Document:

Exhibit 10.1

 

 

AMENDED AND RESTATED

CYTOSORBENTS CORPORATION

2014 LONG-TERM INCENTIVE PLAN

 

     

     

    

  

TABLE OF CONTENTS

 

	 	Page
	1. History; Effective Date.	3
	2. Purposes of the Plan.	3
	3. Terminology.	3
	4. Administration.	3
	(a) Administration of the Plan	3
	(b) Powers of the Administrator	3
	(c) Delegation of Administrative Authority	4
	(d) Non-Uniform Determinations	5
	(e) Limited Liability; Advisors	5
	(f) Indemnification	5
	(g) Effect of Administrator’s Decision	5
	5. Shares Issuable Pursuant to Awards.	5
	(a) Initial Share Pool	5
	(b) Adjustments to Share Pool	5
	(c) Individual Limits	6
	(d) ISO Limit	6
	(e) Source of Shares	6
	6. Participation.	6
	7. Awards.	6
	(a) Awards, In General	6
	(b) Stock Options	6
	(c) Limitation on Reload Options	7
	(d) Stock Appreciation Rights	7
	(e) Repricing	8
	(f) Stock Awards	8
	(g) Stock Units	9
	(h) Performance Shares and Performance Units	10
	(i) Other Stock-Based Awards	10
	(j) Qualified Performance-Based Awards	10
	(k) Awards to Participants Outside the United States	12
	(l) Limitation on Dividend Reinvestment and Dividend Equivalents	12
	8. Withholding of Taxes.	12
	9. Transferability of Awards.	12
	10. Adjustments for Corporate Transactions and Other Events.	13
	(a) Mandatory Adjustments	13
	(b) Discretionary Adjustments	13
	(c) Adjustments to Performance Goals	13
	(d) Statutory Requirements Affecting Adjustments	14
	(e) Dissolution or Liquidation	14

  

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	11. Change in Control Provisions.	14
	(a) Termination of Awards	14
	(b) Other Permitted Actions	15
	(c) Section 409A Savings Clause	15
	12. Substitution of Awards in Mergers and Acquisitions.	15
	13. Compliance with Securities Laws; Listing and Registration.	15
	14. Section 409A Compliance.	16
	15. Plan Duration; Amendment and Discontinuance.	16
	(a) Plan Duration	16
	(b) Amendment and Discontinuance of the Plan	17
	(c) Amendment of Awards	17
	16. General Provisions.	17
	(a) Non-Guarantee of Employment or Service	17
	(b) No Trust or Fund Created	17
	(c) Status of Awards	17
	(d) Subsidiary Employees	18
	(e) Governing Law and Interpretation	18
	(f) Use of English Language	18
	(g) Recovery of Amounts Paid	18
	17. Glossary	18

 

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		1.	History; Effective Date.

 

CYTOSORBENTS CORPORATION, a Delaware
corporation, or successor in interest (“ CytoSorbents ”), has established the AMENDED AND RESTATED CYTOSORBENTS
CORPORATION 2014 LONG-TERM INCENTIVE PLAN, as set forth herein, and as the same may be amended from time to time (the “ Plan
 ”). The Plan was adopted by the Board of Directors of CytoSorbents (the “ Board ”) on April 12, 2017
and was further amended on February 28, 2019. The Plan shall become and is effective as of the date that it is approved by
the stockholders of CytoSorbents(the “Effective Date”). The Plan is a continuation and amendment and restatement of
the CytoSorbents Corporation 2014 Long-Term Incentive Plan (the “2014 Plan”).

 

		2.	Purposes of the Plan.

 

The Plan is designed to:

 

(a) promote the long-term financial
interests and growth of CytoSorbents and its Subsidiaries (together, the “ Company ”) by attracting and retaining
management and other personnel and key service providers with the training, experience and ability to enable them to make a substantial
contribution to the success of the Company’s business;

 

(b) motivate management personnel
by means of growth-related incentives to achieve long-range goals; and

 

(c) further the alignment of interests
of Participants with those of the stockholders of CytoSorbents through opportunities for increased stock or stock-based ownership
in CytoSorbents.

 

Toward these objectives, the Administrator
may grant stock options, stock appreciation rights, stock awards, stock units, performance shares, performance units,
and other stock-based awards to eligible individuals on the terms and subject to the conditions set forth in the Plan.

 

		3.	Terminology.

 

Except as otherwise specifically
provided in an Award Agreement, capitalized words and phrases used in the Plan or an Award Agreement shall have the meaning set
forth in the glossary at Section 17 of the Plan or as defined the first place such word or phrase appears in the Plan.

 

		4.	Administration.

 

(a) Administration of the Plan. The Plan shall
be administered by the Administrator.

 

(b) Powers of the Administrator.
The Administrator shall, except as otherwise provided under the Plan, have plenary authority, in its sole and absolute discretion,
to grant Awards pursuant to the terms of the Plan to Eligible Individuals and to take all other actions necessary or desirable
to carry out the purpose and intent of the Plan. Among other things, the Administrator shall have the authority, in its sole and
absolute discretion, subject to the terms and conditions of the Plan to:

 

(i) determine the Eligible Individuals
to whom, and the time or times at which, Awards shall be granted;

 

(ii) determine the types of Awards to be granted
any Eligible Individual;

 

(iii) determine the number of shares
of Common Stock to be covered by or used for reference purposes for each Award or the value to be transferred pursuant to any Award;

 

(iv) determine the terms, conditions
and restrictions applicable to each Award (which need not be identical) and any shares acquired pursuant thereto, including, without
limitation, (A) the purchase price of any shares of Common Stock, (B) the method of payment for shares purchased pursuant to any
Award, (C) the method for satisfying any tax withholding obligation arising in connection with any Award, including by the
withholding or delivery of shares of Common Stock, (D) the timing, terms and conditions of the exercisability, vesting or payout
of any Award or any shares acquired pursuant thereto, (E) the Performance Goals applicable to any Award and the extent to which
such Performance Goals have been attained, (F) the time of the expiration of any Award, (G) the effect of the Participant’s
Termination of Service on any of the foregoing, and (H) all other terms, conditions and restrictions applicable to any Award or
shares acquired pursuant thereto as the Administrator shall consider to be appropriate and not inconsistent with the terms of the
Plan;

 

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(v) subject to Sections 7(e),
7(j), 10(c) and 15, modify, amend or adjust the terms and conditions of any Award;

 

(vi) accelerate or otherwise change
the time at or during which an Award may be exercised or becomes payable and waive or accelerate the lapse, in whole or in part,
of any restriction, condition or risk of forfeiture with respect to such Award; provided , however , that, except
in connection with death, disability or a Change in Control, no such change, waiver or acceleration shall be made with respect
to a Qualified Performance-Based Award if the effect of such action would cause the Award to fail to qualify for the Section 162(m)
Exemption or shall be made to any Award that is considered “deferred compensation” within the meaning of Section 409A
of the Code if the effect of such action is inconsistent with Section 409A of the Code;

 

(vii) determine whether an Award
will be paid or settled in cash, shares of Common Stock, or in any combination thereof and whether, to what extent and under what
circumstances cash or shares of Common Stock payable with respect to an Award shall be deferred either automatically or at the
election of the Participant;

 

(viii) for any purpose, including
but not limited to, qualifying for preferred or beneficial tax treatment, accommodating the customs or administrative challenges
or otherwise complying with the tax, accounting or regulatory requirements of one or more jurisdictions, adopt, amend, modify,
administer or terminate sub-plans, appendices, special provisions or supplements applicable to Awards regulated by the laws of
a particular jurisdiction, which sub-plans, appendices, supplements and special provisions may take precedence over other provisions
of the Plan, and prescribe, amend and rescind rules and regulations relating to such sub-plans, supplements and special provisions;

 

(ix) establish any “blackout”
period, during which transactions affecting Awards may not be effectuated, that the Administrator in its sole discretion deems
necessary or advisable;

 

(x) determine the Fair Market Value
of shares of Common Stock or other property for any purpose under the Plan or any Award;

 

(xi) administer, construe and interpret
the Plan, Award Agreements and all other documents relevant to the Plan and Awards issued thereunder, and decide all other matters
to be determined in connection with an Award;

 

(xii) establish, amend, rescind
and interpret such administrative rules, regulations, agreements, guidelines, instruments and practices for the administration
of the Plan and for the conduct of its business as the Administrator deems necessary or advisable;

 

(xiii) correct any defect, supply
any omission or reconcile any inconsistency in the Plan or in any Award or Award Agreement in the manner and to the extent the
Administrator shall consider it desirable to carry it into effect; and

 

(xiv) otherwise administer the Plan and all Awards
granted under the Plan.

 

(c) Delegation of Administrative
Authority. The Administrator may designate officers or employees of the Company to assist the Administrator in the administration
of the Plan and, to the extent permitted by applicable law and stock exchange rules, the Administrator may delegate to officers
or other employees of the Company the Administrator’s duties and powers under the Plan, subject to such conditions and limitations
as the Administrator shall prescribe, including without limitation the authority to execute agreements or other documents on behalf
of the Administrator; provided, however, that such delegation of authority shall not extend to the granting of, or exercise of
discretion with respect to, Awards to Eligible Individuals who are “covered employees” within the meaning of Section 162(m)
of the Code or officers under Section 16 of the Exchange Act.

 

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(d) Non-Uniform Determinations.
The Administrator’s determinations under the Plan (including without limitation, determinations of the persons to receive
Awards, the form, amount and timing of such Awards, the terms and provisions of such Awards and the Award Agreements evidencing
such Awards, and the ramifications of a Change in Control upon outstanding Awards) need not be uniform and may be made by the Administrator
selectively among Awards or persons who receive, or are eligible to receive, Awards under the Plan, whether or not such persons
are similarly situated.

 

(e) Limited Liability; Advisors.
To the maximum extent permitted by law, no member of the Administrator shall be liable for any action taken or decision made in
good faith relating to the Plan or any Award thereunder. The Administrator may employ counsel, consultants, accountants, appraisers,
brokers or other persons. The Administrator, CytoSorbents, and the officers and directors of CytoSorbents shall be entitled to
rely upon the advice, opinions or valuations of any such persons.

 

(f) Indemnification. To the
maximum extent permitted by law, by CytoSorbents’s charter and by-laws, and by any directors’ and officers’ liability
insurance coverage which may be in effect from time to time, the members of the Administrator and any agent or delegate of the
Administrator who is a director, officer or employee of CytoSorbents or an Affiliate shall be indemnified by CytoSorbents against
any and all liabilities and expenses to which they may be subjected by reason of any act or failure to act with respect to their
duties on behalf of the Plan.

 

(g) Effect of Administrator’s
Decision. All actions taken and determinations made by the Administrator on all matters relating to the Plan or any Award pursuant
to the powers vested in it hereunder shall be in the Administrator’s sole and absolute discretion, unless in contravention
of any express term of the Plan, including, without limitation, any determination involving the appropriateness or equitableness
of any action. All determinations made by the Administrator shall be conclusive, final and binding on all parties concerned, including
CytoSorbents, its stockholders, any Participants and any other employee, consultant, or director of CytoSorbents and its Affiliates,
and their respective successors in interest. No member of the Administrator, nor any director, officer, employee or representative
of CytoSorbents shall be personally liable for any action, determination or interpretation made in good faith with respect to the
Plan or Awards.

 

		5.	Shares Issuable Pursuant to Awards.

 

(a) Share Pool. The number
of shares of Common Stock issuable pursuant to Awards that may be granted under the Plan (the “ Share Pool ”)
shall be equal to an aggregate 13,400,000 shares which represents (i) 2,400,000 shares approved by stockholders under the
2014 Plan (ii) an additional 5,000,000 shares approved by the stockholders on June 6, 2017, plus (iii) an additional 6,000,000
shares approved by the stockholders on the Effective Date.

 

(b) Adjustments to Share Pool.
The Share Pool shall be adjusted, in addition to any adjustments to be made pursuant to Section 10 of the Plan, as follows:

 

(i) The Share Pool shall be reduced,
on the date of grant, by one share for each share of Common Stock made subject to an Award granted under the Plan;

 

(ii) The Share Pool shall be increased,
on the relevant date, by the number of unissued shares of Common Stock underlying or used as a reference measure for any Award
or portion of an Award that is cancelled, forfeited, expired, terminated unearned or settled in cash, in any such case without
the issuance of shares, and by the number of shares of Common Stock used as a reference measure for any Award that are not issued
upon settlement of such Award either due to a net settlement or otherwise;

 

(iii) The Share Pool shall be increased,
on the forfeiture date, by the number of shares of Common Stock that are forfeited back to CytoSorbents after issuance due to a
failure to meet an Award contingency or condition with respect to any Award or portion of an Award;

 

(iv) The Share Pool shall be increased,
on the exercise date, by the number of shares of Common Stock withheld by or surrendered (either actually or through attestation)
to CytoSorbents in payment of the exercise price of any Award; and

 

(v) The Share Pool shall be increased,
on the relevant date, by the number of shares of Common Stock withheld by or surrendered (either actually or through attestation)
to CytoSorbents in payment of the statutory minimum Tax Withholding Obligation that arises in connection with any Award.

 

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(c) Individual Limits. Subject to adjustment
as provided in Section 10 of the Plan:

 

(i) the maximum number of shares
of Common Stock that may be made subject to Awards granted under the Plan during a calendar year to any one person in the form
of stock options or stock appreciation rights is, in the aggregate, 500,000 shares;

 

(ii) the maximum number of shares
of Common Stock that may be made subject to Awards granted under the Plan during a calendar year to any one person in the form
of Performance Awards is, in the aggregate, 250,000 shares,

 

(iii) in connection with Awards
granted under the Plan during a calendar year to any one person in the form of Performance Shares, the maximum cash amount payable
thereunder is the amount equal to the number of shares made subject to the Award, as limited by Section 5(c)(ii), multiplied
by the Fair Market Value as determined as of the payment date; and

 

(iv) in connection with Awards granted
under the Plan during a calendar year to any one person in the form of Performance Units, the maximum cash amount payable under
such Performance Units is $500,000; provided, however, that each of the limitations set forth above in clauses (i), (ii)
and (iii) of this Section 5(c) shall be multiplied by two when applied to Awards granted to any individual during the calendar
year in which such individual first commences service with CytoSorbents or a Subsidiary; and provided, further, that the
limitations set forth above in clauses (ii) and (iii) of this Section 5(c) shall be multiplied by the number of calendar years
over which the applicable Performance Period spans (in whole or in part), if the Performance Period is longer than 12 months’
duration, when applied to Performance Awards. If an Award is terminated, surrendered or canceled in the same year in which it was
granted, such Award nevertheless will continue to be counted against the limitations set forth above in this Section 5(c)
for the calendar year in which it was granted.

 

(d) ISO Limit. Subject to
adjustment pursuant to Section 10 of the Plan, the maximum number of shares of Common Stock that may be issued pursuant to
stock options granted under the Plan that are intended to qualify as Incentive Stock Options within the meaning of Section 422
of the Code shall be equal to the number of shares in the Share Pool.

 

(e) Source of Shares. The
shares of Common Stock with respect to which Awards may be made under the Plan shall be shares authorized for issuance under CytoSorbents’s
charter but unissued, or issued and reacquired, including without limitation shares purchased in the open market or in private
transactions.

 

		6.	Participation.

 

Participation in the Plan shall
be open to all Eligible Individuals, as may be selected by the Administrator from time to time. The Administrator may also grant
Awards to Eligible Individuals in connection with hiring, recruiting or otherwise, prior to the date the individual first performs
services for CytoSorbents or a Subsidiary; provided , however , that such Awards shall not become vested or exercisable,
and no shares shall be issued to such individual, prior to the date the individual first commences performance of such services.

 

		7.	Awards.

 

(a) Awards, In General. The
Administrator, in its sole discretion, shall establish the terms of all Awards granted under the Plan consistent with the terms
of the Plan. Awards may be granted individually or in tandem with other types of Awards, concurrently with or with respect to outstanding
Awards. All Awards are subject to the terms and conditions provided in the Award Agreement, which shall be delivered to the Participant
receiving such Award upon, or as promptly as is reasonably practicable following, the grant of such Award. Unless otherwise specified
by the Administrator, in its sole discretion, or otherwise provided in the Award Agreement, an Award shall not be effective unless
the Award Agreement is signed or otherwise accepted by CytoSorbents and the Participant receiving the Award (including by electronic
delivery and/or electronic signature).

 

(b) Stock Options.

 

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(i) Grants. A stock option
means a right to purchase a specified number of shares of Common Stock from CytoSorbents at a specified price during a specified
period of time. The Administrator may from time to time grant to Eligible Individuals Awards of Incentive Stock Options or Nonqualified
Options; provided , however , that Awards of Incentive Stock Options shall be limited to employees of CytoSorbents
or of any current or hereafter existing “parent corporation” or “subsidiary corporation,” as defined in
Sections 424(e) and 424(f) of the Code, respectively, of CytoSorbents, and any other Eligible Individuals who are eligible
to receive Incentive Stock Options under the provisions of Section 422 of the Code. No stock option shall be an Incentive
Stock Option unless so designated by the Administrator at the time of grant or in the applicable Award Agreement.

 

(ii) Exercise. Stock options
shall be exercisable at such time or times and subject to such terms and conditions as shall be determined by the Administrator;
provided, however, that Awards of stock options may not have a term in excess of ten years’ duration unless required
otherwise by applicable law. The exercise price per share subject to a stock option granted under the Plan shall not be less than
the Fair Market Value of one share of Common Stock on the date of grant of the stock option, except as provided under applicable
law or with respect to stock options that are granted in substitution of similar types of awards of a company acquired by CytoSorbents
or a Subsidiary or with which CytoSorbents or a Subsidiary combines (whether in connection with a corporate transaction, such as
a merger, combination, consolidation or acquisition of property or stock, or otherwise) to preserve the intrinsic value of such
awards.

 

(iii) Termination of Service.
Except as provided in the applicable Award Agreement or otherwise determined by the Administrator, to the extent stock options
are not vested and exercisable, a Participant’s stock options shall be forfeited upon his or her Termination of Service.

 

(iv) Additional Terms and Conditions.
The Administrator may, by way of the Award Agreement or otherwise, determine such other terms, conditions, restrictions, and/or
limitations, if any, of any Award of stock options, provided they are not inconsistent with the Plan.

 

(c) Limitation on Reload Options.
The Administrator shall not grant stock options under this Plan that contain a reload or replenishment feature pursuant to which
a new stock option would be granted automatically upon receipt of delivery of Common Stock to CytoSorbents in payment of the exercise
price or any tax withholding obligation under any other stock option.

 

(d) Stock Appreciation Rights.

 

(i) Grants. The Administrator
may from time to time grant to Eligible Individuals Awards of stock appreciation rights. A stock appreciation right entitles the
Participant to receive, subject to the provisions of the Plan and the Award Agreement, a payment having an aggregate value equal
to the product of  (i) the excess of  (A) the Fair Market Value on the exercise date of one share of Common
Stock over (B) the base price per share specified in the Award Agreement, times (ii) the number of shares specified by the stock
appreciation right, or portion thereof, which is exercised. The base price per share specified in the Award Agreement shall not
be less than the lower of the Fair Market Value on the date of grant or the exercise price of any tandem stock option to which
the stock appreciation right is related, or with respect to stock appreciation rights that are granted in substitution of similar
types of awards of a company acquired by CytoSorbents or a Subsidiary or with which CytoSorbents or a Subsidiary combines (whether
in connection with a corporate transaction, such as a merger, combination, consolidation or acquisition of property or stock, or
otherwise) such base price as is necessary to preserve the intrinsic value of such awards.

