Document:

EX-4.3

 Exhibit 4.3 

EXECUTION VERSION 
 Supplemental
Indenture in Respect of Subsidiary Guarantees 
 December 1, 2016 

SECOND SUPPLEMENTAL INDENTURE, dated as of December 1, 2016 (this “Supplemental Indenture”), among the Subsidiaries
listed on Schedule A hereto (the “New Subsidiary Guarantors” and each, a “New Subsidiary Guarantor”), Envision Healthcare Corporation (f/k/a New Amethyst Corp.) (together with its successors and assigns, the
“Company”) and Wilmington Trust, National Association, as Trustee under the Indenture referred to below. 
 W I T N E S S E
T H: 
 WHEREAS, the Company and the Trustee, are party to an Indenture, dated as of December 1, 2016 (as amended, supplemented, waived
or otherwise modified, the “Indenture”), relating to the issuance from time to time by the Company of Notes; 
 WHEREAS,
Section 1308 of the Indenture provides that the Company is required to cause the New Subsidiary Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which the New Subsidiary Guarantors shall guarantee the
Company’s Subsidiary Guaranteed Obligations under the Notes pursuant to a Subsidiary Guarantee on the terms and conditions set forth herein and in Article XIII of the Indenture; 

WHEREAS, each New Subsidiary Guarantor desires to enter into such supplemental indenture for good and valuable consideration, including
substantial economic benefit in that the financial performance and condition of such New Subsidiary Guarantor is dependent on the financial performance and condition of the Company, the obligations hereunder of which such New Subsidiary Guarantor
has guaranteed, and on such New Subsidiary Guarantor’s access to working capital through the Company’s access to revolving credit borrowings under the Senior ABL Facility; and 

WHEREAS, pursuant to Section 901 of the Indenture, the parties hereto are authorized to execute and deliver this Supplemental Indenture
to amend the Indenture, without the consent of any Holder. 
 NOW, THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the New Subsidiary Guarantors, the Company and the Trustee mutually covenant and agree for the benefit of the Holders of the Notes as follows: 

1. Defined Terms. As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recital hereto are used
herein as so defined. The words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section
hereof. 

 2. Agreement to Guarantee. Each New Subsidiary Guarantor hereby agrees, jointly and
severally with the other New Subsidiary Guarantors fully and unconditionally, to guarantee the Subsidiary Guaranteed Obligations under the Indenture and the Notes on the terms and subject to the conditions set forth in Article XIII of the
Indenture and to be bound by (and shall be entitled to the benefits of) all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

3. Termination, Release and Discharge. Each New Subsidiary Guarantor’s Subsidiary Guarantee shall terminate and be of no further
force or effect, and each New Subsidiary Guarantor shall be released and discharged from all obligations in respect of such Subsidiary Guarantee, as and when provided in Section 1303 of the Indenture. 

4. Parties. Nothing in this Supplemental Indenture is intended or shall be construed to give any Person, other than the Holders and the
Trustee, any legal or equitable right, remedy or claim under or in respect of any New Subsidiary Guarantor’s Subsidiary Guarantee or any provision contained herein or in Article XIII of the Indenture. 

5. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.
THE TRUSTEE, THE COMPANY, ANY OTHER OBLIGOR IN RESPECT OF THE NOTES AND (BY THEIR ACCEPTANCE OF THE NOTES) THE HOLDERS AGREE TO SUBMIT TO THE JURISDICTION OF ANY UNITED STATES FEDERAL OR STATE COURT LOCATED IN THE BOROUGH OF MANHATTAN, IN THE CITY
OF NEW YORK IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS SUPPLEMENTAL INDENTURE. 
 6. 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. The Trustee makes no representation or warranty as to the validity or sufficiency of
this Supplemental Indenture or as to the accuracy of the recitals to this Supplemental Indenture. 
 7. Counterparts. The parties
hereto may sign one or more copies of this Supplemental Indenture in counterparts, all of which together shall constitute one and the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile
transmission, PDF or other similar electronic transmission shall constitute effective execution and delivery of this Supplemental Indenture as to all the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes.
Signatures of the parties hereto transmitted by facsimile transmission, PDF or other similar electronic transmission shall be deemed to be their original signatures for all purposes. 

8. Headings. The section headings herein are for convenience of reference only and shall not be deemed to alter or affect the meaning or
interpretation of any provisions hereof. 

  
 2 

 
							
	ENVISION GUARANTORS:
	
	CLINICAL PARTNERS MANAGEMENT COMPANY, LLC
	NORTHWOOD ANESTHESIA ASSOCIATES, L.L.C.
			
		 	By:	 	/s/ William A. Sanger
		 		 	     Name:	 	William A. Sanger
		 		 	     Title:	 	Manager

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 A1 LEASING, INC.

	 ABBOTT AMBULANCE, INC.

	 ACCENT HOME HEALTH CARE INC.

	 ADAM TRANSPORTATION SERVICE, INC.

	 AFFILION, INC.

	 AIR AMBULANCE SPECIALISTS, INC.

	 AMBULANCE ACQUISITION, INC.

	 AMERICAN EMERGENCY PHYSICIANS MANAGEMENT, INC.

	 AMERICAN INVESTMENT ENTERPRISES, INC.

	 AMERICAN MEDICAL PATHWAYS, INC.

	 AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.

	 AMERICAN MEDICAL RESPONSE HOLDINGS, INC.

	 AMERICAN MEDICAL RESPONSE MANAGEMENT, INC.

	 AMERICAN MEDICAL RESPONSE MID-ATLANTIC, INC.

	 AMERICAN MEDICAL RESPONSE NORTHWEST, INC.

	 AMERICAN MEDICAL RESPONSE OF COLORADO, INC.

	 AMERICAN MEDICAL RESPONSE OF CONNECTICUT, INCORPORATED

	 AMERICAN MEDICAL RESPONSE OF GEORGIA, INC.

	 AMERICAN MEDICAL RESPONSE OF ILLINOIS, INC.

	 AMERICAN MEDICAL RESPONSE OF INLAND EMPIRE

	 AMERICAN MEDICAL RESPONSE OF MASSACHUSETTS, INC.

	 AMERICAN MEDICAL RESPONSE OF NORTH CAROLINA, INC.

	 AMERICAN MEDICAL RESPONSE OF OKLAHOMA, INC.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 AMERICAN MEDICAL RESPONSE OF SOUTH CAROLINA, INC.

	 AMERICAN MEDICAL RESPONSE OF SOUTHERN CALIFORNIA

	 AMERICAN MEDICAL RESPONSE OF TENNESSEE, INC.

	 AMERICAN MEDICAL RESPONSE OF TEXAS, INC.

	 AMERICAN MEDICAL RESPONSE WEST

	 AMERICAN MEDICAL RESPONSE, INC.

	 AMR BAY STATE, LLC

	 AMR HOLDCO, INC.

	 AMR OF CENTRAL TEXAS I, LLC

	 AMR OF CENTRAL TEXAS II, LLC

	 APH LABORATORY SERVICES, INC.

	 ARIZONA EMS HOLDINGS, INC.

	 ASSOCIATED AMBULANCE SERVICE, INC.

	 ATLANTIC AMBULANCE SERVICES ACQUISITION, INC.

	 ATLANTIC/KEY WEST AMBULANCE, INC.

	 ATLANTIC/PALM BEACH AMBULANCE, INC.

	 BEACON TRANSPORTATION, INC.

	 BESTPRACTICES, INC.

	 BLYTHE AMBULANCE SERVICE

	 BOWERS COMPANIES, INC.

	 BROWARD AMBULANCE, INC.

	 COMMUNITY AUTO AND FLEET SERVICES L.L.C.

	 COMMUNITY EMS, INC.

	 COMTRANS AMBULANCE SERVICE, INC.

	 COMTRANS, INC.

	 CORNING AMBULANCE SERVICE INC.

	 DESERT VALLEY MEDICAL TRANSPORT, INC.

	 DONLOCK, LTD.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 E.M.S. VENTURES, INC.

	 EASTERN AMBULANCE SERVICE, INC.

	 EASTERN PARAMEDICS, INC.

	 EHR MANAGEMENT CO.

	 EMCARE ANESTHESIA PROVIDERS, INC.

	 EMCARE HOLDCO, INC.

	 EMCARE HOLDINGS INC.

	 EMCARE OF CALIFORNIA, INC.

	 EMCARE PHYSICIAN PROVIDERS, INC.

	 EMCARE PHYSICIAN SERVICES, INC.

	 EMCARE, INC.

	 EMERGENCY MEDICAL SERVICES LP CORPORATION

	 EMERGENCY MEDICAL TRANSPORT, INC.

	 EMERGENCY MEDICAL TRANSPORTATION, INC.

