharge or defense of a
Guarantor. Each Guarantor waives presentation to, demand of payment from and protest to the
Issuers of any of the Guaranteed Obligations and also waives notice of protest for nonpayment.
Each Guarantor waives notice of any default under the Notes or the Guaranteed Obligations. The
obligations of each Guarantor hereunder shall not be affected by (i) the failure of any Holder or
the Trustee to assert any claim or demand or to enforce any right or remedy against the Issuers or
any other Person under this Indenture, the Notes or any other agreement or otherwise; (ii) any
extension or renewal of this Indenture, the Notes or any other agreement; (iii) any rescission,
waiver, amendment or modification of any of the terms or provisions of this Indenture, the Notes or
any other agreement; (iv) the release of any security held by any Holder or the Trustee for the
Guaranteed Obligations or any Guarantor; (v) the failure of any Holder or Trustee to exercise any
right or remedy against any other guarantor of the Guaranteed Obligations; or (vi) any change in
the ownership of such Guarantor, except as provided in Section 10.03.

     (c) If any Holder or the Trustee is required by any court or otherwise to return to the
Issuers, the Guarantors or any custodian, trustee, liquidator or other similar official acting in
relation to either the Issuers or the Guarantors, any amount paid by either to the Trustee or such
Holder, this Guarantee, to the extent theretofore discharged, shall be reinstated in full force and
effect. Each Guarantor hereby waives any right to which it may be entitled to have its obligations
hereunder divided among the Guarantors, such that such Guarantor’s obligations would be less than
the full amount claimed. Each Guarantor hereby waives any right to which it may be entitled to
have the assets of the Issuers first be used and depleted as payment of the Issuers’ or such
Guarantor’s obligations hereunder prior to any amounts being claimed from or paid by such Guarantor
hereunder. Each Guarantor hereby waives any right to which it may be entitled to require that the
Issuers be sued prior to an action being initiated against such Guarantor.

     (d) Each Guarantor further agrees that its Guarantee herein constitutes a guarantee of
payment, performance and compliance when due (and not a guarantee of collection) and waives any
right to require that any resort be had by any Holder or the Trustee to any security held for
payment of the Guaranteed Obligations.

     (e) Except as expressly set forth in Sections 8.01, 10.02, 10.03 and 10.07, the obligations of
each Guarantor hereunder shall not be subject to any reduction, limitation, impairment or
termination for any reason, including any claim of waiver, release, surrender, alteration or
compromise, and shall not be subject to any defense of setoff, counterclaim, recoupment or
termination whatsoever or by reason of the invalidity, illegality or unenforceability of the
Guaranteed Obligations or otherwise. Without limiting the generality of the foregoing, the
obligations of each Guarantor herein shall not be discharged or impaired or otherwise affected by
the failure of any Holder or the Trustee to assert any claim or demand or to enforce any remedy
under this Indenture, the Notes or any other agreement, by any waiver or modification of any
thereof, by any default, failure or delay, willful or otherwise, in the performance of the
obligations, or by any other act or thing or omission or delay to do any other act or thing which
may or might in any manner or to any extent vary the risk of any Guarantor or would otherwise
operate as a discharge of any Guarantor as a matter of law or equity.

     (f) Each Guarantor agrees that its Guarantee shall remain in full force and effect until
payment in full of all the Guaranteed Obligations. Each Guarantor further agrees that its
Guarantee herein shall continue to be effective or be reinstated, as the case may be, if at any
time payment, or any part thereof, of principal of or interest on any Guaranteed Obligation is
rescinded or must otherwise be restored by any Holder or the Trustee upon the bankruptcy or
reorganization of the Issuers or otherwise.

     (g) In furtherance of the foregoing and not in limitation of any other right which any Holder
or the Trustee has at law or in equity against any Guarantor by virtue hereof, upon the failure of
the Issuers to pay the principal of or interest on any Guaranteed obligation when and as the same
shall become due, whether at maturity, by acceleration, by redemption or otherwise, or to perform
or comply with any other Guaranteed Obligation, each Guarantor hereby promises to and shall, upon
receipt of written demand by the Trustee, forthwith pay, or cause to be paid, in cash, to the
Holders or the Trustee an amount equal to the sum of (i) the unpaid principal amount of such
Guaranteed Obligations, (ii) accrued and unpaid interest on such Guaranteed Obligations (but only
to the extent not prohibited by applicable law) and (iii) all other monetary obligations of the
Issuers to the Holders and the Trustee.

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     (h) Each Guarantor agrees that it shall not be entitled to any right of subrogation in
relation to the Holders in respect of any Guaranteed Obligations guaranteed hereby until payment in
full of all Guaranteed Obligations. Each Guarantor further agrees that, as between it, on the one
hand, and the Holders and the Trustee, on the other hand, (x) the maturity of the Guaranteed
Obligations guaranteed hereby may be accelerated as provided in Article VI for the purposes of any
Guarantee herein, notwithstanding any stay, injunction or other prohibition preventing such
acceleration in respect of the Guaranteed Obligations guaranteed hereby, and (y) in the event of
any declaration of acceleration of such Guaranteed Obligations as provided in Article VI, such
Guaranteed Obligations (whether or not due and payable) shall forthwith become due and payable by
such Guarantor for the purposes of this Section 10.01.

     (i) Each Guarantor also agrees to pay any and all costs and expenses (including reasonable
attorneys’ fees and expenses) incurred by the Trustee or any Holder in enforcing any rights under
this Section 10.01.

     (j) Upon request of the Trustee, each Guarantor shall execute and deliver such further
instruments and do such further acts as may be reasonably necessary or proper to carry out more
effectively the purpose of this Indenture.

     (k) Notwithstanding the foregoing, the guarantee by Vanguard Health Financial Company LLC, and
any claims thereunder, shall be pari passu with any claim, right or entitlement that the United
States Government or Internal Revenue Service may have with respect to the assets of Vanguard
Health Financial Company LLC in connection with the closing agreement entered into under Section
7121 of the Code between Vanguard Health Financial Company LLC and the Commissioner of Internal
Revenue with respect to the election under Section 953(d) of the Code made (or to be made) by
Volunteer Insurance, Ltd.; provided, however, that such pari passu treatment shall apply to no more
than an amount of assets of Vanguard Health Financial Company, LLC with an adjusted basis equal to
10% of the gross income (as defined in such closing agreement) of Volunteer Insurance, Ltd.

     Section 10.02 Limitation on Liability. Any term or provision of this Indenture to the
contrary notwithstanding, the maximum aggregate amount of the Guaranteed Obligations guaranteed
hereunder by any Guarantor shall not exceed the maximum amount that can be hereby guaranteed
without rendering this Indenture, as it relates to such Guarantor, voidable under applicable
fraudulent conveyance or fraudulent transfer provisions of the United States Bankruptcy Code or any
comparable provisions of State law or similar laws affecting the rights of creditors generally.

     Section 10.03 Release. A Guarantee as to any Subsidiary Guarantor shall terminate and
be of no further force or effect and such Subsidiary Guarantor shall automatically and
unconditionally be released and discharged from all of its obligations under this Article X if:

     (a) (1) all of its assets or Capital Stock is sold or transferred, in each case in a
transaction in compliance with Section 4.08 hereof;

     (2) the Guarantor merges with or into, or consolidates with or amalgamates with, or
transfers all or substantially all of its assets to, another Person in compliance with
Article V hereof;

     (3) (A) the Subsidiary Guarantor’s guarantee of the Credit Agreement is released or
such release is authorized under the Credit Agreement and the administrative agent under the
Credit Agreement has agreed to release such guarantee subject only to, and promptly
following, the release of such Subsidiary Guarantor’s Guarantee under this Indenture or (B)
the Indebtedness that resulted in the creation of such Guarantee is released or discharged;

     (4) such Subsidiary Guarantor is designated an Unrestricted Subsidiary in accordance
with the terms of this Indenture; or

     (5) the exercise by the Issuers of their Legal Defeasance option or Covenant Defeasance
option as described under Article VIII or the discharge of the Issuers’ obligations under
this Indenture in accordance with the terms of this Indenture.

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     (b) VHS Holdco I shall be automatically and unconditionally released and discharged
from all of its obligations under its Guarantee of the Notes only if the conditions
described in paragraphs (1) or (3)(A) of Section 10.03(a) are satisfied with respect to VHS
Holdco I.

     (c) Notwithstanding the foregoing, if any Guarantor is released from its Guarantee
pursuant to paragraph (a)(1), (2) or (3) of Section 10.03(a) above, and such Guarantor is
not released from its guarantee of the Credit Agreement within 30 days after the release of
its Guarantee, then such Guarantor shall immediately provide a Guarantee under this
Indenture until such Guarantor’s guarantee under the Credit Agreement is released.

     Notwithstanding any other provisions of this Indenture, Vanguard may be released from all of
its obligations under its Guarantee and shall cease to be a Guarantor for all purposes under this
Indenture, at the option of the Issuers and Vanguard at any time following the Issue Date.

     Section 10.04 Successors and Assigns. This Article X shall be binding upon each
Guarantor and its successors and assigns and shall inure to the benefit of the successors and
assigns of the Trustee and the Holders and, in the event of any transfer or assignment of rights by
any Holder or the Trustee, the rights and privileges conferred upon that party in this Indenture
and in the Notes shall automatically extend to and be vested in such transferee or assignee, all
subject to the terms and conditions of this Indenture.

     Section 10.05 No Waiver. Neither a failure nor a delay on the part of either the
Trustee or the Holders in exercising any right, power or privilege under this Article X shall
operate as a waiver thereof, nor shall a single or partial exercise thereof preclude any other or
further exercise of any right, power or privilege. The rights, remedies and benefits of the
Trustee and the Holders herein expressly specified are cumulative and not exclusive of any other
rights, remedies or benefits which either may have under this Article X at law, in equity, by
statute or otherwise.

     Section 10.06 Modification. No modification, amendment or waiver of any provision of
this Article X, nor the consent to any departure by any Guarantor therefrom, shall in any event be
effective unless the same shall be in writing and signed by the Trustee, and then such waiver or
consent shall be effective only in the specific instance and for the purpose for which given. No
notice to or demand on any Guarantor in any case shall entitle such Guarantor to any other or
further notice or demand in the same, similar or other circumstances.

     Section 10.07 Execution of Supplemental Indenture for Future Guarantors. Each
Subsidiary and other Person which is required to become a Guarantor pursuant to Section 4.13 shall
promptly execute and deliver to the Trustee a supplemental indenture in the form of Exhibit E
hereto pursuant to which such Subsidiary or other Person shall become a Guarantor under this
Article X and shall guarantee the Guaranteed Obligations. Concurrently with the execution and
delivery of such supplemental indenture, the Issuers shall deliver to the Trustee an Opinion of
Counsel and an Officers’ Certificate to the effect that such supplemental indenture has been duly
authorized, executed and delivered by such Subsidiary or other Person and that, subject to the
application of bankruptcy, insolvency, moratorium, fraudulent conveyance or transfer and other
similar laws relating to creditors’ rights generally and to the principles of equity, whether
considered in a proceeding at law or in equity, the Guarantee of such Guarantor is a legal, valid
and binding obligation of such Guarantor, enforceable against such Guarantor in accordance with its
terms and/or to such other matters as the Trustee may reasonably request.

ARTICLE XI

SATISFACTION AND DISCHARGE

     Section 11.01 Satisfaction and Discharge. This Indenture shall be discharged and
shall cease to be of further effect as to all Notes issued hereunder, when:

     (1) either:

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     (a) all Notes that have been authenticated, except lost, stolen or destroyed
Notes that have been replaced or paid and Notes for whose payment money has been
deposited in trust and thereafter repaid to the Issuers, have been delivered to the
Trustee for cancellation; or

     (b) all Notes that have not been delivered to the Trustee for cancellation have
become due and payable by reason of the mailing of a notice of redemption or
otherwise or shall become due and payable within one year or are to be called for
redemption within one year and the Issuers have irrevocably deposited or caused to
be deposited with the Trustee as trust funds in trust solely for the benefit of the
Holders, cash in U.S. dollars, non-callable Government Securities, or a combination
of cash in U.S. dollars and non-callable Government Securities, in amounts as shall
be sufficient without consideration of any reinvestment of interest, to pay and
discharge the entire Indebtedness on the Notes not delivered to the Trustee for
cancellation for principal, premium and Additional Interest, if any, and accrued
interest to the date of maturity or redemption;

     (2) the Issuers have paid or caused to be paid all sums payable by them under this
Indenture; and

     (3) in the event of a deposit as provided in clause (1)(b) above, the Issuers have
delivered irrevocable instructions to the Trustee under this Indenture to apply the
deposited money toward the payment of the Notes issued hereunder at maturity or the
redemption date, as the case may be.

     In addition, the Issuers must deliver an Officers’ Certificate and an Opinion of Counsel to
the Trustee stating that all conditions precedent to satisfaction and discharge have been
satisfied.

     Notwithstanding the satisfaction and discharge of this Indenture, (a) if money has been
deposited with the Trustee pursuant to this Section 11.01(1)(b), the provisions of Sections 11.02
and 8.06 hereof shall survive such satisfaction and discharge and (b) the Co-Issuer’s Guarantee
under the Credit Agreement shall remain in full force and effect until payment in full of the
Credit Agreement. In addition, nothing in this Section 11.01 shall be deemed to discharge those
provisions of Section 7.07 hereof, that, by their terms, survive the satisfaction and discharge of
this Indenture.

     Section 11.02 Application of Trust Money. Subject to the provisions of Section 8.06
hereof, all money deposited with the Trustee pursuant to Section 12.01 hereof shall be held in
trust and applied by it, in accordance with the provisions of the Notes and this Indenture, to the
payment, either directly or through any Paying Agent (including the Issuers acting as their own
Paying Agent) as the Trustee may determine, to the Persons entitled thereto, of the principal (and
premium and Additional Interest, if any) and interest for whose payment such money has been
deposited with the Trustee; but such money need not be segregated from other funds except to the
extent required by law.

     If the Trustee or Paying Agent is unable to apply any money or Government Securities in
accordance with Section 11.01 hereof by reason of any legal proceeding or by reason of any order or
judgment of any court or governmental authority enjoining, restraining or otherwise prohibiting
such application, the Issuers’ and any Guarantor’s obligations under this Indenture and the Notes
shall be revived and reinstated as though no deposit had occurred pursuant to Section 11.01 hereof;
provided that if the Issuers have made any payment of principal of, interest or premium or
Additional Interest, if any, on any Notes because of the reinstatement of its obligations, the
Issuers shall be subrogated to the rights of the Holders of such Notes to receive such payment from
the money or Government Securities held by the Trustee or Paying Agent.

ARTICLE XII

MISCELLANEOUS

     Section 12.01 Trust Indenture Act Controls. If any provision of this Indenture
limits, qualifies or conflicts with the duties imposed by TIA Section 318(c), the imposed duties
shall control.

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     Section 12.02 Notices. Any notice or communication by the Issuers, any Guarantor or
the Trustee to the others is duly given if in writing and delivered in Person or by first class
mail (registered or certified, return receipt requested), facsimile transmission or overnight air
courier guaranteeing next day delivery, to the others’ address:

If to the Issuers and/or any Guarantor:

Vanguard Health Systems, Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Facsimile No.: 615-665-6197

Attention: General Counsel

With a copy to:

Simpson Thacher & Bartlett LLP

425 Lexington Avenue

New York, New York 10017

Facsimile No.: (212) 455-2502

Attention: Risë Norman, Esq.

If to the Trustee:

U.S. Bank National Association

Corporate Trust Services

60 Livingston Avenue

St. Paul, Minnesota 55107

Facsimile No.: (651) 495-3918

Attention: Richard Prokosch

     The Issuers, any Guarantor or the Trustee, by notice to the others, may designate additional
or different addresses for subsequent notices or communications.

     All notices and communications (other than those sent to Holders) shall be deemed to have been
duly given: at the time delivered by hand, if personally delivered; five Business Days after being
deposited in the mail, postage prepaid, if mailed; when receipt acknowledged, if transmitted by
facsimile; and the next Business Day after timely delivery to the courier, if sent by overnight air
courier guaranteeing next day delivery.

     Any notice or communication to a Holder shall be mailed by first class mail, certified or
registered, return receipt requested, or by overnight air courier guaranteeing next day delivery to
its address shown on the register kept by the Registrar. Any notice or communication shall also be
so mailed to any Person described in TIA Section 313(c), to the extent required by the TIA.
Failure to mail a notice or communication to a Holder or any defect in it shall not affect its
sufficiency with respect to other Holders.

     If a notice or communication is mailed in the manner provided above within the time
prescribed, it is duly given, whether or not the addressee receives it.

     If the Issuers mail a notice or communication to Holders, they shall mail a copy to the
Trustee and each Agent at the same time.

     Section 12.03 Communication by Holders of Notes with Other Holders of Notes. Holders
may communicate pursuant to TIA Section 312(b) with other Holders with respect to their rights
under this Indenture or the Notes. The Issuers, the Trustee, the Registrar and anyone else shall
have the protection of TIA Section 312(c).

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     Section 12.04 Certificate and Opinion as to Conditions Precedent. Upon any request or
application by the Issuers to the Trustee to take any action under this Indenture (other than in
connection with the Authentication Order, dated the date hereof, and delivered to the Trustee in
connection with the issuance of the Initial Notes), the Issuers shall furnish to the Trustee:

     (1) an Officers’ Certificate in form and substance reasonably satisfactory to the
Trustee (which must include the statements set forth in Section 12.05 hereof) stating that,
in the opinion of the signers, all conditions precedent and covenants, if any, provided for
in this Indenture relating to the proposed action have been satisfied; and

     (2) an Opinion of Counsel in form and substance reasonably satisfactory to the Trustee
(which must include the statements set forth in Section 12.05 hereof) stating that, in the
opinion of such counsel, all such conditions precedent and covenants have been satisfied.

     Section 12.05 Statements Required in Certificate or Opinion. Each certificate or
opinion with respect to compliance with a condition or covenant provided for in this Indenture
(other than a certificate provided pursuant to TIA Section 314(a)(4)) must comply with the
provisions of TIA Section 314(e) and must include:

     (1) a statement that the Person making such certificate or opinion has read such
covenant or condition;

     (2) a brief statement as to the nature and scope of the examination or investigation
upon which the statements or opinions contained in such certificate or opinion are based;

     (3) a statement that, in the opinion of such Person, he or she has made such
examination or investigation as is necessary to enable him or her to express an informed
opinion as to whether or not such covenant or condition has been satisfied; and

     (4) a statement as to whether or not, in the opinion of such Person, such condition or
covenant has been satisfied.