 

(ii) Exercise. Stock appreciation
rights shall be exercisable at such time or times and subject to such terms and conditions as shall be determined by the Administrator;
provided, however, that stock appreciation rights granted under the Plan may not have a term in excess of ten years’
duration unless required otherwise by applicable law. The applicable Award Agreement shall specify whether payment by CytoSorbents
of the amount receivable upon any exercise of a stock appreciation right is to be made in cash or shares of Common Stock or a combination
of both, or shall reserve to the Administrator or the Participant the right to make that determination prior to or upon the exercise
of the stock appreciation right. If upon the exercise of a stock appreciation right a Participant is to receive a portion of such
payment in shares of Common Stock, the number of shares shall be determined by dividing such portion by the Fair Market Value of
a share of Common Stock on the exercise date. No fractional shares shall be used for such payment and the Administrator shall determine
whether cash shall be given in lieu of such fractional shares or whether such fractional shares shall be eliminated.

 

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(iii) Termination of Service.
Except as provided in the applicable Award Agreement or otherwise determined by the Administrator, to the extent stock appreciation
rights are not vested and exercisable, a Participant’s stock appreciation rights shall be forfeited upon his or her Termination
of Service.

 

(iv) Additional Terms and Conditions.
The Administrator may, by way of the Award Agreement or otherwise, determine such other terms, conditions, restrictions, and/or
limitations, if any, of any Award of stock appreciation rights, provided they are not inconsistent with the Plan.

 

(e) Repricing. Notwithstanding
anything herein to the contrary, except in connection with a corporate transaction involving CytoSorbents (including, without limitation,
any stock dividend, stock split, extraordinary cash dividend, recapitalization, reorganization, merger, consolidation, split-up,
spin-off, combination, or exchange of shares), the terms of options and stock appreciation rights granted under the Plan may not
be amended, after the date of grant, to reduce the exercise price of such options or stock appreciation rights, nor may outstanding
options or stock appreciation rights be canceled in exchange for (i) cash, (ii) options or stock appreciation rights with
an exercise price or base price that is less than the exercise price or base price of the original outstanding options or stock
appreciation rights, or (iii) other Awards, unless such action is approved by CytoSorbents’s stockholders.

 

(f) Stock Awards.

 

(i) Grants. The Administrator
may from time to time grant to Eligible Individuals Awards of unrestricted Common Stock or Restricted Stock (collectively, “
Stock Awards ”) on such terms and conditions, and for such consideration, including no consideration or such minimum
consideration as may be required by law, as the Administrator shall determine. Stock Awards shall be evidenced in such manner as
the Administrator may deem appropriate, including via book-entry registration.

 

(ii) Vesting. Restricted
Stock shall be subject to such vesting, restrictions on transferability and other restrictions, if any, and/or risk of forfeiture
as the Administrator may impose at the date of grant or thereafter. The Restriction Period to which such vesting, restrictions
and/or risk of forfeiture apply may lapse under such circumstances, including without limitation upon the attainment of Performance
Goals, in such installments, or otherwise, as the Administrator may determine. In the event that the Administrator conditions the
grant or vesting of a Stock Award upon the attainment of Performance Goals, or the attainment of Performance Goals together with
the continued service of the Participant, the Administrator may, prior to or at the time of grant, designate the Stock Award as
a Qualified Performance-Based Award. Subject to the provisions of the Plan and the applicable Award Agreement, during the Restriction
Period, the Participant shall not be permitted to sell, assign, transfer, pledge or otherwise encumber shares of Restricted Stock.

 

(iii) Rights of a Stockholder;
Dividends. Except to the extent restricted under the Award Agreement relating to the Restricted Stock, a Participant granted
Restricted Stock shall have all of the rights of a stockholder of Common Stock including, without limitation, the right to vote
Restricted Stock. Cash dividends declared payable on Common Stock shall be paid, with respect to outstanding Restricted Stock,
either as soon as practicable following the dividend payment date or deferred for payment to such later date as determined by the
Administrator, and shall be paid in cash or as unrestricted shares of Common Stock having a Fair Market Value equal to the amount
of such dividends or may be reinvested in additional shares of Restricted Stock as determined by the Administrator; provided
, however , that dividends declared payable on Restricted Stock that is granted as a Performance Award shall be held by
CytoSorbents and made subject to forfeiture at least until achievement of the applicable Performance Goal related to such shares
of Restricted Stock. Stock distributed in connection with a stock split or stock dividend, and other property distributed as a
dividend, shall be subject to restrictions and a risk of forfeiture to the same extent as the Restricted Stock with respect to
which such Common Stock or other property has been distributed. As soon as is practicable following the date on which restrictions
on any shares of Restricted Stock lapse, CytoSorbents shall deliver to the Participant the certificates for such shares or shall
cause the shares to be registered in the Participant’s name in book-entry form, in either case with the restrictions removed,
provided that the Participant shall have complied with all conditions for delivery of such shares contained in the Award Agreement
or otherwise reasonably required by CytoSorbents.

 

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(iv) Termination of Service.
Except as provided in the applicable Award Agreement, upon Termination of Service during the applicable Restriction Period, Restricted
Stock and any accrued but unpaid dividends that are at that time subject to restrictions shall be forfeited; provided that
the Administrator may provide, by rule or regulation or in any Award Agreement, or may determine in any individual case, that restrictions
or forfeiture conditions relating to Restricted Stock will be waived in whole or in part in the event of terminations resulting
from specified causes, and the Administrator may in other cases waive in whole or in part the forfeiture of Restricted Stock.

 

(v) Additional Terms and Conditions.
The Administrator may, by way of the Award Agreement or otherwise, determine such other terms, conditions, restrictions, and/or
limitations, if any, of any Award of Restricted Stock, provided they are not inconsistent with the Plan.

 

(g) Stock Units.

 

(i) Grants. The Administrator
may from time to time grant to Eligible Individuals Awards of unrestricted stock Units or Restricted Stock Units on such terms
and conditions, and for such consideration, including no consideration or such minimum consideration as may be required by law,
as the Administrator shall determine. Restricted Stock Units represent a contractual obligation by CytoSorbents to deliver a number
of shares of Common Stock, an amount in cash equal to the Fair Market Value of the specified number of shares subject to the Award,
or a combination of shares of Common Stock and cash, in accordance with the terms and conditions set forth in the Plan and any
applicable Award Agreement.

 

(ii) Vesting and Payment.
Restricted Stock Units shall be subject to such vesting, risk of forfeiture and/or payment provisions as the Administrator may
impose at the date of grant. The Restriction Period to which such vesting and/or risk of forfeiture apply may lapse under such
circumstances, including without limitation upon the attainment of Performance Goals, in such installments, or otherwise, as the
Administrator may determine. In the event that the Administrator conditions the vesting and/or lapse of risk of forfeiture of Restricted
Stock Units upon the attainment of Performance Goals, or the attainment of Performance Goals together with the continued service
of the Participant, the Administrator may, prior to or at the time of grant, designate the Award of Restricted Stock Units as a
Qualified Performance-Based Award. Shares of Common Stock, cash or a combination of shares of Common Stock and cash, as applicable,
payable in settlement of Restricted Stock Units shall be delivered to the Participant as soon as administratively practicable,
but no later than 30 days, after the date on which payment is due under the terms of the Award Agreement provided that
the Participant shall have complied with all conditions for delivery of such shares or payment contained in the Award Agreement
or otherwise reasonably required by CytoSorbents, or in accordance with an election of the Participant, if the Administrator so
permits, that meets the requirements of Section 409A of the Code.

 

(iii) No Rights of a Stockholder;
Dividend Equivalents. Until shares of Common Stock are issued to the Participant in settlement of stock Units, the Participant
shall not have any rights of a stockholder of CytoSorbents with respect to the stock Units or the shares issuable thereunder. The
Administrator may grant to the Participant the right to receive Dividend Equivalents on stock Units, on a current, reinvested and/or
restricted basis, subject to such terms as the Administrator may determine provided , however , that Dividend Equivalents
payable on stock Units that are granted as a Performance Award shall, rather than be paid on a current basis, be accrued and made
subject to forfeiture at least until achievement of the applicable Performance Goal related to such stock Units.

 

(iv) Termination of Service.
Upon Termination of Service during the applicable deferral period or portion thereof to which forfeiture conditions apply, or upon
failure to satisfy any other conditions precedent to the delivery of shares of Common Stock or cash to which such Restricted Stock
Units relate, all Restricted Stock Units and any accrued but unpaid Dividend Equivalents with respect to such Restricted Stock
Units that are then subject to deferral or restriction shall be forfeited; provided that the Administrator may provide,
by rule or regulation or in any Award Agreement, or may determine in any individual case, that restrictions or forfeiture conditions
relating to Restricted Stock Units will be waived in whole or in part in the event of termination resulting from specified causes,
and the Administrator may in other cases waive in whole or in part the forfeiture of Restricted Stock Units.

 

(v) Additional Terms and Conditions.
The Administrator may, by way of the Award Agreement or otherwise, determine such other terms, conditions, restrictions, and/or
limitations, if any, of any Award of stock Units, provided they are not inconsistent with the Plan.

 

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(h) Performance Shares and Performance Units.

 

(i) Grants. The Administrator
may from time to time grant to Eligible Individuals Awards in the form of Performance Shares and Performance Units. Performance
Shares, as that term is used in this Plan, shall refer to shares of Common Stock or Units that are expressed in terms of Common
Stock, the issuance, vesting, lapse of restrictions on or payment of which is contingent on performance as measured against predetermined
objectives over a specified Performance Period. Performance Units, as that term is used in this Plan, shall refer to dollar-denominated
Units valued by reference to designated criteria established by the Administrator, other than Common Stock, the issuance, vesting,
lapse of restrictions on or payment of which is contingent on performance as measured against predetermined objectives over a specified
Performance Period. The applicable Award Agreement shall specify whether Performance Shares and Performance Units will be settled
or paid in cash or shares of Common Stock or a combination of both, or shall reserve to the Administrator or the Participant the
right to make that determination prior to or at the payment or settlement date.

 

(ii) Performance Criteria.
The Administrator shall, prior to or at the time of grant, condition the grant, vesting or payment of, or lapse of restrictions
on, an Award of Performance Shares or Performance Units upon (A) the attainment of Performance Goals during a Performance Period
or (B) the attainment of Performance Goals and the continued service of the Participant. The Administrator may, prior to or at
the time of grant, designate an Award of Performance Shares or Performance Units as a Qualified Performance-Based Award. The length
of the Performance Period, the Performance Goals to be achieved during the Performance Period, and the measure of whether and to
what degree such Performance Goals have been attained shall be conclusively determined by the Administrator in the exercise of
its absolute discretion. Performance Goals may include minimum, maximum and target levels of performance, with the size of the
Award or payout of Performance Shares or Performance Units or the vesting or lapse of restrictions with respect thereto based on
the level attained. An Award of Performance Shares or Performance Units shall be settled as and when the Award vests or at a later
time specified in the Award Agreement or in accordance with an election of the Participant, if the Administrator so permits, that
meets the requirements of Section 409A of the Code.

 

(iii) Additional Terms and Conditions.
The Administrator may, by way of the Award Agreement or otherwise, determine such other terms, conditions, restrictions, and/or
limitations, if any, of any Award of Performance Shares or Performance Units, provided they are not inconsistent with the
Plan.

 

(i) Other Stock-Based Awards.
The Administrator may from time to time grant to Eligible Individuals Awards in the form of Other Stock-Based Awards. Other Stock-Based
Awards in the form of Dividend Equivalents may be (A) awarded on a free-standing basis or in connection with another Award other
than a stock option or stock appreciation right, (B) paid currently or credited to an account for the Participant, including the
reinvestment of such credited amounts in Common Stock equivalents, to be paid on a deferred basis, and (C) settled in cash or Common
Stock as determined by the Administrator; provided , however , that Dividend Equivalents payable on Other Stock-Based
Awards that are granted as a Performance Award shall, rather than be paid on a current basis, be accrued and made subject to forfeiture
at least until achievement of the applicable Performance Goal related to such Other Stock-Based Awards. Any such settlements, and
any such crediting of Dividend Equivalents, may be subject to such conditions, restrictions and contingencies as the Administrator
shall establish.

 

(j) Qualified Performance-Based Awards.

 

(i) Stock Options and Stock Appreciation
Rights. The provisions of the Plan are intended to ensure that all stock options and stock appreciation rights granted hereunder
to any Participant who is or may be a “covered employee” (within the meaning of Section 162(m)(3) of the Code)
in the tax year in which such stock option or stock appreciation right is expected to be deductible to CytoSorbents or a Subsidiary
qualify for the Section 162(m) Exemption, and all such Awards shall therefore be considered Qualified Performance-Based Awards,
and the Plan shall be interpreted and operated consistent with that intention.

 

    	 	10	 

     

    

 

(ii) Grant Process for Performance
Awards. When granting any Award other than a stock option or stock appreciation right, the Administrator may designate such
Award as a Qualified Performance-Based Award, based upon a determination that (A) the recipient is or may be a “covered employee”
(within the meaning of Section 162(m)(3) of the Code) with respect to such Award and (B) the Administrator wishes such Award
to qualify for the Section 162(m) Exemption. For any Award so designated as a Qualified Performance-Based Award, the Administrator
shall take steps to ensure that the terms of any such Award (and of the grant thereof) shall be consistent with such designation
(including, without limitation, that all such Awards be granted by a committee composed solely of  “outside directors”
(within the meaning of Section 162(m) of the Code) and that the Performance Goals be established, in writing, by the Administrator
within the time period prescribed by Section 162(m) of the Code). The Performance Goals established by the Administrator for
each Qualified Performance-Based Award shall be objective such that a third party having knowledge of the relevant facts could
determine whether or not any Performance Goal has been achieved, or the extent of such achievement, and the amount, if any, which
has been earned by the Participant based on such performance. The Administrator may retain in an Award Agreement the discretion
to reduce (but not to increase) the amount or number of Qualified Performance-Based Awards which will be earned based on the achievement
of Performance Goals. When the Performance Goals are established, the Administrator shall also specify the manner in which the
level of achievement of such Performance Goals shall be calculated and the weighting assigned to such Performance Goals.

 

(iii) Certification and Payment.
Following completion of the applicable Performance Period, and prior to any, as applicable, grant, vesting, lapse of restrictions
on or payment of a Qualified Performance-Based Award, the Administrator shall determine in accordance with the terms of the Award
and shall certify in writing whether the applicable Performance Goal(s) were achieved, or the level of such achievement, and the
amount, if any, earned by the Participant based upon such performance. For this purpose, approved minutes of the meeting of the
Administrator at which certification is made shall be sufficient to satisfy the requirement of a written certification. No Qualified
Performance-Based Awards will be granted, become vested, have restrictions lapse or be paid, as applicable, for a Performance Period
until such certification is made by the Administrator. The amount of a Qualified Performance-Based Award actually granted, vested,
or paid to a Participant, or on which restrictions shall lapse, may be less than the amount determined by the applicable Performance
Goal formula, at the discretion of the Administrator to take into account additional factors that the Administrator may deem relevant
to the assessment of individual or corporate performance for the Performance Period or otherwise, subject to the terms and conditions
of the applicable Award Agreement.

 

(iv) Performance Goals. Performance
Goals may be applied on a per share or absolute basis and relative to one or more Performance Metrics, or any combination thereof,
and may be measured pursuant to U.S. generally accepted accounting principles (“ GAAP ”), non-GAAP or other
objective standards in a manner consistent with CytoSorbents’ or its Subsidiary’s established accounting policies,
all as the Administrator shall determine at the time the Performance Goals for a Performance Period are established. The Administrator
may, in its sole discretion, provide that one or more objectively determinable adjustments shall be made to the manner in which
one or more of the Performance Goals is to be calculated or measured to take into account, or ignore, one or more of the following:
(1) items related to a change in accounting principle; (2) items relating to financing activities; (3) expenses
for restructuring or productivity initiatives; (4) other non-operating items; (5) items related to acquisitions; (6) items
attributable to the business operations of any entity acquired by the Company during the Performance Period; (7) items related
to the sale or disposition of a business or segment of a business; (8) items related to discontinued operations that do not
qualify as a segment of a business under U.S. generally accepted accounting principles; (9) items attributable to any stock
dividend, stock split, combination or exchange of stock occurring during the Performance Period; (10) any other items of significant
income or expense which are determined to be appropriate adjustments; (11) items relating to unusual or extraordinary corporate
transactions, events or developments, (12) items related to amortization of acquired intangible assets; (13) items that are
outside the scope of the Company’s core, on-going business activities; (14) changes in foreign currency exchange rates; (15)
items relating to changes in tax laws; (16) certain identified expenses (including, but not limited to, cash bonus expenses, incentive
expenses and acquisition-related transaction and integration expenses); (17) items relating to asset impairment charges; or (18)
items relating to gains or unusual or nonrecurring events or changes in applicable law, accounting principles or business conditions.
For all Awards intended to qualify as Qualified Performance-Based Awards, such determinations shall be made within the time prescribed
by, and otherwise in compliance with, Section 162(m) of the Code.

 

    	 	11	 

     

    

 

(v) Non-delegation. No delegate
of the Administrator is permitted to exercise authority granted to the Administrator under Section 4 to the extent that the
exercise of such authority by the delegate would cause an Award designated as a Qualified Performance-Based Award not to qualify
for, or to cease to qualify for, the Section 162(m) Exemption.

 

(k) Awards to Participants Outside
the United States. The Administrator may grant Awards to Eligible Individuals who are foreign nationals, who are located outside
the United States or who are not compensated from a payroll maintained in the United States, or who are otherwise subject to (or
could cause CytoSorbents or a Subsidiary to be subject to) tax, legal or regulatory provisions of countries or jurisdictions outside
the United States, on such terms and conditions different from those specified in the Plan as may, in the judgment of the Administrator,
be necessary or desirable in order that any such Award shall conform to laws, regulations, and customs of the country or jurisdiction
in which the Participant is then resident or primarily employed or to foster and promote achievement of the purposes of the Plan.

 

(l) Limitation on Dividend Reinvestment
and Dividend Equivalents. Reinvestment of dividends in additional Restricted Stock at the time of any dividend payment, and
the payment of shares of Common Stock with respect to dividends to Participants holding Awards of stock Units, shall only be permissible
if sufficient shares are available under the Share Pool for such reinvestment or payment (taking into account then outstanding
Awards). In the event that sufficient shares are not available under the Share Pool for such reinvestment or payment, such reinvestment
or payment shall be made in the form of a grant of stock Units equal in number to the shares of Common Stock that would have been
obtained by such payment or reinvestment, the terms of which stock Units shall provide for settlement in cash and for Dividend
Equivalent reinvestment in further stock Units on the terms contemplated by this Section 7(l).

 

		8.	Withholding of Taxes.

 

Participants and holders of Awards
shall pay to CytoSorbents or its Affiliate, or make arrangements satisfactory to the Administrator for payment of, any Tax Withholding
Obligation in respect of Awards granted under the Plan no later than the date of the event creating the tax or social insurance
contribution liability. The obligations of CytoSorbents under the Plan shall be conditional on such payment or arrangements. Unless
otherwise determined by the Administrator, Tax Withholding Obligations may be settled in whole or in part with shares of Common
Stock, including unrestricted outstanding shares surrendered to CytoSorbents and unrestricted shares that are part of the Award
that gives rise to the Tax Withholding Obligation, having a Fair Market Value on the date of surrender or withholding equal to
the statutory minimum amount (and not any greater amount) required to be withheld for tax or social insurance contribution purposes,
all in accordance with such procedures as the Administrator establishes. CytoSorbents or its Affiliate may deduct, to the extent
permitted by law, any such Tax Withholding Obligations from any payment of any kind otherwise due to the Participant or holder
of an Award.

