Document:

AMENDMENT NO. 6 TO AMENDED & RESTATED CREDIT AGRMT

 

Exhibit 10.1

PEDIATRIX MEDICAL GROUP

AMENDED AND RESTATED CREDIT AGREEMENT

Originally Dated as of June 27, 1996

As Amended and Restated as of November 1, 2000

As Amended and Restated as of August 14, 2001

Amendment No. 6

Dated as of September 23, 2003

FLEET NATIONAL BANK, AGENT AND LENDER

U.S. BANK NATIONAL ASSOCIATION, SYNDICATION AGENT AND LENDER

HSBC BANK USA, DOCUMENTATION AGENT AND LENDER

 

 

AMENDMENT NO. 6

TO AMENDED AND RESTATED CREDIT AGREEMENT

Dated as of September 23, 2003

     This agreement, dated as of September 23, 2003 (this “Amendment”), is
among Pediatrix Medical Group, Inc., a Florida corporation, the Material
Related Entities of Pediatrix Medical Group, Inc. from time to time party
hereto, and the Lenders from time to time party hereto, including Fleet
National Bank, both in its capacity as a Lender and in its capacity as an
Agent, U.S. Bank National Association, formerly known as Firstar Bank N.A.,
both in its capacity as a Lender and in its capacity as Syndication Agent, and
HSBC Bank USA, both in its capacity as a Lender and in its capacity as
Documentation Agent. The parties hereto agree as follows:

     1.     Credit Agreement; Definitions. This Amendment amends the Credit
Agreement originally dated as of June 27, 1996, as amended and restated as of
November 1, 2000 and as further amended and restated as of August 14, 2001
among the parties hereto (as in effect prior to giving effect to this
Amendment, the “Credit Agreement”). Terms used in this Amendment but not
defined herein are used as defined in the Credit Agreement.

     2.     Amendment of Credit Agreement. Effective upon the date hereof, the
Credit Agreement is amended as follows:

		
	 	     2.1. Amendment of Section 6.11. Section 6.11 of the Credit Agreement
is amended to read in its entirety as follows:

		
	 	     “6.11 Capital Expenditures. The Borrowers will not make
aggregate Capital Expenditures exceeding $10,000,000 in any fiscal
year, except that in fiscal year 2003, the Borrowers may make
aggregate Capital Expenditures of $10,000,000 plus up to
$11,000,000 for the purchase of the property at 1301 Concord
Terrace in Sunrise, Florida that serves as the Borrowers’ corporate
headquarters.”

     3.     Representation and Warranty. In order to induce the Agent and the
Lenders to enter into this Amendment, each of the Obligors jointly and
severally represents and warrants that, after giving effect to this Amendment,
no Default exists.

     4.     Payment of Agent’s Legal Expenses. Upon or prior to the effectiveness
of this Amendment, each of the Borrowers jointly and severally agrees to pay
the reasonable legal fees and expenses of the Agent with respect to this
Amendment and the transactions contemplated hereby.

     5.     Miscellaneous. The Credit Agreement as amended by this Amendment (the
“Amended Credit Agreement”) and all of the Credit Documents are each confirmed
as being in full force and effect. This Amendment, the Amended Credit
Agreement and the other Credit Documents referred to herein or therein
constitute the entire understanding of the parties with respect to the subject
matter hereof and thereof and supersede all prior and current

 

 

understandings and agreements, whether written or oral. Each of this
Amendment and the Amended Credit Agreement is a Credit Document and may be
executed in any number of counterparts, which together shall constitute one
instrument, and shall bind and inure to the benefit of the parties and their
respective successors and assigns, including as such successors and assigns all
holders of any Credit Obligation. This Amendment shall be governed by and
construed in accordance with the laws (other than the conflict of law rules) of
The Commonwealth of Massachusetts.

[The remainder of this page intentionally left blank.]

2

 

     IN WITNESS WHEREOF, each of the undersigned has duly executed this
Amendment (or caused this Amendment to be executed on its behalf by its officer
or representative thereunto duly authorized) under seal as of the date first
written above.

	 	 	 
	 	 	
PEDIATRIX MEDICAL GROUP, INC. (Florida)
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Chief Financial Officer
	 
	 
	 	 	
FOOTHILL MEDICAL GROUP, INC.

MAGELLA MEDICAL ASSOCIATES MIDWEST, P.C.