     Section 12.06 Rules by Trustee and Agents. The Trustee may make reasonable rules for
action by or at a meeting of Holders. The Registrar or Paying Agent may make reasonable rules and
set reasonable requirements for its functions.

     Section 12.07 No Personal Liability of Directors, Officers, Employees and
Stockholders. No past, present or future director, officer, employee, incorporator or
stockholder of the Issuers or any direct or indirect parent entity (other than VHS Holdco I or
Vanguard), as such, shall have any liability for any obligations of the Issuers under the Notes,
this Indenture, or for any claim based on, in respect of, or by reason of, such obligations or
their creation. Each Holder of Notes by accepting a Note waives and releases all such liability.
The waiver and release are part of the consideration for issuance of the Notes. The waiver may not
be effective to waive liabilities under the federal securities laws.

     Section 12.08 Governing Law. THIS INDENTURE, THE NOTES AND THE GUARANTEES SHALL BE
GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

     Section 12.09 Successors. All agreements of the Issuers in this Indenture and the
Notes shall bind their respective successors. All agreements of the Trustee in this Indenture
shall bind its successors. All agreements of each Guarantor in this Indenture shall bind its
successors, except as otherwise provided in Section 12.04 hereof.

     Section 12.10 Severability. In case any provision in this Indenture or in the Notes
is invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining
provisions shall not in any way be affected or impaired thereby.

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     Section 12.11 Counterpart Originals. The parties may sign any number of copies of
this Indenture. Each signed copy shall be an original, but all of them together represent the same
agreement.

     Section 12.12 Table of Contents, Headings, etc. The Table of Contents,
Cross-Reference Table and Headings of the Articles and Sections of this Indenture have been
inserted for convenience of reference only, are not to be considered a part of this Indenture and
shall in no way modify or restrict any of the terms or provisions hereof.

[Signatures on following page]

-85-

 

Dated as of January 29, 2010

	 	 	 	 	 
	 	SIGNATURES

VANGUARD HEALTH HOLDING COMPANY II, LLC

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman	 
	 	 	Title:  	Executive Vice President	 
	 
	 	VANGUARD HOLDING COMPANY II, INC.

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman	 
	 	 	Title:  	Executive Vice President	 
	 
	 	VANGUARD HEALTH SYSTEMS, INC.,

as Guarantor

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman	 
	 	 	Title:  	Executive Vice President	 
	 

[Indenture]

 

 

	 	 	 	 	 
	 	VANGUARD HEALTH HOLDING COMPANY I, LLC

BHS PHYSICIANS ALLIANCE FOR ACE, LLC

HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.

MACNEAL PHYSICIANS GROUP, LLC

VANGUARD HEALTH FINANCIAL COMPANY, LLC

VANGUARD HEALTH MANAGEMENT, INC.

VHS ACQUISITION CORPORATION

VHS ACQUISITION SUBSIDIARY NUMBER 1, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 2, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 5, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 7, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 8, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 9, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 10, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 11, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 12, INC.

VHS CHICAGO MARKET PROCUREMENT, LLC

VHS GENESIS LABS, INC.

VHS HOLDING COMPANY, INC.

VHS IMAGING CENTERS, INC.

VHS OF ANAHEIM, INC.

VHS OF ARROWHEAD, INC.

VHS OF HUNTINGTON BEACH, INC.

VHS OF ILLINOIS, INC.

VHS OF ORANGE COUNTY, INC.

VHS OF PHOENIX, INC.

VHS OF SOUTH PHOENIX, INC.

VHS OUTPATIENT CLINICS, INC.

BAPTIST MEDICAL MANAGEMENT SERVICE ORGANIZATION, LLC

HEALTHCARE COMPLIANCE, L.L.C.

MACNEAL HEALTH PROVIDERS, INC.

MACNEAL MANAGEMENT SERVICES, INC.

PROS TEMPORARY STAFFING, INC.

WATERMARK PHYSICIAN SERVICES, INC.,

as Guarantors

 	 
	 	By:  	/s. RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 

[Indenture]

 

 

	 	 	 	 	 
	 	VHS SAN ANTONIO PARTNERS, LLC,

as Guarantor

By: VHS Acquisition Subsidiary Number 5, Inc.,

        its
Member

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE ANAHEIM VHS LIMITED PARTNERSHIP,

as Guarantor

By: VHS of Anaheim, Inc., its General Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE HUNTINGTON BEACH VHS LIMITED PARTNERSHIP,

as Guarantor

By: VHS of Huntington Beach, Inc.,

        its General
Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE VHS ARIZONA IMAGING CENTERS LIMITED PARTNERSHIP,

as Guarantor

By: VHS Imaging Centers, Inc.,

        its General Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald P. Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 

[Indenture]

 

 

Dated as of January 29, 2010

	 	 	 	 	 
	 	U.S. BANK NATIONAL ASSOCIATION

 	 
	 	By:  	                                    /s/ RICHARD PROKOSCH
 	 
	 	 	Authorized Signatory 	 
	 	 	 	 

Indenture Counterpart Signature Page

 

 

EXHIBIT A1

[Face of Note]

 
CUSIP/ISIN

8% Notes due 2018

			
	 	 	 
	No. ______
	 	$_________

VANGUARD HEALTH HOLDING COMPANY II, LLC

and

VANGUARD HOLDING COMPANY II, INC.

promise to pay to CEDE & CO. or registered assigns, the principal sum of $                     DOLLARS
on February 1, 2018.

Interest Payment Dates: February 1 and August 1

Record Dates: January 15 and July 15

Dated: January 29, 2010

	 	 	 	 	 
	 	VANGUARD HEALTH HOLDING COMPANY II, LLC

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HOLDING COMPANY II, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. Bank National Association, as Trustee

	 	 	 	 	 
	 	 	 
	By:  	 	 	 	 
	 	Authorized Signatory 	 	 	 
	 	 	 	 

A1-1

 

	 	 	 	 	 

[Back of Note]

8% Senior Notes due 2018

[Insert the Global Note Legend, if applicable pursuant to the provisions of the Indenture]

[Insert the Private Placement Legend, if applicable pursuant to the provisions of the Indenture]

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) Interest. Vanguard Health Holding Company II, LLC, a Delaware limited liability
company, (“VHS Holdco II”), Vanguard Holding Company II, Inc., a Delaware corporation and a wholly
owned subsidiary of VHS Holdco II (together with VHS Holdco II, the “Issuers”), promise to pay
interest on the principal amount of this Senior Note at 8% per annum from January 29,
2010a until maturity and shall pay the Additional Interest, if any, payable
pursuant to Section 5 of the Registration Rights Agreement referred to below. The Issuers shall
pay interest and Additional Interest, if any, semi-annually in arrears on February 1 and August 1
of each year, or if any such day is not a Business Day, on the next succeeding Business Day (each,
an “Interest Payment Date”). Interest on the Notes shall accrue from the most recent date to which
interest has been paid or, if no interest has been paid, from January 29, 2010* until
the principal hereof is due. The first Interest Payment Date shall be August 1, 2010*.
The Issuers shall pay interest on overdue principal at the rate borne by the Notes, and they shall
pay interest on overdue installments of interest at the same rate to the extent lawful. Interest
shall be computed on the basis of a 360-day year of twelve 30-day months.

     (2) Method of Payment. The Issuers shall pay interest on the Notes (except defaulted
interest) and Additional Interest, if any, to the Persons who are registered Holders of Notes at
the close of business on the January 15 or July 15 next preceding the Interest Payment Date, even
if such Notes are canceled after such record date and on or before such Interest Payment Date,
except as provided in Section 2.12 of the Indenture with respect to defaulted interest. Payments
in respect of Notes represented by Global Notes (including principal, premium, if any, and
interest) shall be made by wire transfer of immediately available funds to the accounts specified
by The Depository Trust Company or any successor depositary. The Issuers shall make all payments
in respect of a Definitive Note (including principal, premium, if any, and interest), at the office
of each Paying Agent, except that, at the option of the Issuers, payment of interest may be made by
mailing a check to the registered address of each Holder thereof; provided, however, that payments
on the Notes may also be made in the case of a Holder of at least $1,000,000 aggregate principal
amount of Notes, by wire transfer to a U.S. dollar account maintained by the payee with a bank in
the United States if such Holder elects payment by wire transfer by giving written notice to the
Trustee or a Paying Agent to such effect designating such account no later than 30 days immediately
preceding the relevant due date for payment (or such other date as the Trustee may accept in its
discretion). Such payment shall be in such coin or currency of the United States of America as at
the time of payment is legal tender for payment of public and private debts.

     (3) Paying Agent and Registrar. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuers may change any
Paying Agent or Registrar without notice to any Holder. The Issuers or any of their Subsidiaries
may act in any such capacity.

     (4) Indenture. The Issuers have issued the Notes under an Indenture dated as of
January 29, 2010 (the “Indenture”) among the Issuers, the Guarantors and the Trustee. The terms of
the Notes include those stated in the Indenture and those made part of the Indenture by reference
to the TIA. Terms defined in the Indenture and not defined herein have the meanings ascribed
thereto in the Indenture. The Notes are subject to all the terms and provi-

 

			
	a	 	In the case of the Initial Notes.

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sions of the Indenture, and Holders are referred to the Indenture and the TIA for a statement
of such terms. To the extent any provision of this Note conflicts with the express provisions of
the Indenture, the provisions of the Indenture shall govern and be controlling.

     The Notes are senior obligations of the Issuers. This Note is one of the Initial Notes
referred to in the Indenture. The Notes include the Initial Notes, any Additional Notes and any
Exchange Notes issued in exchange for Initial Notes or Additional Notes pursuant to the Indenture.
The Initial Notes, any Additional Notes and any Exchange Notes are treated as a single class of
securities under the Indenture. The Indenture imposes certain limitations on the ability of the
Issuers and their Restricted Subsidiaries to, among other things, make certain Investments and
other Restricted Payments, pay dividends and other distributions, incur Indebtedness, enter into
consensual restrictions upon the payment of certain dividends and distributions by such Restricted
Subsidiaries, enter into or permit certain transactions with Affiliates, create or Incur Liens and
make asset sales. The Indenture also imposes limitations on the ability of the Issuers and each
Guarantor to consolidate or merge with or into any other Person or convey, transfer or lease all or
substantially all of its property.

     To guarantee the due and punctual payment of the principal and interest on the Notes and all
other amounts payable by the Issuers under the Indenture and the Notes when and as the same shall
be due and payable, whether at maturity, by acceleration or otherwise, according to the terms of
the Notes and the Indenture, the Guarantors have, jointly and severally, unconditionally guaranteed
the obligations of the Issuers under the Notes on a senior basis pursuant to the terms of the
Indenture.

     (5) Optional Redemption.

     (a) Except as set forth in subparagraphs (b) and (c) of this Paragraph 5, the Issuers shall
not have the option to redeem the Notes prior to February 1, 2014. On or after February 1, 2014,
the Issuers may redeem all or a part of the Notes upon not less than 30 nor more than 60 days’
notice, at the redemption prices (expressed as percentages of principal amount) set forth below
plus accrued and unpaid interest and Additional Interest, if any, on the Notes redeemed to, but not
including, the applicable redemption date, if redeemed during the twelve-month period beginning on
February 1 of the years indicated below, subject to the rights of Holders on the relevant record
date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	 
	2014
	 	 	104.000	%
	2015
	 	 	102.000	%
	2016 and thereafter
	 	 	100.000	%

     Unless the Issuers default in the payment of the redemption price, interest shall cease to
accrue on the Notes or portions thereof called for redemption on the applicable redemption date.

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time on or
prior to February 1, 2013, the Issuers may on any one or more occasions redeem up to 35% of the
aggregate principal amount of Notes issued under the Indenture (including any Additional Notes
issued after the Issue Date) at a redemption price of 108.000% of the principal amount thereof,
plus accrued and unpaid interest and Additional Interest, if any, to, but not including the
redemption date, with the net cash proceeds of one or more Equity Offerings (1) by the Issuers or
(2) by any direct or indirect parent of VHS Holdco II, in each case, to the extent the net cash
proceeds thereof are contributed to the common equity capital of VHS Holdco II or used to purchase
Capital Stock (other than Disqualified Stock) of VHS Holdco II from it; provided that (1) at least
65% in aggregate principal amount of the Notes issued under the Indenture (excluding Notes held by
the Issuers and their Subsidiaries) remains outstanding immediately after the occurrence of such
redemption and (2) that such redemption occurs within 120 days of the date of the closing of such
Equity Offering.

     (c) At any time prior to February 1, 2014, the Issuers may also redeem all or a part of the
Notes, upon not less than 30 nor more than 60 days’ prior notice mailed by first-class mail to each
Holder’s registered address, at a redemption price equal to 100% of the principal amount of the
Notes redeemed plus the Applicable Premium as of, and accrued and unpaid interest and Additional
Interest, if any, to but not including, the date of redemption, subject

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to the rights of Holders of Notes on the relevant record date to receive interest due on the
relevant interest payment date.

     (6) Mandatory Redemption. The Issuers are not required to make mandatory redemption
or sinking fund payments with respect to the Notes.

     (7) Notice of Redemption. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction or discharge of the Indenture. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000.

     (8) Repurchase at the Option of Holder.

     (a) If there is a Change of Control, the Issuers shall make an offer (a “Change of Control
Offer”) to each Holder of the Notes to repurchase all or any part (equal to $2,000 or an integral
multiple of $1,000) of that Holder’s Notes at a purchase price in cash equal to 101% of the
aggregate principal amount of Notes repurchased plus accrued and unpaid interest and Additional
Interest, if any, on the Notes repurchased to, but not including, the date of purchase, subject to
the rights of Holders on the relevant record date to receive interest due on the relevant interest
payment date. Within 30 days following any Change of Control, except to the extent that the
Issuers have exercised their right to redeem the Notes in accordance with Article III of the
Indenture (or if a third party makes a Change of Control Offer in accordance with the terms of the
Indenture), the Issuers shall mail a notice to each Holder setting forth the procedures governing
the Change of Control Offer as required by the Indenture.

     (b) If VHS Holdco II or a Restricted Subsidiary of VHS Holdco II consummates any Asset Sales,
within ten Business Days of each date on which the aggregate amount of Excess Proceeds exceeds
$30.0 million, the Issuers shall commence an offer to all Holders of Notes and all holders of other
Pari Passu Indebtedness containing provisions similar to those set forth in the Indenture with
respect to offers to purchase or redeem with the proceeds of sales of assets (an “Asset Sale
Offer”) pursuant to Section 4.08 of the Indenture to purchase the maximum principal amount of Notes
and such other Pari Passu Indebtedness that may be purchased out of the Excess Proceeds at an offer
price in cash in an amount equal to 100% of the principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, thereon to the date of purchase, in accordance with the
procedures set forth in the Indenture. To the extent that, any Excess Proceeds remain after the
consummation of an Asset Sale Offer, the Issuers may use those Excess Proceeds for any purpose not
otherwise prohibited by the Indenture. If the aggregate principal amount of Notes and other Pari
Passu Indebtedness tendered into such Asset Sale Offer exceeds the amount of Excess Proceeds, the
Trustee shall select the Notes and such other Pari Passu Indebtedness to be purchased on a pro rata
basis. Holders of Notes that are the subject of an offer to purchase shall receive an Asset Sale
Offer from the Issuers prior to any related purchase date and may elect to have such Notes
purchased by completing the form entitled “Option of Holder to Elect Purchase” attached to the
Notes.

     (9) Denominations, Transfer, Exchange. The Notes are in registered form without
coupons in denominations of $2,000 and integral multiples of $1,000. The transfer of Notes may be
registered and Notes may be exchanged as provided in the Indenture. The Registrar and the Trustee
may require a Holder, among other things, to furnish appropriate endorsements and transfer
documents and the Issuers may require a Holder to pay any taxes and fees required by law or
permitted by the Indenture. The Issuers need not exchange or register the transfer of any Note or
portion of a Note selected for redemption, except for the unredeemed portion of any Note being
redeemed in part. Also, the Issuers need not exchange or register the transfer of any Notes for a
period of 15 days before a selection of Notes to be redeemed or during the period between a record
date and the corresponding Interest Payment Date.

     (10) Persons Deemed Owners. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) Amendment, Supplement and Waiver. Subject to certain exceptions, the Indenture
or the Notes may be amended or supplemented with the consent of the Holders of at least a majority
in aggregate principal

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amount of the then outstanding Notes including Additional Notes, if any, voting as a single
class, and any existing Default or Event of Default or compliance with any provision of the
Indenture or the Notes may be waived with the consent of the Holders of a majority in aggregate
principal amount of the then outstanding Notes including Additional Notes, if any, voting as a
single class. Without the consent of any Holder of a Note, the Indenture or the Notes may be
amended or supplemented (i) to cure any ambiguity, defect or inconsistency, (ii) to provide for
uncertificated Notes in addition to or in place of certificated Notes, (iii) to provide for the
assumption of either Issuers’ obligations to Holders of the Notes in the case of a merger or
consolidation or sale of all or substantially all of such Issuers’ assets, (iv) to make any change
that would provide any additional rights or benefits to the Holders of the Notes or that does not
adversely affect the legal rights under the Indenture of any such Holder, (v) to comply with the
requirements of the Commission in order to effect or maintain the qualification of the Indenture
under the TIA, (vi) to add a Guarantee of the Notes or to release the Guarantee of Vanguard, (vii)
to conform the text of the Indenture, the Notes or the Guarantees to any provision of the
“Description of Notes” in the Offering Memorandum to the extent that such provision in the
Description of Notes in the Offering Memorandum was intended to be a verbatim recitation of a
provision of this Indenture, the Notes or the Guarantees or (viii) to evidence and provide for the
acceptance and appointment under this Indenture of a successor Trustee thereunder pursuant to the
requirements thereof.

     (12) Defaults and Remedies. If an Event of Default occurs and is continuing, the
Trustee or the Holders of at least 25% in aggregate principal amount of the then outstanding Notes
may declare all the Notes to be due and payable immediately. Notwithstanding the foregoing, in the
case of an Event of Default arising from certain events of bankruptcy or insolvency with respect to
the Issuers, all outstanding Notes shall become due and payable immediately without further action
or notice. Holders may not enforce the Indenture or the Notes except as provided in the Indenture.
Subject to certain limitations, Holders of a majority in aggregate principal amount of the then
outstanding Notes may direct the Trustee in its exercise of any trust or power. The Holders of a
majority in aggregate principal amount of the then outstanding Notes by notice to the Trustee may,
on behalf of the Holders of all of the Notes, rescind an acceleration or waive any existing Default
or Event of Default and its consequences under the Indenture except a continuing Default or Event
of Default in the payment of interest or premium or Additional Interest, if any, on, or the
principal of, the Notes. The Issuers are required to deliver to the Trustee annually a statement
regarding compliance with the Indenture, and the Issuers are required, upon becoming aware of any
Default or Event of Default, to deliver to the Trustee a statement specifying such Default or Event
of Default.