 

		9.	Transferability of Awards.

 

General Nontransferability Absent
Administrator Permission. Except as otherwise determined by the Administrator or as required by applicable law, and in any
event in the case of an Incentive Stock Option or a tandem stock appreciation right granted with respect to an Incentive Stock
Option, no Award granted under the Plan shall be transferable by a Participant otherwise than by will or the laws of descent and
distribution. The Administrator shall not permit any transfer of an Award for value. An Award may be exercised during the lifetime
of the Participant, only by the Participant or, during the period the Participant is under a legal disability, by the Participant’s
guardian or legal representative, unless otherwise determined by the Administrator. Awards granted under the Plan shall not be
subject in any manner to alienation, anticipation, sale, transfer, assignment, pledge, or encumbrance, except as otherwise determined
by the Administrator; provided, however, that the restrictions in this sentence shall not apply to the shares of Common
Stock received in connection with an Award after the date that the restrictions on transferability of such shares set forth in
the applicable Award Agreement have lapsed. Nothing in this paragraph shall be interpreted or construed as overriding the terms
of any CytoSorbents stock ownership or retention policy, now or hereafter existing, that may apply to the Participant or shares
of Common Stock received under an Award.

 

    	 	12	 

     

    

 

		10.	Adjustments for Corporate Transactions and Other Events.

 

(a) Mandatory Adjustments.
In the event of a merger, consolidation, stock rights offering, statutory share exchange or similar event affecting CytoSorbents
(each, a “ Corporate Event ”) or a stock dividend, stock split, reverse stock split, separation, spinoff, reorganization,
extraordinary dividend of cash or other property, share combination or subdivision, or recapitalization or similar event affecting
the capital structure of CytoSorbents (each, a “ Share Change ”) that occurs at any time after adoption of this
Plan by the Board (including any such Corporate Event or Share Change that occurs after such adoption and coincident with or prior
to the Effective Date), the Administrator shall make equitable and appropriate substitutions or proportionate adjustments to (i) the
aggregate number and kind of shares of Common Stock or other securities on which Awards under the Plan may be granted to Eligible
Individuals, (ii) the maximum number of shares of Common Stock or other securities with respect to which Awards may be granted
during any one calendar year to any individual, (iii) the maximum number of shares of Common Stock or other securities that may
be issued with respect to Incentive Stock Options granted under the Plan, (iv) the number of shares of Common Stock or other securities
covered by each outstanding Award and the exercise price, base price or other price per share, if any, and other relevant terms
of each outstanding Award, and (v) all other numerical limitations relating to Awards, whether contained in this Plan or in
Award Agreements; provided , however , that any fractional shares resulting from any such adjustment shall be eliminated.

 

(b) Discretionary Adjustments.
In the case of Corporate Events, the Administrator may make such other adjustments to outstanding Awards as it determines to be
appropriate and desirable, which adjustments may include, without limitation, (i) the cancellation of outstanding Awards in
exchange for payments of cash, securities or other property or a combination thereof having an aggregate value equal to the value
of such Awards, as determined by the Administrator in its sole discretion (it being understood that in the case of a Corporate
Event with respect to which stockholders of CytoSorbents receive consideration other than publicly traded equity securities of
the ultimate surviving entity, any such determination by the Administrator that the value of a stock option or stock appreciation
right shall for this purpose be deemed to equal the excess, if any, of the value of the consideration being paid for each share
of Common Stock pursuant to such Corporate Event over the exercise price or base price of such stock option or stock appreciation
right shall conclusively be deemed valid and that any stock option or stock appreciation right may be cancelled for no consideration
upon a Corporate Event if its exercise price or base price does not exceed the value of the consideration being paid for each share
of Common Stock pursuant to such Corporate Event), (ii) the substitution of securities or other property (including, without limitation,
cash or other securities of CytoSorbents and securities of entities other than CytoSorbents) for the shares of Common Stock subject
to outstanding Awards, and (iii) the substitution of equivalent awards, as determined in the sole discretion of the Administrator,
of the surviving or successor entity or a parent thereof  (“ Substitute Awards ”).

 

(c) Adjustments to Performance
Goals. The Administrator may, in its discretion, adjust the Performance Goals applicable to any Awards to reflect any unusual
or non-recurring events and other extraordinary items, impact of charges for restructurings, discontinued operations and the cumulative
effects of accounting or tax changes, each as defined by generally accepted accounting principles or as identified in CytoSorbents’s
consolidated financial statements, notes to the consolidated financial statements, management’s discussion and analysis or
other CytoSorbents filings with the Securities and Exchange Commission; provided, however, that, except in connection with
death, disability or a Change in Control, no such adjustment shall be made if the effect would be to cause an Award that is intended
to be a Qualified Performance-Based Award to no longer constitute a Qualified Performance-Based Award. If the Administrator determines
that a change in the business, operations, corporate structure or capital structure of CytoSorbents or the applicable subsidiary,
business segment or other operational unit of CytoSorbents or any such entity or segment, or the manner in which any of the foregoing
conducts its business, or other events or circumstances, render the Performance Goals to be unsuitable, the Administrator may modify
such Performance Goals or the related minimum acceptable level of achievement, in whole or in part, as the Administrator deems
appropriate and equitable; provided, however , that, except in connection with death, disability or a Change in Control,
no such modification shall be made if the effect would be to cause an Award that is intended to be a Qualified Performance-Based
Award to no longer constitute a Qualified Performance-Based Award.

 

    	 	13	 

     

    

 

(d) Statutory Requirements Affecting
Adjustments. Notwithstanding the foregoing: (A) any adjustments made pursuant to Section 10 to Awards that are considered
 “deferred compensation” within the meaning of Section 409A of the Code shall be made in compliance with the requirements
of Section 409A of the Code; (B) any adjustments made pursuant to Section 10 to Awards that are not considered “deferred
compensation” subject to Section 409A of the Code shall be made in such a manner as to ensure that after such adjustment,
the Awards either (1) continue not to be subject to Section 409A of the Code or (2) comply with the requirements
of Section 409A of the Code; (C) in any event, the Administrator shall not have the authority to make any adjustments pursuant
to Section 10 to the extent the existence of such authority would cause an Award that is not intended to be subject to Section 409A
of the Code at the date of grant to be subject thereto; and (D) any adjustments made pursuant to Section 10 to Awards that
are Incentive Stock Options shall be made in compliance with the requirements of Section 424(a) of the Code.

 

(e) Dissolution or Liquidation.
Unless the Administrator determines otherwise, all Awards outstanding under the Plan shall terminate upon the dissolution or liquidation
of CytoSorbents.

 

		11.	Change in Control Provisions.

 

(a) Termination of Awards.
Notwithstanding the provisions of Section 11(b), in the event that any transaction resulting in a Change in Control occurs,
outstanding Awards will terminate upon the effective time of such Change in Control unless provision is made in connection with
the transaction for the continuation or assumption of such Awards by, or for the issuance therefor of Substitute Awards of, the
surviving or successor entity or a parent thereof. Solely with respect to Awards that will terminate as a result of the immediately
preceding sentence and except as otherwise provided in the applicable Award Agreement:

 

(i) the outstanding Awards of stock
options and stock appreciation rights that will terminate upon the effective time of the Change in Control shall, immediately before
the effective time of the Change in Control, become fully exercisable and the holders of such Awards will be permitted, immediately
before the Change in Control, to exercise the Awards;

 

(ii) the outstanding shares of Restricted
Stock the vesting or restrictions on which are then solely time-based and not subject to achievement of Performance Goals shall,
immediately before the effective time of the Change in Control, become fully vested, free of all transfer and lapse restrictions
and free of all risks of forfeiture;

 

(iii) the outstanding shares of
Restricted Stock the vesting or restrictions on which are then subject to and pending achievement of Performance Goals shall, immediately
before the effective time of the Change in Control and unless the Award Agreement provides for vesting or lapsing of restrictions
in a greater amount upon the occurrence of a Change in Control, become vested, free of transfer and lapse restrictions and risks
of forfeiture in such amounts as if the applicable Performance Goals for the unexpired Performance Period had been achieved at
the target level set forth in the applicable Award Agreement;

 

(iv) the outstanding Restricted
Stock Units, Performance Shares and Performance Units the vesting, earning or settlement of which is then solely time-based and
not subject to or pending achievement of Performance Goals shall, immediately before the effective time of the Change in Control,
become fully earned and vested and shall be settled in cash or shares of Common Stock (consistent with the terms of the Award Agreement
after taking into account the effect of the Change in Control transaction on the shares) as promptly as is practicable, subject
to any applicable limitations imposed thereon by Section 409A of the Code; and

 

(v) the outstanding Restricted Stock
Units, Performance Shares and Performance Units the vesting, earning or settlement of which is then subject to and pending achievement
of Performance Goals shall, immediately before the effective time of the Change in Control and unless the Award Agreement provides
for vesting, earning or settlement in a greater amount upon the occurrence of a Change in Control, become vested and earned in
such amounts as if the applicable Performance Goals for the unexpired Performance Period had been achieved at the target level
set forth in the applicable Award Agreement and shall be settled in cash or shares of Common Stock (consistent with the terms of
the Award Agreement after taking into account the effect of the Change in Control transaction on the shares) as promptly as is
practicable, subject to any applicable limitations imposed thereon by Section 409A of the Code.

 

    	 	14	 

     

    

 

Implementation of the provisions
of this Section 11(a) shall be conditioned upon consummation of the Change in Control.

 

(b) Other Permitted Actions.
In the event that any transaction resulting in a Change in Control occurs, the Administrator may take any of the actions set forth
in Section 10 with respect to any or all Awards granted under the Plan.

 

(c) Section 409A Savings
Clause. Notwithstanding the foregoing, if any Award is considered to be a “nonqualified deferred compensation plan”
within the meaning of Section 409A of the Code, this Section 11 shall apply to such Award only to the extent that its
application would not result in the imposition of any tax or interest or the inclusion of any amount in income under Section 409A
of the Code.

 

		12.	Substitution of Awards in Mergers and Acquisitions.

 

Awards may be granted under the
Plan from time to time in substitution for assumed awards held by employees, officers, consultants or directors of entities who
become employees, officers, consultants or directors of CytoSorbents or a Subsidiary as the result of a merger or consolidation
of the entity for which they perform services with CytoSorbents or a Subsidiary, or the acquisition by CytoSorbents of the assets
or stock of the such entity. The terms and conditions of any Awards so granted may vary from the terms and conditions set forth
herein to the extent that the Administrator deems appropriate at the time of grant to conform the Awards to the provisions of the
assumed awards for which they are substituted and to preserve their intrinsic value as of the date of the merger, consolidation
or acquisition transaction. To the extent permitted by applicable law and marketplace or listing rules of the primary securities
market or exchange on which the Common Stock is listed or admitted for trading, any available shares under a stockholder-approved
plan of an acquired company (as appropriately adjusted to reflect the transaction) may be used for Awards granted pursuant to this
Section 12 and, upon such grant, shall not reduce the Share Pool.

 

		13.	Compliance with Securities Laws; Listing and Registration.

 

(a) The obligation of CytoSorbents
to sell or deliver Common Stock with respect to any Award granted under the Plan shall be subject to all applicable laws, rules
and regulations, including all applicable federal, state securities laws, and the obtaining of all such approvals by governmental
agencies as may be deemed necessary or appropriate by the Administrator. If at any time the Administrator determines that the delivery
of Common Stock under the Plan is or may be unlawful under the laws of any applicable jurisdiction, or Federal, state or foreign
(non-United States) securities laws, the right to exercise an Award or receive shares of Common Stock pursuant to an Award shall
be suspended until the Administrator determines that such delivery is lawful. If at any time the Administrator determines that
the delivery of Common Stock under the Plan would or may violate the rules of any exchange on which CytoSorbents’s securities
are then listed for trade, the right to exercise an Award or receive shares of Common Stock pursuant to an Award shall be suspended
until the Administrator determines that such delivery would not violate such rules. If the Administrator determines that the exercise
or nonforfeitability of, or delivery of benefits pursuant to, any Award would violate any applicable provision of securities laws
or the listing requirements of any stock exchange upon which any of CytoSorbents’s equity securities are listed, then the
Administrator may postpone any such exercise, nonforfeitability or delivery, as applicable, but CytoSorbents shall use all reasonable
efforts to cause such exercise, nonforfeitability or delivery to comply with all such provisions at the earliest practicable date.

 

(b) Each Award is subject to the
requirement that, if at any time the Administrator determines, in its absolute discretion, that the listing, registration or qualification
of Common Stock issuable pursuant to the Plan is required by any securities exchange or under any state, federal or foreign (non-United
States) law, or the consent or approval of any governmental regulatory body is necessary or desirable as a condition of, or in
connection with, the grant of an Award or the issuance of Common Stock, no such Award shall be granted or payment made or Common
Stock issued, in whole or in part, unless listing, registration, qualification, consent or approval has been effected or obtained
free of any conditions not acceptable to the Administrator.

 

    	 	15	 

     

    

 

(c) In the event that the disposition
of Common Stock acquired pursuant to the Plan is not covered by a then current registration statement under the Securities Act
of 1933, as amended (the “ Securities Act ”), and is not otherwise exempt from such registration, such Common
Stock shall be restricted against transfer to the extent required by the Securities Act or regulations thereunder, and the Administrator
may require a person receiving Common Stock pursuant to the Plan, as a condition precedent to receipt of such Common Stock, to
represent to CytoSorbents in writing that the Common Stock acquired by such person is acquired for investment only and not with
a view to distribution and that such person will not dispose of the Common Stock so acquired in violation of Federal, state or
foreign securities laws and furnish such information as may, in the opinion of counsel for the Company, be appropriate to permit
the Company to issue the Common Stock in compliance with applicable Federal, state or foreign securities laws.

 

		14.	Section 409A Compliance.

 

It is the intention of CytoSorbents
that any Award that constitutes a “nonqualified deferred compensation plan” within the meaning of Section 409A
of the Code shall comply in all respects with the requirements of Section 409A of the Code to avoid the imposition of any
tax or interest or the inclusion of any amount in income pursuant to Section 409A of the Code, and the terms of each such
Award shall be construed, administered and deemed amended, if applicable, in a manner consistent with this intention. Notwithstanding
the foregoing, neither CytoSorbents nor any of its Affiliates nor any of its or their directors, officers, employees, agents or
other service providers will be liable for any taxes, penalties or interest imposed on any Participant or other person with respect
to any amounts paid or payable (whether in cash, shares of Common Stock or other property) under any Award, including any taxes,
penalties or interest imposed under or as a result of Section 409A of the Code. Any payments described in an Award that are
due within the “short term deferral period” as defined in Section 409A of the Code shall not be treated as deferred
compensation unless applicable law requires otherwise. For purposes of any Award, each amount to be paid or benefit to be provided
to a Participant that constitutes deferred compensation subject to Section 409A of the Code shall be construed as a separate
identified payment for purposes of Section 409A of the Code. For purposes of Section 409A of the Code, the payment of
Dividend Equivalents under any Award shall be construed as earnings and the time and form of payment of such Dividend Equivalents
shall be treated separately from the time and form of payment of the underlying Award. Notwithstanding any other provision of the
Plan to the contrary, with respect to any Award that constitutes a “nonqualified deferred compensation plan” within
the meaning of Section 409A of the Code, any payments (whether in cash, shares of Common Stock or other property) to be made
with respect to the Award that become payable on account of the Participant’s separation from service, within the meaning
of Section 409A of the Code, while the Participant is a “specified employee” (as determined in accordance with
the uniform policy adopted by the Administrator with respect to all of the arrangements subject to Section 409A of the Code
maintained by CytoSorbents and its Affiliates) and which would otherwise be paid within six months after the Participant’s
separation from service shall be accumulated (without interest) and paid on the first day of the seventh month following the Participant’s
separation from service or, if earlier, within 15 days after the appointment of the personal representative or executor of
the Participant’s estate following the Participant’s death. Notwithstanding anything in the Plan or an Award Agreement
to the contrary, in no event shall the Administrator exercise its discretion to accelerate the payment or settlement of an Award
where such payment or settlement constitutes deferred compensation within the meaning of Code section 409A unless, and solely to
the extent that, such accelerated payment or settlement is permissible under Treasury Regulation section 1.409A-3(j)(4).

 

		15.	Plan Duration; Amendment and Discontinuance.

 

(a) Plan Duration. The
Plan shall remain in effect, subject to the right of the Board or the Compensation Committee to amend or terminate the Plan at
any time, until the earlier of  (a) the earliest date as of which all Awards granted under the Plan have been satisfied
in full or terminated and no shares of Common Stock approved for issuance under the Plan remain available to be granted under new
Awards or (b) February 28, 2029. No Awards shall be granted under the Plan after such termination date. Subject to other
applicable provisions of the Plan, all Awards made under the Plan on or before February 28, 2029, or such earlier termination
of the Plan, shall remain in effect until such Awards have been satisfied or terminated in accordance with the Plan and the terms
of such Awards.

 

    	 	16	 

     

    

 

(b) Amendment and Discontinuance
of the Plan. The Board or the Compensation Committee may amend, alter or discontinue the Plan, but no amendment, alteration
or discontinuation shall be made which would materially impair the rights of a Participant with respect to a previously granted
Award without such Participant’s consent, except such an amendment made to comply with applicable law or rule of any securities
exchange or market on which the Common Stock is listed or admitted for trading or to prevent adverse tax or accounting consequences
to CytoSorbents or the Participant. Notwithstanding the foregoing, no such amendment shall be made without the approval of CytoSorbents’s
stockholders to the extent such amendment would (A) materially increase the benefits accruing to Participants under the Plan, (B)
materially increase the number of shares of Common Stock which may be issued under the Plan or to a Participant, (C) materially
expand the eligibility for participation in the Plan, (D) eliminate or modify the prohibition set forth in Section 7(f) on
repricing of stock options and stock appreciation rights, (E) lengthen the maximum term or lower the minimum exercise price
or base price permitted for stock options and stock appreciation rights, or (F) modify the prohibition on the issuance of reload
or replenishment options. Except as otherwise determined by the Board or Compensation Committee, termination of the Plan shall
not affect the Administrator’s ability to exercise the powers granted to it hereunder with respect to Awards granted under
the Plan prior to the date of such termination.

 

(c) Amendment of Awards.
Subject to Section 7(e), the Administrator may unilaterally amend the terms of any Award theretofore granted, but no such
amendment shall materially impair the rights of any Participant with respect to an Award without the Participant’s consent,
except such an amendment made to cause the Plan or Award to comply with applicable law, applicable rule of any securities exchange
on which the Common Stock is listed or admitted for trading, or to prevent adverse tax or accounting consequences for the Participant
or the Company or any of its Affiliates. For purposes of the foregoing sentence, an amendment to an Award that results in a change
in the tax consequences of the Award to the Participant shall not be considered to be a material impairment of the rights of the
Participant and shall not require the Participant’s consent.