MAGELLA MEDICAL GROUP, INC. (d/b/a MAGELLA

    MEDICAL GROUP, A MEDICAL CORPORATION)

MAGELLA NEVADA, LLC

MICHAEL POKROY, M.D. PROF. CORP. d/b/a OBSTETRIX

    MEDICAL GROUP OF NEVADA, LTD.

NEONATAL AND PEDIATRIC INTENSIVE CARE

    MEDICAL GROUP, INC.

OBSTETRIX MEDICAL GROUP OF CALIFORNIA, A

    PROFESSIONAL CORPORATION

OBSTETRIX MEDICAL GROUP OF COLORADO, P.C.

OBSTETRIX MEDICAL GROUP OF KANSAS AND

    MISSOURI, P.A.

PEDIATRIX MEDICAL GROUP OF ARKANSAS, P.A.

PEDIATRIX MEDICAL GROUP OF CALIFORNIA, A

    PROFESSIONAL CORPORATION

PEDIATRIX MEDICAL GROUP OF COLORADO, P.C.

PEDIATRIX MEDICAL GROUP OF ILLINOIS, P.C.

PEDIATRIX MEDICAL GROUP OF KANSAS, P.A.

PEDIATRIX MEDICAL GROUP OF KENTUCKY, PSC

PEDIATRIX MEDICAL GROUP OF MICHIGAN, P.C.

PEDIATRIX MEDICAL GROUP OF MISSOURI, P.C.

PEDIATRIX MEDICAL GROUP OF NORTH CAROLINA, P.C.

PEDIATRIX MEDICAL GROUP OF OHIO CORP.

PEDIATRIX MEDICAL GROUP OF OKLAHOMA, P.C.

PEDIATRIX MEDICAL GROUP OF PENNSYLVANIA, P.C.

PEDIATRIX MEDICAL GROUP OF PUERTO RICO, P.S.C.

PEDIATRIX MEDICAL GROUP NEONATOLOGY AND

    PEDIATRIC INTENSIVE CARE SPECIALISTS

    OF NEW YORK, P.C.

PEDIATRIX MEDICAL GROUP
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Attorney-in-Fact

3

 

	 	 	 
	 	 	
PEDIATRIX MEDICAL GROUP, S.P.

PERINATAL PEDIATRICS, P.A.

POKROY MEDICAL GROUP OF NEVADA, LTD.

    d/b/a PEDIATRIX MEDICAL GROUP OF NEVADA
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Attorney-in-Fact
	 
	 
	 	 	
ALASKA NEONATOLOGY ASSOCIATES, INC.

ASSOCIATES IN NEONATOLOGY, INC.

AUGUSTA NEONATOLOGY ASSOCIATES, P.C.

BNA ACQUISITION COMPANY, INC.

CENTRAL OKLAHOMA NEONATOLOGY

    ASSOCIATES, INC.

CNA ACQUISITION CORP.

DES MOINES PERINATAL CENTER, INC.

FLORIDA REGIONAL NEONATAL ASSOCIATES, P.A.

FORT WORTH NEONATAL ASSOCIATES BILLING, INC.

GNPA ACQUISITION COMPANY, INC.

KNA, INC.

MAGELLA HEALTHCARE CORPORATION

MAGELLA HEALTHCARE GROUP, L.P.

MAGELLA MEDICAL ASSOCIATES BILLING, INC.

MAGELLA MEDICAL ASSOCIATES OF GEORGIA, P.C.

MAGELLA TEXAS, LLC

MERCY NEONATOLOGY, INC.

MNPC ACQUISITION COMPANY, INC.

MOUNTAIN STATES NEONATOLOGY, INC.

NACF ACQUISITION COMPANY, INC.

NEONATAL SPECIALISTS, LTD.

NEONATOLOGY ASSOCIATES BILLING, INC.

NEONATOLOGY-CARDIOLOGY ASSOCIATES, P.A.

NSPA ACQUISITION COMPANY, INC.

OBSTETRIX MEDICAL GROUP OF ARIZONA, P.C.

OBSTETRIX MEDICAL GROUP OF DELAWARE, INC.

OBSTETRIX MEDICAL GROUP OF PENNSYLVANIA, P.C.

OBSTETRIX MEDICAL GROUP OF PHOENIX, P.C.

OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.

OBSTETRIX MEDICAL GROUP OF

    WASHINGTON, INC., P.S.
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Treasurer

4

 

	 	 	 
	 	 	
OBSTETRIX MEDICAL GROUP, INC.