	 EMERGENCY MEDICINE EDUCATION SYSTEMS, INC.

	 EMS VENTURES OF SOUTH CAROLINA, INC.

	 EPSILON MANAGEMENT GROUP, INC.

	 FIVE COUNTIES AMBULANCE SERVICE, INC.

	 FLORIDA EMERGENCY PARTNERS, INC.

	 FOUNTAIN AMBULANCE SERVICE, INC.

	 GILA HOLDCO LLC

	 GOLD COAST AMBULANCE SERVICE

	 GOLD CROSS AMBULANCE SERVICE OF PA., INC.

	 GOLD CROSS AMBULANCE SERVICES, INC.

	 GRACE BEHAVIORAL HEALTH, L.L.C.

	 GREATER PINELLAS TRANSPORTATION MANAGEMENT SERVICES, INC.

	 GUARDIAN HEALTH CARE, INC.

	 GUARDIAN HEALTHCARE GROUP, INC.

	 GUARDIAN HEALTHCARE HOLDINGS, INC.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 HANK’S ACQUISITION CORP.

	 HEALTH PRIORITY HOME CARE, INC.

	 HEALTHCARE ADMINISTRATIVE SERVICES, INC.

	 HEMET VALLEY AMBULANCE SERVICE, INC.

	 HERREN ENTERPRISES, INC.

	 HOLIDAY ACQUISITION COMPANY, INC.

	 INTERNATIONAL LIFE SUPPORT, INC.

	 JLM HEALTHCARE, INC.

	 KMAC, INC.

	 KUTZ AMBULANCE SERVICE, INC.

	 LASALLE AMBULANCE INC.

	 LIFE LINE AMBULANCE SERVICE, INC.

	 LIFECARE AMBULANCE SERVICE, INC.

	 LIFEFLEET SOUTHEAST, INC.

	 MAINSTAY SOLUTIONS, LLC

	 MARLBORO HUDSON AMBULANCE & WHEELCHAIR SERVICE, INC.

	 MEDEVAC MEDICAL RESPONSE, INC.

	 MEDEVAC MIDAMERICA, INC.

	 MEDIC ONE AMBULANCE SERVICES, INC.

	 MEDIC ONE OF COBB, INC.

	 MEDICAL EMERGENCY DEVICES AND SERVICES (MEDS), INC.

	 MEDI-CAR AMBULANCE SERVICE, INC.

	 MEDI-CAR SYSTEMS, INC.

	 MEDICS AMBULANCE SERVICE (DADE), INC.

	 MEDICS AMBULANCE SERVICE, INC.

	 MEDICS AMBULANCE, INC.

	 MEDICS EMERGENCY SERVICES OF PALM BEACH COUNTY, INC.

	 MEDICS SUBSCRIPTION SERVICES, INC.

	 MEDICS TRANSPORT SERVICES, INC.

	 MEDICWEST AMBULANCE, INC.

	 MEDICWEST HOLDINGS, INC.

	 MEDLIFE EMERGENCY MEDICAL SERVICE, INC.

	 MEDSTAT EMS, INC.

	 MERCURY AMBULANCE SERVICE, INC.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 MERCY AMBULANCE OF EVANSVILLE, INC.

	 MERCY LIFE CARE

	 MERCY, INC.

	 METRO AMBULANCE SERVICE (RURAL), INC.

	 METRO AMBULANCE SERVICE, INC.

	 METRO AMBULANCE SERVICES, INC.

	 METRO CARE CORP.

	 METROPOLITAN AMBULANCE SERVICE

	 MIDWEST AMBULANCE MANAGEMENT COMPANY

	 MOBILE MEDIC AMBULANCE SERVICE, INC.

	 NATIONAL AMBULANCE & OXYGEN SERVICE, INC.

	 NEVADA RED ROCK AMBULANCE, INC.

	 NEVADA RED ROCK HOLDINGS, INC.

	 NORTH MISS. AMBULANCE SERVICE, INC.

	 OHERBST, INC.

	 PACIFIC AMBULANCE, INC.

	 PARAMED, INC.

	 PARK AMBULANCE SERVICE INC.

	 PHYSICIAN ACCOUNT MANAGEMENT, INC.

	 PHYSICIANS & SURGEONS AMBULANCE SERVICE, INC.

	 PROFESSIONAL MEDICAL TRANSPORT, INC.

	 PROVIDER ACCOUNT MANAGEMENT, INC.

	 PUCKETT AMBULANCE SERVICE, INC.

	 R/M ARIZONA HOLDINGS, INC.

	 R/M MANAGEMENT CO., INC.

	 R/M OF TENNESSEE G.P., INC.

	 R/M OF TENNESSEE L.P., INC.

	 RADIOLOGY STAFFING SOLUTIONS, INC.

	 RADSTAFFING MANAGEMENT SOLUTIONS, INC.

	 RANDLE EASTERN AMBULANCE SERVICE, INC.

	 REIMBURSEMENT TECHNOLOGIES, INC.

	 RIVER MEDICAL INCORPORATED

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 RURAL/METRO (DELAWARE), INC.

	 RURAL/METRO CORPORATION

	 RURAL/METRO CORPORATION

	 RURAL/METRO CORPORATION OF FLORIDA

	 RURAL/METRO CORPORATION OF TENNESSEE

	 RURAL/METRO FIRE DEPT., INC.

	 RURAL/METRO OF BREWERTON, INC.

	 RURAL/METRO OF CALIFORNIA, INC.

	 RURAL/METRO OF CENTRAL ALABAMA, INC.

	 RURAL/METRO OF CENTRAL COLORADO, INC.

	 RURAL/METRO OF CENTRAL OHIO, INC.

	 RURAL/METRO OF GREATER SEATTLE, INC.

	 RURAL/METRO OF NEW YORK, INC.

	 RURAL/METRO OF NORTHERN CALIFORNIA, INC.

	 RURAL/METRO OF NORTHERN OHIO, INC.

	 RURAL/METRO OF OHIO, INC.

	 RURAL/METRO OF OREGON, INC.

	 RURAL/METRO OF ROCHESTER, INC.

	 RURAL/METRO OF SAN DIEGO, INC.

	 RURAL/METRO OF SOUTHERN CALIFORNIA, INC.

	 RURAL/METRO OF SOUTHERN OHIO, INC.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	ENVISION GUARANTORS (cont’d):
	
	 S. FISHER & S. THOMAS INC.

	 SEMINOLE COUNTY AMBULANCE, INC.

	 SIOUX FALLS AMBULANCE, INC.

	 SOUTHWEST AMBULANCE AND RESCUE OF ARIZONA, INC.

	 SOUTHWEST AMBULANCE OF CASA GRANDE, INC.

	 SOUTHWEST AMBULANCE OF NEW MEXICO, INC.

	 SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA, INC.

	 SOUTHWEST AMBULANCE OF TUCSON, INC.

	 SOUTHWEST GENERAL SERVICES, INC.

	 SPRINGS AMBULANCE SERVICE, INC.

	 SSAG, LLC

	 STAT HEALTHCARE, INC.

	 SUNRISE HANDICAP TRANSPORT CORP.

	 SW GENERAL, INC.

	 T.M.S. MANAGEMENT GROUP INC.

	 TEK AMBULANCE, INC.

	 THE AID AMBULANCE COMPANY, INC.

	 THE AID COMPANY, INC.

	 TIDEWATER AMBULANCE SERVICE, INC.

	 TKG, INC.

	 TOWNS AMBULANCE SERVICE, INC.

	 TRANSPORTATION MANAGEMENT SERVICES OF BREVARD, INC.

	 TROUP COUNTY EMERGENCY MEDICAL SERVICES, INC.

	 VALLEY FIRE SERVICE, INC.

	 VELITA SMITH HOME HEALTH, INC.

	 V.I.P. PROFESSIONAL SERVICES, INC.

	 VISTA STAFFING SOLUTIONS, INC.

	 VITAL ENTERPRISES, INC.

	 W&W LEASING COMPANY, INC.

	 WP ROCKET HOLDINGS INC.

		
	By:	 	/s/ Craig A. Wilson
		 	      Name:	 	Craig A. Wilson
		 	      Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	ACCESS 2 CARE, LLC
		
		 	By: MISSION CARE SERVICES, LLC, as Manager of Access 2 Care, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Manager of Mission Care Services, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	ACUTE MANAGEMENT, LLC
		
		 	By: HAWKEYE HOLDCO LLC, as Sole Member of Acute Management, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	AGAPE HEALTH CARE AGENCY, LLC.
	CARE CONNECTION OF CINCINNATI LLC
	GEM CITY HOME CARE, LLC
	GUARDIAN OHIO NEWCO, LLC
		
		 	By: GUARDIAN HEALTHCARE HOLDINGS, INC., as Sole Member of Agape Health Care Agency, LLC, Care Connection of Cincinnati LLC, Gem City Home Care, LLC and Guardian Ohio NewCo, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	 ALPHA PHYSICIAN RESOURCES, L.L.C.