 

		16.	General Provisions.

 

(a) Non-Guarantee of Employment
or Service. Nothing in the Plan or in any Award Agreement thereunder shall confer any right on an individual to continue in
the service of CytoSorbents or any Affiliate or shall interfere in any way with the right of CytoSorbents or any Affiliate to terminate
such service at any time with or without cause or notice and whether or not such termination results in (i) the failure of
any Award to vest or become payable; (ii) the forfeiture of any unvested or vested portion of any Award; and/or (iii) any other
adverse effect on the individual’s interests under any Award or the Plan. No person, even though deemed an Eligible Individual,
shall have a right to be selected as a Participant, or, having been so selected, to be selected again as a Participant. To the
extent that an Eligible Individual who is an employee of a Subsidiary receives an Award under the Plan, that Award shall in no
event be understood or interpreted to mean that CytoSorbents is the Participant’s employer or that the Participant has an
employment relationship with CytoSorbents.

 

(b) No Trust or Fund Created.
Neither the Plan nor any Award shall create or be construed to create a trust or separate fund of any kind or a fiduciary relationship
between CytoSorbents and a Participant or any other person. To the extent that any Participant or other person acquires a right
to receive payments from CytoSorbents pursuant to an Award, such right shall be no greater than the right of any unsecured general
creditor of CytoSorbents.

 

(c) Status of Awards. Awards
shall be special incentive payments to the Participant and shall not be taken into account in computing the amount of salary or
compensation of the Participant for purposes of determining any pension, retirement, death, severance or other benefit under (a) any
pension, retirement, profit-sharing, bonus, insurance, severance or other employee benefit plan of CytoSorbents or any Affiliate
now or hereafter in effect under which the availability or amount of benefits is related to the level of compensation or (b) any
agreement between (i) CytoSorbents or any Affiliate and (ii) the Participant, except as such plan or agreement shall otherwise
expressly provide.

 

    	 	17	 

     

    

 

(d) Subsidiary Employees.
In the case of a grant of an Award to an Eligible Individual who provides services to any Subsidiary, CytoSorbents may, if the
Administrator so directs, issue or transfer the shares of Common Stock, if any, covered by the Award to the Subsidiary, for such
lawful consideration as the Administrator may specify, upon the condition or understanding that the Subsidiary will transfer the
shares of Common Stock to the Eligible Individual in accordance with the terms of the Award specified by the Administrator pursuant
to the provisions of the Plan. All shares of Common Stock underlying Awards that are forfeited or canceled after such issue or
transfer of shares to the Subsidiary shall revert to CytoSorbents.

 

(e) Governing Law and Interpretation.
The validity, construction and effect of the Plan, of Award Agreements entered into pursuant to the Plan, and of any rules, regulations,
determinations or decisions made by the Administrator relating to the Plan or such Award Agreements, and the rights of any and
all persons having or claiming to have any interest therein or thereunder, shall be determined exclusively in accordance with applicable
United States federal laws and the laws of the State of Delaware without regard to its conflict of laws principles. The captions
of the Plan are not part of the provisions hereof and shall have no force or effect. Except where the context otherwise requires:
(i) the singular includes the plural and vice versa; (ii) a reference to one gender includes other genders; (iii) a reference
to a person includes a natural person, partnership, corporation, association, governmental or local authority or agency or other
entity; and (iv) a reference to a statute, ordinance, code or other law includes regulations and other instruments under it and
consolidations, amendments, re-enactments or replacements of any of them.

 

(f) Use of English Language.
The Plan, each Award Agreement, and all other documents, notices and legal proceedings entered into, given or instituted pursuant
to an Award shall be written in English, unless otherwise determined by the Administrator. If a Participant receives an Award Agreement,
a copy of the Plan or any other documents related to an Award translated into a language other than English, and if the meaning
of the translated version is different from the English version, the English version shall control.

 

(g) Recovery of Amounts Paid.
Except as otherwise provided by the Administrator, Awards granted under the Plan shall be subject to any and all policies, guidelines,
codes of conduct, or other agreement or arrangement adopted by the Board or Compensation Committee with respect to the recoupment,
recovery or clawback of compensation (collectively, the “Recoupment Policy”) and/or to any provisions set forth in
the applicable Award Agreement under which CytoSorbents may recover from current and former Participants any amounts paid or shares
of Common Stock issued under an Award and any proceeds therefrom under such circumstances as the Administrator determines appropriate.
The Administrator may apply the Recoupment Policy to Awards granted before the policy is adopted to the extent required by applicable
law or rule of any securities exchange or market on which shares of Common Stock are listed or admitted for trading, as determined
by the Administrator in its sole discretion.

 

		17.	Glossary.

 

Under this Plan, except where the context otherwise
indicates, the following definitions apply:

 

“Administrator ”
means the Compensation Committee, or such other committee(s) or officer(s) duly appointed by the Board or the Compensation Committee
to administer the Plan or delegated limited authority to perform administrative actions under the Plan, and having such powers
as shall be specified by the Board or the Compensation Committee; provided, however, that at any time the Board may serve as the
Administrator in lieu of or in addition to the Compensation Committee or such other committee(s) or officer(s) to whom administrative
authority has been delegated. With respect to any Award to which Section 16 of the Exchange Act applies, the Administrator
shall consist of either the Board or a committee of the Board, which committee shall consist of two or more directors, each of
whom is intended to be, to the extent required by Rule 16b-3 of the Exchange Act, a “non-employee director” as
defined in Rule 16b-3 of the Exchange Act and an “independent director” to the extent required by the rules of
the national securities exchange that is the principal trading market for the Common Stock, and with respect to any Award that
is intended to be a Qualified Performance-Based Award, the Administrator shall consist of two or more directors, each of whom is
intended to be, to the extent required by Section 162(m) of the Code, an “outside director” as defined under Section 162(m)
of the Code; provided , that with respect to Awards made to a member of the Board who is not an employee of the Company,
 “Administrator” means the Board. Any member of the Administrator who does not meet the foregoing requirements shall
abstain from any decision regarding an Award and shall not be considered a member of the Administrator to the extent required to
comply with Rule 16b-3 of the Exchange Act or Section 162(m) of the Code.

 

    	 	18	 

     

    

 

“ Affiliate”
means any entity, whether now or hereafter existing, which controls, is controlled by, or is under common control with, CytoSorbents
or any successor to CytoSorbents. For this purpose, “control” (including the correlative meanings of the terms “controlled
by” and “under common control with”) shall mean ownership, directly or indirectly, of 50% or more of the total
combined voting power of all classes of voting securities issued by such entity, or the possession, directly or indirectly, of
the power to direct the management and policies of such entity, by contract or otherwise.

 

“ Award ” means
any stock option, stock appreciation right, stock award, stock unit, Performance Share, Performance Unit, and/or Other Stock-Based
Award granted under this Plan. An Award shall be subject to the terms and conditions set forth in the Plan in effect on the date
of grant.

 

“Award Agreement”
means the written document(s), including an electronic writing acceptable to the Administrator, and any notice, addendum or supplement
thereto, memorializing the terms and conditions of an Award granted pursuant to the Plan and which shall incorporate the terms
of the Plan.

 

“ Board ” means the Board of Directors
of CytoSorbents.

 

“ Change in Control
 ” means the first of the following to occur: (i) a Change in Ownership of CytoSorbents, (ii) a Change in Effective Control
of CytoSorbents, or (iii) a Change in the Ownership of Assets of CytoSorbents, as described herein and construed in accordance
with Code section 409A.

 

(i) A “Change in Ownership
of CytoSorbents” shall occur on the date that any one Person acquires, or Persons Acting as a Group acquire, ownership of
the capital stock of CytoSorbents that, together with the stock held by such Person or Group, constitutes more than 50% of the
total fair market value or total voting power of the capital stock of CytoSorbents. However, if any one Person is, or Persons Acting
as a Group are, considered to own more than 50%, on a fully diluted basis, of the total fair market value or total voting power
of the capital stock of CytoSorbents, the acquisition of additional stock by the same Person or Persons Acting as a Group is not
considered to cause a Change in Ownership of CytoSorbents or to cause a Change in Effective Control of CytoSorbents (as described
below). An increase in the percentage of capital stock owned by any one Person, or Persons Acting as a Group, as a result
of a transaction in which CytoSorbents acquires its stock in exchange for property will be treated as an acquisition of stock.

 

(ii) A “Change in Effective
Control of CytoSorbents” shall occur on the date either (A) a majority of members of CytoSorbents’s Board is replaced
during any 12-month period by directors whose appointment or election is not endorsed by a majority of the members of CytoSorbents’s
Board before the date of the appointment or election, or (B) any one Person, or Persons Acting as a Group, acquires (or has acquired
during the 12-month period ending on the date of the most recent acquisition by such Person or Persons) ownership of stock of CytoSorbents
possessing 35% or more of the total voting power of the stock of CytoSorbents.

 

(iii) A “Change in the Ownership
of Assets of CytoSorbents” shall occur on the date that any one Person acquires, or Persons Acting as a Group acquire (or
has or have acquired during the 12-month period ending on the date of the most recent acquisition by such Person or Persons), assets
from CytoSorbents that have a total gross fair market value equal to or more than 60% of the total gross fair market value of all
of the assets of CytoSorbents immediately before such acquisition or acquisitions. For this purpose, gross fair market value means
the value of the assets of CytoSorbents, or the value of the assets being disposed of, determined without regard to any liabilities
associated with such assets.

 

The following rules of construction apply in interpreting
the definition of Change in Control:

 

(A) A “ Person ”
means any individual, entity or group within the meaning of Section 13(d)(3) or 14(d)(2) of the Securities Exchange Act of
1934, as amended, other than employee benefit plans sponsored or maintained by CytoSorbents and by entities controlled by CytoSorbents
or an underwriter, initial purchaser or placement agent temporarily holding the capital stock of CytoSorbents pursuant to a registered
public offering.

 

(B) Persons will be considered to
be Persons Acting as a Group (or Group) if they are owners of a corporation that enters into a merger, consolidation, purchase
or acquisition of stock, or similar business transaction with the corporation. If a Person owns stock in both corporations that
enter into a merger, consolidation, purchase or acquisition of stock, or similar transaction, such stockholder is considered to
be acting as a Group with other stockholders only with respect to the ownership in that corporation before the transaction giving
rise to the change and not with respect to the ownership interest in the other corporation. Persons will not be considered to be
acting as a Group solely because they purchase assets of the same corporation at the same time or purchase or own stock of the
same corporation at the same time, or as a result of the same public offering.

 

    	 	19	 

     

    

 

(C) A Change in Control shall not
include a transfer to a related person as described in Code section 409A or a public offering of capital stock of CytoSorbents.

 

(D) For purposes of the definition
of Change in Control, Section 318(a) of the Code applies to determine stock ownership. Stock underlying a vested option is
considered owned by the individual who holds the vested option (and the stock underlying an unvested option is not considered owned
by the individual who holds the unvested option). For purposes of the preceding sentence, however, if a vested option is exercisable
for stock that is not substantially vested (as defined by Treasury Regulation §1.83-3(b) and (j)), the stock underlying the
option is not treated as owned by the individual who holds the option.

 

“ CytoSorbents ” means CytoSorbents
Corporation, a Delaware corporation.

 

“Code” means
the Internal Revenue Code of 1986, as amended from time to time, and any successor thereto, the Treasury Regulations thereunder
and other relevant interpretive guidance issued by the Internal Revenue Service or the Treasury Department. Reference to any specific
section of the Code shall be deemed to include such regulations and guidance, as well as any successor section, regulations and
guidance.

 

“Common Stock”
means shares of common stock of CytoSorbents, par value $0.001 per share, and any capital securities into which they are converted.

 

“ Company ” means
CytoSorbents and its Subsidiaries, except where the context otherwise requires. For purposes of determining whether a Change in
Control has occurred, Company shall mean only CytoSorbents.

 

“Compensation Committee” means
the Compensation Committee of the Board.

 

“ Dividend Equivalent
 ” means a right, granted to a Participant, to receive cash, Common Stock, stock Units or other property equal in value to
dividends paid with respect to a specified number of shares of Common Stock.

 

“ Effective Date ”
means the date on which adoption of the Plan is approved by the stockholders of CytoSorbents.

 

“ Eligible Individuals
 ” means (i) officers and employees of, and other individuals, including non-employee directors, who are natural persons
providing bona fide services to or for, CytoSorbents or any of its Subsidiaries, provided that such services are not in
connection with the offer or sale of securities in a capital-raising transaction and do not directly or indirectly promote or maintain
a market for CytoSorbents’s securities, and (ii) prospective officers, employees and service providers who have accepted
offers of employment or other service relationship from CytoSorbents or a Subsidiary.

 

“ Exchange Act ”
means the Securities Exchange Act of 1934, as amended from time to time, and any successor thereto. Reference to any specific section
of the Exchange Act shall be deemed to include such regulations and guidance issued thereunder, as well as any successor section,
regulations and guidance.

 

“Fair Market Value
 ” means, on a per share basis as of any date, unless otherwise determined by the Administrator:

 

(i) if the principal market for
the Common Stock (as determined by the Administrator if the Common Stock is listed or admitted to trading on more than one exchange
or market) is a national securities exchange or an established securities market, the official closing price per share of Common
Stock for the regular market session on that date on the principal exchange or market on which the Common Stock is then listed
or admitted to trading or, if no sale is reported for that date, on the last preceding day on which a sale was reported, all as
reported by such source as the Administrator may select;

 

(ii) if the principal market for
the Common Stock is not a national securities exchange or an established securities market, but the Common Stock is quoted by a
national quotation system, the average of the highest bid and lowest asked prices for the Common Stock on that date as reported
on a national quotation system or, if no prices are reported for that date, on the last preceding day on which prices were reported,
all as reported by such source as the Administrator may select; or

 

    	 	20	 

     

    

 

(iii) if the Common Stock is neither
listed or admitted to trading on a national securities exchange or an established securities market, nor quoted by a national quotation
system, the value determined by the Administrator in good faith by the reasonable application of a reasonable valuation method,
which method may, but need not, include taking into account an appraisal of the fair market value of the Common Stock conducted
by a nationally recognized appraisal firm selected by the Administrator.

 

Notwithstanding the preceding, for
foreign, federal, state and local income tax reporting purposes and for such other purposes as the Administrator deems appropriate,
the Fair Market Value shall be determined by the Administrator in accordance with uniform and nondiscriminatory standards adopted
by it from time to time.

 

“ Full Value Award
 ” means an Award that results in CytoSorbents transferring the full value of a share of Common Stock under the Award, whether
or not an actual share of stock is issued. Full Value Awards shall include, but are not limited to, stock awards, stock units,
Performance Shares, Performance Units that are payable in Common Stock, and Other Stock-Based Awards for which CytoSorbents transfers
the full value of a share of Common Stock under the Award, but shall not include Dividend Equivalents.

 

“ Incentive Stock Option
 ” means any stock option that is designated, in the applicable Award Agreement or the resolutions of the Administrator under
which the stock option is granted, as an “incentive stock option” within the meaning of Section 422 of the Code
and otherwise meets the requirements to be an “incentive stock option” set forth in Section 422 of the Code.

 

“ Nonqualified Option ” means
any stock option that is not an Incentive Stock Option.

 

“ Other Stock-Based Award
 ” means an Award of Common Stock or any other Award that is valued in whole or in part by reference to, or is otherwise based
upon, shares of Common Stock, including without limitation Dividend Equivalents and convertible debentures.

 

“ Participant ”
means an Eligible Individual to whom one or more Awards are or have been granted pursuant to the Plan and have not been fully settled
or cancelled and, following the death of any such person, his successors, heirs, executors and administrators, as the case may
be.

 

“ Performance Award
 ” means a Full Value Award, the grant, vesting, lapse of restrictions or settlement of which is conditioned upon the achievement
of performance objectives over a specified Performance Period and includes, without limitation, Performance Shares and Performance
Units.

 

“ Performance Goals
 ” means the performance goals established by the Administrator in connection with the grant of Awards based on Performance
Metrics or other performance criteria selected by the Administrator; provided , however , that in the case of Qualified
Performance-Based Awards, such performance goals shall be based on the attainment of specified levels of one or more Performance
Metrics.

 

“ Performance Period
 ” means that period established by the Administrator during which any Performance Goals specified by the Administrator with
respect to such Award are to be measured.

 

“ Performance Metrics
 ” means criteria established by the Administrator relating to any of the following, as it may apply to an individual, one
or more business units, divisions, or Affiliates, or on a company-wide basis, and in absolute terms, relative to a base period,
or relative to the performance of one or more comparable companies, peer groups, or an index covering multiple companies:

 

(i) Earnings or Profitability
Metrics : any derivative of revenue; earnings/loss (gross, operating, net, or adjusted); earnings/loss before interest and
taxes (“EBIT”); earnings/loss before interest, taxes, depreciation and amortization (“EBITDA”); profit
margins; operating margins; expense levels or ratios; provided that any of the foregoing metrics may be adjusted to eliminate
the effect of any one or more of the following: interest expense, asset impairments or investment losses, early extinguishment
of debt or stock-based compensation expense;

 

(ii) Return Metrics : any
derivative of return on investment, assets, equity or capital (total or invested);

 

(iii) Investment Metrics:
relative risk-adjusted investment performance; investment performance of assets under management;

 

    	 	21	 

     

    

 

(iv) Cash Flow Metrics :
any derivative of operating cash flow; cash flow sufficient to achieve financial ratios or a specified cash balance; free cash
flow; cash flow return on capital; net cash provided by operating activities; cash flow per share; working capital;

 

(v) Liquidity Metrics : any
derivative of debt leverage (including debt to capital, net debt-to-capital, debt-to-EBITDA or other liquidity ratios);

 

(vi) Stock Price and Equity Metrics
: any derivative of return on stockholders’ equity; total stockholder return; stock price; stock price appreciation; market
capitalization; earnings/loss per share (basic or diluted) (before or after taxes); and/or

 

(vii) Strategic Metrics:
metrics including, but not limited to, product research and development; completion of an identified special project; clinical
trials; regulatory filings or approvals; patent application or issuance; manufacturing or process development; sales or net sales;
market share; market penetration; economic value added; customer service; customer satisfaction; inventory control; balance of
cash, cash equivalents and marketable securities; growth in assets; key hires; employee satisfaction; employee retention; business
expansion; acquisitions, divestitures, joint ventures; capital or fund raising to support operations; government grants; license
arrangements; collaboration or customer agreements or arrangements; legal compliance or safety and risk reduction; or such other
measures as determined by the Administrator consistent with these performance measures.

 

“Performance Shares
 ” means a grant of stock or stock Units the issuance, vesting or payment of which is contingent on performance as measured
against predetermined objectives over a specified Performance Period.

 

“ Performance Units
 ” means a grant of dollar-denominated Units the value, vesting or payment of which is contingent on performance against predetermined
objectives over a specified Performance Period.

 

“ Plan ” means
this Amended and Restated CytoSorbents Corporation 2014 Long-Term Incentive Plan, as set forth herein and as it may be amended
from time to time.

 

“ Qualified Performance-Based
Award ” means an Award intended to qualify for the Section 162(m) Exemption, as provided in Section 7(j).

 

“ Restricted Stock
 ” means an Award of shares of Common Stock to a Participant that may be subject to certain transferability and other restrictions
and to a risk of forfeiture (including by reason of not satisfying certain Performance Goals).

 

“ Restricted Stock Unit
 ” means a right granted to a Participant to receive shares of Common Stock or cash at the end of a specified deferral period,
which right may be conditioned on the satisfaction of certain requirements (including the satisfaction of certain Performance Goals).

 

“ Restriction Period
 ” means, with respect to Full Value Awards, the period commencing on the date of grant of such Award to which vesting or
transferability and other restrictions and a risk of forfeiture apply and ending upon the expiration of the applicable vesting
conditions, transferability and other restrictions and lapse of risk of forfeiture and/or the achievement of the applicable Performance
Goals (it being understood that the Administrator may provide that vesting shall occur and/or restrictions shall lapse with respect
to portions of the applicable Award during the Restriction Period.