OZARK NEONATAL ASSOCIATES, INC.

PALM BEACH NEO ACQUISITIONS, INC.

PASCV ACQUISITION COMPANY, INC.

PEDIATRIX MEDICAL GROUP OF DELAWARE, INC.

PEDIATRIX MEDICAL GROUP OF FLORIDA, INC.

PEDIATRIX MEDICAL GROUP OF GEORGIA, P.C.

PEDIATRIX MEDICAL GROUP OF INDIANA, P.C.

PEDIATRIX MEDICAL GROUP OF NEW MEXICO, P.C.

PEDIATRIX MEDICAL GROUP OF SOUTH CAROLINA, P.A.

PEDIATRIX MEDICAL GROUP OF TENNESSEE, P.C.

PEDIATRIX MEDICAL GROUP OF TEXAS BILLING, INC.

PEDIATRIX MEDICAL GROUP OF WASHINGTON, INC., P.S.

PEDIATRIX MEDICAL GROUP, INC. (Utah)

PEDIATRIX MEDICAL GROUP, P.A.

PEDIATRIX MEDICAL GROUP, P.C. (Virginia)
PEDIATRIX MEDICAL GROUP, P.C. (West Virginia)

PEDIATRIX OF MARYLAND, P.A.

PEDIATRIX SCREENING, INC.

PMG ACQUISITION CORP.

PNA ACQUISITION CO., INC.

RPNA ACQUISITION COMPANY, INC.

SCPMC ACQUISITION CO.

SNCA ACQUISITION COMPANY, INC.

ST. JOSEPH NEONATOLOGY CONSULTANTS, INC.

TEXAS MATERNAL FETAL MEDICINE BILLING, INC.
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Treasurer
	 
	 
	 	 	
PEDIATRIX FLORIDA, LLC

PEDIATRIX MEDICAL GROUP (INTERNATIONAL), INC.

PEDIATRIX MEDICAL MANAGEMENT, L.P.

PEDIATRIX MEDICAL MANAGEMENT GROUP, INC.

PEDIATRIX MEDICAL SERVICES, INC.

PEDIATRIX TEXAS I, LLC

PMGSC, P.A.
	 
	 
	 	 	
By: /s/ Karl B. Wagner
	 	 	

	 	 	
Karl B. Wagner, Treasurer

5

 

	 	 	 
	 	 	
FLEET NATIONAL BANK
	 
	 
	 	 	
By: /s/ Virginia C. Stolzenthaler, Managing Director
	 	 	

	 	 	
Virginia C. Stolzenthaler, Managing Director

	 	 	 

6

 

	 	 	 
	 	 	
U.S. BANK NATIONAL ASSOCIATION
	 
	 
	 	 	
By: /s/ S. Walker Choppin
	 	 	

	 	 	
S. Walker Choppin, Senior Vice President

	 	 	 

7

 

	 	 	 
	 	 	
HSBC BANK USA
	 
	 
	 	 	
By: /s/ Gregory G. Roll
	 	 	

	 	 	
Gregory G. Roll, First Vice President

8

 

	 	 	 
	 	 	
UBS AG, STAMFORD BRANCH
	 
	 
	 	 	
By: /s/ Wilfred V. Saint
	 	 	

	 	 	
Wilfred V. Saint, Associate Director

Banking Products Services, US
	 	 	 
	 	 	 
	 
	 
	 	 	
By: /s/ Jennifer L. Poccia
	 	 	

	 	 	
Jennifer L. Poccia, Associate Director

Banking Products Services, US

9

 

	 	 	 
	 	 	
THE INTERNATIONAL BANK OF MIAMI, N.A.
	 
	 
	 	 	
By: /s/ Eduardo Hornero
	 	 	

	 	 	
Eduardo Hornero, Vice President
	 
	 
	 	 	
By: /s/ Jorge Maklouf
	 	 	

	 	 	
Jorge Maklouf, Senior Vice President

10<PAGE>
                                                                     EXHIBIT 4.1

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE INDENTURE
HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A
NOMINEE OF A DEPOSITARY. THIS SECURITY IS EXCHANGEABLE FOR SECURITIES REGISTERED
IN THE NAME OF A PERSON OTHER THAN THE DEPOSITARY OR ITS NOMINEE ONLY IN THE
LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE AND MAY NOT BE TRANSFERRED
EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF SUCH DEPOSITARY OR BY A
NOMINEE OF SUCH DEPOSITARY TO SUCH DEPOSITARY OR ANOTHER NOMINEE OF SUCH
DEPOSITARY OR BY SUCH DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR OF SUCH
DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR.