			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE DELAWARE VALLEY, LLC

			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE HPPP, LLC

		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of American Medical Response HPPP, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE OF MARICOPA, LLC

			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMERICAN MEDICAL RESPONSE OF PIMA, LLC

			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	AMR BROCKTON, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	APEX ACQUISITION LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	BRAVO REIMBURSEMENT SPECIALIST, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	CMORX, LLC
		
		 	By: EMCARE, INC., as Sole Member of CMORx, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	ED SOLUTIONS, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	EDIMS, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	EMS MANAGEMENT LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EMS OFFSHORE MEDICAL SERVICES, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EMSC SERVICESCO, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EVERRAD, LLC
		
		 	By: TEMPLETON READINGS, LLC, as Sole Member of EverRad, LLC
		
		 	By: EMCARE, INC., as Sole Member of Templeton Readings, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	EVOLUTION HEALTH LLC
			
		 	By:	 	/s/ Craig A.
Wilson                              
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	EVOLUTION MOBILE IMAGING, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	HAWKEYE HOLDCO LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	MEDASSOCIATES, LLC
		
		 	By: EMCARE, INC., as Sole Member of MedAssociates, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	MISSION CARE OF ILLINOIS, LLC
		
		 	By: MISSION CARE SERVICES, LLC, as Manager of Mission Care of Illinois, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Manager of Mission Care Services, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	MISSION CARE OF MISSOURI, LLC
		
		 	By: MISSION CARE SERVICES, LLC, as Manager of Mission Care of Missouri, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Manager of Mission Care Services, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                          
		 		 	Title:	 	Secretary
	
	MISSION CARE SERVICES, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Manager of Mission Care Services, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	MSO NEWCO, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	PHOENIX PHYSICIANS, LLC
	STREAMLINED MEDICAL SOLUTIONS LLC
		
		 	By: EMCARE, INC., as Sole Member of Phoenix Physicians, LLC and Streamlined Medical Solutions LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	PINNACLE CONSULTANTS MID-ATLANTIC, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	PROVEN HEALHCARE SOLUTIONS OF NEW JERSEY, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	PROVIDACARE, L.L.C.
		
		 	By: AMERICAN MEDICAL PATHWAYS, INC., as Sole Member of ProvidaCare, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	QRX MEDICAL MANAGEMENT, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Senior Vice President and Secretary
	
	RMC CORPORATE CENTER, L.L.C.
		
		 	By: RURAL/METRO CORPORATION, as Member of RMC Corporate Center, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	RURAL/METRO MID-SOUTH, L.P.
		
		 	By: R/M OF TENNESSEE G.P., INC., as General Partner of Rural/Metro Mid-South, L.P.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	RURAL/METRO OF INDIANA, L.P.
		
		 	By: THE AID AMBULANCE COMPANY, INC., as General Partner of Rural/Metro of Indiana, L.P.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	RURAL/METRO OF TENNESSEE, L.P.
		
		 	By: R/M OF TENNESSEE G.P., INC., as General Partner of Rural/Metro of Tennessee, L.P.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	RURAL/METRO OPERATING COMPANY, LLC
		
		 	By: RURAL/METRO CORPORATION, as Sole Member of Rural/Metro Operating Company, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	SAN DIEGO MEDICAL SERVICES ENTERPRISE, LLC
		
		 	By: RURAL/METRO OF SOUTHERN CALIFORNIA, INC., as Member of San Diego Medical Services Enterprise, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
		
		 	By: RURAL/METRO OF SAN DIEGO, INC., as Member of San Diego Medical Services Enterprise, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	REGIONAL EMERGENCY SERVICES, L.P.
		
		 	By: FLORIDA EMERGENCY PARTNERS, INC., as General Partner of Regional Emergency Services, L.P.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	ROSE RADIOLOGY, LLC
		
		 	By: SPOTLIGHT HOLDCO LLC, as Sole Member of Rose Radiology, LLC
		
		 	By: EMCARE, INC., as Sole Member of EmCare, Inc.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary
	
	SEAWALL ACQUISITION, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	SPOTLIGHT HOLDCO LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	SUN DEVIL ACQUISITION LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	TEMPLETON READINGS, LLC
		
		 	By: EMCARE, INC., as Sole Member of Templeton Readings, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	WHITAKER PHYSICIANS SERVICES, L.L.C.
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson                              
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	AMERICAN MEDICAL RESPONSE OF NEW YORK, LLC
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of American Medical Response of New York, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	METROCARE SERVICES—ABILENE, L.P.
		
		 	By: AMR OF CENTRAL TEXAS II, LLC, as General Partner of MetroCare Services—Abilene, L.P.
		
		 	By: AMERICAN MEDICAL RESPONSE, INC., as Sole Member of AMR of Central Texas II, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	PATIENT ADVOCACY GROUP, LLC
		
		 	By: AMR HOLDCO, INC., as Sole Member of Patient Advocacy Group, LLC
			
		 	By:	 	/s/ Craig A. Wilson
		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	ENVISION GUARANTORS (cont’d):
	
	ERGENCY STAFFING AND RECRUITING, LLC
			
		 	By:	 	/s/ Douglas P. Webster, D.O.
		 		 	Name:	 	Douglas P. Webster, D.O.
		 		 	Title:	 	Manager

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	AMSURG GUARANTORS:
	
	AMSURG ABILENE, INC.
	AMSURG ABILENE EYE, INC.
	AMSURG ALTAMONTE SPRINGS FL, INC.
	AMSURG ANESTHESIA MANAGEMENT SERVICES, LLC
	AMSURG ARCADIA CA, INC.
	AMSURG BURBANK, INC.
	AMSURG COLTON CA, INC.
	AMSURG CRYSTAL RIVER, INC.
	AMSURG EC BEAUMONT, INC.
	AMSURG EC SANTA FE, INC.
	AMSURG EC ST. THOMAS, INC.
	AMSURG EC TOPEKA, INC.
	AMSURG EC WASHINGTON, INC.
	AMSURG EL PASO, INC.
	AMSURG ESCONDIDO CA, INC.
	AMSURG FINANCE, INC.
	AMSURG FRESNO ENDOSCOPY, INC.
	AMSURG GLENDORA CA, INC.
	AMSURG HILLMONT, INC.
	AMSURG HOLDINGS, INC.
	AMSURG INGLEWOOD, INC.
	AMSURG KEC, INC.
	AMSURG KISSIMMEE FL, INC.
	AMSURG LA JOLLA, INC.
	AMSURG LANCASTER PA, LLC
	AMSURG MAIN LINE PA, LLC
	AMSURG MARYVILLE, INC.
	AMSURG MELBOURNE, INC.
	AMSURG NORTHWEST FLORIDA, INC.
	AMSURG OAKLAND CA, INC.
	AMSURG OCALA, INC.
	AMSURG PALMETTO, INC.
	AMSURG POTTSVILLE PA, LLC
	AMSURG SAN ANTONIO TX, INC.
	AMSURG SAN LUIS OBISPO CA, INC.
	AMSURG SUNCOAST, INC.
	AMSURG TEMECULA CA, INC.
	AMSURG TEMECULA II INC.
	AMSURG TORRANCE, INC.
	AMSURG SCRANTON PA, INC.
		
	By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Vice President, Secretary and Treasurer

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	AMSURG GUARANTORS (cont’d):
	
	ASDH I, LLC
	AUSTIN NSC, LLC
	CORAL SPRINGS NSC, LLC
	DAVIS NSC, LLC
	FULLERTON NSC, LLC
	KENWOOD NSC, LLC
	LONG BEACH NSC, LLC
	NSC RBO EAST, LLC
	NSC WEST PALM, LLC
	SAN ANTONIO NSC, LLC
	SHI II, LLC
	TAMPA BAY NSC, LLC
	TORRANCE NSC, LLC
	TOWSON NSC, LLC
	TWIN FALLS NSC, LLC
	WESTON NSC, LLC
		
	By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Vice President, Secretary and Treasurer
	
	AUSTIN NSC, LP
		
		 	      By: Austin NSC, LLC, its general partner
			
		 	      By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Vice President, Secretary and Treasurer
	
	WILTON NSC, LLC
		
		 	 By: AmSurg Holdings, Inc. as the managing member

			
		 	      By:	 	/s/ Claire M. Gulmi
		 	      Name:	 		 	Claire M. Gulmi
		 	      Title:	 		 	Vice President, Secretary and Treasurer

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	AMSURG GUARANTORS (cont’d):
	
	 ALL WOMEN’S HEALTHCARE HOLDINGS, INC.