 

“ Section 162(m) Exemption
 ” means the exemption from the limitation on deductibility imposed by Section 162(m) of the Code that is set forth in
Section 162(m)(4)(C) of the Code subject to any changes to or applicability of such section as set forth in applicable law,
regulations, and guidance.

 

“ Subsidiary ”
means any corporation or other entity in an unbroken chain of corporations or other entities beginning with CytoSorbents if each
of the corporations or other entities, or group of commonly controlled corporations or other entities, other than the last corporation
or other entity in the unbroken chain then owns stock or other equity interests possessing 50% or more of the total combined voting
power of all classes of stock or other equity interests in one of the other corporations or other entities in such chain or otherwise
has the power to direct the management and policies of the entity by contract or by means of appointing a majority of the members
of the board or other body that controls the affairs of the entity; provided, however, that solely for purposes of determining
whether a Participant has a Termination of Service that is a “separation from service” within the meaning of Section 409A
of the Code or whether an Eligible Individual is eligible to be granted an Award that in the hands of such Eligible Individual
would constitute a “nonqualified deferred compensation plan” within the meaning of Section 409A of the Code, a
 “Subsidiary” of a corporation or other entity means all other entities with which such corporation or other entity
would be considered a single employer under Sections 414(b) or 414(c) of the Code.

 

    	 	22	 

     

    

 

“ Tax Withholding Obligation
 ” means any federal, state, local or foreign (non-United States) income, employment or other tax or social insurance contribution
required by applicable law to be withheld in respect of Awards.

 

“ Termination of Service
 ” means the termination of the Participant’s employment or consultancy with, or performance of services for, CytoSorbents
and its Subsidiaries. Temporary absences from employment because of illness, vacation or leave of absence and transfers among CytoSorbents
and its Subsidiaries shall not be considered Terminations of Service. With respect to any Award that constitutes a “nonqualified
deferred compensation plan” within the meaning of Section 409A of the Code, “Termination of Service” shall
mean a “separation from service” as defined under Section 409A of the Code to the extent required by Section 409A
of the Code to avoid the imposition of any tax or interest or the inclusion of any amount in income pursuant to Section 409A
of the Code. A Participant has a separation from service within the meaning of Section 409A of the Code if the Participant
terminates employment with CytoSorbents and all Subsidiaries for any reason. A Participant will generally be treated as having
terminated employment with CytoSorbents and all Subsidiaries as of a certain date if the Participant and the entity that employs
the Participant reasonably anticipate that the Participant will perform no further services for CytoSorbents or any Subsidiary
after such date or that the level of bona fide services that the Participant will perform after such date (whether as an employee
or an independent contractor) will permanently decrease to no more than 20 percent (20%) of the average level of bona fide
services performed (whether as an employee or an independent contractor) over the immediately preceding 36-month period (or the
full period of services if the Participant has been providing services for fewer than 36 months); provided, however,
that the employment relationship is treated as continuing while the Participant is on military leave, sick leave or other bona
fide leave of absence if the period of leave does not exceed six months or, if longer, so long as the Participant retains
the right to reemployment with CytoSorbents or any Subsidiary.

 

“ Total and Permanent Disability
 ” means, with respect to a Participant, except as otherwise provided in the relevant Award Agreement, that a Participant
is (i) unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment
that can be expected to last until the Participant’s death or result in death, or (ii) determined to be totally disabled
by the Social Security Administration or other governmental or quasi-governmental body that administers a comparable social insurance
program outside of the United States in which the Participant participates and which conditions the right to receive benefits under
such program on the Participant being unable to engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment that can be expected to last until the Participant’s death or result in death. The Administrator
shall have sole authority to determine whether a Participant has suffered a Total and Permanent Disability and may require such
medical or other evidence as it deems necessary to judge the nature and permanency of the Participant’s condition.

 

“ Unit ” means
a bookkeeping entry used by CytoSorbents to record and account for the grant of the following types of Awards until such time as
the Award is paid, cancelled, forfeited or terminated, as the case may be: stock units, Restricted Stock Units, Performance
Units, and Performance Shares that are expressed in terms of units of Common Stock.

 

{end of document}

 

    	 	23EX-4.2

 Exhibit 4.2 

Execution Version 
  

 
  

TENET HEALTHCARE CORPORATION 
 AND
THE GUARANTORS FROM TIME TO TIME PARTY HERETO 
  

 
 Thirty-First
Supplemental 
 Indenture 

Dated as of August 26, 2019 
  

 
 (Supplemental
Indenture to Indenture Dated as of November 6, 2001) 
  

 
 THE BANK OF NEW
YORK MELLON TRUST COMPANY, N.A., 
 as Trustee 
  

 
 4.625% Senior Secured First Lien Notes
Due 2024 
  
  

 

 TABLE OF CONTENTS 

 

					
	 	  	Page	 
	
	 ARTICLE ONE
  

DEFINITIONS AND OTHER PROVISIONS OF GENERAL APPLICATION
	  
 

 

		
	 SECTION 1.1. RELATION TO EXISTING INDENTURE
	  	 	1	 
	 SECTION 1.2. DEFINITIONS
	  	 	2	 
	
	 ARTICLE TWO
  

GENERAL TERMS AND CONDITIONS OF THE NOTES
	  
 

 

		
	 SECTION 2.1. FORM AND DATING
	  	 	17	 
	 SECTION 2.2. EXECUTION AND AUTHENTICATION
	  	 	17	 
	 SECTION 2.3. REGISTRAR AND PAYING AGENT
	  	 	18	 
	 SECTION 2.4. PAYING AGENT TO HOLD MONEY IN TRUST
	  	 	18	 
	 SECTION 2.5. TRANSFER AND EXCHANGE
	  	 	18	 
	
	 ARTICLE THREE
  

REDEMPTION AND PREPAYMENT
	  
 

 

		
	 SECTION 3.1. OPTIONAL REDEMPTION
	  	 	28	 
	 SECTION 3.2. SINKING FUND
	  	 	29	 
	 SECTION 3.3. OFFER TO PURCHASE BY APPLICATION OF BALANCE IN NET AVAILABLE CASH
	  	 	30	 
	
	 ARTICLE FOUR
  

COVENANTS
	  
 

 

		
	 SECTION 4.1. LIMITATIONS ON LIENS
	  	 	31	 
	 SECTION 4.2. LIMITATIONS ON SALE AND LEASE-BACK TRANSACTIONS
	  	 	32	 
	 SECTION 4.3. LIMITATIONS ON ISSUANCES OF GUARANTEES BY SUBSIDIARIES
	  	 	32	 
	 SECTION 4.4. ADDITIONAL NOTE GUARANTEES
	  	 	33	 
	 SECTION 4.5. SEC REPORTS
	  	 	33	 
	 SECTION 4.6. ASSET DISPOSITIONS
	  	 	33	 
	 SECTION 4.7. OFFER TO REPURCHASE UPON CHANGE OF CONTROL
	  	 	35	 
	
	 ARTICLE FIVE
  

REMEDIES
	  
 

 

		
	 SECTION 5.1. EVENTS OF DEFAULT
	  	 	37	 
	
	 ARTICLE SIX
  

DEFEASANCE AND COVENANT DEFEASANCE
	  
 

 

		
	 SECTION 6.1. DEFEASANCE AND DISCHARGE
	  	 	39	 
	 SECTION 6.2. COVENANT DEFEASANCE
	  	 	39	 
	 SECTION 6.3. CONDITIONS TO LEGAL OR COVENANT DEFEASANCE
	  	 	39	 

  
 -i- 

					
	
	 ARTICLE SEVEN
  

AMENDMENT, SUPPLEMENT AND WAIVER
	  
 

 

	
	 ARTICLE EIGHT
  

COLLATERAL AND SECURITY
	  
 

 

		
	 SECTION 8.1. EQUAL AND RATABLE SHARING OF COLLATERAL BY HOLDERS OF FIRST-PRIORITY STOCK
SECURED DEBT
	  	 	41	 
	 SECTION 8.2. STOCK LIEN SECURITY DOCUMENTS
	  	 	42	 
	 SECTION 8.3. RELEASE OF SECURITY INTERESTS
	  	 	42	 
	 SECTION 8.4. ADDITIONAL FIRST-PRIORITY STOCK SECURED DEBT
	  	 	43	 
	 SECTION 8.5. COMPLIANCE WITH TRUST INDENTURE ACT
	  	 	44	 
	 SECTION 8.6. COLLATERAL TRUSTEE
	  	 	45	 
	 SECTION 8.7. FURTHER ASSURANCES
	  	 	45	 
	
	 ARTICLE NINE
  

NOTE GUARANTEES
	  
 

 

		
	 SECTION 9.1. GUARANTEE
	  	 	45	 
	 SECTION 9.2. LIMITATION ON GUARANTOR
	  	 	46	 
	 SECTION 9.3. EXECUTION AND DELIVERY OF NOTE GUARANTEE
	  	 	46	 
	 SECTION 9.4. GUARANTORS MAY CONSOLIDATE, ETC., ONLY ON CERTAIN TERMS
	  	 	47	 
	 SECTION 9.5. RELEASES
	  	 	47	 
	
	 ARTICLE TEN
  

SATISFACTION AND DISCHARGE
	  
 

 

		
	 SECTION 10.1. SATISFACTION AND DISCHARGE OF THIRTY-FIRST SUPPLEMENTAL INDENTURE
	  	 	48	 
	 SECTION 10.2. APPLICATION OF TRUST MONEY
	  	 	49	 
	
	 ARTICLE ELEVEN
  

MISCELLANEOUS
	  
 

 

	 SECTION 11.1. CONDITIONS PRECEDENT
	  	 	49	 
	 SECTION 11.2. RELATIONSHIP TO EXISTING INDENTURE
	  	 	49	 
	 SECTION 11.3. MODIFICATION OF THE EXISTING INDENTURE
	  	 	49	 
	 SECTION 11.4. NOTICES
	  	 	49	 
	 SECTION 11.5. GOVERNING LAW; SUBMISSION TO JURISDICTION
	  	 	51	 
	 SECTION 11.6. COUNTERPARTS
	  	 	51	 
	 SECTION 11.7. WAIVER OF JURY TRIAL
	  	 	51	 
	 SECTION 11.8. FORCE MAJEURE
	  	 	51	 

 EXHIBITS 
  

			
	EXHIBIT A	  	FORM OF NOTE
	EXHIBIT B	  	FORM OF CERTIFICATE OF TRANSFER
	EXHIBIT C	  	FORM OF CERTIFICATE OF EXCHANGE
	EXHIBIT D	  	FORM OF CERTIFICATE OF TRANSFEREE
	EXHIBIT E	  	FORM OF NOTATION OF GUARANTEE
	EXHIBIT F	  	FORM OF SUPPLEMENTAL INDENTURE

  
 -ii- 

 THIRTY-FIRST SUPPLEMENTAL INDENTURE, dated as of August 26, 2019, among Tenet
Healthcare Corporation, a corporation duly organized and existing under the laws of the State of Nevada (herein called the “Company”), the Guarantors (as defined herein) from time to time party hereto and The Bank of New York Mellon
Trust Company, N.A., as successor trustee to The Bank of New York (herein called “Trustee”). 
 RECITALS: 

WHEREAS, the Company has heretofore executed and delivered to The Bank of New York, as predecessor trustee to the Trustee, an Indenture, dated
as of November 6, 2001 (the “Existing Indenture”, and the Existing Indenture, as supplemented by this Thirty-First Supplemental Indenture, the “Indenture”), providing for the issuance from time to time of the
Company’s debentures, notes or other evidences of indebtedness (herein and therein called the “Securities”), to be issued in one or more series as provided in the Existing Indenture; 

WHEREAS, Section 901 of the Existing Indenture permits the Company and the Trustee to enter into an indenture supplemental to the
Existing Indenture to provide for the issuance of and establish the form and terms and conditions of any additional series of Securities; 

WHEREAS, Sections 201, 301 and 901 of the Existing Indenture permit the form of notes of each additional series of notes to be
established pursuant to an indenture supplemental to the Existing Indenture; 
 WHEREAS, Section 301 of the Existing Indenture permits
certain terms of any additional series of notes to be established pursuant to an indenture supplemental to the Existing Indenture; 

WHEREAS, pursuant to resolutions of the Board of Directors of the Company adopted at a meeting duly called on August 7, 2019, the Company
has authorized the issuance of up to $600,000,000 in aggregate principal amount of 4.625% Senior Secured First Lien Notes Due 2024 (such 4.625% Senior Secured First Lien Notes Due 2024, in an unlimited amount, the “Notes”);

 WHEREAS, the Company has duly authorized the execution and delivery of this Thirty-First Supplemental Indenture to establish the form and
terms of the Notes; 
 WHEREAS, all acts and requirements necessary to make this Thirty-First Supplemental Indenture a valid and legally
binding agreement according to its terms have been done; and 
 WHEREAS, the foregoing recitals are made as statements of fact by the
Company and not by the Trustee; 
 NOW, THEREFORE, THIS THIRTY-FIRST SUPPLEMENTAL INDENTURE WITNESSETH: 

For and in consideration of the premises and the issuance of the Notes provided for herein, it is mutually agreed, for the equal and
proportionate benefit of all holders of the Notes, as follows: 
 ARTICLE ONE 

DEFINITIONS AND OTHER PROVISIONS OF GENERAL APPLICATION 

Section 1.1. Relation to Existing Indenture 

This Thirty-First Supplemental Indenture constitutes an integral part of the Existing Indenture (the provisions of which, as modified by this
Thirty-First Supplemental Indenture, shall apply to the Notes) in respect of the Notes but shall not modify, amend or otherwise affect the Existing Indenture insofar as it relates to any other series of Securities or affect in any manner the terms
and conditions of the Securities of any other series. To the extent any provision of this Thirty-First Supplemental Indenture conflicts with the express provisions of the Existing Indenture, the provisions of this Thirty-First Supplemental
Indenture shall govern and be controlling. 

 Section 1.2. Definitions 

For all purposes of this Thirty-First Supplemental Indenture, the capitalized terms used herein (i) which are defined in this
Section 1.2 have the respective meanings assigned thereto in this Section 1.2, and (ii) which are defined in the Existing Indenture (and which are not defined in this Section 1.2) have the respective meanings assigned thereto in
the Existing Indenture. For all purposes of this Thirty-First Supplemental Indenture: 
 1.2.1 All references herein to Articles and
Sections, unless otherwise specified, refer to the corresponding Articles and Sections of this Thirty-First Supplemental Indenture; 
 1.2.2
The terms “hereof”, “herein”, “hereby”, “hereto”, “hereunder” and “herewith” refer to this Thirty-First Supplemental Indenture; and 

1.2.3 The following terms, as used herein, have the following meanings: 

“144A Global Note” means a Global Note substantially in the form of Exhibit A 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 will be issued in a denomination equal to the outstanding principal amount of the Notes issued
in reliance on Rule 144A. 
 “acceptable commitment” has the meaning specified in Section 4.6 hereof. 

“Act of Required Stock Secured Debtholders” means, as to any matter at any time: 

(1) prior to the Discharge of First-Priority Stock Secured Obligations, a direction in writing delivered to the Collateral
Trustee by or with the written consent of the holders of more than 50% of the sum of: 
 (a) the aggregate outstanding
principal amount of First-Priority Stock Secured Debt (including outstanding letters of credit whether or not then available or drawn); and 

(b) other than in connection with the exercise of remedies, the aggregate unfunded commitments to extend credit which, when
funded, would constitute First-Priority Stock Secured Debt; and 
 (2) at any time after the Discharge of First-Priority
Stock Secured Obligations, a direction in writing delivered to the Collateral Trustee by or with the written consent of the holders of Junior Stock Secured Debt representing the Required Junior Stock Secured Debtholders. 

For purposes of this definition, (a) Stock Secured Debt registered in the name of, or beneficially owned by, the Company or any Affiliate of the Company
will be deemed not to be outstanding and (b) votes will be determined in accordance with Section 7.2 of the Collateral Trust Agreement. Any such Act of Required Stock Secured Debtholders shall be accompanied by a certificate signed by
an authorized officer of each First-Priority Stock Lien Representative, in the case of clause (1) above, or of each Junior Stock Lien Representative, in the case of clause (2) above, certifying that such written direction is
being delivered to the Collateral Trustee by the requisite number of holders for such written direction to constitute an Act of Required Stock Secured Debtholders, and the Collateral Trustee may rely conclusively on, and shall be fully protected in
relying upon, such certificate in proceeding with any direction set forth in such Act of Required Stock Secured Debtholders. 

“Additional Assets” means: 

(1) any property, plant or equipment or other assets or capital expenditures used in a Related Business or that replace the
assets that were the subject of the Asset Disposition; 

  
 -2- 

 (2) the Capital Stock of a Person that becomes a Subsidiary as a result of
the acquisition of such Capital Stock by the Company or another Subsidiary; or 
 (3) Capital Stock in any Person that at
such time is a Subsidiary; 
 provided, however, that any such Subsidiary described in clause (2) or (3) above is primarily
engaged in a Related Business or replaces the assets that were the subject of the Asset Disposition. 
 “Additional Notes”
means additional Notes (other than the Initial Notes) issued under this Thirty-First Supplemental Indenture in accordance with Section 2.2 hereof, as part of the same series as the Initial Notes; provided that such additional Notes shall
be part of the same issue as, and be fungible with, the Initial Notes for U.S. federal income tax purposes. 
 “Additional
Secured Debt Designation” means a notice in substantially the form of Exhibit A to the Collateral Trust Agreement. 

“Adjusted Treasury Rate” means, as obtained by the Company, with respect to any Redemption Date: 

(1) the average of the yields in each statistical release for the immediately preceding week designated “H.15” or any
successor publication which is published 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 “U.S. government
securities—Treasury constant maturities— nominal,” for the maturity corresponding to the Comparable Treasury Issue; 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 annum equal to the semi-annual 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 Adjusted Treasury Rate shall be calculated on the third Business Day preceding the Redemption
Date; or, in the case of a satisfaction and discharge or a defeasance, on the third Business Day prior to the date on which the Company deposits the amount required under the Indenture. 

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

 “Applicable Law” has the meaning specified in Section 11.5 hereof. 

“Applicable Premium” means, as determined by the Company, with respect to any Note on any Redemption Date, the greater of:

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

(2) the excess, if any, of (a) the present value at such Redemption Date of (i) the Redemption Price of such Note on
September 1, 2021 (as set forth in Section 3.1 hereof), plus (ii) all required interest payments due on such Note through September 1, 2021 (excluding accrued but unpaid interest and Special Interest (if any) to the applicable
Redemption Date), computed using a discount rate equal to the Adjusted Treasury Rate as of such Redemption Date plus 50 basis points, over (b) the principal amount of such 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. 