Unless this certificate is presented by an authorized representative of The
Depository Trust Company, a New York corporation ("DTC"), to the Company or its
agent for registration of transfer, exchange or payment, and any certificate
issued is registered in the name of Cede & Co. or in such other name as is
requested by an authorized representative of DTC (and any payment is made to
Cede & Co. or to such other entity as is 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.

                                                                Principal Amount
R19
                                     HCA INC.                       $350,000,000

                         5.25% NOTE DUE NOVEMBER 6, 2008

                                   GLOBAL NOTE

                                                                 CUSIP 404119AK5

         HCA Inc. (f/k/a HCA - The Healthcare Company), a corporation duly
organized and existing under the laws of the State of Delaware (herein called
the "Company," which term includes any successor corporation under the Indenture
hereinafter referred to), for value received, hereby promises to pay to Cede &
Co., as the nominee of DTC, or registered assigns, the principal amount of Three
Hundred Fifty Million Dollars ($350,000,000), on November 6, 2008 (the "Maturity
Date") and to pay interest (computed on the basis of a 360-day year of twelve
30-day months) on May 6 and November 6 in each year (each, an "Interest Payment
Date"), beginning on May 6, 2004, and at the Maturity Date specified above on
said principal amount, at the rate of 5.25% per annum, from November 6, 2003
until payment of said principal amount has been made or duly provided for. The
interest so payable on any Interest Payment Date (other than at maturity) will
be paid to the Person in whose name this Global Note is

<PAGE>

registered at the close of business on the twenty-first day of the month prior
to the month in which such interest payment is due (a "Regular Record Date"),
unless the Company shall default in the payment of interest due on any such
Interest Payment Date, in which case such defaulted interest shall be paid to
the Person in whose name this Global Note is registered at the close of business
on a Special Record Date for the payment of such defaulted interest established
by notice to the registered holders of Notes (as hereinafter defined) not less
than ten days preceding such Special Record Date. In any case where the date for
any payment on the Notes is not a Business Day, such payment shall be made on
the next succeeding Business Day. A Business Day is any day that is not a
Saturday or Sunday and that, in The City of New York, New York, is not a day on
which banking institutions are generally authorized or required by law or
executive order to close.

         Both principal of and interest on this Global Note are payable in
immediately available funds in any coin or currency of the United States of
America, which at the time of payment is legal tender for the payment of public
and private debts. Payments of principal and interest will be made in The City
of New York, New York, at the Corporate Trust Office of The Bank of New York, or
at such other office or agency of the Company as the Company shall designate
pursuant to the Indenture referred to elsewhere herein.

         This Global Note is a duly authorized issue of debentures, notes, bonds
or other evidences of indebtedness of the Company (the "Securities"), of the
series hereinafter specified, issued or to be issued under an Indenture dated as
of December 16, 1993, as supplemented, as may be amended by indentures
supplemental thereto (the "Indenture"), duly executed and delivered by the
Company to The Bank of New York, the successor to Bank One Trust Company, N.A.,
who was in turn the successor to The First National Bank of Chicago, as trustee
(the "Trustee"), to which Indenture reference is hereby made for a description
of the respective rights and duties thereunder of the Trustee, the Company and
the Holders of the Securities. The Securities may be issued in one or more
series, which different series may be issued in various aggregate principal
amounts, may mature at different times, may bear interest at different rates,
may have different conversion prices (if any), may be subject to different
redemption provisions, may be subject to different sinking, purchase or
analogous funds, may be subject to different covenants and Events of Default and
may otherwise vary as in the Indenture provided. This Global Note, Certificate
R19, represents a Global Security representing the entire principal amount of a
series of Securities designated "5.25% Notes due November 6, 2008" (the "Notes")
issued under the Indenture. Unless otherwise provided herein, all terms used in
this Global Note, which are defined in the Indenture, shall have the meanings
assigned to them in the Indenture.

         The Notes do not have a sinking fund.