	 ALL WOMEN’S HEALTHCARE, INC.

	 ALL WOMEN’S HEALTHCARE OF DADE, INC.

	 ALL WOMEN’S HEALTHCARE OF SAWGRASS, INC.

	 ALL WOMEN’S HEALTHCARE OF WEST BROWARD, INC.

	 ALL WOMEN’S HEALTHCARE SERVICES, INC.

	 DISCOVERY CLINICAL RESEARCH, INC.

	 FM HEALTHCARE SERVICES, INC.

	 FMO HEALTHCARE HOLDINGS, INC.

	 FO INVESTMENTS, INC.

	 FO INVESTMENTS II, INC.

	 FO INVESTMENTS III, INC.

	 GLOBAL SURGICAL PARTNERS, INC.

	 SHERIDAN RADIOLOGY MANAGEMENT SERVICES, INC.

	 SHERIDAN RADIOLOGY SERVICES, INC.

		
	By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Vice President and Treasurer

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	AMSURG GUARANTORS (cont’d):
	
	 ANESTHESIOLOGISTS OF GREATER ORLANDO, INC.

	 ANESTHESIOLOGY ASSOCIATES OF TALLAHASSEE, INC.

	 BETHESDA ANESTHESIA ASSOCIATES, INC.

	 BOCA ANESTHESIA SERVICE, INC.

	 DRS. ELLIS, ROJAS, ROSS & DEBS, INC.

	 FLAMINGO ANESTHESIA ASSOCIATES, INC.

	 GREATER FLORIDA ANESTHESIOLOGISTS, LLC

	 GYNECOLOGIC ONCOLOGY ASSOCIATES, INC.

	 JACKSONVILLE BEACHES ANESTHESIA ASSOCIATES, INC.

	 JUPITER ANESTHESIA ASSOCIATES, L.L.C.

	 JUPITER HEALTHCARE, LLC

	 NEW GENERATIONS BABEE BAG, INC.

	 NORTH FLORIDA PERINATAL ASSOCIATES, INC.

	 PARITY HEALTHCARE, INC.

	 SHERIDAN ANESTHESIA SERVICES OF ALABAMA, INC.

	 SHERIDAN ANESTHESIA SERVICES OF LOUISIANA, INC.

	 SHERIDAN ANESTHESIA SERVICES OF VIRGINIA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF ARIZONA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF LOUISIANA, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF NEW MEXICO, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF VIRGINIA, INC.

	 SHERIDAN CLINICAL RESEARCH, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF MISSOURI, INC.

		
	By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Chief Executive Officer

  
 [Signature Page to
Second Supplemental Indenture] 

 
					
	AMSURG GUARANTORS (cont’d):
	
	 BAY AREA ANESTHESIA, L.L.C.

	 COASTAL ANESTHESIA STAFFING, LLC

	 COASTAL ANESTHESIOLOGY CONSULTANTS, LLC

	 MEDICAL INFORMATION MANAGEMENT SOLUTIONS, LLC

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF OHIO, INC.

	 SHERIDAN CHILDREN’S HEALTHCARE SERVICES OF KENTUCKY, INC.

	 SHERIDAN CHILDREN’S SERVICES OF ALABAMA, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF NORTH MISSOURI, INC.

	 SHERIDAN EMERGENCY PHYSICIAN SERVICES OF SOUTH FLORIDA, INC.

	 SHERIDAN HEALTHCARE, INC.

	 SHERIDAN HEALTHCARE OF LOUISIANA, INC.

	 SHERIDAN HEALTHCARE OF MISSOURI, INC.

	 SHERIDAN HEALTHCARE OF VERMONT, INC.

	 SHERIDAN HEALTHCARE OF VIRGINIA, INC.

	 SHERIDAN HEALTHCARE OF WEST VIRGINIA, INC.

	 SHERIDAN HEALTHCORP, INC.

	 SHERIDAN HEALTHCORP OF CALIFORNIA, INC.

	 SHERIDAN HEALTHY HEARING SERVICES, INC.

	 SHERIDAN HOLDINGS, INC.

	 SHERIDAN ROP SERVICES OF VIRGINIA, INC.

	 SHERIDAN INVESTCO, LLC

	 SOUTHEAST PERINATAL ASSOCIATES, INC. SUNBEAM ASSET, LLC

	 SUNBEAM INTERMEDIATE HOLDINGS, INC.

	 SUNBEAM PRIMARY HOLDINGS, INC.

	 TENNESSEE VALLEY NEONATOLOGY, INC.

	 TIVA HEALTHCARE, INC.

		
	By:	 	/s/ Claire M. Gulmi
		 	      Name:	 	Claire M. Gulmi
		 	      Title:	 	Chief Executive Officer

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	AMSURG GUARANTORS (cont’d):
	
	 CHANDLER EMERGENCY MEDICAL GROUP, L.L.C. D/B/A PREMIER EMERGENCY MEDICAL
SPECIALISTS

			
		 	By:	 	/s/ Claire M. Gulmi
		 		 	      Name:	 	Claire M. Gulmi
		 		 	      Title:	 	Manager
	
	PARTNERS IN MEDICAL BILLING, INC.
			
		 	By:	 	/s/ Jillian Marcus
		 		 	      Name:	 	Jillian Marcus
		 		 	      Title:	 	President
	
	 SHERIDAN ROP SERVICES OF FLORIDA, INC.

	SENTINEL HEALTHCARE SERVICES, LLC
			
		 	By:	 	/s/ Jillian Marcus
		 		 	      Name:	 	Jillian Marcus
		 		 	      Title:	 	Vice President
	
	 ALLEGIANTMD, INC.

	 ARIZONA PERINATAL CARE CENTERS, LLC

BROAD MIDWEST ANESTHESIA, LLC

	 DOCTORS BILLING SERVICE, INC.

	 MEDI-BILL OF NORTH FLORIDA, INC.

	 NORTH FLORIDA ANESTHESIA CONSULTANTS, INC.

SHERIDAN CADR SOLUTIONS, INC.

SHERIDAN HOSPITALIST SERVICES OF FLORIDA, INC.

SHERIDAN LEADERSHIP ACADEMY, INC.

SHERIDAN SCIENTIFIC INTELLIGENCE, INC.

	 ST. LUCIE ANESTHESIA ASSOCIATES, LLC

VALLEY CLINICAL RESEARCH, INC.

			
		 	By:	 	/s/ Jillian Marcus
		 		 	      Name:	 	Jillian Marcus
		 		 	      Title:	 	Vice President and Secretary

  
 [Signature Page to
Second Supplemental Indenture] 

 
							
	AMSURG GUARANTORS (cont’d):
	
	PHYSICIAN OFFICE PARTNERS, INC.
			
		 	By:	 	/s/ Robert Davey
		 		 	      Name:	 	Robert Davey
		 		 	      Title:	 	President

  

							
	 NAC PROPERTIES, LLC

VALLEY ANESTHESIOLOGY CONSULTANTS, INC.

			
		 	By:	 	/s/ Robert J. Coward
		 		 	      Name:	 	Robert J. Coward
		 		 	      Title:	 	President

  
 [Signature Page to
Supplemental Indenture] 

 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly
executed as of the date first above written. 
  

					
	ENVISION HEALTHCARE CORPORATION
		
	By:	 	/s/ Claire M. Gulmi
		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Executive Vice President and Chief Financial Officer

  
 [Signature Page to
Supplemental Indenture] 

 
			
	 WILMINGTON TRUST, NATIONAL ASSOCIATION,

as Trustee

		
	By:	 	Joseph P. O’Donnell
		 	Authorized Officer

  
 [Signature Page to
Supplemental Indenture] 