  
 -3- 

 “Asset Disposition” means any sale, lease, transfer or other voluntary
disposition (or series of related sales, leases, transfers or dispositions) by the Company or any of its Subsidiaries, including any disposition by means of a merger, consolidation or similar transaction (each referred to for the purposes of this
definition as a “disposition”), of: 
 (1) any shares of Capital Stock of a Subsidiary of the Company (other
than directors’ qualifying shares or shares required by applicable law to be held by a Person other than the Company or one of its Subsidiaries); 

(2) all or substantially all the assets of any division or line of business of the Company or any of its Subsidiaries; or 

(3) any other assets of the Company or any of its Subsidiaries outside of the ordinary course of business of the Company or
such Subsidiary other than, in the case of clauses (1), (2) and (3) above, 
 (A) a disposition by a
Subsidiary to the Company or by the Company or any Subsidiary to a Subsidiary Guarantor or by any Subsidiary that is not a Subsidiary Guarantor to any Subsidiary; 

(B) for purposes of this definition only, a disposition of all or substantially all of the Company’s assets in accordance
with Section 801 of the Existing Indenture or any disposition that constitutes a Change of Control; 
 (C) a disposition
of assets with a fair market value of less than $100.0 million; 
 (D) a disposition of cash or cash equivalents (as set
forth on the Company’s balance sheet in accordance with GAAP); 
 (E) the creation of a Lien (but not the sale or other
disposition of the property subject to such Lien); 
 (F) a Hospital Swap; 

(G) a disposition of property no longer used or useful in the conduct of the business of the Company and its Subsidiaries; 

(H) a foreclosure on assets or transfer by reason of eminent domain; 

(I) a disposition of an account receivable in connection with the collection or compromise thereof; 

(J) a financing transaction with respect to property built or acquired by the Company or any of its Subsidiaries after the
Issue Date, including Sale and Lease-Back Transactions, in any such case not prohibited by the Indenture; 
 (K) a
disposition in the ordinary course of business by any Subsidiary engaged in the insurance business in order to provide insurance to the Company and its Subsidiaries; 

(L) a disposition of investments in joint ventures to the extent required by, or made pursuant to, customary buy/sell
arrangements between the joint venture parties set forth in joint venture agreements and similar binding arrangements; 
 (M)
a disposition of Capital Stock in connection with ordinary course syndications of Subsidiaries or joint ventures owning or operating one or more healthcare facilities, including, without limitation, hospitals, ambulatory surgery centers, outpatient
diagnostic centers, imaging centers or long-term care facilities in any transaction or series of related transactions with an aggregate fair market value of less than $100.0 million; and 

  
 -4- 

 (N) a disposition of Capital Stock or assets of a Subsidiary that does not
own or operate a hospital or have any direct or indirect equity ownership interest in a Subsidiary that owns or operates a hospital. 

“Asset Disposition Offer” has the meaning specified in Section 3.3 hereof. 

“Attributable Debt” when used in connection with a Sale and Lease-Back Transaction, means, as of the date of determination,
(i) as to any capitalized lease obligations, the liability related thereto set forth on the consolidated balance sheet of the Company and (ii) as to any operating lease, the present value (discounted at the rate per annum equal to the rate
of interest set forth or implicit in the term of the lease, as determined in good faith by the Board of Directors of the Company) of the total obligation of the lessee for net rental payments during the remaining term of the lease (including any
period for which an option to extend such lease has been exercised). 
 “Authentication Order” has the meaning specified in
Section 2.2 hereof. 
 “Bankruptcy Law” means Title 11, U.S. Code or any similar federal or state law for the
relief of debtors. 
 “Borrowing Base” means, at any time, an amount equal to 85% of the net book value of accounts
receivable (under which the Company or a Subsidiary is the account debtor) of the Company and its Subsidiaries, in each case, arising out of the services rendered or goods sold in the ordinary course of business. 

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

“Calculation Date” has the meaning specified in the definition of “Secured Debt Ratio”. 

“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 interests (whether general or limited) or membership interests; 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, 
 but excluding from
all of the foregoing any debt securities convertible into Capital Stock, whether or not such debt securities include any right of participation with Capital Stock. 

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

(1) the sale, lease or transfer, in one or a series of related transactions, of all or substantially all of the assets of the
Company and its Subsidiaries, taken as a whole, to any Person; 
 (2) the Company becomes aware (by way of a report or any
other filing pursuant to Section 13(d) of the Exchange Act, proxy, vote, written notice or otherwise) of 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), 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 40% or more of the total voting power of the Company’s Voting Stock; or 

  
 -5- 

 (3) the Company merges, consolidates or amalgamates with or into any other
Person or any other Person merges, consolidates or amalgamates with or into the Company, in any such event pursuant to a transaction in which the outstanding Voting Stock of the Company is reclassified into or exchanged for cash, securities or other
property, other than any such transaction where: 
 (A) the outstanding Voting Stock of the Company is reclassified into or
exchanged for other Voting Stock of the Company or for Voting Stock of the surviving Person, and 
 (B) the holders of the
Voting Stock of the Company immediately prior to such transaction own, directly or indirectly, not less than a majority of the Voting Stock of the Company or the surviving Person immediately after such transaction as before the transaction. 

“Change of Control Offer” has the meaning specified in Section 4.7(a) hereof. 

“Change of Control Payment” has the meaning specified in Section 4.7(a) hereof. 

“Change of Control Payment Date” has the meaning specified in Section 4.7(a)(2) hereof. 

“Clearstream” means Clearstream Banking, S.A. 

“Code” has the meaning specified in Section 11.8 hereof. 

“Collateral” has the meaning specified in the Pledge Agreement and the other Stock Lien Security Documents. 

“Collateral Trust Agreement” means the Collateral Trust Agreement, dated as of March 3, 2009, by and among the Company,
the other Pledgors from time to time party thereto, the Trustee, the other Secured Debt Representatives (as defined therein) from time to time party thereto and the Collateral Trustee, as the same may be amended, amended and restated, supplemented
or otherwise modified from time to time, including by that certain Collateral Trust Joinder executed and delivered by the Trustee to the Collateral Trustee on the date hereof. 

“Collateral Trust Joinder” means (1) with respect to the provisions of the Collateral Trust Agreement relating to any
additional Stock Secured Debt, an agreement substantially in the form of Exhibit B to the Collateral Trust Agreement and (2) with respect to the provisions of the Collateral Trust Agreement relating to the addition of additional Pledgors,
an agreement substantially in the form of Exhibit C to the Collateral Trust Agreement. 
 “Collateral Trustee” means
The Bank of New York Mellon Trust Company, N.A., in its capacity as Collateral Trustee under the Collateral Trust Agreement, together with its successors in such capacity. 

“Comparable Treasury Issue” means the U.S. Treasury security selected by an Independent Investment Banker as having a maturity
most nearly equal to September 1, 2021, provided, however, that if the period from the Redemption Date to September 1, 2021 is less than one year, the weekly average yield on actually traded U.S. Treasury securities adjusted
to a constant maturity of one year will be used. 
 “Comparable Treasury Price” means, with respect to any Redemption Date,
(1) the average of five Reference Treasury Dealer Quotations for such Redemption Date, after excluding the highest and lowest Reference Treasury Dealer Quotations, or (2) if the Independent Investment Banker obtains fewer than five such
Reference Treasury Dealer Quotations, the average of all such quotations. 
 “Consolidated Net Income” means, for any
period, the consolidated net income (or loss) attributable to the shareholders of the Company and its Consolidated Subsidiaries for such period determined in accordance with generally accepted accounting principles. 

  
 -6- 

 “Consolidated Net Tangible Assets” means the total amount of assets (less
applicable reserves and other properly deductible items) after deducting therefrom (a) all current liabilities as disclosed on the consolidated balance sheet of the Company and its Consolidated Subsidiaries (excluding any deferred income taxes
that are included in current liabilities) and (b) all goodwill, trade names, trademarks, patents, unamortized debt issue costs and other like intangible assets, all as set forth on the most recent consolidated balance sheet of the Company and
its Consolidated Subsidiaries and in each case computed in accordance with GAAP. 
 “Consolidated Subsidiaries” means those
Subsidiaries that are consolidated with the Company for financial reporting purposes. 
 “Consolidated Total Assets” means,
as of any date of determination, after giving pro forma effect to any acquisition of assets on such date, the sum of the amounts that would appear on the consolidated balance sheet of the Company and its Consolidated Subsidiaries as the total assets
of the Company and its Consolidated Subsidiaries. 
 “Covenant Defeasance” has the meaning specified in Section 6.2
hereof. 
 “Credit Agreement” means the Amended and Restated Credit Agreement, dated as of October 19, 2010, among the
Company, the lenders and issuers party thereto, Citicorp USA, Inc., as administrative agent, and Citigroup Global Markets Inc., Merrill Lynch, Pierce, Fenner & Smith Incorporated, Wells Fargo Capital Finance, LLC, Barclays Capital, GE
Capital Markets, Inc. and The Bank of Nova Scotia as joint book runners, including any related notes, guarantees, collateral documents, instruments and agreements executed in connection therewith, and, in each case, as amended, restated, amended and
restated, modified, renewed, refunded, replaced (whether upon or after termination or otherwise) or refinanced by any other debt (including by means of sales of debt securities and including any amendment, restatement, amendment and restatement,
modification, renewal, refunding, replacement or refinancing) in whole or in part from time to time. 
 “Custodian” means
the Trustee, as custodian with respect to the Notes in global form, or any successor entity thereto. 
 “Debt” means, with
respect to any specified Person, any debt of such Person in respect of borrowed money, including Guarantees related thereto. 

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

“Defeasance” has the meaning specified in Section 6.1 hereof. 

“Definitive Note” means a certificated Note registered in the name of the Holder thereof and issued in accordance with
Section 2.5 hereof, substantially in the form of Exhibit A 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 2.3 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 the Indenture. 

“Designated Non-Cash Consideration” means the fair market value of non-cash consideration received by the Company or any of its Subsidiaries in connection with an Asset Disposition 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 or collection on such Designated
Non-Cash Consideration. 
 “Discharge of First-Priority Stock Secured Obligations”
means the occurrence of all of the following: 
 (1) termination or expiration of all commitments to extend credit that would
constitute First-Priority Stock Secured Debt; 

  
 -7- 

 (2) payment in full in cash of the principal of and interest and premium (if
any) on all First-Priority Stock Secured Debt (other than any undrawn letters of credit); 
 (3) discharge or cash
collateralization (at the lower of (A) 105% of the aggregate undrawn amount and (B) the percentage of the aggregate undrawn amount required for release of liens under the terms of the applicable First-Priority Stock Lien Document) of all
outstanding letters of credit constituting First-Priority Stock Secured Debt; and 
 (4) payment in full in cash of all other
First-Priority Stock Secured Obligations that are outstanding and unpaid at the time the First-Priority Stock Secured Debt is paid in full in cash (other than any obligations for taxes, costs, indemnifications, reimbursements, damages and other
liabilities in respect of which no claim or demand for payment has been made at such time). 
 “Domestic Hospital
Subsidiary” means each of the Company’s current and future direct and indirect Subsidiaries organized in a jurisdiction in the United States that (i) owns or operates a hospital or (ii) has a direct or indirect equity
ownership interest in a Subsidiary that owns or operates a hospital, other than, in each of the cases (i) and (ii), any such Subsidiary that is a non-wholly-owned Subsidiary if the organizational
documents thereof or related joint venture or similar agreements, or applicable law, would (A) prohibit the pledge of the Capital Stock of such Subsidiary without the consent of the equity holders thereof (other than the Company or its wholly
owned Subsidiaries) or (B) upon the making of such pledge, trigger in favor of the equity holders thereof (other than the Company or its wholly owned Subsidiaries) rights in respect of the Capital Stock of such Subsidiary. 

“DTC” has the meaning specified in Section 2.3 hereof. 

“EBITDA” means, for any period, (a) Consolidated Net Income for such period plus (b) the sum of, in each case to the
extent included in the calculation of such Consolidated Net Income, but without duplication, (i) losses from discontinued operations, (ii) losses attributable to divested or closed businesses, (iii) any provision for income taxes,
(iv) any net loss from the sale, consolidation or deconsolidation of facilities, (v) any net income attributable to noncontrolling interests, (vi) Interest Expense, (vii) any extraordinary,
non-recurring or unusual expenses or losses, in each case, including any restructuring charges, separation costs or integration costs or losses from the early extinguishment of debt, (viii) impairments of
long-lived assets and goodwill, (ix) depreciation and amortization expenses, (x) stock-based-compensation expense, and (xi) other non-operating expenses, net, minus (c) the sum of, in each
case to the extent included in the calculation of such Consolidated Net Income but without duplication, (i) the cumulative effect (positive or negative, as the case may be) of changes in accounting principle, (ii) income from discontinued
operations, (iii) income attributable to divested or closed businesses, (iv) any net credit for taxes, (v) any net income from the sale, consolidation or deconsolidation of facilities, (vi) any net loss attributable to
noncontrolling interests, (vii) any extraordinary or non-recurring or unusual income or gains or income from the early extinguishment of debt, and (viii) other
non-operating income, net. 
 “Euroclear” means Euroclear Bank S.A./N.V., as
operator of the Euroclear system. 
 “Event of Default” has the meaning specified in Section 5.1 hereof. 

“Exchange Notes” means the notes issued in the Exchange Offer pursuant to Section 2.5(f) hereof. 

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

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

“Existing Secured Notes” means (i) all 4.625% Senior Secured First Lien Notes due 2024 issued prior to the date hereof
pursuant to the Existing Indenture, as supplemented by that certain Twenty-Ninth Supplemental Indenture, dated as of June 14, 2017, by and among the Company, the Guarantors from time to time party thereto and the Trustee, (ii) all 4.875%
Senior Secured First Lien Notes due 2026 issued on the date hereof pursuant to the Existing Indenture, as supplemented by that certain Thirty-Second Supplemental Indenture, dated as of August 26, 2019, by and among the Company, the Guarantors
from time to time party thereto and the Trustee and (iii) all 

  
 -8- 

 
5.125% Senior Secured First Lien Notes due 2027 issued on the date hereof pursuant to the Existing Indenture, as supplemented by that certain Thirty-Third Supplemental Indenture, dated as of
August 26, 2019, by and among the Company, the Guarantors from time to time party thereto and the Trustee. 
 “First-Priority
Stock Lien” means a Lien granted by a Stock Lien Security Document to the Collateral Trustee, at any time, upon any property of the Company or any other Pledgor to secure First-Priority Stock Secured Obligations. 

“First-Priority Stock Lien Documents” means the Note Documents and the indenture, credit agreement or other agreement pursuant
to which any First-Priority Stock Secured Obligations are incurred and the Stock Lien Security Documents (other than any Stock Lien Security Documents that do not secure First-Priority Stock Secured Obligations). 

“First-Priority Stock Lien Representative” means: 

(1) in the case of the Notes or Existing Secured Notes, the Trustee; or 

(2) in the case of any other Series of First-Priority Stock Secured Debt, the trustee, agent or representative of the
holders of such Series of First-Priority Stock Secured Debt who maintains the transfer register for such Series of First-Priority Stock Secured Debt and (A) is appointed as a representative of the First-Priority Stock Secured Debt
(for purposes related to the administration of the Stock Lien Security Documents) pursuant to the credit agreement, indenture or other agreement governing such Series of First-Priority Stock Secured Debt and (B) has executed a Collateral
Trust Joinder. 
 “First-Priority Stock Secured Debt” means: 

(1) the Existing Secured Notes and the “Obligations” (as defined in the LC Facility) outstanding under the LC
Facility; 
 (2) the Initial Notes issued on the date hereof (including any related Exchange Notes); and 

(3) any other Debt that is secured equally and ratably with the Notes by a First-Priority Stock Lien that was permitted to be
incurred and so secured under each applicable Stock Secured Debt Document; provided, in the case of any Debt referred to in this clause (3), that: 

(a) on or before the date on which such Debt is incurred by the Company or any Subsidiary, such Debt is designated by the
Company as “First-Priority Stock Secured Debt” for the purposes of the Stock Secured Debt Documents in an Additional Secured Debt Designation executed and delivered in accordance with Section 3.8(a) of the Collateral Trust
Agreement; provided, that no Obligation or Debt may be designated as both Junior Stock Secured Debt and First-Priority Stock Secured Debt; 

(b) the First-Priority Stock Lien Representative for such Debt executes and delivers a Collateral Trust Joinder in accordance
with Section 3.8(b) of the Collateral Trust Agreement; and 
 (c) all other requirements set forth in
Section 3.8 of the Collateral Trust Agreement have been complied with. 
 “First-Priority Stock Secured Obligations”
means the First-Priority Stock Secured Debt and all other Obligations in respect thereof. 
 “GAAP” means generally accepted
accounting principles in the United States of America as in effect from time to time set forth in the opinions and pronouncements of the Accounting Principles Board of the American Institute of Certified Public Accountants and the statements and
pronouncements of the Financial Accounting 

  
 -9- 

 
Standards Board, or in such other statements by such other entity (such as International Financial Reporting Standards) as may be in general use by significant segments of the accounting
profession, that are applicable to the circumstances as of the date of determination. 
 “Global Note Legend” means the
legend set forth in Section 2.5(g)(2) hereof, which is required to be placed on all Global Notes issued under the 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 Depositary or its nominee, substantially in the form of Exhibit A 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 2.1, 2.5(b)(3), 2.5(b)(4), 2.5(d)(2) or 2.5(f) hereof. 

“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, by way of a pledge of assets or through letters of credit or reimbursement agreements in respect thereof, of all or any part of any Debt. 

“Guarantors” means the Subsidiary Guarantors and any other Subsidiary of the Company that executes a Note Guarantee in
accordance with the provisions of the Indenture, and their respective successors and assigns, in each case, until the Note Guarantee of such Person has been released in accordance with the provisions of the Indenture. 

“Holder” means the person in whose name a Note is registered in the register of the Notes. 

“Hospital Swap” means an exchange of assets and, to the extent necessary to equalize the value of the assets being exchanged,
cash by the Company or one of its Subsidiaries for one or more hospitals and/or one or more Related Businesses, or for 100% of the Capital Stock of any Person owning or operating one or more hospitals and/or one or more Related Businesses;
provided that cash does not exceed 30% of the sum of the amount of the cash and the fair market value of the Capital Stock or assets received or given by the Company or such Subsidiary in such transaction. Notwithstanding the foregoing, the
Company and its Subsidiaries may consummate two Hospital Swaps in any 12-month period without regard to the requirements of the proviso in the previous sentence. 

“incur” has the meaning specified in Section 4.1 hereof. 

“Independent Investment Banker” means a Reference Treasury Dealer appointed by the Company as such. 

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

“Initial Notes” means the first $600,000,000 aggregate principal amount of Notes issued under the Indenture on the date
hereof. 
 “Interest Expense” means, for any period, the consolidated total interest expense of the Company and its
Consolidated Subsidiaries for such period plus interest capitalized during such period in accordance with GAAP. 
 “Issue
Date” means the date of issuance of the Initial Notes. 
 “Junior Stock Lien” means a Lien granted by a Stock Lien
Security Document to the Collateral Trustee, at any time, upon any property of the Company or any other Pledgor to secure Junior Stock Secured Obligations. 

“Junior Stock Lien Documents” means, collectively, any indenture, credit agreement or other agreement governing each
Series of Junior Stock Secured Debt and the Stock Lien Security Documents (other than any Stock Lien Security Documents that do not secure Junior Stock Secured Obligations). 