     (13) Discharge and Defeasance. Subject to certain conditions, the Issuers at any time
may terminate some or all of its obligations under the Notes, the Guarantees and the Indenture if
the Issuers deposit with the Trustee money or Government Securities for the payment of principal of
and interest on the Notes to redemption or maturity, as the case may be.

     (14) Trustee Dealings with the Issuers. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuers or their
Affiliates, and may otherwise deal with the Issuers or their Affiliates, as if it were not the
Trustee.

     (15) No Recourse Against Others. A director, manager, officer, employee,
incorporator, member or stockholder of the Issuers or any of the Guarantors, as such, shall not
have any liability for any obligations of the Issuers or the Guarantors under the Notes, the
Guarantees or the Indenture or for any claim based on, in respect of, or by reason of, such
obligations or their creation. Each Holder by accepting a Note waives and releases all such
liability. The waiver and release are part of the consideration for the issuance of the Notes.

     (16) Authentication. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

     (17) Abbreviations. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

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     (18) Additional Rights of Holders of Restricted Global Notes and Restricted Definitive
Notes. In addition to the rights provided to Holders of Notes under the Indenture, Holders of
Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the
Registration Rights Agreement dated as of January 29, 2010, among the Issuers, the Guarantors and
the Initial Purchasers named therein or, in the case of Additional Notes, Holders of Restricted
Global and Restricted Definitive Notes shall have the rights set forth in one or more registration
rights agreements, if any, among the Issuers, the Guarantors and the other parties thereto,
relating to rights given by the Issuers and the Guarantors to the purchasers of any Additional
Notes (collectively, the “Registration Rights Agreement”).

     (19) CUSIP Numbers. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuers have caused CUSIP numbers to be printed on
the Notes, and the Trustee may use CUSIP numbers in notices of redemption as a convenience to
Holders. No representation is made as to the accuracy of such numbers either as printed on the
Notes or as contained in any notice of redemption, and reliance may be placed only on the other
identification numbers placed thereon.

     (20) GOVERNING LAW. THE LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO
CONSTRUE THE INDENTURE, THIS NOTE AND THE GUARANTEES.

     The Issuers shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

Vanguard Health Holding Company II, LLC

Vanguard Holding Company II, Inc.

c/o Vanguard Health Systems Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Attention: General Counsel

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ASSIGNMENT FORM

     To assign this Note, fill in the form below:

	 	 	 
	(I) or (we) assign and transfer this Note to:
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 
(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 
(Print or type assignee’s name, address and zip code)

and irrevocably appoint ________________________ to transfer this Note on the books of the Issuers.
The agent may substitute another to act for him.

Date: _______________

	 	 	 
	Your Signature:
	 	 
	 

	 	 
	 

	 	(Sign exactly as your name appears on
the face of this Note)

Signature Guarantee*: _____________________

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

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OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Note purchased by the Issuers pursuant to Section 4.08 or
4.11 of the Indenture, check the appropriate box below:

o Section 4.08          o Section 4.11

     If you want to elect to have only part of the Note purchased by the Issuers pursuant to
Section 4.08 or Section 4.11 of the Indenture, state the amount you elect to have purchased:

$______________

Date: __________________

	 	 	 
	Your Signature:
	 	 
	 

	 	 
	 

	 	(Sign exactly as your name appears on
the face of this Note)

	 	 	 
	Tax Identification No.:
	 	 
	 

	 	 

Signature Guarantee*: __________________

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

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SCHEDULE OF EXCHANGES OF INTERESTS IN THE GLOBAL NOTE*

     The following exchanges of a part of this Global Note for an interest in another Global Note
or for a Definitive Note, or exchanges of a part of another Global Note or Definitive Note for an
interest in this Global Note, have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal	 	 
	 	 	 	 	 	 	Amount of	 	 
	 	 	Amount of	 	Amount of	 	this	 	 
	 	 	decrease in	 	increase in	 	Global Note	 	Signature of
	 	 	Principal	 	Principal	 	following	 	authorized
	 	 	Amount of this	 	Amount of this	 	such decrease	 	officer of Trustee
	Date of Exchange	 	Global Note	 	Global Note	 	(or increase)	 	or Custodian
	 	 	 	 	 	 	 	 	 

 

			
	*	 	This schedule should be included only if the Note is issued in global form.

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EXHIBIT A2

[Face of Regulation S Temporary Global Note]

 
CUSIP/ISIN

8% Senior Notes due 2018

			
	 	 	 
	No. ______
	 	$____________

VANGUARD HEALTH HOLDING COMPANY II, LLC

and

VANGUARD HOLDING COMPANY II, INC.

promise to pay to CEDE & CO. or registered assigns, the principal sum of $____________
DOLLARS on February 1, 2018.

Interest Payment Dates: February 1 and August 1

Record Dates: January 15 and July 15

Dated: January 29, 2010

	 	 	 	 	 
	 	VANGUARD HEALTH HOLDING COMPANY II, LLC

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HOLDING COMPANY II, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. Bank National Association, as Trustee

	 	 	 	 	 
	By:  	 	 	 
	 	Authorized Signatory 	 	 
	 	 	 	 

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[Back of Regulation S Temporary Global Note]

8% Senior Notes due 2018

THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES
GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED
HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF THIS REGULATION S TEMPORARY GLOBAL NOTE
SHALL BE ENTITLED TO RECEIVE PAYMENT OF INTEREST HEREON.

THIS GLOBAL NOTE IS HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING THIS NOTE) OR ITS
NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS HEREOF, AND IS NOT TRANSFERABLE TO ANY
PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT (1) THE TRUSTEE MAY MAKE SUCH NOTATIONS HEREON AS MAY BE
REQUIRED PURSUANT TO SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE EXCHANGED IN WHOLE
BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3) THIS GLOBAL NOTE MAY BE DELIVERED
TO THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 2.11 OF THE INDENTURE AND (4) THIS GLOBAL NOTE
MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF THE ISSUERS.

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM, THIS NOTE MAY
NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE DEPOSITARY OR BY A
NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER NOMINEE OF THE DEPOSITARY OR BY THE
DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.
UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST
COMPANY (55 WATER STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUERS OR THEIR AGENT FOR
REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME
OF CEDE & CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND
ANY PAYMENT IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS MAY BE REQUESTED BY AN AUTHORIZED
REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO
ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN.

THIS NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES
ACT”), AND MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED EXCEPT IN ACCORDANCE WITH THE
FOLLOWING SENTENCE. BY ITS ACQUISITION HEREOF OR OF A BENEFICIAL INTEREST HEREIN, THE ACQUIRER:

     (1) REPRESENTS THAT:

     (A) IT AND ANY ACCOUNT FOR WHICH IT IS ACTING IS A “QUALIFIED INSTITUTIONAL BUYER”
(WITHIN THE MEANING OF RULE 144A UNDER THE SECURITIES ACT) AND THAT IT EXERCISES SOLE
INVESTMENT DISCRETION WITH RESPECT TO EACH SUCH ACCOUNT,

     (B) IT IS AN INSTITUTIONAL “ACCREDITED INVESTOR” (WITHIN THE MEANING OF RULE 501(a)
(1), (2),(3) OR (7) UNDER THE SECURITIES ACT) (AN “INSTITUTIONAL ACCREDITED INVESTOR”), OR

     (C) IT IS NOT A U.S. PERSON (WITHIN THE MEANING OF REGULATION S UNDER THE SECURITIES
ACT), AND

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     (2) AGREES FOR THE BENEFIT OF THE ISSUERS THAT IT SHALL NOT OFFER, SELL, PLEDGE OR OTHERWISE
TRANSFER THIS NOTE OR ANY BENEFICIAL INTEREST HEREIN, EXCEPT IN ACCORDANCE WITH THE SECURITIES ACT
AND ANY APPLICABLE SECURITIES LAWS OF ANY STATE OF THE UNITED STATES AND ONLY:

     (A) TO THE ISSUERS,

     (B) PURSUANT TO A REGISTRATION STATEMENT WHICH HAS BECOME EFFECTIVE UNDER THE
SECURITIES ACT,

     (C) TO A QUALIFIED INSTITUTIONAL BUYER IN COMPLIANCE WITH RULE 144A UNDER THE
SECURITIES ACT,

     (D) IN AN OFFSHORE TRANSACTION IN COMPLIANCE WITH RULE 904 OF REGULATION S UNDER THE
SECURITIES ACT,

     (E) IN A PRINCIPAL AMOUNT OF NOT LESS THAN $100,000, TO AN INSTITUTIONAL ACCREDITED
INVESTOR THAT, PRIOR TO SUCH TRANSFER, DELIVERS TO THE TRUSTEE A DULY COMPLETED AND SIGNED
CERTIFICATE (THE FORM OF WHICH MAY BE OBTAINED FROM THE TRUSTEE) RELATING TO THE
RESTRICTIONS ON TRANSFER OF THIS NOTE, OR

     (F) PURSUANT TO AN EXEMPTION FROM REGISTRATION PROVIDED BY RULE 144 UNDER THE
SECURITIES ACT OR ANY OTHER AVAILABLE EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE
SECURITIES ACT.

PRIOR TO THE REGISTRATION OF ANY TRANSFER IN ACCORDANCE WITH (2)(C) ABOVE OR (2)(D) ABOVE, A DULY
COMPLETED AND SIGNED CERTIFICATE (THE FORM OF WHICH MAY BE OBTAINED FROM THE TRUSTEE) MUST BE
DELIVERED TO THE TRUSTEE. PRIOR TO THE REGISTRATION OF ANY TRANSFER IN ACCORDANCE WITH (2)(E) OR
(F) ABOVE, THE ISSUERS RESERVE THE RIGHT TO REQUIRE THE DELIVERY OF SUCH LEGAL OPINIONS,
CERTIFICATIONS OR OTHER EVIDENCE AS MAY REASONABLY BE REQUIRED IN ORDER TO DETERMINE THAT THE
PROPOSED TRANSFER IS BEING MADE IN COMPLIANCE WITH THE SECURITIES ACT AND APPLICABLE STATE
SECURITIES LAWS. NO REPRESENTATION IS MADE AS TO THE AVAILABILITY OF ANY RULE 144 EXEMPTION FROM
THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT, AND (3) AGREES THAT IT SHALL DELIVER TO EACH
PERSON TO WHOM THIS NOTE OR AN INTEREST HEREIN IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT
OF THIS LEGEND. IN CONNECTION WITH ANY TRANSFER OF THIS NOTE OR ANY INTEREST HEREIN WITHIN THE
TIME PERIOD REFERRED TO ABOVE, THE HOLDER MUST CHECK THE APPROPRIATE BOX SET FORTH ON THE REVERSE
HEREOF RELATING TO THE MANNER OF SUCH TRANSFER AND SUBMIT THIS CERTIFICATE TO THE TRUSTEE. AS USED
HEREIN, THE TERMS “OFFSHORE TRANSACTION,” “UNITED STATES” AND “U.S. PERSON” HAVE THE MEANINGS GIVEN
TO THEM BY RULE 902 OF REGULATION S UNDER THE SECURITIES ACT. THE INDENTURE CONTAINS A PROVISION
REQUIRING THE TRUSTEE TO REFUSE TO REGISTER ANY TRANSFER OF THIS NOTE IN VIOLATION OF THE FOREGOING
RESTRICTIONS.

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) Interest. Vanguard Health Holding Company II, LLC, a Delaware limited liability
company, (“VHS Holdco II”), Vanguard Holding Company II, Inc., a Delaware corporation and a wholly
owned subsidiary of

A2-3

 

VHS Holdco II (together with VHS Holdco II, the “Issuers”), promise to pay interest on the
principal amount of this Note at 8% per annum from January 29, 2010a until
maturity and shall pay the Additional Interest, if any, payable pursuant to Section 5 of the
Registration Rights Agreement referred to below. The Issuers shall pay interest and Additional
Interest, if any, semi-annually in arrears on February 1 and August 1 of each year, or if any such
day is not a Business Day, on the next succeeding Business Day (each, an “Interest Payment Date”).
Interest on the Notes shall accrue from the most recent date to which interest has been paid or, if
no interest has been paid, from January 29, 2010* until the principal hereof is due.
The first Interest Payment Date shall be August 1, 2010*. The Issuers shall pay
interest on overdue principal at the rate borne by the Notes, and they shall pay interest on
overdue installments of interest at the same rate to the extent lawful. Interest shall be computed
on the basis of a 360-day year of twelve 30-day months.

     Until this Regulation S Temporary Global Note is exchanged for one or more Regulation S
Permanent Global Notes, the Holder hereof shall not be entitled to receive payments of interest
hereon; until so exchanged in full, this Regulation S Temporary Global Note shall in all other
respects be entitled to the same benefits as other Notes under the Indenture.

     (2) Method of Payment. The Issuers shall pay interest on the Notes (except defaulted
interest) and Additional Interest, if any, to the Persons who are registered Holders of Notes at
the close of business on the January 15 or July 15 next preceding the Interest Payment Date, even
if such Notes are canceled after such record date and on or before such Interest Payment Date,
except as provided in Section 2.12 of the Indenture with respect to defaulted interest. Payments
in respect of Notes represented by Global Notes (including principal, premium, if any, and
interest) shall be made by wire transfer of immediately available funds to the accounts specified
by The Depository Trust Company or any successor depositary. The Issuers shall make all payments
in respect of a Definitive Note (including principal, premium, if any, and interest), at the office
of each Paying Agent, except that, at the option of the Issuers, payment of interest may be made by
mailing a check to the registered address of each Holder thereof; provided, however, that payments
on the Notes may also be made in the case of a Holder of at least $1,000,000 aggregate principal
amount of Notes, by wire transfer to a U.S. dollar account maintained by the payee with a bank in
the United States if such Holder elects payment by wire transfer by giving written notice to the
Trustee or a Paying Agent to such effect designating such account no later than 30 days immediately
preceding the relevant due date for payment (or such other date as the Trustee may accept in its
discretion). Such payment shall be in such coin or currency of the United States of America as at
the time of payment is legal tender for payment of public and private debts.

     (3) Paying Agent and Registrar. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuers may change any
Paying Agent or Registrar without notice to any Holder. The Issuers or any of their Subsidiaries
may act in any such capacity.

     (4) Indenture. The Issuers have issued the Notes under an Indenture dated as of
January 29, 2010 (the “Indenture”) among the Issuers, the Guarantors and the Trustee. The terms of
the Notes include those stated in the Indenture and those made part of the Indenture by reference
to the TIA. Terms defined in the Indenture and not defined herein have the meanings ascribed
thereto in the Indenture. The Notes are subject to all the terms and provisions of the Indenture,
and Holders are referred to the Indenture and the TIA for a statement of such terms. To the extent
any provision of this Note conflicts with the express provisions of the Indenture, the provisions
of the Indenture shall govern and be controlling.

     The Notes are senior obligations of the Issuers. This Note is one of the Initial Notes
referred to in the Indenture. The Notes include the Initial Notes, any Additional Notes and any
Exchange Notes issued in exchange for Initial Notes or Additional Notes pursuant to the Indenture.
The Initial Notes, any Additional Notes and any Exchange Notes are treated as a single class of
securities under the Indenture. The Indenture imposes certain limita-

 

			
	a	 	In the case of the Initial Notes.

A2-4

 

tions on the ability of the Issuers and their Restricted Subsidiaries to, among other things,
make certain Investments and other Restricted Payments, pay dividends and other distributions,
incur Indebtedness, enter into consensual restrictions upon the payment of certain dividends and
distributions by such Restricted Subsidiaries, enter into or permit certain transactions with
Affiliates, create or Incur Liens and make asset sales. The Indenture also imposes limitations on
the ability of the Issuers and each Guarantor to consolidate or merge with or into any other Person
or convey, transfer or lease all or substantially all of its property.

     To guarantee the due and punctual payment of the principal and interest on the Notes and all
other amounts payable by the Issuers under the Indenture and the Notes when and as the same shall
be due and payable, whether at maturity, by acceleration or otherwise, according to the terms of
the Notes and the Indenture, the Guarantors have, jointly and severally, unconditionally guaranteed
the obligations of the Issuers under the Notes on a senior basis pursuant to the terms of the
Indenture.

     (5) Optional Redemption.

     (a) Except as set forth in subparagraphs (b) and (c) of this Paragraph 5, the Issuers shall
not have the option to redeem the Notes prior to February 1, 2014. On or after February 1, 2014,
the Issuers may redeem all or a part of the Notes upon not less than 30 nor more than 60 days’
notice, at the redemption prices (expressed as percentages of principal amount) set forth below
plus accrued and unpaid interest and Additional Interest, if any, on the Notes redeemed to, but not
including, the applicable redemption date, if redeemed during the twelve-month period beginning on
February 1 of the years indicated below, subject to the rights of Holders on the relevant record
date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	 
	 
	2014
	 	 	104.000	%
	2015
	 	 	102.000	%
	2016 and thereafter
	 	 	100.000	%

     Unless the Issuers default in the payment of the redemption price, interest shall cease to
accrue on the Notes or portions thereof called for redemption on the applicable redemption date.

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time on or
prior to February 1, 2013, the Issuers may on any one or more occasions redeem up to 35% of the
aggregate principal amount of Notes issued under the Indenture (including any Additional Notes
issued after the Issue Date) at a redemption price of 108.000% of the principal amount thereof,
plus accrued and unpaid interest and Additional Interest, if any, to, but not including the
redemption date, with the net cash proceeds of one or more Equity Offerings (1) by the Issuers or
(2) by any direct or indirect parent of VHS Holdco II, in each case, to the extent the net cash
proceeds thereof are contributed to the common equity capital of VHS Holdco II or used to purchase
Capital Stock (other than Disqualified Stock) of VHS Holdco II from it; provided that (1) at least
65% in aggregate principal amount of the Notes issued under the Indenture (excluding Notes held by
the Issuers and their subsidiaries) remains outstanding immediately after the occurrence of such
redemption and (2) that such redemption occurs within 120 days of the date of the closing of such
Equity Offering.

     (c) At any time prior to February 1, 2014, the Issuers may also redeem all or a part of the
Notes, upon not less than 30 nor more than 60 days’ prior notice mailed by first-class mail to each
Holder’s registered address, at a redemption price equal to 100% of the principal amount of the
Notes redeemed plus the Applicable Premium as of, and accrued and unpaid interest and Additional
Interest, if any, to, the date of redemption, subject to the rights of Holders on the relevant
record date to receive interest due on the relevant interest payment date.