 SCHEDULE A 
  

					
	 	  	 New Subsidiary Guarantors
	  	 Jurisdiction of Organization

	1.	  	All Women’s Healthcare Holdings, Inc.	  	Delaware
	2.	  	All Women’s Healthcare of Dade, Inc.	  	Florida
	3.	  	All Women’s Healthcare of Sawgrass, Inc.	  	Florida
	4.	  	All Women’s Healthcare of West Broward, Inc.	  	Florida
	5.	  	All Women’s Healthcare Services, Inc.	  	Florida
	6.	  	All Women’s Healthcare, Inc.	  	Florida
	7.	  	AllegiantMD, Inc.	  	Florida
	8.	  	AmSurg Abilene Eye, Inc.	  	Tennessee
	9.	  	AmSurg Abilene, Inc.	  	Tennessee
	10.	  	AmSurg Altamonte Springs FL, Inc.	  	Tennessee
	11.	  	AmSurg Anesthesia Management Services, LLC	  	Tennessee
	12.	  	AmSurg Arcadia CA, Inc.	  	Tennessee
	13.	  	AmSurg Burbank, Inc.	  	Tennessee
	14.	  	AmSurg Colton CA, Inc.	  	Tennessee
	15.	  	AmSurg Crystal River, Inc.	  	Tennessee
	16.	  	AmSurg EC Beaumont, Inc.	  	Tennessee
	17.	  	AmSurg EC Santa Fe, Inc.	  	Tennessee
	18.	  	AmSurg EC St. Thomas, Inc.	  	Tennessee
	19.	  	AmSurg EC Topeka, Inc.	  	Tennessee
	20.	  	AmSurg EC Washington, Inc.	  	Tennessee
	21.	  	AmSurg El Paso, Inc.	  	Tennessee
	22.	  	AmSurg Escondido CA, Inc.	  	Tennessee
	23.	  	AmSurg Finance, Inc.	  	Tennessee
	24.	  	AmSurg Fresno Endoscopy, Inc.	  	Tennessee
	25.	  	AmSurg Glendora CA, Inc.	  	Tennessee
	26.	  	AmSurg Hillmont, Inc.	  	Tennessee
	27.	  	AmSurg Holdings, Inc.	  	Delaware
	28.	  	AmSurg Inglewood, Inc.	  	Tennessee
	29.	  	AmSurg KEC, Inc.	  	Tennessee
	30.	  	AmSurg Kissimmee FL, Inc.	  	Tennessee
	31.	  	AmSurg La Jolla, Inc.	  	Tennessee
	32.	  	AmSurg Lancaster PA, LLC	  	Tennessee
	33.	  	AmSurg Main Line PA, LLC	  	Tennessee
	34.	  	AmSurg Maryville, Inc.	  	Tennessee
	35.	  	AmSurg Melbourne, Inc.	  	Tennessee
	36.	  	AmSurg Northwest Florida, Inc.	  	Tennessee
	37.	  	AmSurg Oakland CA, Inc.	  	Tennessee
	38.	  	AmSurg Ocala, Inc.	  	Tennessee
	39.	  	AmSurg Palmetto, Inc.	  	Tennessee
	40.	  	AmSurg Pottsville PA, LLC	  	Tennessee
	41.	  	AmSurg San Antonio TX, Inc.	  	Tennessee

					
	42.	  	AmSurg San Luis Obispo CA, Inc.	  	Tennessee
	43.	  	AmSurg Scranton PA, Inc.	  	Tennessee
	44.	  	AmSurg Suncoast, Inc.	  	Tennessee
	45.	  	AmSurg Temecula CA, Inc.	  	Tennessee
	46.	  	AmSurg Temecula II Inc.	  	Tennessee
	47.	  	AmSurg Torrance, Inc.	  	Tennessee
	48.	  	Anesthesiologists of Greater Orlando, Inc.	  	Florida
	49.	  	Anesthesiology Associates of Tallahassee, Inc.	  	Florida
	50.	  	Arizona Perinatal Care Centers, LLC	  	Arizona
	51.	  	ASDH I, LLC	  	Tennessee
	52.	  	Austin NSC, LLC	  	Tennessee
	53.	  	Austin NSC, LP	  	Texas
	54.	  	Bay Area Anesthesia, L.L.C.	  	Florida
	55.	  	Bethesda Anesthesia Associates, Inc.	  	Florida
	56.	  	Boca Anesthesia Service, Inc.	  	Florida
	57.	  	Broad Midwest Anesthesia, LLC	  	Missouri
	58.	  	Chandler Emergency Medical Group, L.L.C. d/b/a Premier Emergency Medical Specialists	  	Arizona
	59.	  	Coastal Anesthesia Staffing, LLC	  	Florida
	60.	  	Coastal Anesthesiology Consultants, LLC	  	Florida
	61.	  	Coral Springs NSC, LLC	  	Tennessee
	62.	  	Davis NSC, LLC	  	Tennessee
	63.	  	Discovery Clinical Research, Inc.	  	Florida
	64.	  	Doctors Billing Service, Inc.	  	California
	65.	  	Drs. Ellis, Rojas, Ross & Debs, Inc.	  	Florida
	66.	  	Flamingo Anesthesia Associates, Inc.	  	Florida
	67.	  	FM Healthcare Services, Inc.	  	Florida
	68.	  	FMO Healthcare Holdings, Inc.	  	Delaware
	69.	  	FO Investments II, Inc.	  	Florida
	70.	  	FO Investments III, Inc.	  	Florida
	71.	  	FO Investments, Inc.	  	Florida
	72.	  	Fullerton NSC, LLC	  	Tennessee
	73.	  	Global Surgical Partners, Inc.	  	Florida
	74.	  	Greater Florida Anesthesiologists, LLC	  	Florida
	75.	  	Gynecologic Oncology Associates, Inc.	  	Florida
	76.	  	Jacksonville Beaches Anesthesia Associates, Inc.	  	Florida
	77.	  	Jupiter Anesthesia Associates, L.L.C.	  	Florida
	78.	  	Jupiter Healthcare, LLC	  	Florida
	79.	  	Kenwood NSC, LLC	  	Tennessee
	80.	  	Long Beach NSC, LLC	  	Tennessee
	81.	  	Medi-Bill of North Florida, Inc.	  	Florida
	82.	  	Medical Information Management Solutions, LLC	  	Arizona
	83.	  	NAC Properties, LLC	  	Georgia
	84.	  	New Generations Babee Bag, Inc.	  	Florida
	85.	  	North Florida Anesthesia Consultants, Inc.	  	Florida

					
	86.	  	North Florida Perinatal Associates, Inc.	  	Florida
	87.	  	NSC RBO East, LLC	  	Tennessee
	88.	  	NSC West Palm, LLC	  	Tennessee
	89.	  	Parity Healthcare, Inc.	  	Florida
	90.	  	Partners in Medical Billing, Inc.	  	Florida
	91.	  	Physician Office Partners, Inc.	  	Kansas
	92.	  	San Antonio NSC, LLC	  	Tennessee
	93.	  	Sentinel Healthcare Services, LLC	  	Georgia
	94.	  	Sheridan Anesthesia Services of Alabama, Inc.	  	Florida
	95.	  	Sheridan Anesthesia Services of Louisiana, Inc.	  	Florida
	96.	  	Sheridan Anesthesia Services of Virginia, Inc.	  	Florida
	97.	  	Sheridan CADR Solutions, Inc.	  	Florida
	98.	  	Sheridan Children’s Healthcare Services of Virginia, Inc.	  	Florida
	99.	  	Sheridan Children’s Healthcare Services of Arizona, Inc.	  	Florida
	100.	  	Sheridan Children’s Healthcare Services of Kentucky, Inc.	  	Florida
	101.	  	Sheridan Children’s Healthcare Services of Louisiana, Inc.	  	Florida
	102.	  	Sheridan Children’s Healthcare Services of New Mexico, Inc.	  	Florida
	103.	  	Sheridan Children’s Healthcare Services of Ohio, Inc.	  	Florida
	104.	  	Sheridan Children’s Healthcare Services, Inc.	  	Florida
	105.	  	Sheridan Children’s Services of Alabama, Inc.	  	Florida
	106.	  	Sheridan Clinical Research, Inc.	  	Florida
	107.	  	Sheridan Emergency Physician Services of Missouri, Inc.	  	Florida
	108.	  	Sheridan Emergency Physician Services of North Missouri, Inc.	  	Florida
	109.	  	Sheridan Emergency Physician Services of South Florida, Inc.	  	Florida
	110.	  	Sheridan Emergency Physician Services, Inc.	  	Florida
	111.	  	Sheridan Healthcare of Louisiana, Inc.	  	Florida
	112.	  	Sheridan Healthcare of Missouri, Inc.	  	Florida
	113.	  	Sheridan Healthcare of Vermont, Inc.	  	Florida
	114.	  	Sheridan Healthcare of Virginia, Inc.	  	Florida
	115.	  	Sheridan Healthcare of West Virginia, Inc.	  	West Virginia
	116.	  	Sheridan Healthcare, Inc.	  	Delaware
	117.	  	Sheridan Healthcorp of California, Inc.	  	California
	118.	  	Sheridan Healthcorp, Inc.	  	Florida
	119.	  	Sheridan Healthy Hearing Services, Inc.	  	Florida
	120.	  	Sheridan Holdings, Inc.	  	Delaware
	121.	  	Sheridan Hospitalist Services of Florida, Inc.	  	Florida
	122.	  	Sheridan InvestCo, LLC	  	Delaware
	123.	  	Sheridan Leadership Academy, Inc.	  	Florida
	124.	  	Sheridan Radiology Management Services, Inc.	  	Delaware
	125.	  	Sheridan Radiology Services, Inc.	  	Delaware
	126.	  	Sheridan ROP Services of Florida, Inc.	  	Florida
	127.	  	Sheridan ROP Services of Virginia, Inc.	  	Florida
	128.	  	Sheridan Scientific Intelligence, Inc.	  	Florida
	129.	  	SHI II, LLC	  	Tennessee
	130.	  	Southeast Perinatal Associates, Inc.	  	Florida