  
 -10- 

 “Junior Stock Lien Representative” means, in the case of any Series of
Junior Stock Secured Debt, the trustee, agent or representative of the holders of such Series of Junior Stock Secured Debt who maintains the transfer register for such Series of Junior Stock Secured Debt and (A) is appointed as a
Junior Stock Lien Representative (for purposes related to the administration of the Stock Lien Security Documents) pursuant to the indenture, credit agreement or other agreement governing such Series of Junior Stock Secured Debt, together with
its successors in such capacity and (B) has executed a Collateral Trust Joinder. 
 “Junior Stock Secured Debt” means
(a) the Company’s 5.125% Senior Secured Second Lien Notes due 2025, (b) the Company’s 6.250% Senior Secured Second Lien Notes due 2027; and (c) any other Debt that is secured by a Junior Stock Lien on the Collateral that was
permitted to be incurred and so secured under each applicable Stock Secured Debt Document; provided, that in the case of any such Debt: 

(1) on or before the date on which such Debt is incurred by the Company or any Subsidiary, such Debt is designated by the
Company as “Junior Stock Secured Debt” for the purposes of the Stock Secured Debt Documents in an Additional Secured Debt Designation executed and delivered in accordance with Section 3.8(a) of the Collateral Trust Agreement;
provided, that no Obligation or Debt may be designated as both Junior Stock Secured Debt and First-Priority Stock Secured Debt; 

(2) the Junior Stock Lien Representative for such Debt executes and delivers a Collateral Trust Joinder in accordance with
Section 3.8(b) of the Collateral Trust Agreement; and 
 (3) all other requirements set forth in Section 3.8
of the Collateral Trust Agreement have been complied with. 
 “Junior Stock Secured Obligations” means Junior Stock Secured
Debt and all other Obligations in respect thereof. 
 “LC Facility” means that certain letter of credit facility agreement,
dated as of March 7, 2014, as amended on September 15, 2016 and August 12, 2019, among the Company, certain financial institutions party thereto from time to time as letter of credit participants and issuers, and Barclays
Bank PLC, as administrative agent as amended, restated, or otherwise modified from time to time. 
 “Letter of
Transmittal” means the letter of transmittal to be prepared by the Company and sent to all Holders of the Notes for use by such Holders in connection with the Exchange Offer. 

“Liens” means liens, mortgages, pledges, charges, security interests or other encumbrances. 

“Net Available Cash” from an Asset Disposition means cash payments received therefrom (including any cash payments received by
way of deferred payment of principal pursuant to a note or installment receivable or otherwise and proceeds from the sale or other disposition of any securities received as consideration, but only as and when received, but excluding any other
consideration received in the form of assumption by the acquiring Person of debt or other obligations relating to such properties or assets or received in any other non-cash form), in each case net of: 

(1) all legal, title and recording tax expenses, commissions and other fees and expenses incurred, and all federal, state,
provincial, foreign and local taxes required to be accrued as a liability under GAAP, as a consequence of such Asset Disposition; 

(2) all payments made on any debt which is secured by any assets subject to such Asset Disposition, in accordance with the
terms of any Lien upon or other security agreement of any kind with respect to such assets, or which must by its terms, or in order to obtain a necessary consent to such Asset Disposition, or by applicable law, be repaid out of the proceeds from
such Asset Disposition; 
 (3) all distributions and other payments required to be made to minority interest holders in
Subsidiaries as a result of such Asset Disposition; 

  
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 (4) the deduction of appropriate amounts provided by the seller as a
reserve, in accordance with GAAP, against any liabilities associated with the property or other assets disposed in such Asset Disposition and retained by the Company or any Subsidiaries after such Asset Disposition; and 

(5) any portion of the purchase price from an Asset Disposition placed in escrow, whether as a reserve for adjustment of the
purchase price, for satisfaction of indemnities in respect of such Asset Disposition or otherwise in connection with that Asset Disposition; provided, however, that upon the termination of that escrow, Net Available Cash will be
increased by any portion of funds in the escrow that are released to the Company or any of its Subsidiaries. 
 “Note
Documents” means the Indenture, the Notes, the Note Guarantees and the Stock Lien Security Documents. 
 “Note
Guarantee” means the Guarantee by each Guarantor of the Company’s Obligations under the Indenture and the Notes, executed pursuant to the provisions of the Indenture. 

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

“Obligations” means any principal, interest, premium (if any), penalties, fees, indemnifications, reimbursements, damages,
expenses and other liabilities payable under the documentation governing any Debt. 
 “Offer Amount” has the meaning
specified in Section 3.3 hereof. 
 “Offer Period” has the meaning specified in Section 3.3 hereof. 

“Officer” means, with respect to any Person, the Chairman of the Board, the Chief Executive Officer, the President, the Chief
Operating Officer, the Chief Financial Officer, the Treasurer, any Assistant Treasurer, the Controller, the Secretary or any Vice President of such Person. 

“Other Secured Debt” has the meaning specified in Section 4.1 hereof. 

“Participant” means, with respect to the Depositary, Euroclear or Clearstream, a Person who has an account with the
Depositary, Euroclear or Clearstream, respectively (and, with respect to DTC, shall include Euroclear and Clearstream). 
 “Paying
Agent” has the meaning specified in Section 2.3 hereof. 
 “Permitted Credit Agreement Debt” means Debt
outstanding under the Credit Agreement in an amount not to exceed at any time the greater of (x) $1,500,000,000 and (y) the Borrowing Base at such time. 

“Permitted Joint Venture Transaction” means a transaction or series of related transactions in which a Person who is not an
Affiliate of the Company acquires less than a majority of Capital Stock of a Subsidiary in an aggregate amount for each such transaction and any related transactions not to exceed 5% of the Consolidated Total Assets; provided, that
(i) any sale, lease, transfer or other voluntary disposition (or series of related sales, leases, transfers or dispositions) of assets by the Company or any of its Subsidiaries, including any disposition by means of a merger, consolidation or
similar transaction, shall comply with Section 4.6 hereof and (ii) the aggregate fair market value of all such Subsidiary’s whose Capital Stock that is owned by the Company or a Subsidiary Guarantor and that is not pledged as
Collateral for the Notes shall not exceed $500,000,000 at the time of, and immediately after giving effect to, any such transaction. 

“Permitted Prior Liens” means Liens that arise by operation of law and are not voluntarily granted, to the extent entitled by
law to priority over the Liens created by the Stock Lien Security Documents. 

  
 -12- 

 “Person” means any individual, corporation, partnership, limited liability
company, joint venture, trust, unincorporated organization or government or any agency or political subdivision thereof. 
 “Pledge
Agreement” means the Stock Pledge Agreement, dated as of March 3, 2009, among the Company, the other Pledgors from time to time party thereto and the Collateral Trustee, as amended by that certain First Amendment to Stock Pledge
Agreement, dated as of May 8, 2009, among the Pledgors and the Collateral Trustee, that certain Second Amendment to Stock Pledge Agreement, dated as of June 15, 2009, among the Pledgors and the Collateral Trustee, that certain Third
Amendment to Stock Pledge Agreement, dated as of March 7, 2014, among the Pledgors and the Collateral Trustee, that certain Fourth Amendment to Stock Pledge Agreement, dated as of March 23, 2015, among the Pledgors and the Collateral
Trustee, that certain Joinder Agreement, dated as of October 2, 2015 by the Pledgors party thereto, that certain Pledge Amendment, dated as of October 5, 2015, among the Pledgors and the Collateral Trustee, that certain Fifth Amendment to
Stock Pledge Agreement, dated as of December 1, 2016 among the Pledgors and the Collateral Trustee, that certain Sixth Amendment to Stock Pledge Agreement, dated as of July 14, 2017, among the Pledgors and the Collateral Trustee, and that
certain Seventh Amendment to Stock Pledge Agreement, dated as of February 5, 2019 among the Pledgors and the Collateral Trustee, as the same may be further amended, amended and restated, supplemented or otherwise modified from time to time.

 “Pledgors” means the Company and any other Person (if any) that at any time provides collateral security for any Stock
Secured Obligations. 
 “Primary Treasury Dealer” means a primary U.S. government securities dealer in New York City. 

“Private Placement Legend” means the legend set forth in Section 2.5(g)(1) hereof to be placed on all Notes issued
under the Indenture except where otherwise permitted by the provisions of the Indenture. 
 “Proceeds” means any and all
cash, securities and other property realized from collection, sale, foreclosure or enforcement of the Liens upon any Collateral (including distributions of Collateral in satisfaction of any Stock Secured Obligations) after payment of any applicable
Permitted Prior Liens. 
 “Purchase Date” has the meaning specified in Section 3.3 hereof. 

“Qualified Equity Offering” means the issue and sale of common stock of the Company (other than to a Subsidiary) in a bona
fide public or private offering. 
 “Qualified Institutional Buyer” or “QIB” has the meaning specified in
Rule 144A. 
 “Reference Treasury Dealer” means: 

(1) Barclays Capital Inc. and its successor; provided that, if Barclays Capital Inc. ceases to be a Primary Treasury
Dealer, the Company will substitute another Primary Treasury Dealer; and 
 (2) any other Primary Treasury Dealer selected by
the Company. 
 “Reference Treasury Dealer Quotation” means, with respect to each Reference Treasury Dealer and any
Redemption Date, the average, as determined by the Independent Investment Banker, 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 Independent
Investment Banker by such Reference Treasury Dealer at 5:00 p.m., New York City time, on the third Business Day preceding such Redemption Date. 

“Registrar” has the meaning specified in Section 2.3 hereof. 

“Registration Rights Agreement” means the Exchange and Registration Rights Agreement, dated as of the date hereof among the
Company, the Guarantors and the other parties named on the signature pages thereof, as such agreement may be amended, modified or supplemented from time to time and, with respect to any Additional Notes,

  
 -13- 

 
one or more registration rights agreements among the Company, the Guarantors and the other parties thereto, as such agreement(s) may be amended, modified or supplemented from time to time,
in each case relating to rights given by the Company to the purchasers of Notes to register such Notes under the Securities Act. 

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

“Regulation S Global Note” means a Global Note substantially in the form of
Exhibit A 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 Notes sold in reliance on Rule 903 of Regulation S. 
 “Related Business”
means a business affiliated or associated with a hospital or any business related or ancillary to the provision of health care services or information or the investment in, or the management, leasing or operation of, any of the foregoing. 

“Required Junior Stock Secured Debtholders” means, at any time, the holders of more than 50% of the sum of: 

(1) the aggregate outstanding principal amount of Junior Stock Secured Debt (including outstanding letters of credit whether or
not then available or drawn); and 
 (2) other than in connection with the exercise of remedies, the aggregate unfunded
commitments to extend credit which, when funded, would constitute Junior Stock Secured Debt. 
 For purposes of this definition,
(a) Junior Stock Secured Debt registered in the name of, or beneficially owned by, the Company or any Affiliate of the Company will be deemed not to be outstanding, and (b) votes will be determined in accordance with the provisions of
Section 7.2 of the Collateral Trust Agreement. Any written direction or consent from the Required Junior Stock Secured Debtholders shall be accompanied by a certificate signed by an authorized officer of each Junior Stock Lien
Representative certifying that such written direction or consent is being delivered to the Collateral Trustee by the requisite number of holders to constitute the Required Junior Stock Secured Debtholders, and the Collateral Trustee may rely
conclusively on, and shall be fully protected in relying upon, such certificate in proceeding with any such written direction or consent. 

“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 Period” means the 40-day distribution compliance period as defined in
Regulation S. 
 “Rule 144” means Rule 144 under the Securities Act (including any successor
rule thereto), as the same may be amended from time to time. 
 “Rule 144A” means Rule 144A
under the Securities Act (including any successor rule thereto), as the same may be amended from time to time. 

“Rule 903” means Rule 903 under the Securities Act (including any successor rule thereto), as the
same may be amended from time to time. 
 “Rule 904” means Rule 904 under the Securities Act
(including any successor rule thereto), as the same may be amended from time to time. 
 “Sale and Lease-Back
Transaction” means any arrangement with any Person (other than the Company or a Subsidiary), or to which any such Person is a party, providing for the leasing to the Company or a Subsidiary for a period of more than three years of any
hospital that has been or is to be sold or transferred by the Company or such Subsidiary to such Person or to any other Person (other than the Company or a Subsidiary), to which the funds have been or are to be advanced by such Person on the
security of the leased property. 

  
 -14- 

 “Secured Debt” means Debt secured by a Lien upon the property or assets of
the Company or any of its direct or indirect Subsidiaries. 
 “Secured Debt Ratio” means, as of any date of determination,
the ratio of (a) Secured Debt to (b) the aggregate amount of EBITDA for the most recent four consecutive fiscal quarters ending prior to such determination date. In the event that the Company or any of its Subsidiaries issues, incurs,
creates, assumes, guarantees, redeems, retires or extinguishes any Secured Debt (other than Secured Debt incurred under any revolving credit facility unless such Secured Debt has been permanently repaid and has not been replaced) subsequent to the
commencement of the period for which the Secured Debt Ratio is being calculated but prior to or simultaneously with the event for which the calculation of the Secured Debt Ratio is made (the “Calculation Date”), then the Secured
Debt Ratio shall be calculated giving pro forma effect to such issuance, incurrence, creation, assumption, guarantee, redemption, retirement or extinguishment of Secured Debt, as if the same had occurred at the beginning of the applicable
four-quarter period. 
 For purposes of making the computation referred to above, acquisitions, dispositions, mergers, consolidations and
disposed operations (as determined in accordance with GAAP) that have been made by the Company or any of its Subsidiaries 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 acquisitions, dispositions, mergers, consolidations and disposed operations (and the change in any associated Secured Debt 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 Subsidiary or was merged with or into the Company or any of its Subsidiaries since
the beginning of such period shall have made any acquisition, disposition, merger, consolidation or disposed operation that would have required adjustment pursuant to this definition, then the Secured Debt Ratio shall be calculated giving pro forma
effect thereto for such period as if such acquisition, disposition, merger, consolidation or disposed operation 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 a transaction, the pro forma calculations shall be made in
accordance with Regulation S-X under the Securities Act of 1933, as amended, as determined in good faith by a responsible financial or accounting officer of the Company. For purposes of making the computation
referred to above, any Secured Debt under a revolving credit facility computed on a pro forma basis shall be computed based upon the amount of such Secured Debt outstanding on the Calculation Date. 

“Securities” has the meaning ascribed to it in the first paragraph under the caption “Recitals.” 

“Senior Debt” means with respect to any Person: 

(1) Debt of such Person, whether outstanding on the Issue Date or thereafter incurred; and 

(2) all other Obligations of such Person (including interest accruing on or after the filing of any petition in bankruptcy or
for reorganization relating to such Person whether or not post-filing interest is allowed in such proceeding) in respect of Debt described in clause (1) above, 

unless, in the case of clauses (1) and (2) above, in the instrument creating or evidencing the same or pursuant to which the same is
outstanding, it is provided that such Debt or other Obligations are subordinated in right of payment to the Notes or the Note Guarantee of such Person, as the case may be; provided, however, that Senior Debt shall not include: 

(1) any Obligation of such Person to the Company or any of its Subsidiaries; 

(2) any liability for U.S. federal, state, local or other taxes owed or owing by such Person; 

  
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 (3) any accounts payable or other liability to trade creditors arising in
the ordinary course of business; 
 (4) any Debt or other Obligation of such Person which is subordinate or junior in any
respect to any other Debt or other Obligation of such Person; or 
 (5) that portion of any Debt which at the time of
incurrence is incurred in violation of the Indenture. 
 “Series of First-Priority Stock Secured Debt”
means, severally, the Notes, each series of Existing Secured Notes and each other issue or series of First-Priority Stock Secured Debt for which a single transfer register is maintained. 

“Series of Junior Stock Secured Debt” means, severally, each issue or series of Junior Stock Secured Debt
for which a single transfer register is maintained. 
 “Series of Stock Secured Debt” means, severally,
each Series of First-Priority Stock Secured Debt and each Series of Junior Stock Secured Debt. 
 “Significant
Subsidiary” means any Subsidiary that would be a “significant subsidiary” as defined in Article 1, Rule 1-02 of Regulation S-X,
promulgated pursuant to the Securities Act, as such Regulation is in effect on the Issue Date. 
 “Special Interest” has the
meaning set forth in the Registration Rights Agreement. 
 “Stock Lien Security Documents” means the Collateral Trust
Agreement, each Collateral Trust Joinder relating to Stock Secured Debt, the Pledge Agreement and all security agreements, pledge agreements, collateral assignments, collateral agency agreements, control agreements or other grants or transfers for
security executed and delivered by the Company or any other Pledgor creating (or purporting to create) a Lien upon Collateral in favor of the Collateral Trustee, for the benefit of the Stock Secured Parties, in each case, as amended, modified,
renewed, restated or replaced, in whole or in part, from time to time, in accordance with its terms and Section 7.1 of the Collateral Trust Agreement. 

“Stock Secured Debt” means First-Priority Stock Secured Debt and Junior Stock Secured Debt. 

“Stock Secured Debt Documents” means the First-Priority Stock Lien Documents and the Junior Stock Lien Documents. 

“Stock Secured Debt Representative” means each First-Priority Stock Lien Representative and each Junior Stock Lien
Representative. 
 “Stock Secured Obligations” means First-Priority Stock Secured Obligations and Junior Stock Secured
Obligations. 
 “Stock Secured Parties” means the holders of Stock Secured Obligations, the Stock Secured Debt
Representatives on behalf of the holders of Stock Secured Obligations, and the Collateral Trustee. 
 “Subsidiary” means,
with respect to any Person, (i) any corporation, limited liability company, association or other business entity of which more than 50% of the outstanding voting power of shares of Capital Stock entitled (without regard to the occurrence of any
contingency) to vote in the election of directors, managers, managing members or trustees thereof is at the time owned or controlled, directly or indirectly, by such Person or one or more other Subsidiaries of that Person (or a combination thereof)
and (ii) any partnership (a) the sole general partner or the managing general partner of which is such Person or a Subsidiary of such Person or (b) the only general partners of which are such Person or one or more Subsidiaries of such
Person (or any combination thereof). 

  
 -16- 

 “Subsidiary Guarantors” means each of the Company’s current and future
direct and indirect Subsidiaries organized in a jurisdiction in the United States that (i) owns or operates a hospital or (ii) has a direct or indirect equity ownership interest in a Subsidiary that owns or operates a hospital, other than,
in each of the cases (i) and (ii), any such Subsidiary that is a non-wholly-owned Subsidiary if the organizational documents thereof or related joint venture or similar agreements, or applicable law,
would (A) prohibit the Guarantee of the Notes without the consent of the equity holders thereof (other than the Company or its wholly owned Subsidiaries) or (B) upon the making of such Guarantee, trigger in favor of the equity holders
thereof (other than the Company or its wholly owned Subsidiaries) rights in respect of the Capital Stock of such Subsidiary. 

“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. 
 “U.S. Government Obligation” has the meaning specified in Section 6.3(1) hereof. 

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

“Voting Stock” of any specified 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. 
 ARTICLE TWO 

GENERAL TERMS AND CONDITIONS OF THE NOTES 

Section 2.1. Form and Dating 

(a) General. The Notes and the Trustee’s certificate of authentication will be substantially in the form of
Exhibit A hereto. The Notes may have notations, legends or endorsements required by law, stock exchange rule or usage. Each Note will 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 will
constitute, and are hereby expressly made, a part of this Thirty-First Supplemental Indenture and the Company, the Guarantors and the Trustee, by their execution and delivery of this Thirty-First Supplemental 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 the Indenture, the provisions of the Indenture shall govern and be controlling. 

(b) Global Notes. Notes issued in global form will be substantially in the form of Exhibit A 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 will be substantially in the form of Exhibit A
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 will represent such of the outstanding Notes as will be specified therein
and each shall provide that it represents the aggregate principal amount of outstanding Notes from time to time endorsed thereon 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 will 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 2.5 hereof. 

Section 2.2. Execution and Authentication 

At least one Officer must sign the Notes for the Company by manual or facsimile signature. 