     (6) Mandatory Redemption. The Issuers are not required to make mandatory redemption
or sinking fund payments with respect to the Notes.

     (7) Notice of Redemption. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection

A2-5

 

with a defeasance of the Notes or a satisfaction or discharge of the Indenture. Notes in
denominations larger than $2,000 may be redeemed in part but only in whole multiples of $1,000.

     (8) Repurchase at the Option of Holder.

     (a) If there is a Change of Control, the Issuers shall make an offer (a “Change of Control
Offer”) to each Holder of the Notes to repurchase all or any part (equal to $2,000 or an integral
multiple of $1,000) of that Holder’s Notes at a purchase price in cash equal to 101% of the
aggregate principal amount of Notes repurchased plus accrued and unpaid interest and Additional
Interest, if any, on the Notes repurchased to, but not including, the date of purchase, subject to
the rights of Holders on the relevant record date to receive interest due on the relevant interest
payment date. Within 30 days following any Change of Control, except to the extent that the
Issuers have exercised their right to redeem the Notes in accordance with Article III of the
Indenture (or if a third party makes a Change of Control Offer in accordance with the terms of the
Indenture), the Issuers shall mail a notice to each Holder setting forth the procedures governing
the Change of Control Offer as required by the Indenture.

     (b) If VHS Holdco II or a Restricted Subsidiary of VHS Holdco II consummates any Asset Sales,
within ten Business Days of each date on which the aggregate amount of Excess Proceeds exceeds
$30.0 million, the Issuers shall commence an offer to all Holders and all holders of other Pari
Passu Indebtedness containing provisions similar to those set forth in the Indenture with respect
to offers to purchase or redeem with the proceeds of sales of assets (an “Asset Sale Offer”)
pursuant to Section 4.08 of the Indenture to purchase the maximum principal amount of Notes and
such other Pari Passu Indebtedness that may be purchased out of the Excess Proceeds at an offer
price in cash in an amount equal to 100% of the principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, thereon to the date of purchase, in accordance with the
procedures set forth in the Indenture. To the extent that any Excess Proceeds remain after the
consummation of an Asset Sale Offer, the Issuers may use those Excess Proceeds for any purpose not
otherwise prohibited by the Indenture. If the aggregate principal amount of Notes and other Pari
Passu Indebtedness tendered into such Asset Sale Offer exceeds the amount of Excess Proceeds, the
Trustee shall select the Notes and such other Pari Passu Indebtedness to be purchased on a pro rata
basis. Holders of Notes that are the subject of an offer to purchase shall receive an Asset Sale
Offer from the Issuers prior to any related purchase date and may elect to have such Notes
purchased by completing the form entitled “option of Holder to Elect Purchase” attached to the
Notes.

     (9) Denominations, Transfer, Exchange. The Notes are in registered form without
coupons in denominations of $2,000 and integral multiples of $1,000. The transfer of Notes may be
registered and Notes may be exchanged as provided in the Indenture. The Registrar and the Trustee
may require a Holder, among other things, to furnish appropriate endorsements and transfer
documents and the Issuers may require a Holder to pay any taxes and fees required by law or
permitted by the Indenture. The Issuers need not exchange or register the transfer of any Note or
portion of a Note selected for redemption, except for the unredeemed portion of any Note being
redeemed in part. Also, the Issuers need not exchange or register the transfer of any Notes for a
period of 15 days before a selection of Notes to be redeemed or during the period between a record
date and the corresponding Interest Payment Date.

     This Regulation S Temporary Global Note is exchangeable in whole or in part for one or more
Global Notes only (i) on or after the termination of the 40-day distribution compliance period (as
defined in Regulation S) and (ii) upon presentation of certificates (accompanied by an Opinion of
Counsel, if applicable) required by Article II of the Indenture. Upon exchange of this Regulation
S Temporary Global Note for one or more Global Notes, the Trustee shall cancel this Regulation S
Temporary Global Note.

     (10) Persons Deemed Owners. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) Amendment, Supplement And Waiver. Subject to certain exceptions, the Indenture
or the Notes may be amended or supplemented with the consent of the Holders of at least a majority
in aggregate principal amount of the then outstanding Notes including Additional Notes, if any,
voting as a single class, and any existing Default or Event of Default or compliance with any
provision of the Indenture or the Notes may be waived with the consent of the Holders of a majority
in aggregate principal amount of the then outstanding Notes including Addi-

A2-6

 

tional Notes, if any, voting as a single class. Without the consent of any Holder of a Note,
the Indenture or the Notes may be amended or supplemented (i) to cure any ambiguity, defect or
inconsistency, (ii) to provide for uncertificated Notes in addition to or in place of certificated
Notes, (iii) to provide for the assumption of either Issuers’ obligations to Holders of the Notes
in the case of a merger or consolidation or sale of all or substantially all of such Issuers’
assets, (iv) to make any change that would provide any additional rights or benefits to the Holders
or that does not adversely affect the legal rights under the Indenture of any such Holder, (v) to
comply with the requirements of the Commission in order to effect or maintain the qualification of
the Indenture under the TIA, (vi) to add a Guarantee of the Notes or to release the Guarantee of
Vanguard, (vii) to conform the text of the Indenture, the Notes or the Guarantees to any provision
of the “Description of Notes” in the Offering Memorandum to the extent that such provision in the
Description of Notes in the Offering Memorandum was intended to be a verbatim recitation of a
provision of this Indenture, the Notes or the Guarantees or (viii) to evidence and provide for the
acceptance and appointment under this Indenture of a successor Trustee thereunder pursuant to the
requirements thereof.

     (12) Defaults and Remedies. If any Event of Default occurs and is continuing, the
Trustee or the Holders of at least 25% in aggregate principal amount of the then outstanding Notes
may declare all the Notes to be due and payable immediately. Notwithstanding the foregoing, in the
case of an Event of Default arising from certain events of bankruptcy or insolvency with respect to
the Issuers, all outstanding Notes shall become due and payable immediately without further action
or notice. Holders may not enforce the Indenture or the Notes except as provided in the Indenture.
Subject to certain limitations, Holders of a majority in aggregate principal amount of the then
outstanding Notes may direct the Trustee in its exercise of any trust or power. The Holders of a
majority in aggregate principal amount of the then outstanding Notes by notice to the Trustee may,
on behalf of the Holders of all of the Notes, rescind an acceleration or waive any existing Default
or Event of Default and its consequences under the Indenture except a continuing Default or Event
of Default in the payment of interest or premium or Additional Interest, if any, on, or the
principal of, the Notes. The Issuers are required to deliver to the Trustee annually a statement
regarding compliance with the Indenture, and the Issuers are required, upon becoming aware of any
Default or Event of Default, to deliver to the Trustee a statement specifying such Default or Event
of Default.

     (13) Discharge and Defeasance. Subject to certain conditions, the Issuers at any time
may terminate some or all of its obligations under the Notes, the Guarantees and the Indenture if
the Issuers deposit with the Trustee money or Government Securities for the payment of principal of
and interest on the Notes to redemption or maturity, as the case may be.

     (14) Trustee Dealings with the Issuers. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuers or their
Affiliates, and may otherwise deal with the Issuers or their Affiliates, as if it were not the
Trustee.

     (15) No Recourse Against Others. A director, manager, officer, employee,
incorporator, member or stockholder of the Issuers or any of the Guarantors, as such, shall not
have any liability for any obligations of the Issuers or the Guarantors under the Notes, the
Guarantees or the Indenture or for any claim based on, in respect of, or by reason of, such
obligations or their creation. Each Holder by accepting a Note waives and releases all such
liability. The waiver and release are part of the consideration for the issuance of the Notes.

     (16) Authentication. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

     (17) Abbreviations. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

     (18) Additional Rights of Holders. In addition to the rights provided to Holders of
Notes under the Indenture, Holders of Restricted Global Notes and Restricted Definitive Notes shall
have all the rights set forth in the Registration Rights Agreement dated as of January 29, 2010,
among the Issuers, the Guarantors and the Initial Purchasers named therein or, in the case of
Additional Notes, Holders of Restricted Global Notes and Restricted Definitive Notes shall have the
rights set forth in one or more registration rights agreements, if any, among the Issuers, the

A2-7

 

Guarantors and the other parties thereto, relating to rights given by the Issuers and the
Guarantors to the purchasers of any Additional Notes (collectively, the “Registration Rights
Agreement”).

     (19) CUSIP Numbers. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuers have caused CUSIP numbers to be printed on
the Notes, and the Trustee may use CUSIP numbers in notices of redemption as a convenience to
Holders. No representation is made as to the accuracy of such numbers either as printed on the
Notes or as contained in any notice of redemption, and reliance may be placed only on the other
identification numbers placed thereon.

     (20) GOVERNING LAW. THE LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO
CONSTRUE THE INDENTURE, THIS NOTE AND THE GUARANTEES.

     The Issuers shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

Vanguard Health Holding Company II, LLC

Vanguard Holding Company II, Inc.

c/o Vanguard Health Systems Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Attention: General Counsel

A2-8

 

ASSIGNMENT FORM

     To assign this Note, fill in the form below:

	 	 	 
	(I) or (we) assign and transfer this Note to:
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 
(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 
(Print or type assignee’s name, address and zip code)

and irrevocably appoint ________________________ to transfer this Note on the books of the Issuers.
The agent may substitute another to act for him.

Date: __________________

	 	 	 
	Your Signature:
	 	 
	 

	 	 
	 

	 	(Sign exactly as your name appears on
the face of this Note)

Signature Guarantee*: ___________________________

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A2-9

 

OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Note purchased by the Issuers pursuant to Section 4.08 or
4.11 of the Indenture, check the appropriate box below:

o Section 4.08          o Section 4.11

     If you want to elect to have only part of the Note purchased by the Issuers pursuant to
Section 4.08 or Section 4.11 of the Indenture, state the amount you elect to have purchased:

$______________

Date: __________________

	 	 	 
	Your Signature:
	 	 
	 

	 	 
	 

	 	(Sign exactly as your name appears on
the face of this Note)

	 	 	 
	Tax Identification No.:
	 	 
	 

	 	 
	 

	 	 

Signature Guarantee*: __________________

 

			
	*	 	Participant in a recognized. Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A2-10

 

SCHEDULE OF EXCHANGES OF INTERESTS IN THE REGULATION S TEMPORARY

GLOBAL NOTE

     The following exchanges of a part of this Regulation S Temporary Global Note for an interest
in another Global Note, or exchanges of a part of another Restricted Global Note for an interest in
this Regulation S Temporary Global Note, have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal	 	 
	 	 	 	 	 	 	Amount of	 	 
	 	 	Amount of	 	Amount of	 	this	 	 
	 	 	decrease in	 	increase in	 	Global Note	 	Signature of
	 	 	Principal	 	Principal	 	following	 	authorized
	 	 	Amount of this	 	Amount of this	 	such decrease	 	officer of Trustee
	Date of Exchange	 	Global Note	 	Global Note	 	(or increase)	 	or Custodian
	 	 	 	 	 	 	 	 	 

A2-11

 

EXHIBIT B

FORM OF CERTIFICATE OF TRANSFER

Vanguard Health Holding Company II, LLC

Vanguard Holding Company II, Inc.

c/o Vanguard Health Systems Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Attention: General Counsel

U.S. Bank National Association

Corporate Trust Services

60 Livingston Avenue

St. Paul, Minnesota 55107

Attention: General Counsel

Re: 8% Notes due 2018

     Reference is hereby made to the Indenture, dated as of January 29, 2010 (the “Indenture”),
among Vanguard Health Holding Company II, LLC, a Delaware limited liability company (“VHS Holdco
II”), Vanguard Holding Company II, Inc., a Delaware corporation and a wholly owned subsidiary of
VHS Holdco II (together with VHS Holdco II, the “Issuers”), the Guarantors party thereto and U.S.
Bank National Association, as trustee. Capitalized terms used but not defined herein shall have
the meanings given to them in the Indenture.

     _______________, (the “Transferor”) owns and proposes to transfer the Note[s] or
interest in such Note[s] specified in Annex A hereto, in the principal amount of $_________ in
such Note[s] or interests (the “Transfer”), to ________________________ (the “Transferee”), as
further specified in Annex A hereto. In connection with the Transfer, the Transferor hereby
certifies that:

[CHECK ALL THAT APPLY]

     1. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE 144A GLOBAL NOTE
OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO RULE 144A. The Transfer is being effected pursuant to
and in accordance with Rule 144A under the Securities Act of 1933, as amended (the “Securities
Act”), and, accordingly, the Transferor hereby further certifies that the beneficial interest or
Definitive Note is being transferred to a Person that the Transferor reasonably believes is
purchasing the beneficial interest or Definitive Note for its own account, or for one or more
accounts with respect to which such Person exercises sole investment discretion, and such Person
and each such account is a “qualified institutional buyer” within the meaning of Rule 144A in a
transaction meeting the requirements of Rule 144A, and such Transfer is in compliance with any
applicable blue sky securities laws of any state of the United States. Upon consummation of the
proposed Transfer in accordance with the terms of the Indenture, the transferred beneficial
interest or Definitive Note shall be subject to the restrictions on transfer enumerated in the
Private Placement Legend printed on the 144A Global Note and/or the Restricted Definitive Note and
in the Indenture and the Securities Act.

     2. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE REGULATION S
TEMPORARY GLOBAL NOTE, THE REGULATION S PERMANENT GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE
PURSUANT TO REGULATION S. The Transfer is being effected pursuant to and in accordance with Rule
903 or Rule 904 under the Securities Act and, accordingly, the Transferor hereby further certifies
that (i) the Transfer is not being made to a Person in the United States and (x) at the time the
buy order was originated, the Transferee was outside the United States or such Transferor and any
Person acting on its behalf reasonably believed and believes that the Transferee was outside the
United States or (y) the transaction was

B-1

 

executed in, on or through the facilities of a designated offshore securities market and
neither such Transferor nor any Person acting on its behalf knows that the transaction was
prearranged with a buyer in the United States, (ii) no directed selling efforts have been made in
contravention of the requirements of Rule 903(b) or Rule 904(b) of Regulation S under the
Securities Act, (iii) the transaction is not part of a plan or scheme to evade the registration
requirements of the Securities Act and (iv) if the proposed transfer is being made prior to the
expiration of the Restricted Period, the transfer is not being made to a U.S. Person or for the
account or benefit of a U.S. Person (other than an Initial Purchaser). Upon consummation of the
proposed transfer in accordance with the terms of the Indenture, the transferred beneficial
interest or Definitive Note shall be subject to the restrictions on Transfer enumerated in the
Private Placement Legend printed on the Regulation S Permanent Global Note, the Regulation S
Temporary Global Note and/or the Restricted Definitive Note and in the Indenture and the Securities
Act.

     3. o CHECK AND COMPLETE IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE IAI
GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO ANY PROVISION OF THE SECURITIES ACT OTHER
THAN RULE 144A OR REGULATION S. The Transfer is being effected in compliance with the transfer
restrictions applicable to beneficial interests in Restricted Global Notes and Restricted
Definitive Notes and pursuant to and in accordance with the Securities Act and any applicable blue
sky securities laws of any state of the United States, and accordingly the Transferor hereby
further certifies that (check one):

     (a) o such Transfer is being effected pursuant to and in accordance with Rule 144 under the
Securities Act; or

     (b) o such Transfer is being effected to the Issuers or a subsidiary thereof; or

     (c) o such Transfer is being effected pursuant to an effective registration statement under
the Securities Act and in compliance with the prospectus delivery requirements of the Securities
Act; or

     (d) o such Transfer is being effected to an Institutional Accredited Investor and pursuant to
an exemption from the registration requirements of the Securities Act other than Rule 144A, Rule
144, Rule 903 or Rule 904, and the Transferor hereby further certifies that it has not engaged in
any general solicitation within the meaning of Regulation D under the Securities Act and the
Transfer complies with the transfer restrictions applicable to beneficial interests in a Restricted
Global Note or Restricted Definitive Notes and the requirements of the exemption claimed, which
certification is supported by (1) a certificate executed by the Transferee in the form of Exhibit D
to the Indenture and (2) requested by an Issuer, an Opinion of Counsel provided by the Transferor
or the Transferee (a copy of which the Transferor has attached to this certification), to the
effect that such Transfer is in compliance with the Securities Act. Upon consummation of the
proposed transfer in accordance with the terms of the Indenture, the transferred beneficial
interest or Definitive Note shall be subject to the restrictions on transfer enumerated in the
Private Placement Legend printed on the IAI Global Note and/or the Restricted Definitive Notes and
in the Indenture and the Securities Act.

     4. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN AN UNRESTRICTED
GLOBAL NOTE OR OF AN UNRESTRICTED DEFINITIVE NOTE.

     (a) o CHECK IF TRANSFER IS PURSUANT TO RULE 144. (i) The Transfer is being effected pursuant
to and in accordance with Rule 144 under the Securities Act and in compliance with the transfer
restrictions contained in the Indenture and any applicable blue sky securities laws of any state of
the United States and (ii) the restrictions on transfer contained in the Indenture and the Private
Placement Legend are not required in order to maintain compliance with the Securities Act. Upon
consummation of the proposed Transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall no longer be subject to the restrictions
on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes, on
Restricted Definitive Notes and in the Indenture.

     (b) o CHECK IF TRANSFER IS PURSUANT TO REGULATION S. (i) The Transfer is being effected
pursuant to and in accordance with Rule 903 or Rule 904 under the Securities Act and in compliance
with the transfer restrictions contained in the Indenture and any applicable blue sky securities
laws of any state of the United

B-2

 

States and (ii) the restrictions on transfer contained in the Indenture and the Private
Placement Legend are not required in order to maintain compliance with the Securities Act. Upon
consummation of the proposed Transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall no longer be subject to the restrictions
on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes, on
Restricted Definitive Notes and in the Indenture.

     (c) o CHECK IF TRANSFER IS PURSUANT TO OTHER EXEMPTION. (i) The Transfer is being effected
pursuant to and in compliance with an exemption from the registration requirements of the
Securities Act other than Rule 144, Rule 903 or Rule 904 and in compliance with the transfer
restrictions contained in the Indenture and any applicable blue sky securities laws of any state of
the United States and (ii) the restrictions on transfer contained in the Indenture and the Private
Placement Legend are not required in order to maintain compliance with the Securities Act. Upon
consummation of the proposed Transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall not be subject to the restrictions on
transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes or
Restricted Definitive Notes and in the Indenture.

     This certificate and the statements contained herein are made for your benefit and the benefit
of the Issuers.