					
	131.	  	St. Lucie Anesthesia Associates, LLC	  	Florida
	132.	  	Sunbeam Asset LLC	  	Delaware
	133.	  	Tampa Bay NSC, LLC	  	Tennessee
	134.	  	Tennessee Valley Neonatology, Inc.	  	Florida
	135.	  	Tiva Healthcare, Inc.	  	Florida
	136.	  	Torrance NSC, LLC	  	Tennessee
	137.	  	Towson NSC, LLC	  	Tennessee
	138.	  	Twin Falls NSC, LLC	  	Tennessee
	139.	  	Valley Anesthesiology Consultants, Inc.	  	Arizona
	140.	  	Valley Clinical Research, Inc.	  	Florida
	141.	  	Weston NSC, LLC	  	Tennessee
	142.	  	Wilton NSC, LLC	  	Connecticut
	143.	  	A1 Leasing, Inc.	  	Florida
	144.	  	Abbott Ambulance, Inc.	  	Missouri
	145.	  	Accent Home Health Care Inc.	  	Indiana
	146.	  	Access 2 Care, LLC	  	Missouri
	147.	  	Acute Management, LLC	  	Texas
	148.	  	Adam Transportation Service, Inc.	  	New York
	149.	  	Affilion, Inc.	  	Delaware
	150.	  	Agape Health Care Agency, LLC.	  	Ohio
	151.	  	Air Ambulance Specialists, Inc.	  	Colorado
	152.	  	Alpha Physician Resources, L.L.C. (a/k/a Alpha Group I, LLC)	  	New Jersey
	153.	  	Ambulance Acquisition, Inc.	  	Delaware
	154.	  	American Emergency Physicians Management, Inc.	  	California
	155.	  	American Investment Enterprises, Inc.	  	Nevada
	156.	  	American Medical Pathways, Inc.	  	Delaware
	157.	  	American Medical Response Ambulance Service, Inc.	  	Delaware
	158.	  	American Medical Response Delaware Valley, LLC	  	Delaware
	159.	  	American Medical Response Holdings, Inc.	  	Delaware
	160.	  	American Medical Response HPPP, LLC	  	Delaware
	161.	  	American Medical Response Management, Inc.	  	Delaware
	162.	  	American Medical Response Mid-Atlantic, Inc.	  	Pennsylvania
	163.	  	American Medical Response Northwest, Inc.	  	Oregon
	164.	  	American Medical Response of Colorado, Inc.	  	Delaware
	165.	  	American Medical Response of Connecticut, Incorporated	  	Connecticut
	166.	  	American Medical Response of Georgia, Inc.	  	Delaware
	167.	  	American Medical Response of Illinois, Inc.	  	Delaware
	168.	  	American Medical Response of Inland Empire	  	California
	169.	  	American Medical Response of Maricopa, LLC	  	Delaware
	170.	  	American Medical Response of Massachusetts, Inc.	  	Massachusetts
	171.	  	American Medical Response of New York, LLC	  	New York
	172.	  	American Medical Response of North Carolina, Inc.	  	Delaware
	173.	  	American Medical Response of Oklahoma, Inc.	  	Delaware
	174.	  	American Medical Response of Pima, LLC	  	Delaware
	175.	  	American Medical Response of South Carolina, Inc.	  	Delaware
	176.	  	American Medical Response of Southern California	  	California
	177.	  	American Medical Response of Tennessee, Inc.	  	Delaware
	178.	  	American Medical Response of Texas, Inc.	  	Delaware

					
	179.	  	American Medical Response West	  	California
	180.	  	American Medical Response, Inc.	  	Delaware
	181.	  	AMR Bay State, LLC	  	Delaware
	182.	  	AMR Brockton, L.L.C.	  	Delaware
	183.	  	AMR HoldCo, Inc. (f/k/a EMSC Management, Inc.)	  	Delaware
	184.	  	AMR of Central Texas I, LLC	  	Texas
	185.	  	AMR of Central Texas II, LLC	  	Texas
	186.	  	Apex Acquisition LLC	  	Delaware
	187.	  	APH Laboratory Services, Inc.	  	Texas
	188.	  	Arizona EMS Holdings, Inc.	  	Arizona
	189.	  	Associated Ambulance Service Inc.	  	New York
	190.	  	Atlantic Ambulance Services Acquisition, Inc.	  	Delaware
	191.	  	Atlantic/Key West Ambulance, Inc.	  	Delaware
	192.	  	Atlantic/Palm Beach Ambulance, Inc.	  	Delaware
	193.	  	Beacon Transportation, Inc.	  	New York
	194.	  	BestPractices, Inc.	  	Virginia
	195.	  	Blythe Ambulance Service	  	California
	196.	  	Bowers Companies, Inc.	  	California
	197.	  	Bravo Reimbursement Specialist, L.L.C. (a/k/a Bravo Associates, L.L.C.)	  	New Jersey
	198.	  	Broward Ambulance, Inc.	  	Delaware
	199.	  	Care Connection of Cincinnati LLC	  	Ohio
	200.	  	Clinical Partners Management Company, LLC	  	Texas
	201.	  	CMORx, LLC	  	Texas
	202.	  	Community Auto and Fleet Services L.L.C.	  	Delaware
	203.	  	Community EMS, Inc.	  	Massachusetts
	204.	  	ComTrans Ambulance Service, Inc.	  	Arizona
	205.	  	ComTrans, Inc.	  	Delaware
	206.	  	Corning Ambulance Service Inc.	  	New York
	207.	  	Desert Valley Medical Transport, Inc.	  	California
	208.	  	Donlock, Ltd.	  	Pennsylvania
	209.	  	E.M.S. Ventures, Inc.	  	Georgia
	210.	  	Eastern Ambulance Service, Inc.	  	Nebraska
	211.	  	Eastern Paramedics, Inc.	  	Delaware
	212.	  	ED Solutions, LLC	  	New Jersey
	213.	  	EDIMS, L.L.C.	  	New Jersey
	214.	  	EHR Management Co.	  	Delaware
	215.	  	EmCare Anesthesia Providers, Inc.	  	Delaware
	216.	  	EmCare HoldCo, Inc.	  	Delaware
	217.	  	EmCare Holdings Inc.	  	Delaware
	218.	  	EmCare of California, Inc.	  	California
	219.	  	EmCare Physician Providers, Inc.	  	Missouri
	220.	  	EmCare Physician Services, Inc.	  	Delaware
	221.	  	EmCare, Inc.	  	Delaware
	222.	  	 Emergency Medical Services LP Corporation

(f/k/a Emergency Medical Services L.P.)
	  	Delaware
	223.	  	Emergency Medical Transport, Inc.	  	Arizona
	224.	  	Emergency Medical Transportation, Inc.	  	Massachusetts
	225.	  	Emergency Medicine Education Systems, Inc.	  	Texas