         The Notes may be redeemed in whole or in part, at the option of the
Company, at any time and from time to time prior to maturity. The redemption
price shall equal the greater of (i) 100% of the principal amount of the Notes
or (ii) the sum of the present values of the remaining scheduled payments of
principal and interest on the Notes to be redeemed (exclusive of interest
accrued to the date of redemption) discounted to the date of redemption on a
semiannual basis (assuming a 360-day year consisting of twelve 30-day months) at
the then current Treasury Rate

                                       2
<PAGE>

(as defined below), plus 30 basis points. In such case, the Company will pay
accrued and unpaid interest on the principal amount being redeemed to the date
of redemption.

         "Treasury Rate" means, with respect to any redemption date, the rate
per year equal to: (1) the yield, under the heading which represents the average
for the immediately preceding week, appearing in the most recently published
statistical release designated "H.15(519)" or any successor publication which is
published weekly by the Board of Governors of the Federal Reserve System and
which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption "Treasury Constant Maturities,"
for the maturity corresponding to the Comparable Treasury Issue; provided that,
if no maturity is within three months before or after the Remaining Life of the
Notes to be redeemed, yields for the two published maturities most closely
corresponding to the Comparable Treasury Issue shall be determined and the
Treasury Rate shall be interpolated or extrapolated from those yields on a
straight line basis, rounding to the nearest month; or (2) if such release (or
any successor release) is not published during the week preceding the
calculation date or does not contain such yields, the rate per year equal to the
semiannual equivalent yield to maturity of the Comparable Treasury Issue,
calculated using a price for the Comparable Treasury Issue (expressed as a
percentage of its principal amount) equal to the Comparable Treasury Price for
such redemption date. The Treasury Rate shall be calculated on the third
business day preceding the redemption date.

         "Comparable Treasury Issue" means the United States Treasury security
selected by an Independent Investment Banker and having a maturity comparable to
the remaining term of the Notes to be redeemed that would be utilized, at the
time of selection and in accordance with customary financial practice, in
pricing new issues of corporate debt securities of comparable maturity to the
remaining term of the Notes.

         "Comparable Treasury Price" means, with respect to any redemption date,
(a) the average of the Reference Treasury Dealer Quotations for the redemption
date, after excluding the highest and lowest Reference Treasury Dealer
Quotations, or (b) if the Trustee obtains fewer than four Reference Treasury
Dealer Quotations, the average of all the quotations.

         "Independent Investment Banker" means one of the Reference Treasury
Dealers appointed by the Trustee after consultation with the Company.

         "Reference Treasury Dealer Quotations" means, with respect to each
Reference Treasury Dealer and any redemption date, the average, as determined by
the Trustee, of the bid and asked prices for the Comparable Treasury Issue
(expressed in each case as a percentage of its principal amount) quoted in
writing to the Trustee by the Reference Treasury Dealer at 5:00 p.m. on the
third business day preceding the redemption date.

         "Reference Treasury Dealer" means each of Deutsche Bank Securities Inc.
and Merrill Lynch, Pierce, Fenner & Smith Incorporated and their respective
successors; provided however, that if any of the foregoing shall cease to be a
primary U.S. Government securities dealer in New York City (a "Primary Treasury
Dealer"), the Company shall substitute another Primary Treasury Dealer.

                                       3
<PAGE>

         "Remaining Life" means the maturity of a United States Treasury
security selected by an Independent Investment Banker that is comparable to the
remaining term of the Notes.

         The Company will mail notice of any redemption between 30 and 60 days
preceding the redemption date to each Holder of the Notes to be redeemed.

         Unless the Company defaults in payment of the redemption price, on and
after the redemption date, interest will cease to accrue on the Notes or
portions called for redemption.

         In case an Event of Default with respect to the Notes shall have
occurred and be continuing, the principal hereof may be declared, and upon such
declaration shall become, immediately due and payable, in the manner, with the
effect and subject to the conditions provided in the Indenture. The Indenture
provides that such declaration may in certain events be waived by the Holders of
a majority in principal amount of the Notes then Outstanding.

         The Indenture permits, with certain exceptions as therein provided, the
amendment thereof and the modification of the rights and obligations of the
Company and the rights of the Holders of the Securities of each series to be
effected under the Indenture at any time by the Company and the Trustee with the
consent of the Holders of not less than a majority in principal amount of the
Outstanding Securities of each series to be affected. It is also provided in the
Indenture that, prior to any declaration accelerating the maturity of the Notes
as a series, the Holders of a majority in aggregate principal amount of the
Securities of such series at the time Outstanding may on behalf of the Holders
of all of the Securities of such series waive any past default with respect to
the Securities of such series under the Indenture and its consequences, except a
default in the payment of the principal of, or interest on, any of the
Securities of such series.