	 	 	 	 	 
	 
	 	[Insert Name of Transferor]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

Dated: __________________

B-3

 

ANNEX A TO CERTIFICATE OF TRANSFER

	1.	 	The Transferor owns and proposes to transfer the following:

[CHECK ONE OF (a) OR (b)]

	(a)	 	o a beneficial interest in the:

	 	(i)	 	o 144A Global Note (CUSIP _________), or
	 
	 	(ii)	 	o Regulation S Global Note (CUSIP _________), or
	 
	 	(iii)	 	o IAI Global Note (CUSIP _________); or

	(b)	 	o a Restricted Definitive Note.
	 
	2.	 	After the Transfer the Transferee shall hold:

[CHECK ONE]

	(a)	 	o a beneficial interest in the:

	 	(i)	 	o 144A Global Note (CUSIP _________), or
	 
	 	(ii)	 	o Regulation S Global Note (CUSIP _________), or
	 
	 	(iii)	 	o IAI Global Note (CUSIP _________), or
	 
	 	(iv)	 	o Unrestricted Global Note (CUSIP _________); or

	(b)	 	o a Restricted Definitive Note; or
	 
	(c)	 	o an Unrestricted Definitive Note, in accordance with the terms of the Indenture.

B-4

 

EXHIBIT C

FORM OF CERTIFICATE OF EXCHANGE

Vanguard Health Holding Company II, LLC

Vanguard Holding Company II, Inc.

c/o Vanguard Health Systems Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Attention: General Counsel

U.S. Bank National Association

Corporate Trust Services

60 Livingston Avenue

St. Paul, Minnesota 55107

Attention: General Counsel

Re: 8% Senior Notes due 2018 (CUSIP)

     Reference is hereby made to the Indenture, dated as of January 29, 2010 (the “Indenture”),
among Vanguard Health Holding Company II, LLC, a Delaware limited liability company, (“VHS Holdco
II”), Vanguard Holding Company II, Inc., a Delaware corporation and a wholly owned subsidiary of
VHS Holdco II (together with VHS Holdco II, the “Issuers”), the Guarantors party thereto and U.S.
Bank National Association, as trustee. Capitalized terms used but not defined herein shall have
the meanings given to them in the Indenture.

     _________________________ (the “Owner”) owns and proposes to exchange the Note[s] or interest
in such Note[s] specified herein, in the principal amount of $_________ in such Note[s] or
interests (the “Exchange”). In connection with the Exchange, the owner hereby certifies that:

     1. EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN A RESTRICTED GLOBAL
NOTE FOR UNRESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN AN UNRESTRICTED GLOBAL NOTE

     (a) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO BENEFICIAL
INTEREST IN AN UNRESTRICTED GLOBAL NOTE. In connection with the Exchange of the owner’s beneficial
interest in a Restricted Global Note for a beneficial interest in an Unrestricted Global Note in an
equal principal amount, the Owner hereby certifies (i) the beneficial interest is being acquired
for the owner’s own account without transfer, (ii) such Exchange has been effected in compliance
with the transfer restrictions applicable to the Global Notes and pursuant to and in accordance
with the Securities Act of 1933, as amended (the “Securities Act”), (iii) the restrictions on
transfer contained in the Indenture and the Private Placement Legend are not required in order to
maintain compliance with the Securities Act and (iv) the beneficial interest in an Unrestricted
Global Note is being acquired in compliance with any applicable blue sky securities laws of any
state of the United States.

     (b) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO
UNRESTRICTED DEFINITIVE NOTE. In connection with the Exchange of the owner’s beneficial interest
in a Restricted Global Note for an Unrestricted Definitive Note, the Owner hereby certifies (i) the
Definitive Note is being acquired for the owner’s own account without transfer, (ii) such Exchange
has been effected in compliance with the transfer restrictions applicable to the Restricted Global
Notes and pursuant to and in accordance with the Securities Act, (iii) the restrictions on transfer
contained in the Indenture and the Private Placement Legend

C-1

 

are not required in order to maintain compliance with the Securities Act and (iv) the
Definitive Note is being acquired in compliance with any applicable blue sky securities laws of any
state of the United States.

     (c) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN AN
UNRESTRICTED GLOBAL NOTE. In connection with the owner’s Exchange of a Restricted Definitive Note
for a beneficial interest in an Unrestricted Global Note, the Owner hereby certifies (i) the
beneficial interest is being acquired for the Owner’s own account without transfer, (ii) such
Exchange has been effected in compliance with the transfer restrictions applicable to Restricted
Definitive Notes and pursuant to and in accordance with the Securities Act, (iii) the restrictions
on transfer contained in the Indenture and the Private Placement Legend are not required in order
to maintain compliance with the Securities Act and (iv) the beneficial interest is being acquired
in compliance with any applicable blue sky securities laws of any state of the United States.

     (d) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO UNRESTRICTED DEFINITIVE NOTE.
In connection with the owner’s Exchange of a Restricted Definitive Note for an Unrestricted
Definitive Note, the owner hereby certifies (i) the Unrestricted Definitive Note is being acquired
for the owner’s own account without transfer, (ii) such Exchange has been effected in compliance
with the transfer restrictions applicable to Restricted Definitive Notes and pursuant to and in
accordance with the Securities Act, (iii) the restrictions on transfer contained in the Indenture
and the Private Placement Legend are not required in order to maintain compliance with the
Securities Act and (iv) the Unrestricted Definitive Note is being acquired in compliance with any
applicable blue sky securities laws of any state of the United States.

     2. EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES
FOR RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES

     (a) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO RESTRICTED
DEFINITIVE NOTE. In connection with the Exchange of the Owner’s beneficial interest in a
Restricted Global Note for a Restricted Definitive Note with an equal principal amount, the owner
hereby certifies that the Restricted Definitive Note is being acquired for the Owner’s own account
without transfer. Upon consummation of the proposed Exchange in accordance with the terms of the
Indenture, the Restricted Definitive Note issued shall continue to be subject to the restrictions
on transfer enumerated in the Private Placement Legend printed on the Restricted Definitive Note
and in the Indenture and the Securities Act.

     (b) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN A
RESTRICTED GLOBAL NOTE. In connection with the Exchange of the Owner’s Restricted Definitive Note
for a beneficial interest in the [CHECK ONE] o 144A Global Note, o
Regulation S Global Note, o IAI
Global Note with an equal principal amount, the owner hereby certifies (i) the beneficial interest
is being acquired for the Owner’s own account without transfer and (ii) such Exchange has been
effected in compliance with the transfer restrictions applicable to the Restricted Global Notes and
pursuant to and in accordance with the Securities Act, and in compliance with any applicable blue
sky securities laws of any state of the United States. Upon consummation of the proposed Exchange
in accordance with the terms of the Indenture, the beneficial interest issued shall be subject to
the restrictions on transfer enumerated in the Private Placement Legend printed on the relevant
Restricted Global Note and in the Indenture and the Securities Act.

C-2

 

     This certificate and the statements contained herein are made for your benefit and the benefit
of the Issuers.

	 	 	 	 	 
	 
	 	
[Insert Name of Transferor]

 	 
	 	 	 
	 	By:  	
 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

Dated: _______________

C-3

 

EXHIBIT D

FORM OF CERTIFICATE FROM ACQUIRING INSTITUTIONAL ACCREDITED INVESTOR

Vanguard Health Holding Company II, LLC

Vanguard Holding Company II, Inc.

c/o Vanguard Health Systems Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Attention: General Counsel

U.S. Bank National Association

Corporate Trust Services

60 Livingston Avenue

St. Paul, Minnesota 55107

Attention: General Counsel

Re: 8% Senior Notes due 2018

     Reference is hereby made to the Indenture,
dated as of January 29, 2010 (the “Indenture”),
among Vanguard Health Holding Company II, LLC, a Delaware limited liability company, (“VHS Holdco
II”), Vanguard Holding Company II, Inc., a Delaware corporation and a wholly owned subsidiary of
VHS Holdco II (together with VHS Holdco II, the “Issuers”), the Guarantors party thereto and U.S.
Bank National Association, as trustee. Capitalized terms used but not defined herein shall have
the meanings given to them in the Indenture.

     In connection with our proposed purchase of
$____________ aggregate principal amount of:

     (a) o a beneficial interest in a Global Note, or

     (b) o a Definitive Note, we confirm that:

     1. We understand that any subsequent transfer of the Notes or any interest therein is subject
to certain restrictions and conditions set forth in the Indenture and the undersigned agrees to be
bound by, and not to resell, pledge or otherwise transfer the Notes or any interest therein except
in compliance with, such restrictions and conditions and the Securities Act of 1933, as amended
(the “Securities Act”).

     2. We understand that the offer and sale of the Notes have not been registered under the
Securities Act, and that the Notes and any interest therein may not be offered or sold except as
permitted in the following sentence. We agree, on our own behalf and on behalf of any accounts for
which we are acting as hereinafter stated, that if we should sell the Notes or any interest
therein, we shall do so only (A) to the Issuers or any subsidiary thereof, (B) in accordance with
Rule 144A under the Securities Act to a “qualified institutional buyer” (as defined therein), (C)
to an institutional “accredited investor” (as defined below) that, prior to such transfer,
furnishes (or has furnished on its behalf by a U.S. broker-dealer) to you and to the Issuers a
signed letter substantially in the form of this letter and, if requested by an Issuer, an Opinion
of Counsel in form reasonably acceptable to the Issuers to the effect that such transfer is in
compliance with the Securities Act, (D) outside the United States in accordance with Rule 904 of
Regulation S under the Securities Act, (E) pursuant to the provisions of Rule 144(k) under the
Securities Act or (F) pursuant to an effective registration statement under the Securities Act, and
we further agree to provide to any Person purchasing the Definitive Note or beneficial interest in
a Global Note from us in a transaction meeting the requirements of clauses (A) through (E) of this
paragraph a notice advising such purchaser that resales thereof are restricted as stated herein.

D-1

 

     3. We understand that, on any proposed resale of the Notes or beneficial interest therein, we
shall be required to furnish to you and the Issuers such certifications, legal opinions and other
information as you and the Issuers may reasonably require to confirm that the proposed sale
complies with the foregoing restrictions. We further understand that the Notes purchased by us
shall bear a legend to the foregoing effect.

     4. We are an institutional “accredited investor” (as defined in Rule 501(a)(1), (2), (3) or
(7) of Regulation D under the Securities Act) and have such knowledge and experience in financial
and business matters as to be capable of evaluating the merits and risks of our investment in the
Notes, and we and any accounts for which we are acting are each able to bear the economic risk of
our or its investment.

     5. We are acquiring the Notes or beneficial interest therein purchased by us for our own
account or for one or more accounts (each of which is an institutional “accredited investor”) as to
each of which we exercise sole investment discretion.

     You and the Issuers are entitled to rely upon this letter and are irrevocably authorized to
produce this letter or a copy hereof to any interested party in any administrative or legal
proceedings or official inquiry with respect to the matters covered hereby.

	 	 	 	 	 
	 	[Insert Name of Accredited Investor]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

Dated: __________________

D-2

 

EXHIBIT E

[FORM OF SUPPLEMENTAL INDENTURE TO BE DELIVERED BY SUBSEQUENT GUARANTORS]

     SUPPLEMENTAL INDENTURE (this “Supplemental
Indenture”), dated as of _______________, 201_,
among ________________________ (the “New Guarantor”), a subsidiary of Vanguard Health Holding
Company II, LLC, a Delaware limited liability company (“VHS Holdco II”), Vanguard Holding Company
II, Inc., a Delaware corporation and a wholly owned subsidiary of VHS Holdco II (together with VHS
Holdco II, the “Issuers”) and U.S. Bank National Association, as trustee under the Indenture
referred to below (the “Trustee”).

WITNESSETH

     WHEREAS, the Issuers and the existing Guarantors have heretofore executed and delivered to the
Trustee an indenture (as amended, supplemented or otherwise modified, the “Indenture”), dated as of
January 29. 2010 providing for the issuance of 8% Senior Notes due 2018 (the “Notes”);

     WHEREAS, Section 4.13 of the Indenture provides that under certain circumstances the New
Guarantor shall execute and deliver to the Trustee a supplemental indenture pursuant to which the
New Guarantor shall unconditionally guarantee all of the Issuers’ Obligations under the Notes and
the Indenture on the terms and conditions set forth herein (the “Guarantee”); and

     WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee and the Issuers are authorized
to execute and deliver this Supplemental Indenture.

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

     1. Defined Terms. Defined terms used herein without definition shall have the
meanings assigned to them in the Indenture.

     2. Agreement to Guarantee. The New Guarantor hereby agrees, jointly and severally
with all existing Guarantors (if any), to provide an unconditional Guarantee on the terms and
subject to the conditions set forth in Article X of the Indenture and to be bound by all other
applicable provisions of the Indenture and the Notes and to perform all of the obligations and
agreements of a Guarantor under the Indenture.

     3. No Recourse Against Others. No past, present or future director, manager, officer,
employee, incorporator, stockholder or member of the Issuers, any parent entity of the Issuers or
any Subsidiary, as such, shall have any liability for any obligations of the Issuers or the
Guarantors under the Notes, this Indenture, the Guarantees or for any claim based on, in respect
of, or by reason of, such obligations or their creation. Each Holder of Notes by accepting a Note
waives and releases all such liability. The waiver and release are part of the consideration for
issuance of the Notes. The waiver may not be effective to waive liabilities under the federal
securities laws.

     4. Notices. All notices or other communications to the New Guarantor shall be given
as provided in Section 12.02 of the Indenture.

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

     6. GOVERNING LAW. THIS INDENTURE, THE NOTES AND THE GUARANTEES SHALL BE GOVERNED BY,
AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

E-1

 

     7. 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.

     8. Effect of Headings. The section headings herein are for convenience only and shall
not affect the construction hereof.

     9. Trustee Makes No Representation. The Trustee makes no representation as to the
validity or sufficiency of this Supplemental Indenture.

E-2

 

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

Dated: _______________, 20___

	 	 	 	 	 
	 	[NEW GUARANTOR]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HEALTH HOLDING COMPANY II, LLC

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HOLDING COMPANY II, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HEALTH HOLDING COMPANY I, LLC

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	VANGUARD HEALTH SYSTEMS, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	U.S. BANK NATIONAL ASSOCIATION, as Trustee

 	 
	 	By:  	 	 
	 	 	Authorized Signatory 	 
	 	 	 	 
	 

E-3exv4w2

EXHIBIT 4.2

REGISTRATION RIGHTS AGREEMENT

by and among

VANGUARD HEALTH HOLDING COMPANY II, LLC,

VANGUARD HOLDING COMPANY II, INC.,

VANGUARD HEALTH SYSTEMS, INC.

and

the Other Guarantors Party Hereto

and

Banc of America Securities LLC

Barclays Capital Inc.

Citigroup Global Markets Inc.

Deutsche Bank Securities Inc.

Goldman, Sachs & Co.

Morgan Stanley & Co. Incorporated

Dated as of January 29, 2010

 

 

REGISTRATION RIGHTS AGREEMENT

     This Registration Rights Agreement (this “Agreement”) is made and entered into as of January
29, 2010, by and among Vanguard Health Holding Company II, LLC, a Delaware limited liability
company (the “Company”), and Vanguard Holding Company II, Inc., a Delaware corporation (the
“Co-Issuer” and, together with the Company, the “Companies”), Vanguard Health Systems, Inc., a
Delaware corporation (the “Parent”), the other entities listed on the signature pages hereof as
“Guarantors” (collectively, the “Guarantors”), and Banc of America Securities LLC and Barclays
Capital Inc. on behalf of themselves and as representatives of the several initial purchasers
listed on Schedule I hereto (collectively, the “Initial Purchasers”), each of whom has agreed to
purchase the Companies’ 8% Senior Notes due 2018 (the “Initial Notes”) fully and unconditionally
guaranteed by the Guarantors (the “Guarantees”) pursuant to the Purchase Agreement (as defined
below). The Initial Notes and the Guarantees attached thereto are herein collectively referred to
as the “Initial Securities.” The Companies and the Guarantors are collectively referred to herein
as the “Issuers.”

     This Agreement is made pursuant to the Purchase Agreement, dated January 20, 2010 (the
“Purchase Agreement”), among the Issuers, the Guarantors and the Initial Purchasers (i) for the
benefit of the Initial Purchasers and (ii) for the benefit of the holders from time to time of the
Initial Securities, including the Initial Purchasers. In order to induce the Initial Purchasers to
purchase the Initial Securities, the Issuers have agreed to provide the registration rights set
forth in this Agreement. The execution and delivery of this Agreement is a condition to the
obligations of the Initial Purchasers set forth in Section 5(f) of the Purchase Agreement.

     The parties hereby agree as follows:

     SECTION 1. Definitions. As used in this Agreement, the following capitalized terms shall have
the following meanings:

     Additional Interest Payment Date: With respect to the Initial Securities, each Interest
Payment Date.

     Broker-Dealer: Any broker or dealer registered under the Exchange Act.

     Business Day: Any day other than a Saturday, Sunday or U.S. federal holiday or a day on which
banking institutions or trust companies located in New York, New York are authorized or obligated
to be closed.

     Closing Date: The date of this Agreement.

     Commission: The Securities and Exchange Commission.

     Consummate: A registered Exchange Offer shall be deemed “Consummated” for purposes of this
Agreement upon the occurrence of (i) the filing and effectiveness under the Securities Act of the
Exchange Offer Registration Statement relating to the Exchange Securities to be issued in the
Exchange Offer, (ii) the maintenance of such Registration Statement continuously effective and the
keeping of the Exchange Offer open for a period not less than the minimum pe-

-2-

 

riod required pursuant to Section 3(b) hereof, and (iii) the delivery by the Issuers to the
Registrar under the Indenture of Exchange Securities in the same aggregate principal amount as the
aggregate principal amount of Initial Securities that were tendered by Holders thereof pursuant to
the Exchange Offer.

     Exchange Act: The Securities Exchange Act of 1934, as amended.

     Exchange Offer: The registration by the Issuers under the Securities Act of the Exchange
Securities pursuant to a Registration Statement pursuant to which the Issuers offer the Holders of
all outstanding Transfer Restricted Securities the opportunity to exchange all such outstanding
Transfer Restricted Securities held by such Holders for Exchange Securities in an aggregate
principal amount equal to the aggregate principal amount of the Transfer Restricted Securities
tendered in such exchange offer by such Holders.

     Exchange Offer Registration Statement: The Registration Statement relating to the Exchange
Offer, including the related Prospectus.

     Exempt Resales: The transactions in which the Initial Purchasers propose to sell the Initial
Securities to certain “qualified institutional buyers,” as such term is defined in Rule 144A under
the Securities Act and to certain non-U.S. persons pursuant to Regulation S under the Securities
Act.

     Exchange Securities: The 8% Senior Notes due 2018, of the same series under the Indenture as
the Initial Notes and the Guarantees attached thereto, to be issued to Holders in exchange for
Transfer Restricted Securities pursuant to this Agreement.