					
	226.	  	EMS Management LLC	  	Delaware
	227.	  	EMS Offshore Medical Services, LLC	  	Delaware
	228.	  	EMS Ventures of South Carolina, Inc.	  	South Carolina
	229.	  	EMSC ServicesCo, LLC (f/k/a EMSC TransactionCo, LLC)	  	Delaware
	230.	  	EverRad, LLC	  	Florida
	231.	  	Evolution Health LLC	  	Delaware
	232.	  	Evolution Mobile Imaging, LLC	  	Delaware
	233.	  	Five Counties Ambulance Service, Inc.	  	New York
	234.	  	Florida Emergency Partners, Inc.	  	Texas
	235.	  	Fountain Ambulance Service, Inc.	  	Alabama
	236.	  	Gem City Home Care, LLC.	  	Ohio
	237.	  	Gila Holdco LLC	  	Delaware
	238.	  	Gold Coast Ambulance Service	  	California
	239.	  	Gold Cross Ambulance Service of Pa., Inc.	  	Ohio
	240.	  	Gold Cross Ambulance Services, Inc.	  	Delaware
	241.	  	Grace Behavioral Health, L.L.C.	  	Delaware
	242.	  	Greater Pinellas Transportation Management Services, Inc.	  	Florida
	243.	  	Guardian Health Care, Inc.	  	Texas
	244.	  	Guardian Healthcare Group, Inc.	  	Delaware
	245.	  	Guardian Healthcare Holdings, Inc.	  	Delaware
	246.	  	Guardian Ohio Newco, LLC	  	Ohio
	247.	  	Hank’s Acquisition Corp.	  	Delaware
	248.	  	Hawkeye Holdco LLC	  	Delaware
	249.	  	Health Priority Home Care, Inc.	  	Texas
	250.	  	Healthcare Administrative Services, Inc.	  	Delaware
	251.	  	Hemet Valley Ambulance Service, Inc.	  	California
	252.	  	Herren Enterprises, Inc.	  	California
	253.	  	Holiday Acquisition Company, Inc.	  	Colorado
	254.	  	International Life Support, Inc.	  	Hawaii
	255.	  	JLM Healthcare, Inc.	  	Texas
	256.	  	KMAC, Inc.	  	Texas
	257.	  	Kutz Ambulance Service, Inc.	  	Wisconsin
	258.	  	LaSalle Ambulance Inc.	  	New York
	259.	  	Life Line Ambulance Service, Inc.	  	Arizona
	260.	  	LifeCare Ambulance Service, Inc.	  	Illinois
	261.	  	LifeFleet Southeast, Inc.	  	Florida
	262.	  	Mainstay Solutions, LLC	  	Arizona
	263.	  	Marlboro Hudson Ambulance & Wheelchair Service, Inc.	  	Massachusetts
	264.	  	MedAssociates, LLC	  	Texas
	265.	  	Medevac Medical Response, Inc.	  	Missouri
	266.	  	Medevac MidAmerica, Inc.	  	Missouri
	267.	  	Medic One Ambulance Services, Inc.	  	Delaware
	268.	  	Medic One of Cobb, Inc.	  	Georgia
	269.	  	Medical Emergency Devices and Services (MEDS), Inc.	  	Arizona
	270.	  	Medi-Car Ambulance Service, Inc.	  	Florida
	271.	  	Medi-Car Systems, Inc.	  	Florida
	272.	  	Medics Ambulance Service (Dade), Inc.	  	Florida
	273.	  	Medics Ambulance Service, Inc.	  	Florida
	274.	  	Medics Ambulance, Inc.	  	Florida

					
	275.	  	Medics Emergency Services of Palm Beach County, Inc.	  	Florida
	276.	  	Medics Subscription Services, Inc.	  	Florida
	277.	  	Medics Transport Services, Inc.	  	Florida
	278.	  	MedicWest Ambulance, Inc.	  	Nevada
	279.	  	MedicWest Holdings, Inc.	  	Delaware
	280.	  	MedLife Emergency Medical Service, Inc.	  	Alabama
	281.	  	MedStat EMS, Inc.	  	Mississippi
	282.	  	Mercury Ambulance Service, Inc.	  	Kentucky
	283.	  	Mercy Ambulance of Evansville, Inc.	  	Indiana
	284.	  	Mercy Life Care	  	California
	285.	  	Mercy, Inc.	  	Nevada
	286.	  	Metro Ambulance Service (Rural), Inc.	  	Delaware
	287.	  	Metro Ambulance Service, Inc.	  	Delaware
	288.	  	Metro Ambulance Services, Inc.	  	Georgia
	289.	  	Metro Care Corp.	  	Ohio
	290.	  	MetroCare Services – Abilene, L.P.	  	Texas
	291.	  	Metropolitan Ambulance Service	  	California
	292.	  	Midwest Ambulance Management Company	  	Delaware
	293.	  	Mission Care of Illinois, LLC	  	Illinois
	294.	  	Mission Care of Missouri, LLC	  	Missouri
	295.	  	Mission Care Services, LLC	  	Missouri
	296.	  	Mobile Medic Ambulance Service, Inc.	  	Delaware
	297.	  	MSO Newco, LLC	  	Delaware
	298.	  	National Ambulance & Oxygen Service, Inc.	  	New York
	299.	  	Nevada Red Rock Ambulance, Inc.	  	Delaware
	300.	  	Nevada Red Rock Holdings, Inc.	  	Delaware
	301.	  	North Miss. Ambulance Service, Inc.	  	Mississippi
	302.	  	Northwood Anesthesia Associates, L.L.C.	  	Florida
	303.	  	Oherbst, Inc.	  	Texas
	304.	  	Pacific Ambulance, Inc.	  	California
	305.	  	Paramed, Inc.	  	Michigan
	306.	  	Park Ambulance Service Inc.	  	New York
	307.	  	Patient Advocacy Group, LLC	  	Delaware
	308.	  	Phoenix Physicians, LLC	  	Florida
	309.	  	Physician Account Management, Inc.	  	Florida
	310.	  	Physicians & Surgeons Ambulance Service, Inc.	  	Ohio
	311.	  	Pinnacle Consultants Mid-Atlantic, L.L.C.	  	Delaware
	312.	  	Professional Medical Transport, Inc.	  	Arizona
	313.	  	Proven Healthcare Solutions of New Jersey, LLC (a/k/a Proven Healthcare Solutions)	  	New Jersey
	314.	  	ProvidaCare, L.L.C.	  	Texas
	315.	  	Provider Account Management, Inc.	  	Delaware
	316.	  	Puckett Ambulance Service, Inc.	  	Georgia
	317.	  	QRx Medical Management, LLC	  	Delaware
	318.	  	R/M Arizona Holdings, Inc.	  	Arizona
	319.	  	R/M Management Co., Inc.	  	Arizona
	320.	  	R/M of Tennessee G.P., Inc.	  	Delaware
	321.	  	R/M of Tennessee L.P., Inc.	  	Delaware
	322.	  	Radiology Staffing Solutions, Inc.	  	Delaware

					
	323.	  	Radstaffing Management Solutions, Inc.	  	Delaware
	324.	  	Randle Eastern Ambulance Service, Inc.	  	Florida
	325.	  	Regional Emergency Services, L.P.	  	Delaware
	326.	  	Reimbursement Technologies, Inc.	  	Pennsylvania
	327.	  	River Medical Incorporated	  	Arizona
	328.	  	RMC Corporate Center, L.L.C.	  	Arizona
	329.	  	Rose Radiology, LLC	  	Texas
	330.	  	Rural/Metro (Delaware) Inc.	  	Delaware
	331.	  	Rural/Metro Corporation	  	Delaware
	332.	  	Rural/Metro Corporation	  	Arizona
	333.	  	Rural/Metro Corporation of Florida	  	Florida
	334.	  	Rural/Metro Corporation of Tennessee	  	Tennessee
	335.	  	Rural/Metro Fire Dept., Inc.	  	Arizona
	336.	  	Rural/Metro Mid-South, L.P.	  	Delaware
	337.	  	Rural/Metro of Brewerton, Inc.	  	New York
	338.	  	Rural/Metro of California, Inc.	  	Delaware
	339.	  	Rural/Metro of Central Alabama, Inc.	  	Delaware
	340.	  	Rural/Metro of Central Colorado, Inc.	  	Delaware
	341.	  	Rural/Metro of Central Ohio, Inc.	  	Delaware
	342.	  	Rural/Metro of Greater Seattle, Inc.	  	Washington
	343.	  	Rural/Metro of Indiana, L.P.	  	Delaware
	344.	  	Rural/Metro of New York, Inc.	  	Delaware
	345.	  	Rural/Metro of Northern California, Inc.	  	Delaware
	346.	  	Rural/Metro of Northern Ohio, Inc.	  	Delaware
	347.	  	Rural/Metro of Ohio, Inc.	  	Delaware
	348.	  	Rural/Metro of Oregon, Inc.	  	Delaware
	349.	  	Rural/Metro of Rochester, Inc.	  	New York
	350.	  	Rural/Metro of San Diego, Inc.	  	California
	351.	  	Rural/Metro of Southern California, Inc.	  	Delaware
	352.	  	Rural/Metro of Southern Ohio, Inc.	  	Ohio
	353.	  	Rural/Metro of Tennessee, L.P.	  	Delaware
	354.	  	Rural/Metro Operating Company, LLC	  	Delaware
	355.	  	S. Fisher & S. Thomas Inc.	  	Texas
	356.	  	San Diego Medical Services Enterprise, LLC	  	California
	357.	  	Seawall Acquisition, LLC	  	Delaware
	358.	  	Seminole County Ambulance, Inc.	  	Delaware
	359.	  	Sioux Falls Ambulance, Inc.	  	South Dakota
	360.	  	Southwest Ambulance and Rescue of Arizona, Inc.	  	Arizona
	361.	  	Southwest Ambulance of Casa Grande, Inc.	  	Arizona
	362.	  	Southwest Ambulance of New Mexico, Inc.	  	New Mexico
	363.	  	Southwest Ambulance of Southeastern Arizona, Inc.	  	Arizona
	364.	  	Southwest Ambulance of Tucson, Inc.	  	Arizona
	365.	  	Southwest General Services, Inc.	  	Arizona
	366.	  	Spotlight Holdco LLC	  	Delaware
	367.	  	Springs Ambulance Service, Inc.	  	California
	368.	  	SSAG, LLC	  	Delaware
	369.	  	STAT Healthcare, Inc.	  	Delaware
	370.	  	Streamlined Medical Solutions LLC	  	Texas
	371.	  	Sun Devil Acquisition LLC	  	Delaware