         No reference herein to the Indenture and no provision of this Global
Note or of the Indenture (including the Company's right to defease and discharge
the Notes pursuant to Article Four and Article Fourteen of the Indenture) shall
alter or impair the obligation of the Company, which is absolute and
unconditional, to pay the principal of, and interest on, this Global Note at the
place, at the respective times, at the rate and in the coin or currency herein
prescribed.

         This Global Note shall be exchangeable for Securities registered in the
names of Persons other than the Depositary or its nominee only if (i) the
Depositary notifies the Company that it is unwilling or unable to continue as
the Depositary or if at any time the Depositary ceases to be registered or in
good standing under the United States Securities Exchange Act of 1934, as
amended, and the Company fails to appoint a successor Depositary within 90 days
after the Company receives such notice or becomes aware of such event or (ii)
the Company executes and delivers to the Trustee a Company Order that this
Global Note shall be so exchangeable. To the extent that this Global Note is
exchangeable pursuant to the preceding sentence, it shall be exchangeable for
Notes registered in such names as the Depositary shall direct.

         Except as provided in the immediately preceding paragraph, this Global
Note may not be transferred except as a whole by the Depositary to a nominee

                                       4
<PAGE>

of such Depositary or by a nominee of such Depositary to such Depositary or
another nominee of such Depositary or by such Depositary or any such nominee to
a successor of such Depositary or a nominee of such successor.

         Prior to due presentment for registration of transfer of this Global
Note, the Company, the Trustee and any agent of the Company or the Trustee may
deem and treat the Holder hereof as the absolute owner of this Global Note
(whether or not this Global Note shall be overdue and notwithstanding any
notation of ownership or other writing hereon), for the purpose of receiving
payment hereof or on account hereof (except as otherwise provided in the
Indenture), as herein provided, and for all other purposes, and neither the
Company nor the Trustee nor any Paying Agent nor any Security Registrar shall be
affected by any notice to the contrary. All payments made to or upon the order
of such Holder shall, to the extent of the sum or sums paid, effectually satisfy
and discharge liability for moneys payable on this Global Note.

         None of the Company, the Trustee, any Paying Agent or the Security
Registrar will have any responsibility or liability for any aspect of the
records relating to or payments made on account of beneficial ownership
interests of this Global Note or for maintaining, supervising or reviewing any
records relating to such beneficial ownership interests.

         No recourse for the payment of the principal of, or interest on, this
Global Note, or for any claims based hereon or otherwise in respect hereof, and
no recourse under or upon any obligation, covenant or agreement of the Company
in the Indenture or any indenture supplemental thereto or in any Note or because
of the creation of any indebtedness represented thereby, shall be had against
any incorporator, stockholder, officer or director, as such, past, present or
future, of the Company, whether by virtue of any assessment or penalty or
otherwise, all such liability being, by the acceptance hereof and as part of the
consideration for the issue hereof, expressly waived and released.

         Except as otherwise expressly provided in this Global Note, this Global
Note shall in all respects be entitled to all benefits, and subject to the same
terms and conditions, as definitive registered securities authenticated and
delivered under the Indenture.

         The Indenture and this Global Note shall be governed by and construed
in accordance with the laws of the State of New York.

         This Global Note shall not be valid or become obligatory for any
purpose until the certificate of authentication hereon shall have been signed by
the Trustee under the Indenture referred to on the reverse hereof.

                                       5
<PAGE>

         IN WITNESS WHEREOF, the Company has caused this instrument to be duly
executed under its corporate seal.

<TABLE>
<S>                                 <C>
Dated as of November 6, 2003        HCA INC.

                                    By: /s/ Keith M. Giger
                                        -----------------------------------------------
                                    Name: Keith M. Giger
                                          ---------------------------------------------
                                    Title: Vice President-Finance
                                           --------------------------------------------

                                    Attest: /s/ John M. Franck II
                                            -------------------------------------------
                                    Name: John M. Franck II
                                          ---------------------------------------------
                                    Title: Vice President-Legal and Corporate Secretary
                                           --------------------------------------------
</TABLE>

TRUSTEE'S CERTIFICATE
OF AUTHENTICATION

This is one of the series
of Securities issued under
the within-mentioned Indenture.

THE BANK OF NEW YORK
as Trustee

By: /s/ Robert A. Massimillo
   -----------------------------------

Title: Vice President
      --------------------------------

                                       6

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