     FINRA: The Financial Industry Regulatory Authority.

     Holders: As defined in Section 2(b) hereof.

     Indemnified Holder: As defined in Section 8(a) hereof.

     Indenture: The Indenture, dated as of January 29, 2010, by and among the Issuers and U.S.
Bank National Association, as trustee (the “Trustee”), pursuant to which the Initial Securities are
to be issued, as such Indenture is amended or supplemented from time to time in accordance with the
terms thereof.

     Initial Purchasers: As defined in the preamble hereto.

     Initial Notes: As defined in the preamble hereto.

     Initial Placement: The issuance and sale by the Companies of the Initial Securities to the
Initial Purchasers pursuant to the Purchase Agreement.

     Initial Securities. As defined in the preamble hereto.

     Interest Payment Date: As defined in the Indenture and the Initial Securities.

-3-

 

     Person: An individual, partnership, corporation, trust or unincorporated organization, or a
government or agency or political subdivision thereof.

     Prospectus: The prospectus included in a Registration Statement, as amended or supplemented
by any prospectus supplement and by all other amendments thereto, including post-effective
amendments, and all material incorporated by reference into such Prospectus.

     Registration Default: As defined in Section 5 hereof.

     Registration Statement: Any registration statement of the Issuers relating to (a) an offering
of Exchange Securities pursuant to an Exchange Offer or (b) the registration for resale of Transfer
Restricted Securities pursuant to the Shelf Registration Statement, which is filed pursuant to the
provisions of this Agreement, in each case, including the Prospectus included therein, all
amendments and supplements thereto (including post-effective amendments) and all exhibits and
material incorporated by reference therein.

     Securities Act: The Securities Act of 1933, as amended.

     Shelf Filing Deadline: As defined in Section 4(a) hereof.

     Shelf Registration Statement: As defined in Section 4(a) hereof.

     Shelf Suspension Period: As defined in Section 4(a) hereof.

     Transfer Restricted Securities: Each Initial Security, until the earliest to occur of (a) the
date on which such Initial Security is exchanged in the Exchange Offer for an Exchange Security
entitled to be resold to the public by the Holder thereof without complying with the prospectus
delivery requirements of the Securities Act, (b) the date on which such Initial Security has been
effectively registered under the Securities Act and disposed of in accordance with a Shelf
Registration Statement, (c) the date on which such Initial Security is distributed to the public by
a Broker-Dealer pursuant to the “Plan of Distribution” contemplated by the Exchange Offer
Registration Statement (including delivery of the Prospectus contained therein) and (d) the later
of (x) the date which is two years after the date the Initial Securities were originally issued and
(y) the date upon which such Initial Security (and the related Guarantees) has been resold in
compliance with Rule 144 under the Securities Act; provided that such Initial Security no longer
bears any restrictive legend relating to the Securities Act and does not bear a restricted CUSIP
number.

     Trust Indenture Act: The Trust Indenture Act of 1939, as amended.

     Underwritten Registration or Underwritten Offering: A registration in which securities of the
Companies are sold to an underwriter for reoffering to the public.

     SECTION 2. Securities Subject to this Agreement.

     (a) Transfer Restricted Securities. The securities entitled to the benefits of this Agreement
are the Transfer Restricted Securities.

-4-

 

     (b) Holders of Transfer Restricted Securities. A Person is deemed to be a holder of Transfer
Restricted Securities (each, a “Holder”) whenever such Person owns Transfer Restricted Securities.

     SECTION 3. Registered Exchange Offer.

     (a) Unless the Exchange Offer shall not be permissible under applicable law or Commission
policy (after the procedures set forth in Section 6(a) hereof have been complied with), the Issuers
shall use their reasonable best efforts to (i) cause to be filed with the Commission a Registration
Statement under the Securities Act relating to the Exchange Securities and the Exchange Offer, (ii)
cause such Registration Statement to become effective at the earliest possible time, (iii) in
connection with the foregoing, file (A) all pre-effective amendments to such Registration Statement
as may be necessary in order to cause such Registration Statement to become effective, (B) if
applicable, a post-effective amendment to such Registration Statement pursuant to Rule 430A under
the Securities Act and (C) cause all necessary filings in connection with the registration and
qualification of the Exchange Securities to be made under the state securities or blue sky laws of
such jurisdictions as are necessary to permit Consummation of the Exchange Offer, and (iv) upon the
effectiveness of such Registration Statement, commence the Exchange Offer. The Exchange Offer
shall be on the appropriate form permitting registration of the Exchange Securities to be offered
in exchange for the Transfer Restricted Securities and to permit resales of Initial Securities held
by Broker-Dealers as contemplated by Section 3(c) hereof.

     (b) The Issuers shall cause the Exchange Offer Registration Statement to be effective
continuously and shall keep the Exchange Offer open for a period of not less than the minimum
period required under applicable federal and state securities laws to Consummate the Exchange
Offer; provided, however, that in no event shall such period be less than 20 Business Days after
the date notice of the Exchange Offer is mailed to the Holders. The Issuers shall cause the
Exchange Offer to comply with all applicable federal and state securities laws. No securities
other than the Exchange Securities shall be included in the Exchange Offer Registration Statement.
The Issuers shall use their reasonable best efforts to cause the Exchange Offer to be Consummated
on the earliest practicable date after the Exchange Offer Registration Statement has become
effective, but in no event later than 360 days after the Closing Date (or if such 360th day is not
a Business Day, the next succeeding Business Day).

     (c) The Issuers shall indicate in a “Plan of Distribution” section contained in the Prospectus
forming a part of the Exchange Offer Registration Statement that any Broker-Dealer who holds
Initial Securities that are Transfer Restricted Securities and that were acquired for its own
account as a result of market-making activities or other trading activities (other than Transfer
Restricted Securities acquired directly from the Issuers), may exchange such Initial Securities
pursuant to the Exchange Offer; however, such Broker-Dealer may be deemed to be an “underwriter”
within the meaning of the Securities Act and must, therefore, deliver a prospectus meeting the
requirements of the Securities Act in connection with any resales of the Exchange Securities
received by such Broker-Dealer in the Exchange Offer, which prospectus delivery requirement may be
satisfied by the delivery by such Broker-Dealer of the Prospectus contained in the Exchange Offer
Registration Statement. Such “Plan of Distribution” section shall also contain

-5-

 

all other information with respect to such resales by Broker-Dealers that the Commission may
require in order to permit such resales pursuant thereto, but such “Plan of Distribution” shall not
name any such Broker-Dealer or disclose the amount of Initial Securities held by any such
Broker-Dealer except to the extent required by the Commission as a result of a change in policy
after the date of this Agreement.

     The Issuers shall use their reasonable best efforts to keep the Exchange Offer Registration
Statement continuously effective, supplemented and amended as required by the provisions of Section
6(c) hereof to the extent necessary to ensure that it is available for resales of Initial
Securities acquired by Broker-Dealers for their own accounts as a result of market-making
activities or other trading activities, and to ensure that it conforms with the requirements of
this Agreement, the Securities Act and the policies, rules and regulations of the Commission as
announced from time to time, for a period ending on the earlier of (i) 180 days from the date on
which the Exchange Offer Registration Statement is declared effective and (ii) the date on which a
Broker-Dealer is no longer required to deliver a prospectus in connection with market-making or
other trading activities.

     The Issuers shall provide sufficient copies of the latest version of such Prospectus to
Broker-Dealers promptly upon request at any time during such 180-day (or shorter as provided in the
foregoing sentence) period in order to facilitate such resales.

     SECTION 4. Shelf Registration.

     (a) Shelf Registration. If (i) the Issuers are not required to file an Exchange Offer
Registration Statement or to consummate the Exchange Offer because the Exchange Offer is not
permitted by applicable law or Commission policy (after the procedures set forth in Section 6(a)
hereof have been complied with), (ii) for any reason the Exchange Offer is not Consummated within
360 days after the Closing Date (or if such 360th day is not a Business Day, the next succeeding
Business Day), or (iii) with respect to any Holder of Transfer Restricted Securities (A) such
Holder is prohibited by applicable law or Commission policy from participating in the Exchange
Offer, or (B) such Holder may not resell the Exchange Securities acquired by it in the Exchange
Offer to the public without delivering a prospectus and that the Prospectus contained in the
Exchange Offer Registration Statement is not appropriate or available for such resales by such
Holder, or (C) such Holder is a Broker-Dealer and holds Initial Securities acquired directly from
an Issuer or one of its affiliates, then, upon such Holder’s request, the Issuers shall

     (x) cause to be filed a shelf registration statement pursuant to Rule 415 under the
Securities Act, which may be an amendment to the Exchange Offer Registration Statement (in
either event, the “Shelf Registration Statement”) on or prior to the earliest to occur of
(1) the 90th day after the date on which the Company determines that it is not required to
file the Exchange Offer Registration Statement and (2) the 90th day after the date on which
the Company receives notice from a Holder of Transfer Restricted Securities as contemplated
by clause (ii) above (such date being the “Shelf Filing Deadline”), which Shelf Registration
Statement shall provide for resales of all Transfer Restricted Securities the Holders of
which shall have provided the information required pursuant to Section 4(b) hereof; and

-6-

 

     (y) use their reasonable best efforts to cause such Shelf Registration Statement to be
declared effective by the Commission on or before the 90th day after the Shelf Filing
Deadline (or if such 90th day is not a Business Day, the next succeeding Business Day).

     The Issuers shall use their reasonable best efforts to keep such Shelf Registration Statement
continuously effective, supplemented and amended as required by the provisions of Sections 6(b) and
(c) hereof to the extent necessary to ensure that it is available for resales of Initial Securities
by the Holders of Transfer Restricted Securities entitled to the benefit of this Section 4(a), and
to ensure that it conforms with the requirements of this Agreement, the Securities Act and the
policies, rules and regulations of the Commission as announced from time to time, for a period of
at least two years following the effective date of such Shelf Registration Statement (or shorter
period that will terminate when all the Initial Securities covered by such Shelf Registration
Statement have been sold pursuant to such Shelf Registration Statement).

     Notwithstanding anything to the contrary in this Agreement, at any time the Issuers may delay
the filing of any Shelf Registration Statement or delay or suspend the effectiveness thereof, for a
reasonable period of time, but not in excess of 60 consecutive days or more than three (3) times
during any calendar year (each, a “Shelf Suspension Period”), if the Board of Directors and
Board of Representatives, as applicable, of the Companies determines reasonably and in good faith
that the filing of any such initial Shelf Registration Statement or the continuing effectiveness
thereof would require the disclosure of material non-public information that, in the reasonable
judgment of the Board of Directors and the Board of Representatives, as applicable, of the
Companies, would be detrimental to the Issuers if so disclosed or would otherwise materially
adversely affect a financing, acquisition, disposition, merger or other material transaction or
such action is required by applicable law.

     (b) Provision by Holders of Certain Information in Connection with the Shelf Registration
Statement. No Holder of Transfer Restricted Securities may include any of its Transfer Restricted
Securities in any Shelf Registration Statement pursuant to this Agreement unless and until such
Holder furnishes to the Issuers in writing, within 20 Business Days after receipt of a request
therefor, such information as the Issuers may reasonably request for use in connection with any
Shelf Registration Statement or Prospectus or preliminary Prospectus included therein. Each Holder
as to which any Shelf Registration Statement is being effected agrees to furnish promptly to the
Issuers all information required to be disclosed in order to make the information previously
furnished to the Issuers by such Holder not materially misleading.

     SECTION 5. Additional Interest. If (i) the Exchange Offer has not been Consummated within 360
days after the Closing Date or (ii) any 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 immediately by a post-effective amendment to such
Registration Statement that cures such failure and that is itself immediately declared effective
(each such event referred to in clauses (i) and (ii), a “Registration Default”), the Issuers hereby
agree that the interest rate borne by the Transfer Restricted Securities shall be increased by
0.25% per annum during the 90-day period immediately following the occurrence of any Registration
Default and shall increase by 0.25% per annum at the end of each subsequent

-7-

 

90-day period, but in no event shall such increase exceed 1.00% per annum. Following the cure
of all Registration Defaults relating to any particular Transfer Restricted Securities, the
interest rate borne by the relevant Transfer Restricted Securities will be reduced to the original
interest rate borne by such Transfer Restricted Securities; provided, however, that, if after any
such reduction in interest rate, a different Registration Default occurs, the interest rate borne
by the relevant Transfer Restricted Securities shall again be increased pursuant to the foregoing
provisions. Notwithstanding any other provisions of this Section 5, the Issuers shall not be
obligated to pay Additional Interest provided in this Section 5 during a Shelf Suspension Period
permitted by Section 4 (a) hereof.

     All obligations of the Issuers set forth in the preceding paragraph that are outstanding with
respect to any Transfer Restricted Security at the time such security ceases to be a Transfer
Restricted Security shall survive until such time as all such obligations with respect to such
security shall have been satisfied in full.

     SECTION 6. Registration Procedures.

     (a) Exchange Offer Registration Statement. In connection with the Exchange Offer, the Issuers
shall comply with all of the provisions of Section 6(c) hereof, shall use their reasonable best
efforts to effect such exchange to permit the sale of Transfer Restricted Securities being sold in
accordance with the intended method or methods of distribution thereof, and shall comply with all
of the following provisions:

     (i) If in the reasonable opinion of counsel to the Issuers there is a question as to
whether the Exchange Offer is permitted by applicable law and it is advisable to do so, the
Issuers hereby agree to seek a no-action letter or other favorable decision from the
Commission allowing the Issuers to Consummate an Exchange Offer for such Initial Securities.
The Issuers hereby agree to pursue the issuance of such a decision to the Commission staff
level but shall not be required to take action to effect a change of Commission policy. The
Issuers hereby agree, however, to (A) participate in telephonic conferences with the
Commission, (B) deliver to the Commission staff an analysis prepared by counsel to the
Issuers setting forth the legal bases, if any, upon which such counsel has concluded that
such an Exchange Offer should be permitted and (C) diligently pursue a resolution by the
Commission staff of such submission.

     (ii) As a condition to its participation in the Exchange Offer pursuant to the terms of
this Agreement, each Holder of Transfer Restricted Securities shall furnish, upon the
request of the Issuers, prior to the Consummation thereof, a written representation to the
Issuers (which may be contained in the letter of transmittal contemplated by the Exchange
Offer Registration Statement) to the effect that (A) it is not an affiliate of the Issuers,
(B) it is not engaged in, and does not intend to engage in, and has no arrangement or
understanding with any Person to participate in, a distribution of the Exchange Securities
to be issued in the Exchange Offer and (C) it is acquiring the Exchange Securities in its
ordinary course of business. In addition, all such Holders of Transfer Restricted
Securities shall otherwise cooperate in the Issuers’ preparations for the Exchange Offer.
Each Holder including any Holder that is a Broker-Dealer, hereby acknowledges and agrees
that any such Holder using the Exchange Offer to participate in a distribution of the secu-

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rities to be acquired in the Exchange Offer (1) could not under Commission policy as in
effect on the date of this Agreement rely on the position of the Commission enunciated in
Morgan Stanley & Co., Inc. (available June 5, 1991) and Exxon Capital Holdings
Corporation (available May 13, 1988), as interpreted in the Commission’s letter to
Shearman & Sterling dated July 2, 1993, and similar no-action letters (which may include any
no-action letter obtained pursuant to clause (i) above), and (2) must comply with the
registration and prospectus delivery requirements of the Securities Act in connection with a
secondary resale transaction and that such a secondary resale transaction should be covered
by an effective registration statement containing the selling security holder information
required by Item 507 or 508, as applicable, of Regulation S-K if the resales are of Exchange
Securities obtained by such Holder in exchange for Initial Securities acquired by such
Holder directly from the Issuers.

     (b) Shelf Registration Statement. In connection with the Shelf Registration Statement, the
Issuers shall comply with all the provisions of Section 6(c) hereof and shall use their reasonable
best efforts to effect such registration to permit the sale of the Transfer Restricted Securities
being sold in accordance with the intended method or methods of distribution thereof, and pursuant
thereto the Issuers will as expeditiously as possible prepare and file with the Commission a
Registration Statement relating to the registration on any appropriate form under the Securities
Act, which form shall be available for the sale of the Transfer Restricted Securities in accordance
with the intended method or methods of distribution thereof.