					
	372.	  	Sunrise Handicap Transport Corp.	  	New York
	373.	  	SW General, Inc.	  	Arizona
	374.	  	T.M.S. Management Group, Inc.	  	Florida
	375.	  	TEK Ambulance, Inc.	  	Illinois
	376.	  	Templeton Readings, LLC	  	Maryland
	377.	  	The Aid Ambulance Company, Inc.	  	Delaware
	378.	  	The Aid Company, Inc.	  	Indiana
	379.	  	Tidewater Ambulance Service, Inc.	  	Virginia
	380.	  	TKG, Inc.	  	Oklahoma
	381.	  	Towns Ambulance Service, Inc.	  	New York
	382.	  	Transportation Management Services of Brevard, Inc.	  	Florida
	383.	  	Troup County Emergency Medical Services, Inc.	  	Georgia
	384.	  	V.I.P. Professional Services, Inc.	  	California
	385.	  	Valley Fire Service, Inc.	  	Delaware
	386.	  	Velita Smith Home Health, Inc.	  	Texas
	387.	  	Vista Staffing Solutions, Inc.	  	Delaware
	388.	  	Vital Enterprises, Inc.	  	Massachusetts
	389.	  	W & W Leasing Company, Inc.	  	Arizona
	390.	  	Whitaker Physicians Services, L.L.C.	  	Texas
	391.	  	WP Rocket Holdings Inc.	  	DelawareEX-4.10

 Exhibit 4.10 

Supplemental Indenture in Respect of Subsidiary Guarantees 

November 30, 2016 
 SIXTH
SUPPLEMENTAL INDENTURE, dated as of November 30, 2016 (this “Supplemental Indenture”), among the Subsidiaries listed on Schedule A hereto (the “New Subsidiary Guarantors” and each, a “New Subsidiary
Guarantor”), Envision Healthcare Corporation (the “Company”) and Wilmington Trust, National Association, as Trustee under the Indenture referred to below. 

W I T N E S S E T H: 
 WHEREAS,
the Company, each existing Subsidiary Guarantor under the Indenture referred to below (the “Existing Guarantors”) and the Trustee have heretofore become parties to an Indenture, dated as of June 18, 2014 (as amended, supplemented,
waived or otherwise modified, the “Indenture”), providing for the issuance of Notes in series; 
 WHEREAS,
Section 1308 of the Indenture provides that the Company is required to cause the New Subsidiary Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which the New Subsidiary Guarantors shall guarantee the
Company’s Subsidiary Guaranteed Obligations under the Notes pursuant to a Subsidiary Guarantee on the terms and conditions set forth herein and in Article XIII of the Indenture; 

WHEREAS, each New Subsidiary Guarantor desires to enter into such supplemental indenture for good and valuable consideration, including
substantial economic benefit in that the financial performance and condition of such New Subsidiary Guarantor is dependent on the financial performance and condition of the Company, the obligations hereunder of which such New Subsidiary Guarantor
has guaranteed, and on such New Subsidiary Guarantor’s access to working capital through the Company’s access to revolving credit borrowings under the Senior ABL Facility; and 

WHEREAS, pursuant to Section 901 of the Indenture, the parties hereto are authorized to execute and deliver this Supplemental Indenture
to amend the Indenture, without the consent of any Holder; 
 NOW, THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the New Subsidiary Guarantors, the Company and the Trustee mutually covenant and agree for the benefit of the Holders of the Notes as follows: 

1. Defined Terms. As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recital hereto are
used herein as therein defined. The words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any
particular section hereof. 

 2. Agreement to Guarantee. Each New Subsidiary Guarantor hereby agrees, jointly and
severally with the other New Subsidiary Guarantors and the Existing Guarantors and fully and unconditionally, to guarantee the Subsidiary Guaranteed Obligations under the Indenture and the Notes on the terms and subject to the conditions set forth
in Article XIII of the Indenture and to be bound by (and shall be entitled to the benefits of) all other applicable provisions of the Indenture as a Subsidiary Guarantor.

3. Termination, Release and Discharge. Each New Subsidiary Guarantor’s Subsidiary Guarantee shall terminate and be of no
further force or effect, and each New Subsidiary Guarantor shall be released and discharged from all obligations in respect of such Subsidiary Guarantee, as and when provided in Section 1303 of the Indenture. 

4. Parties. Nothing in this Supplemental Indenture is intended or shall be construed to give any Person, other than the Holders
and the Trustee, any legal or equitable right, remedy or claim under or in respect of any New Subsidiary Guarantor’s Subsidiary Guarantee or any provision contained herein or in Article XIII of the Indenture. 

5. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW
YORK. THE TRUSTEE, THE COMPANY, ANY OTHER OBLIGOR IN RESPECT OF THE NOTES AND (BY THEIR ACCEPTANCE OF THE NOTES) THE HOLDERS AGREE TO SUBMIT TO THE JURISDICTION OF ANY UNITED STATES FEDERAL OR STATE COURT LOCATED IN THE BOROUGH OF MANHATTAN, IN
THE CITY OF NEW YORK IN ANY ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS SUPPLEMENTAL INDENTURE. 
 6. 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. The Trustee makes no representation or warranty
as to the validity or sufficiency of this Supplemental Indenture or as to the accuracy of the recitals to this Supplemental Indenture. 
 7.
Counterparts. The parties hereto may sign one or more copies of this Supplemental Indenture in counterparts, all of which together shall constitute one and the same agreement. 

8. Headings. The section headings herein are for convenience of reference only and shall not be deemed to alter or affect the
meaning or interpretation of any provisions hereof. 

  
 2 

 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly
executed as of the date first above written. 
  

							
	 AMERICAN MEDICAL RESPONSE OF NEW YORK, LLC

		
		 	By: American Medical Response, Inc., as Sole Member
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 AMR OF CENTRAL TEXAS I, LLC

	 AMR OF CENTRAL TEXAS II, LLC

	 COMMUNITY AUTO AND FLEET SERVICES L.L.C.

	 COMTRANS, INC.

	 GILA HOLDCO LLC

	 GRACE BEHAVIORAL HEALTH, L.L.C.

	 SSAG, LLC

			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary
	
	 METROCARE SERVICES – ABILENE, L.P.

			
		 	By:	 	AMR of Central Texas II, LLC, as General Partner
			
		 	By:	 	American Medical Response, Inc., as Sole Member
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

 [Signature Page to Sixth Supplemental Indenture] 

 
							
	PATIENT ADVOCACY GROUP, LLC
			
		 	By:	 	AMR HoldCo, Inc., as Sole Member
			
		 	By:	 	 /s/ Craig A. Wilson

		 		 	Name:	 	Craig A. Wilson
		 		 	Title:	 	Secretary

  
 [Signature Page to
Sixth Supplemental Indenture] 

 
					
	ENVISION HEALTHCARE CORPORATION
		
	By:	 	 /s/ Craig A. Wilson

		 	Name:	 	Craig A. Wilson
		 	Title:	 	Secretary

  
 [Signature Page to
Sixth Supplemental Indenture] 

 
			
	WILMINGTON TRUST, NATIONAL ASSOCIATION,
	as Trustee
		
	By:	 	 /s/ Joseph P. O’Donnell

		 	Authorized Officer

  
 [Signature Page to
Sixth Supplemental Indenture] 

 SCHEDULE A 
  

			
	 New Subsidiary Guarantors
	  	 Jurisdiction of Organization

	American Medical Response of New York, LLC	  	New York
	AMR of Central Texas I, LLC	  	Delaware
	AMR of Central Texas II, LLC	  	Delaware
	Community Auto and Fleet Services L.L.C.	  	Delaware
	ComTrans, Inc.	  	Delaware
	Gila Holdco LLC	  	Delaware
	Grace Behavioral Health, L.L.C.	  	Delaware
	MetroCare Services – Abilene, L.P.	  	Texas
	Patient Advocacy Group, LLC	  	Delaware
	SSAG, LLC	  	Delaware

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00264-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00264-of-00352.parquet"}]]