     (c) General Provisions. In connection with any Registration Statement and any Prospectus
required by this Agreement to permit the sale or resale of Transfer Restricted Securities
(including, without limitation, any Registration Statement and the related Prospectus required to
permit resales of Initial Securities by Broker-Dealers), the Issuers shall:

     (i) use their reasonable best efforts to keep such Registration Statement continuously
effective and provide all requisite financial statements (including, if required by the
Securities Act or any regulation thereunder, financial statements of the Guarantors for the
period specified in Section 3 or 4 hereof, as applicable; upon the occurrence of any event
that would cause any such Registration Statement or the Prospectus contained therein (A) to
contain an untrue statement of material fact or omit to state a material fact necessary to
make the statements therein not misleading or (B) not to be effective and usable for resale
of Transfer Restricted Securities during the period required by this Agreement, the Issuers
shall file promptly an appropriate amendment to such Registration Statement or supplement to
the Prospectus or documents incorporated by reference, in the case of clause (A), correcting
any such misstatement or omission, and, in the case of either clause (A) or (B), use their
reasonable best efforts to cause such amendment to be declared effective and such
Registration Statement and the related Prospectus to become usable for their intended
purpose(s) as soon as practicable thereafter;

     (ii) prepare and file with the Commission such amendments and post-effective amendments
to the applicable Registration Statement as may be necessary to keep the Registration
Statement effective for the applicable period set forth in Section 3 or 4 hereof, as
applicable, or such shorter period as will terminate when all Transfer Re-

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stricted Securities covered by such Registration Statement have been sold; cause the
Prospectus to be supplemented by any required Prospectus supplement, and as so supplemented
to be filed pursuant to Rule 424 under the Securities Act, and to comply fully with the
applicable provisions of Rules 424 and 430A under the Securities Act in a timely manner; and
comply with the provisions of the Securities Act with respect to the disposition of all
securities covered by such Registration Statement during the applicable period in accordance
with the intended method or methods of distribution by the sellers thereof set forth in such
Registration Statement or supplement to the Prospectus;

     (iii) advise the underwriter(s), if any, and selling Holders promptly and, if requested
by such Persons, to confirm such advice in writing, (A) when the Prospectus or any
Prospectus supplement or post-effective amendment has been filed, and, with respect to any
Registration Statement or any post-effective amendment thereto, when the same has become
effective, (B) of any request by the Commission for amendments to the Registration Statement
or amendments or supplements to the Prospectus or for additional information relating
thereto, (C) of the issuance by the Commission of any stop order suspending the
effectiveness of the Registration Statement under the Securities Act or of the suspension by
any state securities commission of the qualification of the Transfer Restricted Securities
for offering or sale in any jurisdiction, or the initiation of any proceeding for any of the
preceding purposes and (D) of the existence of any fact or the happening of any event that
makes any statement of a material fact made in the Registration Statement, the Prospectus,
any amendment or supplement thereto, or any document incorporated by reference therein
untrue, or that requires the making of any additions to or changes in the Registration
Statement or the Prospectus in order to make the statements therein not misleading. If at
any time the Commission shall issue any stop order suspending the effectiveness of the
Registration Statement, or any state securities commission or other regulatory authority
shall issue an order suspending the qualification or exemption from qualification of the
Transfer Restricted Securities under state securities or blue sky laws, the Issuers shall
use their reasonable best efforts to obtain the withdrawal or lifting of such order at the
earliest possible time;

     (iv) furnish without charge to counsel for the Initial Purchasers, each selling Holder
named in any Registration Statement, and each of the underwriter(s), if any, at least one
copy before filing with the Commission, of any Registration Statement or any Prospectus
included therein or any amendments or supplements to any such Registration Statement or
Prospectus (including, if requested by any such Person, all documents incorporated by
reference after the initial filing of such Registration Statement if not available on the
Commission’s EDGAR database), which documents will be subject to the review of the Initial
Purchasers in connection with such sale, if any, for a period of at least five Business
Days, and the Issuers will not file any such Registration Statement or Prospectus or any
amendment or supplement to any such Registration Statement or Prospectus (including all such
documents incorporated by reference) to which an Initial Purchaser of Transfer Restricted
Securities covered by such Registration Statement or the underwriter, if any, shall
reasonably object in writing within five Business Days after the receipt thereof (such
objection to be deemed timely made upon confirmation of telecopy transmission within such
period). The objection of an Initial Purchaser or underwriter, if

-10-

 

any, shall be deemed to be reasonable if such Registration Statement, amendment,
Prospectus or supplement, as applicable, as proposed to be filed, contains an untrue
statement of a material fact or omits to state a material fact necessary to make the
statements therein not misleading;

     (v) promptly prior to the filing of any document that is to be incorporated by
reference into a Registration Statement or Prospectus, provide copies of such document to
the Initial Purchasers, each selling Holder named in any Registration Statement, and to the
underwriter(s), if any, make the Issuers’ representatives available for discussion of such
document and other customary due diligence matters, and include such information in such
document prior to the filing thereof as such selling Holders or underwriter(s), if any,
reasonably may request;

     (vi) make available at reasonable times for inspection by the Initial Purchasers, the
managing underwriter(s), if any, participating in any disposition pursuant to such
Registration Statement and any attorney or accountant retained by such Initial Purchasers or
any of the underwriter(s), all pertinent financial and other records, pertinent corporate
documents and properties of each of the Issuers and cause the Issuers’ officers, directors
and employees to supply all information reasonably requested by any such Holder,
underwriter, attorney or accountant in connection with such Registration Statement or any
post-effective amendment thereto subsequent to the filing thereof and prior to its
effectiveness, in each case, as shall be reasonably necessary to enable such persons to
conduct an investigation within the meaning of Section 11 of the Securities Act; provided,
however, (A) that the foregoing inspection and information gathering shall be coordinated on
behalf of the Initial Purchasers by Cahill, Gordon & Reindel LLP and on behalf of any other
parties by one counsel designated by and on behalf of such other parties as described in
Section 7 hereof, and (B) that any information that is reasonably and in good faith
designated by the Issuers in writing as confidential at the time of delivery of such
information shall be kept confidential by the Initial Purchasers, the Holders, or any such
underwriter, attorney, accountant or other agent, unless (1) disclosure of such information
is required by court or administrative order or is necessary to respond to inquiries of
regulatory authorities, (2) disclosure of such information is required by law (including any
disclosure requirements pursuant to federal securities laws in connection with the filing of
such Registration Statement or the use of any Prospectus), (3) such information becomes
generally available to the public other than as a result of a disclosure or failure to
safeguard such information by such person or (4) such information becomes available to such
Initial Purchaser, Holder, underwriter, attorney, accountant or other agent from a source
other than the Issuer and such source is not known by the relevant Initial Purchaser,
Holder, underwriter, attorney, accountant or other agent to be bound by a confidentiality
agreement or is not otherwise under a duty of trust to the Issuer;

     (vii) if requested by any selling Holders or the underwriter(s), if any, promptly
incorporate in any Registration Statement or Prospectus, pursuant to a supplement or
post-effective amendment if necessary, such information as such selling Holders and
underwriter(s), if any, may reasonably request to have included therein, including, without
limitation, information relating to the “Plan of Distribution” of the Transfer Restricted

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Securities, information with respect to the principal amount of Transfer Restricted
Securities being sold to such underwriter(s), the purchase price being paid therefor and any
other terms of the offering of the Transfer Restricted Securities to be sold in such
offering; and make all required filings of such Prospectus supplement or post-effective
amendment as soon as practicable after the Issuers are notified of the matters to be
incorporated in such Prospectus supplement or post-effective amendment;

     (viii) use reasonable best efforts to confirm that the ratings assigned to the Initial
Securities will apply to the Transfer Restricted Securities covered by the Registration
Statement, if so requested by the Holders of a majority in aggregate principal amount of
Initial Securities covered thereby or the underwriter(s), if any;

     (ix) furnish to each Initial Purchaser, each selling Holder and each of the
underwriter(s), if any, without charge, at least one copy of the Registration Statement, as
first filed with the Commission, and of each amendment thereto, including financial
statements and schedules and if requested all documents incorporated by reference therein
and all exhibits (including exhibits incorporated therein by reference);

     (x) deliver to each selling Holder and each of the underwriter(s), if any, without
charge, as many copies of the Prospectus (including each preliminary prospectus) and any
amendment or supplement thereto as such Persons reasonably may request; the Issuers hereby
consent to the use of the Prospectus and any amendment or supplement thereto by each of the
selling Holders and each of the underwriter(s), if any, in connection with the offering and
the sale of the Transfer Restricted Securities covered by the Prospectus or any amendment or
supplement thereto;

     (xi) enter into such agreements (including an underwriting agreement), and make such
representations and warranties, and take all such other actions in connection therewith in
order to expedite or facilitate the disposition of the Transfer Restricted Securities
pursuant to any Registration Statement contemplated by this Agreement, all to such extent as
may be reasonably requested by an Initial Purchaser or by any Holder of Transfer Restricted
Securities or underwriter in connection with any sale or resale pursuant to any Registration
Statement contemplated by this Agreement; and whether or not an underwriting agreement is
entered into and whether or not the registration is an Underwritten Registration, the
Issuers shall:

     (A) furnish to each Initial Purchaser, each selling Holder and each
underwriter, if any, in such substance and scope as they may reasonably request and
as are customarily made by issuers to underwriters in primary underwritten
offerings, upon the date of the effectiveness of the Shelf Registration Statement:

     (1) a certificate, dated the date of effectiveness of the Shelf
Registration Statement signed by (y) the President or any Vice President and
(z) a principal financial or accounting officer of each of the Issuers,
confirming, as of the date thereof, the matters set forth in paragraphs (i),
(ii) and (iii) of Section 5(e) of the Purchase Agreement and such other
matters as such parties may reasonably request;

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     (2) an opinion, dated the date of effectiveness of the Shelf
Registration Statement of counsel for the Issuers, in form, scope and
substance reasonably satisfactory to the managing underwriter, addressed to
the underwriters covering the matters customarily covered in opinions,
reasonably requested in underwritten offerings, and in any event including a
statement to the effect that such counsel has participated in conferences
with officers and other representatives of the Issuers the Initial
Purchasers’ representatives and the Initial Purchasers’ counsel in
connection with the preparation of such Registration Statement and the
related Prospectus and have considered the matters required to be stated
therein and the statements contained therein, although such counsel has not
independently verified the accuracy, completeness or fairness of such
statements; and that such counsel advises that, on the basis of the
foregoing (relying as to materiality to a large extent upon facts provided
to such counsel by officers and other representatives of the Issuers and
without independent check or verification), no facts came to such counsel’s
attention that caused such counsel to believe that the Registration
Statement, at the time such Registration Statement or any post-effective
amendment thereto became effective, contained an untrue statement of a
material fact or omitted to state a material fact required to be stated
therein or necessary to make the statements therein not misleading, or that
the Prospectus contained in such Registration Statement as of its date
contained an untrue statement of a material fact or omitted to state a
material fact necessary in order to make the statements therein, in light of
the circumstances under which they were made, not misleading. Without
limiting the foregoing, such counsel may state further that such counsel
assumes no responsibility for, and has not independently verified, the
accuracy, completeness or fairness of the financial statements, notes and
schedules and other financial data included in any Registration Statement
contemplated by this Agreement or the related Prospectus; and

     (3) a customary comfort letter, dated the date of effectiveness of the
Shelf Registration Statement in form, scope and substance reasonably
satisfactory to the managing underwriter, from the Issuers’ independent
accountants, in the customary form and covering matters of the type
customarily requested to be covered in comfort letters by underwriters in
connection with primary underwritten offerings;

     (B) set forth in full or incorporate by reference in the underwriting
agreement, if any, the indemnification provisions and procedures of Section 8 hereof
with respect to all parties to be indemnified pursuant to said Section; and

     (C) deliver such other documents and certificates as may be reasonably
requested by such parties to evidence compliance with Section 6(c)(xi)(A) hereof and
with any customary conditions contained in the underwriting agreement or

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other agreement entered into by the Issuers pursuant to this Section 6(c)(xi),
if any.

     If at any time the representations and warranties of the Issuers contemplated in
Section 6(c)(xi)(A)(1) hereof cease to be true and correct, the Issuers shall so advise the
Initial Purchasers and the underwriter(s), if any, and each selling Holder promptly and, if
requested by such Persons, shall confirm such advice in writing;

     (xii) prior to any public offering of Transfer Restricted Securities, cooperate with
the selling Holders, the underwriter(s), if any, and their respective counsel in connection
with the registration and qualification of the Transfer Restricted Securities under the
state securities or blue sky laws of such jurisdictions as the selling Holders or
underwriter(s), if any, may reasonably request and do any and all other acts or things
necessary or advisable to enable the disposition in such jurisdictions of the Transfer
Restricted Securities covered by the Shelf Registration Statement; provided, however, that
none of the Issuers shall be required to register or qualify as a foreign corporation where
it is not then so qualified or to take any action that would subject it to the service of
process in suits or to taxation, other than as to matters and transactions relating to the
Registration Statement, in any jurisdiction where it is not then so subject;

     (xiii) shall issue, upon the request of any Holder of Initial Securities covered by and
sold pursuant to the Shelf Registration Statement, Exchange Securities having an aggregate
principal amount equal to the aggregate principal amount of Initial Securities surrendered
to the Issuers by such Holder in exchange therefor or being sold by such Holder; such
Exchange Securities to be registered in the name of such Holder or in the name of the
purchaser(s) of such Exchange Securities, as the case may be; in return, the Initial
Securities held by such Holder shall be surrendered to the Issuers for cancellation;

     (xiv) cooperate with the selling Holders and the underwriter(s), if any, to facilitate
the timely preparation and delivery of certificates representing Transfer Restricted
Securities to be sold and not bearing any restrictive legends; and enable such Transfer
Restricted Securities to be in such denominations and registered in such names as the
Holders or the underwriter(s), if any, may reasonably request at least two Business Days
prior to any sale of Transfer Restricted Securities made by such Holders or underwriter(s);

     (xv) use their reasonable best efforts to cause the Transfer Restricted Securities
covered by the Registration Statement to be registered with or approved by such other
governmental agencies or authorities as may be necessary to enable the seller or sellers
thereof or the underwriter(s), if any, to consummate the disposition of such Transfer
Restricted Securities, subject to the proviso contained in Section 6(c)(xii) hereof;

     (xvi) if any fact or event contemplated by Section 6(c)(iii)(D) hereof shall exist or
have occurred, prepare a supplement or post-effective amendment to the Registration
Statement or related Prospectus or any document incorporated therein by reference or file
any other required document so that, as thereafter delivered to the purchasers of Transfer Restricted Securities, the Prospectus will not contain an untrue
statement of a material

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fact or omit to state any material fact necessary in order to make
the statements therein, in light of the circumstances under which they were made, not
misleading;

     (xvii) provide a CUSIP number for all Initial Securities not later than the effective
date of the Registration Statement covering such Initial Securities and provide the Trustee
under the Indenture with printed certificates for such Initial Securities which are in a
form eligible for deposit with the Depository Trust Company;

     (xviii) cooperate and assist in any filings required to be made with the FINRA and in
the performance of any due diligence investigation by any underwriter (including any
“qualified independent underwriter”) that is required to be retained in accordance with the
rules and regulations of the FINRA;

     (xix) otherwise use their reasonable best efforts to comply with all applicable rules
and regulations of the Commission, and make generally available to its security holders, as
soon as practicable, a consolidated earning statement meeting the requirements of Rule 158
(which need not be audited) for the twelve-month period (A) commencing at the end of any
fiscal quarter in which Transfer Restricted Securities are sold to underwriters in a firm
commitment or best efforts Underwritten Offering or (B) if not sold to underwriters in such
an offering, beginning with the first month of the Company’s first fiscal quarter commencing
after the effective date of the Registration Statement;

     (xx) cause the Indenture to be qualified under the Trust Indenture Act not later than
the effective date of the first Registration Statement required by this Agreement, and, in
connection therewith, cooperate with the Trustee and the Holders of Initial Securities to
effect such changes to the Indenture as may be required for such Indenture to be so
qualified in accordance with the terms of the Trust Indenture Act; and to execute and use
their reasonable best efforts to cause the Trustee to execute, all documents that may be
required to effect such changes and all other forms and documents required to be filed with
the Commission to enable such Indenture to be so qualified in a timely manner; and

     (xxi) provide promptly to each Holder upon request each document filed with the
Commission pursuant to the requirements of Section 13 and Section 15 of the Exchange Act.

     Each Holder agrees by acquisition of a Transfer Restricted Security that, upon receipt of any
notice from the Issuers of the existence of any fact of the kind described in Section 6(c)(iii)(D)
hereof, such Holder will forthwith discontinue disposition of Transfer Restricted Securities
pursuant to the applicable Registration Statement until such Holder’s receipt of the copies of the
supplemented or amended Prospectus contemplated by Section 6(c)(xvi) hereof, or until it is advised
in writing (the “Advice”) by the Issuers that the use of the Prospectus may be resumed, and has
received copies of any additional or supplemental filings that are incorporated by reference in the
Prospectus. If so directed by the Issuers, each Holder will deliver to the Issuers (at the
Issuers’ expense) all copies, other than permanent file copies then in such Holder’s possession, of the Prospectus covering such Transfer Restricted Securities that was current at
the time of receipt of such notice. In the event the Issuers shall give any such notice, the time
period regarding the effectiveness of such Registration Statement set forth in Section 3 or 4
hereof,
as

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applicable, shall be extended by the number of days during the period from and including
the date of the giving of such notice pursuant to Section 6(c)(iii)(D) hereof to and including the
date when each selling Holder covered by such Registration Statement shall have received the copies
of the supplemented or amended Prospectus contemplated by Section 6(c)(xvi) hereof or shall have
received the Advice; provided, however, that no such extension shall be taken into account in
determining whether Additional Interest is due pursuant to Section 5 hereof or the amount of such
Additional Interest.

     SECTION 7. Registration Expenses.

     (a) All expenses incident to the Issuers’ performance of or compliance with this Agreement
will be borne by the Issuers, jointly and severally, regardless of whether a Registration Statement
becomes effective, including, without limitation: (i) all registration and filing fees and expenses
(including filings made by any Initial Purchaser or Holder with the FINRA (and, if applicable, the
fees and expenses of any “qualified independent underwriter” and its counsel that may be required
by the rules and regulations of the FINRA)); (ii) all fees and expenses of compliance with federal
securities and state securities or blue sky laws; (iii) all expenses of printing (including
printing of Prospectuses), messenger and delivery services and telephone; (iv) all fees and
disbursements of counsel for the Issuers and, subject to Section 7(b) hereof, the Holders of
Transfer Restricted Securities; (v) all application and filing fees in connection with listing the
Exchange Securities on a securities exchange or automated quotation system pursuant to the
requirements thereof, if applicable; all fees and disbursements of independent certified public
accountants of the Issuers (including the expenses of any special audit and comfort letters
required by or incident to such performance).

     Each of the Issuers will, in any event, bear its internal expenses (including, without
limitation, all salaries and expenses of its officers and employees performing legal or accounting
duties), the expenses of any annual audit and the fees and expenses of any Person, including
special experts, retained by the Issuers.

     (b) In connection with any Registration Statement required by this Agreement the Issuers,
jointly and severally, will reimburse the Initial Purchasers and the Holders of Transfer Restricted
Securities being tendered in the Exchange Offer and/or resold pursuant to the “Plan of
Distribution” contained in the Exchange Offer Registration Statement or registered pursuant to the
Shelf Registration Statement, as applicable, for the reasonable fees and disbursements of not more
than one counsel, who shall be Cahill Gordon & Reindel llp or such other counsel as may be
chosen by the Holders of a majority in principal amount of the Transfer Restricted Securities for
whose benefit such Registration Statement is being prepared.

     SECTION 8. Indemnification.

     (a) The Issuers, jointly and severally, agree to indemnify and hold harmless (i) each Holder
and (ii) each Person, if any, who controls (within the meaning of Section 15 of the Securities Act
or Section 20 of the Exchange Act) any Holder (any of the Persons referred to in this
clause (ii) being hereinafter referred to as a “controlling person”) and (iii) the respective
officers, directors, partners, employees, representatives and agents of any Holder or any
controlling person (any Person referred to in clause (i), (ii) or (iii) may hereinafter be referred
to as an “Indem-

-16-

 

nified Holder”), to the fullest extent lawful, from and against any and all losses,
claims, damages, liabilities, judgments, actions and expenses (including, without limitation, and
as incurred, reimbursement of all reasonable costs of investigating, preparing, pursuing, settling,
compromising, paying or defending any claim or action, or any investigation or proceeding by any
governmental agency or body, commenced or threatened, including the reasonable fees and expenses of
counsel to any Indemnified Holder), joint or several, directly or indirectly caused by, related to,
based upon, arising out of or in connection with any untrue statement or alleged untrue statement
of a material fact contained in any Registration Statement or Prospectus (or any amendment or
supplement thereto), or any omission or alleged omission to state therein a material fact required
to be stated therein or necessary to make the statements therein not misleading, except insofar as
such losses, claims, damages, liabilities or expenses are caused by an untrue statement or omission
or alleged untrue statement or omission that is made in reliance upon and in conformity with
information relating to any of the Holders furnished in writing to the Issuers by any of the
Holders expressly for use therein. This indemnity agreement shall be in addition to any liability
which the Issuers may otherwise have.

     In case any action or proceeding (including any governmental or regulatory investigation or
proceeding) shall be brought or asserted against any of the Indemnified Holders with respect to
which indemnity may be sought against the Issuers, such Indemnified Holder (or the Indemnified
Holder controlled by such controlling person) shall promptly notify the Issuers in writing;
provided, however, that the failure to give such notice shall not relieve any of the Issuers of
their obligations pursuant to this Agreement except to the extent they are materially prejudiced as
a proximate result of such failure). In case any such action is brought against any Indemnified
Holder and such Indemnified Holder seeks or intends to seek indemnity from the Issuers, the Issuers
will be entitled to participate in and, to the extent that they shall elect, jointly with all other
indemnifying parties similarly notified, by written notice delivered to the Indemnified Holder
promptly after receiving the aforesaid notice from such Indemnified Holder, to assume the defense
thereof with counsel reasonably satisfactory to such Indemnified Holder; provided, however, if the
defendants in any such action include both the Indemnified Holder and the Issuers and the
Indemnified Holder shall have reasonably concluded (based on the advice of counsel) that a conflict
may arise between the positions of the Issuers and the Indemnified Holder in conducting the defense
of any such action or that there may be legal defenses available to it and/or other Indemnified
Holders which are different from or additional to those available to the Issuers, the Indemnified
Holder or Holders shall have the right to select separate counsel to assume such legal defenses and
to otherwise participate in the defense of such action on behalf of such Indemnified Holder or
Holders. Upon receipt of notice from the Issuers to such Indemnified Holder of the Issuers’
election so to assume the defense of such action and approval by the Indemnified Holder of counsel,
the Issuers will not be liable to such Indemnified Holder under this Section 8 for any legal or
other expenses subsequently incurred by such Indemnified Holder in connection with the defense
thereof unless (i) the Indemnified Holder shall have employed separate counsel in accordance with
the proviso to the next preceding sentence (it being understood, however, that the Issuers shall
not be liable for the expenses of more than one separate counsel (together with local counsel (in
each jurisdiction)), approved by the Issuers (Indemnified Holder
or Holders, in the case of 8(b) and 8(c) hereof), representing the Indemnified Holders who are
parties to such action) or (ii) the Issuers shall not have employed counsel reasonably satisfactory
to the Indemnified Holder to represent the Indemnified Holder within a reasonable time after no-

-17-

 

tice
of commencement of the action, in each of which cases the fees and expenses of counsel shall be at
the expense of the Issuers. It is understood and agreed that the Issuers shall not, in connection
with any proceeding or related proceeding in the same jurisdiction, be liable for the reasonable
fees and expenses of more than one separate firm (together with any local counsel) for all
Indemnified Holders. Each Indemnified Holder, as a condition to indemnification hereunder, shall
use all reasonable efforts to cooperate with the Issuers in the defense of any such action or
claim. The Issuers shall not be liable for any settlement of any such action or proceeding effected
without the Issuers’ prior written consent, but if settled with such consent or if there is a final
judgment for the plaintiff, the Issuers agree to indemnify and hold harmless any Indemnified Holder
from and against any loss, claim, damage, liability or expense by reason of such settlement or
judgment. The Issuers shall not, without the prior written consent of each Indemnified Holder,
settle or compromise or consent to the entry of judgment in or otherwise seek to terminate any
pending or threatened action, claim, litigation or proceeding in respect of which indemnification
or contribution may be sought hereunder (whether or not any Indemnified Holder is a party thereto),
unless such settlement, compromise, consent or termination includes an unconditional release of
each Indemnified Holder from all liability arising out of such action, claim, litigation or
proceeding.

     (b) Each Holder of Transfer Restricted Securities agrees, severally and not jointly, to
indemnify and hold harmless the Issuers and their respective directors, officers, partners,
employees, representatives, and agents of the Issuers who sign a Registration Statement, and any
Person controlling (within the meaning of Section 15 of the Securities Act or Section 20 of the
Exchange Act) any Issuer, and the respective officers, directors, partners, employees,
representatives and agents of each such Person, to the same extent as the foregoing indemnity from
Issuers to each of the Indemnified Holders, but only with respect to claims and actions based on
information relating to such Holder furnished in writing by such Holder expressly for use in any
Registration Statement. In case any action or proceeding shall be brought against the Issuers or
their respective directors, officers, partners, employees, representatives, and agents or any such
controlling person in respect of which indemnity may be sought against a Holder of Transfer
Restricted Securities, such Holder shall have the rights and duties given the Issuers, and the
Issuers, their respective directors, officers, partners, employees, representatives, and agents and
such controlling person shall have the rights and duties given to each Holder by the preceding
paragraph.

     (c) If the indemnification provided for in this Section 8 is unavailable to an indemnified
party under Section 8(a) or (b) hereof (other than by reason of exceptions provided in those
Sections, including by reason of failure to notify the Issuers of indemnification obligations
thereunder to the extent that they are materially prejudiced as a proximate result of such failure)
in respect of any losses, claims, damages, liabilities, judgments, actions or expenses referred to
therein, then each applicable indemnifying party, in lieu of indemnifying such indemnified party,
shall contribute to the amount paid or payable by such indemnified party as a result of such
losses, claims, damages, liabilities or expenses in such proportion as is appropriate to reflect
the relative benefits received by the Issuers, on the one hand, and the Holders, on the other hand,
from the Initial Placement (which in the case of the Issuers shall be deemed to be equal to the
total gross proceeds to the Issuers from the Initial Placement), the amount of Additional
Interest which did not become payable as a result of the filing of the Registration Statement
resulting in such losses, claims, damages, liabilities, judgments actions or expenses, and such
Registration

-18-

 

Statement, or if such allocation is not permitted by applicable law, the relative
fault of the Issuers, on the one hand, and the Holders, on the other hand, in connection with the
statements or omissions which resulted in such losses, claims, damages, liabilities or expenses, as
well as any other relevant equitable considerations. The relative fault of the Issuers on the one
hand and of the Indemnified Holder on the other shall be determined by reference to, among other
things, whether the untrue or alleged untrue statement of a material fact or the omission or
alleged omission to state a material fact relates to information supplied by any Issuer, on the one
hand, or the Indemnified Holders, on the other hand, and the parties’ relative intent, knowledge,
access to information and opportunity to correct or prevent such statement or omission. The amount
paid or payable by a party as a result of the losses, claims, damages, liabilities and expenses
referred to above shall be deemed to include, subject to the limitations set forth in the second
paragraph of Section 8(a) hereof, any legal or other fees or expenses reasonably incurred by such
party in connection with investigating or defending any action or claim.

     The Issuers and each Holder of Transfer Restricted Securities agree that it would not be just
and equitable if contribution pursuant to this Section 8(c) were determined by pro rata allocation
(even if the Holders were treated as one entity for such purpose) or by any other method of
allocation which does not take account of the equitable considerations referred to in the
immediately preceding paragraph. The amount paid or payable by an indemnified party as a result of
the losses, claims, damages, liabilities or expenses referred to in the immediately preceding
paragraph shall be deemed to include, subject to the limitations set forth above, any legal or
other expenses reasonably incurred by such indemnified party in connection with investigating or
defending any such action or claim. Notwithstanding the provisions of this Section 8, none of the
Holders (and its related Indemnified Holders) shall be required to contribute, in the aggregate,
any amount in excess of the amount by which the net proceeds received by such Holder from the sale
of the Initial Securities pursuant to a Registration Statement exceeds the amount of any damages
which such Holder has otherwise been required to 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 to
contribute pursuant to this Section 8(c) are several in proportion to the respective principal
amount of Initial Securities held by each of the Holders hereunder and not joint.

     SECTION 9. Rule 144A. Each of the Issuers hereby agrees with each Holder, for so long as any
Transfer Restricted Securities remain outstanding, to make available to any Holder or beneficial
owner of Transfer Restricted Securities in connection with any sale thereof and any prospective
purchaser of such Transfer Restricted Securities from such Holder or beneficial owner, the
information required by Rule 144A(d)(4) under the Securities Act in order to permit resales of such
Transfer Restricted Securities pursuant to Rule 144A under the Securities Act.

     SECTION 10. Participation in Underwritten Registrations. No Holder may participate in any
Underwritten Registration hereunder unless such Holder (a) agrees to sell such Holder’s Transfer
Restricted Securities on the basis provided in any underwriting arrangements approved
by the Persons entitled hereunder to approve such arrangements and (b) completes and executes
all reasonable questionnaires, powers of attorney, indemnities, underwriting agreements, lock-up
letters and other documents required under the terms of such underwriting arrangements.

-19-

 

     SECTION 11. Selection of Underwriters. The Holders of Transfer Restricted Securities covered
by the Shelf Registration Statement who desire to do so may sell such Transfer Restricted
Securities in an Underwritten Offering. In any such Underwritten Offering, the investment
banker(s) and managing underwriter(s) that will administer such offering will be selected by the
Holders of a majority in aggregate principal amount of the Transfer Restricted Securities included
in such offering; provided, however, that such investment banker(s) and managing underwriter(s)
must be reasonably satisfactory to the Issuers.

     SECTION 12. Miscellaneous.

     (a) Remedies. Each of the Issuers hereby agrees that monetary damages would not be adequate
compensation for any loss incurred by reason of a breach by it of the provisions of this Agreement
and hereby agree to waive the defense in any action for specific performance that a remedy at law
would be adequate.

     (b) No Inconsistent Agreements. Each of the Issuers will not on or after the date of this
Agreement enter into any agreement with respect to its securities that is inconsistent with the
rights granted to the Holders in this Agreement or otherwise conflicts with the provisions hereof.
None of the Issuers has previously entered into any agreement granting any registration rights with
respect to its securities to any Person pursuant to which any such Person would have the right to
include any securities in any Registration Statement to be filed with the Commission as required
under this Agreement. The rights granted to the Holders hereunder do not in any way conflict with
and are not inconsistent with the rights granted to the holders of any Issuer’s securities under
any agreement in effect on the date hereof.

     (c) Adjustments Affecting the Securities. The Issuers will not take any action, or permit any
change to occur, with respect to the Initial Securities that would materially and adversely affect
the ability of the Holders to Consummate any Exchange Offer.

     (d) Amendments and Waivers. The provisions of this Agreement may not be amended, modified or
supplemented, and waivers or consents to or departures from the provisions hereof may not be given
unless the Issuers (i) in the case of Section 5 hereof and this Section 12(d)(i), have obtained the
written consent of Holders of all outstanding Transfer Restricted Securities and (ii) in the case
of all other provisions hereof, have obtained the written consent of Holders of a majority of the
outstanding principal amount of Transfer Restricted Securities (excluding any Transfer Restricted
Securities held by the Issuers or their respective Affiliates). Notwithstanding the foregoing, a
waiver or consent to departure from the provisions hereof that relates exclusively to the rights of
Holders whose securities are being tendered pursuant to the Exchange Offer and that does not affect
directly or indirectly the rights of other Holders whose securities are not being tendered pursuant
to such Exchange Offer may be given by the Holders of a majority of the outstanding principal
amount of Transfer Restricted Securities being tendered or registered; provided, however, that,
with respect to any matter that directly or indirectly affects the rights of any Initial Purchaser
hereunder, the Issuers shall obtain the written consent of
each such Initial Purchaser with respect to which such amendment, qualification, supplement,
waiver, consent or departure is to be effective.

-20-

 

     (e) Notices. All notices and other communications provided for or permitted hereunder shall
be made in writing by hand-delivery, first-class mail (registered or certified, return receipt
requested), telex, telecopier, or air courier guaranteeing overnight delivery:

     (i) if to a Holder, at the address set forth on the records of the Registrar under the
Indenture, with a copy to the Registrar under the Indenture; and

	 	(ii)	 	if to the Issuers
	 
	 	 	 	Vanguard Health Systems, Inc.

20 Burton Hills Boulevard

Suite 100

Nashville, Tennessee 37215

Facsimile: (615) 665-6197

Attention: Ronald P. Soltman, General Counsel
	 
	 	(iii)	 	with a copy to:
	 
	 	 	 	Simpson Thacher & Bartlett LLP

425 Lexington Avenue

New York, New York 10017

Facsimile: (212) 455-2502

Attention: Rise Norman, Esq.

     All such notices and communications shall be deemed to have been duly given: at the time
delivered by hand, if personally delivered; five Business Days after being deposited in the mail,
postage prepaid, if mailed; when answered back, if telexed; when receipt acknowledged, if
telecopied; and on the next Business Day, if timely delivered to an air courier guaranteeing
overnight delivery.

     Copies of all such notices, demands or other communications shall be concurrently delivered by
the Person giving the same to the Trustee at the address specified in the Indenture.

     (f) Successors and Assigns. This Agreement shall inure to the benefit of and be binding upon
the successors and assigns of each of the parties, including, without limitation, and without the
need for an express assignment, subsequent Holders of Transfer Restricted Securities; provided,
however, that this Agreement shall not inure to the benefit of or be binding upon a successor or
assign of a Holder unless and to the extent such successor or assign acquired Transfer Restricted
Securities from such Holder.

     (g) Counterparts. This Agreement may be executed in any number of counterparts and by the
parties hereto in separate counterparts, each of which when so executed shall be
deemed to be an original and all of which taken together shall constitute one and the same
agreement.

-21-

 

     (h) Headings. The headings in this Agreement are for convenience of reference only and shall
not limit or otherwise affect the meaning hereof.

     (i) Governing Law. THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE
LAWS OF THE STATE OF NEW YORK. EACH OF THE PARTIES HEREBY WAIVES ANY RIGHT TO TRIAL BY JURY IN ANY
ACTION, PROCEEDING OR COUNTERCLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT.

     (j) Severability. In the event that any one or more of the provisions contained herein, or
the application thereof in any circumstance, is held invalid, illegal or unenforceable, the
validity, legality and enforceability of any such provision in every other respect and of the
remaining provisions contained herein shall not be affected or impaired thereby.

     (k) Entire Agreement. This Agreement, together with the Purchase Agreement and the Indenture,
is intended by the parties as a final expression of their agreement and intended to be a complete
and exclusive statement of the agreement and understanding of the parties hereto in respect of the
subject matter contained herein. There are no restrictions, promises, warranties or undertakings,
other than those set forth or referred to herein with respect to the registration rights granted by
the Issuers with respect to the Transfer Restricted Securities. This Agreement supersedes all
prior agreements and understandings between the parties with respect to such subject matter.

[Signature Pages Follow]

-22-

 

SCHEDULE I

Banc of America Securities LLC

Barclays Capital Inc.

Citigroup Global Markets Inc.

Deutsche Bank Securities Inc.

Goldman, Sachs & Co.

Morgan Stanley & Co. Incorporated

 

     IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written
above.

	 	 	 	 	 
	 	Vanguard Health Holding Company II, LLC

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	Vanguard Holding Company II, Inc.

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	Vanguard Health Systems, Inc.,

as Guarantor

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 

[Registration
Rights Agreement]

 

	 	 	 	 	 
	 	VANGUARD HEALTH HOLDING COMPANY I, LLC

BHS PHYSICIANS ALLIANCE FOR ACE, LLC

HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.

MACNEAL PHYSICIANS GROUP, LLC

VANGUARD HEALTH FINANCIAL COMPANY, LLC

VANGUARD HEALTH MANAGEMENT, INC.

VHS ACQUISITION CORPORATION

VHS ACQUISITION SUBSIDIARY NUMBER 1, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 2, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 5, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 7, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 8, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 9, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 10, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 11, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 12, INC.

VHS CHICAGO MARKET PROCUREMENT, LLC

VHS GENESIS LABS, INC.

VHS HOLDING COMPANY, INC.

VHS IMAGING CENTERS, INC.

VHS OF ANAHEIM, INC.

VHS OF ARROWHEAD, INC.

VHS OF HUNTINGTON BEACH, INC.

VHS OF ILLINOIS, INC.

VHS OF ORANGE COUNTY, INC.

VHS OF PHOENIX, INC.

VHS OF SOUTH PHOENIX, INC.

VHS OUTPATIENT CLINICS, INC.

BAPTIST MEDICAL MANAGEMENT SERVICE ORGANIZATION, LLC

HEALTHCARE COMPLIANCE, L.L.C.

MACNEAL HEALTH PROVIDERS, INC.

MACNEAL MANAGEMENT SERVICES, INC.

PROS TEMPORARY STAFFING, INC.

WATERMARK PHYSICIAN SERVICES, INC.,

as Guarantors

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 

[Registration
Rights Agreement]

 

 

	 	 	 	 	 
	 	VHS SAN ANTONIO PARTNERS, LLC,

as Guarantor

By: VHS Acquisition Subsidiary Number 5, Inc., its

Member

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE ANAHEIM VHS LIMITED PARTNERSHIP,

as Guarantor

By: VHS of Anaheim, Inc., its General Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE HUNTINGTON BEACH VHS LIMITED PARTNERSHIP,

as Guarantor

By: VHS of Huntington Beach, Inc., its General

Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 
	 
	 	THE VHS ARIZONA IMAGING CENTERS LIMITED PARTNERSHIP,

as Guarantor

By: VHS Imaging Centers, Inc., its General Partner

 	 
	 	By:  	/s/ RONALD P. SOLTMAN
 	 
	 	 	Name:  	Ronald Soltman 	 
	 	 	Title:  	Executive Vice President 	 

[Registration
Rights Agreement]

 

 

     The foregoing Registration Rights Agreement is hereby confirmed and accepted as of the date
first above written:

	 	 	 	 	 
	BANC OF AMERICA SECURITIES LLC

BARCLAYS CAPITAL INC.

CITIGROUP GLOBAL MARKETS INC.

DEUTSCHE BANK SECURITIES INC.

GOLDMAN, SACHS & CO.

MORGAN STANLEY & CO. INCORPORATED

 	 
	By:  	Banc of America Securities LLC,
 	 
	 	as a Representative of the Initial Purchasers 	 
	 	 
	By:  	            /s/ JOHN ROTE
 	 
	 	Managing Director 	 
	 	 	 

[Registration
Rights Agreement]

 

 

	 	 	 	 	 
	 	 
	By:  	            Barclays Capital Inc.,
 	 
	 	as a Representative of the Initial Purchasers 	 
	 	 
	By:  	            /s/ JOHN SKROBE
 	 
	 	Managing Director 	 
	 	 	 

[Registration
Rights Agreement]

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