  
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 If an Officer whose signature is on a Note no longer holds that office at the time a Note is
authenticated, the Note will nevertheless be valid. 
 A Note will not be valid until authenticated by the manual signature of the
Trustee. The signature will be conclusive evidence that the Note has been authenticated under the Indenture. 
 The Trustee will, upon
receipt of a written order of the Company signed by an Officer (an “Authentication Order”), authenticate Notes for original issue that may be validly issued under the Indenture, including any Additional 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 Company pursuant to one or more Authentication Orders, except as provided in Section 306 of the Existing
Indenture. 
 The Trustee may appoint an authenticating agent acceptable to the Company to authenticate Notes. An authenticating agent
may authenticate Notes whenever the Trustee may do so. Each reference in this Thirty-First Supplemental Indenture to authentication 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 Company. 
 Section 2.3. Registrar and Paying Agent 

The Company will 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 will keep a register of the Notes and of their transfer and exchange. The Company 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 Company may change any Paying Agent or Registrar without notice to any Holder. The Company will notify the Trustee in writing of the name and address of any Agent not a party to the
Indenture. If the Company fails to appoint or maintain another entity as Registrar or Paying Agent, the Trustee shall act as such. The Company or any of its Subsidiaries may act as Paying Agent or Registrar. 

The Company initially appoints The Depository Trust Company (“DTC”) to act as Depositary with respect to the Global
Notes. 
 The Company initially appoints the Trustee to act as the Registrar and Paying Agent and to act as Custodian with respect to the
Global Notes and the Trustee hereby agrees so to initially act. 
 Section 2.4. Paying Agent to Hold Money in Trust 

The Company will require each Paying Agent other than the Trustee to agree in writing that the Paying Agent will 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 Special Interest, if any, or interest on the Notes, and will notify the Trustee of any default by the Company 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 Company 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 will have no further liability for the money. 
 Section 2.5. 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
will be exchanged by the Company for Definitive Notes if: 
 (1) the Company delivers to the Trustee notice from the
Depositary that it 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 Company within 90 days
after the date of such notice from the Depositary; 

  
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 (2) the Company in its sole discretion determines that the Global Notes (in
whole but not in part) should be exchanged for Definitive Notes and delivers a written notice to such effect to the Trustee; or 

(3) there has occurred and is continuing an Event of Default with respect to the Notes. 

Upon the occurrence of any of the preceding events in clause (1), (2) or (3) above, Definitive Notes shall be issued in such names
as the Depositary shall instruct the Trustee. Such Definitive Notes will be issued in minimum denominations of $2,000 and integral multiples of $1,000 in excess thereof and will be in registered form only, without coupons. Global Notes
also may be exchanged or replaced, in whole or in part, as provided in Sections 304 and 306 of the Existing Indenture. Every Note authenticated and delivered in exchange for, or in lieu of, a Global Note or any portion thereof, pursuant to
this Section 2.5 or Section 304 or 306 of the Existing Indenture, 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 2.5(a); however, beneficial interests in a Global Note may be transferred and exchanged as provided in Section 2.5(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 will be effected through the Depositary, in accordance with the provisions of the Indenture and the Applicable Procedures. Beneficial interests in the Restricted Global Notes will 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 will 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 Global Note may not be made to a U.S. Person or for the account or
benefit of a U.S. Person. 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 2.5(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 2.5(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 

  
 -19- 

	 	(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 subparagraph (1) above. 

Upon consummation of an Exchange Offer by the Company in accordance with Section 2.5(f) hereof, the requirements of this
Section 2.5(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 Thirty-First Supplemental 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 2.5(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 2.5(b)(2) above and the Registrar receives the
following: 
 (A) if the transferee will 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; and 

(B) if the transferee will take delivery in the form of a beneficial interest in the Regulation S Global Note, then the
transferor must deliver a certificate in the form of Exhibit B hereto, including the certifications in item (2) thereof. 

(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 2.5(b)(2) above and: 

(A) such exchange or transfer is effected pursuant to the 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 Company; 

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

  
 -20- 

	 	(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 this subparagraph (C), 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 (C) above at a
time when an Unrestricted Global Note has not yet been issued, the Company shall issue and, upon receipt of an Authentication Order in accordance with Section 2.2 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 (C) 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 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) thereof, if applicable; 
 (F) if such beneficial interest is being transferred to the Company
or any of its 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, 

  
 -21- 

 the Trustee shall cause the aggregate principal amount of the applicable Global Note to be reduced
accordingly pursuant to Section 2.5(h) hereof, and the Company shall execute and the Trustee shall authenticate and deliver to the 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 2.5(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 2.5(c)(1) shall bear the Private Placement Legend and shall be subject to all restrictions on transfer
contained therein. 
 (2) 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 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 Company; 

(B) such transfer is effected by a Broker-Dealer pursuant to the Exchange Registration Statement in accordance with the
Registration Rights Agreement; or 
 (C) 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 (C), 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) 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 2.5(b)(2) hereof, the Trustee will cause the aggregate principal amount of the applicable Global Note to be reduced accordingly pursuant to Section 2.5(h) hereof, and the
Company will execute and the Trustee will authenticate and deliver to the Person designated in the instructions a Definitive Note in the appropriate principal amount. Any Definitive Note issued in exchange for a beneficial interest pursuant to
this Section 2.5(c)(3) will 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 will 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 2.5(c)(3) will not bear the Private Placement Legend. 

  
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 (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 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 Company or any of its 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 will 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, and in the case of clause (C) above, the Regulation S 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 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 Company; 

  
 -23- 

 (B) such transfer is effected by a Broker-Dealer pursuant to the Exchange
Registration Statement in accordance with the Registration Rights Agreement; or 
 (C) 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 (C), 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 2.5(d)(2), the Trustee will 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 will 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)(C) or (3) above at a time when an Unrestricted Global Note has not yet been issued, the Company will issue and, upon receipt of an
Authentication Order in accordance with Section 2.2 hereof, the Trustee will 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 2.5(e), the Registrar will 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 2.5(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: 

(A) if the transfer will 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; 

  
 -24- 

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

(C) 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 (C), 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) Exchange Offer. Upon the occurrence of the Exchange Offer in accordance with the
Registration Rights Agreement, the Company will issue and, upon receipt of an Authentication Order in accordance with Section 2.2 hereof, the Trustee will 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 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 Company; and 

  
 -25- 

 (2) Unrestricted Definitive Notes in an aggregate principal amount equal to
the principal amount of the Restricted Definitive Notes accepted for exchange in the 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 Company. 
 Concurrently with
the issuance of such Notes, the Trustee will cause the aggregate principal amount of the applicable Restricted Global Notes to be reduced accordingly, and the Company will execute and the Trustee will 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 will appear on the face of all Global Notes and Definitive Notes issued under the Indenture unless specifically stated otherwise in the applicable provisions of this Thirty-First Supplemental
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 the legend in substantially the following form: 
 “THE SECURITY (OR ITS PREDECESSOR) EVIDENCED
HEREBY WAS ORIGINALLY ISSUED IN A TRANSACTION EXEMPT FROM REGISTRATION UNDER SECTION 5 OF THE UNITED STATES SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND THE SECURITY EVIDENCED HEREBY MAY NOT BE OFFERED, SOLD OR
OTHERWISE TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR AN APPLICABLE EXEMPTION THEREFROM. EACH PURCHASER OF THE SECURITY EVIDENCED HEREBY IS HEREBY NOTIFIED THAT THE SELLER MAY BE RELYING ON THE EXEMPTION FROM THE PROVISIONS OF
SECTION 5 OF THE SECURITIES ACT PROVIDED BY RULE 144A THEREUNDER. THE HOLDER OF THE SECURITY EVIDENCED HEREBY AGREES FOR THE BENEFIT OF THE COMPANY THAT (A) SUCH SECURITY MAY BE RESOLD, PLEDGED OR OTHERWISE TRANSFERRED, ONLY
(1)(a) TO A PERSON WHO THE SELLER REASONABLY BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER (AS DEFINED IN RULE 144A UNDER THE SECURITIES ACT) PURCHASING FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF A QUALIFIED INSTITUTIONAL BUYER IN A
TRANSACTION MEETING THE REQUIREMENTS OF RULE 144A UNDER THE SECURITIES ACT, (b) OUTSIDE THE UNITED STATES IN A TRANSACTION MEETING THE REQUIREMENTS OF RULE 903 OR RULE 904 OF REGULATION S UNDER THE SECURITIES ACT,
(c) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER (IF APPLICABLE) OR (d) IN ACCORDANCE WITH ANOTHER EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT (AND BASED
UPON AN OPINION OF COUNSEL ACCEPTABLE TO THE COMPANY IF THE COMPANY SO REQUESTS), (2) TO THE COMPANY OR (3) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT AND, IN EACH CASE, IN ACCORDANCE WITH ANY APPLICABLE SECURITIES LAWS
OF ANY STATE OF THE UNITED STATES OR ANY OTHER APPLICABLE JURISDICTION AND (B) THE HOLDER WILL, AND EACH SUBSEQUENT HOLDER IS REQUIRED TO, NOTIFY ANY PURCHASER OF THE SECURITY EVIDENCED HEREBY OF THE RESALE RESTRICTIONS SET FORTH IN
CLAUSE (A) ABOVE. NO REPRESENTATION CAN BE MADE AS TO THE AVAILABILITY OF THE EXEMPTION PROVIDED BY RULE 144 FOR RESALE OF THE SECURITY EVIDENCED HEREBY.” 

(B) Notwithstanding the foregoing, any Global Note or Definitive Note issued pursuant to subparagraphs (b)(4), (c)(2),
(c)(3), (d)(2), (d)(3), (e)(2), (e)(3) or (f) of this Section 2.5 (and all Notes issued in exchange therefor or substitution thereof) will not bear the Private Placement Legend. The Company may also provide a certificate to the
Trustee instructing the Trustee that the Private Placement Legend no longer applies or issue one or more new Notes to the Trustee in replacement for all or part of the Notes with the Private Placement Legend. 

  
 -26- 

 (2) Global Note Legend. Each Global Note will 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 2.5 OF THE
THIRTY-FIRST SUPPLEMENTAL INDENTURE, (2) THIS GLOBAL NOTE MAY BE EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.5(a) OF THE THIRTY-FIRST SUPPLEMENTAL INDENTURE, (3) THIS GLOBAL NOTE MAY BE DELIVERED TO
THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 309 OF THE EXISTING INDENTURE AND (4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF TENET HEALTHCARE CORPORATION. 

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 COMPANY OR ITS 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.” 
 (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 will be returned to or retained and canceled by the Trustee in
accordance with Section 309 of the Existing Indenture. At any time prior to such cancellation, if any beneficial interest in a Global Note is exchanged for or transferred to a Person who will 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 will be reduced accordingly and an endorsement will 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 will take delivery thereof in the form of a beneficial interest in another Global Note, such other Global
Note will be increased accordingly and an endorsement will 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 Company will execute and the Trustee will authenticate Global Notes
and Definitive Notes upon receipt of an Authentication Order in accordance with Section 2.2 hereof or at the Registrar’s request. 

(2) No service charge will 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 Company 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 304, 906 and 1107 of the Existing Indenture and Sections 3.3, 4.6 and 4.7 hereof). 

  
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 (3) The Registrar will 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 will be the valid Obligations of the Company, evidencing the same Debt, and entitled to the same benefits under the Indenture, as the Global Notes or Definitive Notes surrendered upon such registration of transfer or exchange. 

(5) Neither the Registrar nor the Company will 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 1103 of the Existing Indenture 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 Company 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 Company shall be affected by notice to the contrary. 
 (7) The Trustee
will authenticate Global Notes and Definitive Notes in accordance with the provisions of Section 2.2 hereof. 
 (8) All
certifications, certificates and Opinions of Counsel required to be submitted to the Registrar pursuant to this Section 2.5 to effect a registration of transfer or exchange may be submitted by facsimile. 

(9) The Trustee shall have no obligation or duty to monitor, determine or inquire as to compliance with any restrictions on
transfer imposed under this Indenture or under applicable law with respect to any transfer of any interest in any Note (including any transfers between or among Depositary Participants or beneficial owners of interests in any Global Note) other than
to require delivery of such certificates and other documentation or evidence as are expressly required by, and to do so if and when expressly required by the terms of, this Indenture, and to examine the same to determine substantial compliance as to
form with the express requirements hereof. 
 ARTICLE THREE 

REDEMPTION AND PREPAYMENT 

Section 3.1. Optional Redemption 

(a) At any time prior to September 1, 2021, the Company may redeem the Notes, in whole or in part, at any time, at its option, at a
Redemption Price calculated by the Company equal to 100% of the principal amount of the Notes being redeemed plus the Applicable Premium as of the Redemption Date, plus accrued and unpaid interest thereon and Special Interest, if any, to, but not
including, the Redemption Date. 

  
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 (b) On and after September 1, 2021, the Company may redeem the Notes, in whole or in
part, at its option, at the following Redemption Prices (expressed as percentages of the principal amount thereof), plus accrued and unpaid interest, if any, to the Redemption Date (subject to the right of Holders of record on the relevant record
date to receive interest on the relevant interest payment date), if redeemed during the 12-month period (or, in the case of the period commencing on September 1, 2023, such
12-month period and thereafter) commencing on September 1 of the years set forth below: 
  

					
	 Year
	  	Percentage	 
		
	 2021
	  	 	102.313	% 
		
	 2022
	  	 	101.156	% 
		
	 2023 and thereafter
	  	 	100.000	% 

 (c) At any time or from time to time prior to September 1, 2021, the Company, at its option, may redeem
up to 40% of the aggregate principal amount of the Notes, with the net cash proceeds of one or more Qualified Equity Offerings at a Redemption Price equal to 104.625% of the principal amount of the Notes, to be redeemed, plus accrued and unpaid
interest (including Special Interest, if any) thereon, if any, to the Redemption Date; provided that (1) at least 50% of the aggregate principal amount of the Notes remains outstanding immediately after the occurrence of such redemption
and (2) the redemption occurs within 180 days of the closing of any such Qualified Equity Offering. 
 (d) Any redemption pursuant to
this Section 3.1 shall, except as provided in clause (e) below, be made pursuant to the provisions of Article Eleven of the Existing Indenture. 

(e) Any notice of an optional redemption may, at the Company’s discretion, be subject to one or more conditions precedent, including, but
not limited to, completion of an equity offering, other offering, incurrence of indebtedness, or other corporate transaction or event and notice of any redemption in respect thereof may be given prior to the completion thereof and may be partial as
a result of only some of the conditions being satisfied; provided, however, that any such conditions precedent shall be set forth in the notice of redemption and that such notice shall state that, in the Company’s discretion, the
Redemption Date may be delayed until such time as any or all such conditions shall be satisfied (or waived by the Company in its sole discretion), or such redemption may not occur and such notice may be rescinded in the event that any or all such
conditions shall not have been satisfied (or waived by the Company in its sole discretion) by the Redemption Date, or by the Redemption Date so delayed. 

(f) The following provision shall apply with respect to the Notes (notwithstanding the first sentence of the first paragraph of
Section 1103 of the Existing Indenture, which shall be deemed modified and amended by the following): 
 If less than
all of the Notes are to be redeemed at any time, selection of Notes for redemption will be made according to the applicable procedures of the Depositary; provided that Notes with a principal amount of $2,000 will not be redeemed in part. 

Section 3.2. Sinking Fund 

The Company is not required to make mandatory sinking fund payments with respect to the Notes. 

  
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 Section 3.3. Offer to Purchase by Application of Balance in Net Available Cash

 In the event that, pursuant to Section 4.6 hereof, the Company is required to commence an offer to all Holders of Notes (and to
holders of other First-Priority Stock Secured Debt) to purchase Notes (and such other First-Priority Stock Secured Debt) (an “Asset Disposition Offer”), it will follow the procedures specified below. 

The Asset Disposition Offer shall be made to all Holders of Notes and all holders of other First-Priority Stock Secured Debt. The Asset
Disposition Offer will 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 three Business Days after the termination of the Offer Period (the “Purchase Date”), the Company will apply the Net Available Cash available for the Asset Disposition Offer (the “Offer
Amount”) to the purchase of Notes and such other First-Priority Stock Secured Debt (on a pro rata basis, if applicable) or, if less than the Offer Amount has been tendered, all Notes and other First-Priority Stock Secured Debt
tendered in response to the Asset Disposition Offer. Payment for any Notes so purchased will be made in the same manner as interest payments are made. 

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, will 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 will be payable to Holders who tender Notes pursuant to the Asset
Disposition Offer. 
 Upon the commencement of an Asset Disposition Offer, the Company will send, electronically or by first class mail, a
notice to the Trustee and each of the Holders and each of the holders of other First-Priority Stock Secured Debt. The notice will contain all instructions and materials necessary to enable such holders to tender Notes and other First-Priority
Stock Secured Debt pursuant to the Asset Disposition Offer. The notice, which will govern the terms of the Asset Disposition Offer, will state: 

(1) that the Asset Disposition Offer is being made pursuant to this Section 3.3 and Section 4.6 hereof and the length
of time the Asset Disposition Offer will remain open; 
 (2) the Offer Amount, the purchase price and the Purchase Date; 

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

(4) that, unless the Company defaults in making such payment, any Note accepted for payment pursuant to the Asset Disposition
Offer will cease to accrue interest after the Purchase Date; 
 (5) that Holders electing to have a Note purchased pursuant
to an Asset Disposition Offer may elect to have Notes purchased only in denominations of $2,000 and in integral multiples of $1,000 in excess thereof; 

(6) that Holders electing to have Notes purchased pursuant to any Asset Disposition Offer will 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 Company, a Depositary, if appointed by the Company, or a Paying Agent at the address specified in
the notice at least three days before the Purchase Date; 
 (7) that holders of Notes and other First-Priority Stock Secured
Debt will be entitled to withdraw their election if the Company, the Depositary or the Paying Agent, as the case may be, receives, not later than 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 or other First-Priority Stock Secured Debt the holder delivered for purchase and a statement that such holder is withdrawing his election to have such Note or other First-Priority Stock
Secured Debt purchased; 

  
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 (8) that, if the aggregate principal amount of Notes and other
First-Priority Stock Secured Debt surrendered by holders thereof exceeds the Offer Amount, the Company will select the Notes and other First-Priority Stock Secured Debt to be purchased on a pro rata basis based on the principal amount of
Notes and such other First-Priority Stock Secured Debt surrendered (with such adjustments as may be deemed appropriate by the Company so that only Notes in denominations of $2,000, or integral multiples of $1,000 in excess thereof, will be
purchased); and 
 (9) that Holders whose Notes were purchased only in part will be issued new Notes equal in principal
amount to the unpurchased portion of the Notes surrendered (or transferred by book-entry transfer). 
 On or before the Purchase Date, the
Company will, to the extent lawful, accept for payment, on a pro rata basis to the extent necessary, the Offer Amount of Notes and other First-Priority Stock Secured Debt or portions thereof tendered pursuant to the Asset Disposition Offer,
or if less than the Offer Amount has been tendered, all Notes and other First-Priority Stock Secured Debt tendered, and will deliver or cause to be delivered to the Trustee the Notes properly accepted together with an Officers’ Certificate
stating that such Notes or portions thereof were accepted for payment by the Company in accordance with the terms of this Section 3.3. The Company, the Depositary or the Paying Agent, as the case may be, will 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 Company for purchase, and the Company will promptly issue a new Note, and
the Trustee, upon written request from the Company, will 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 Company to the Holder thereof. The Company will publicly announce the results of the Asset Disposition Offer on the Purchase Date. 

Other than as specifically provided in this Section 3.3, any purchase pursuant to this Section 3.3 shall be made pursuant to the
provisions of Article Eleven of the Existing Indenture. 
 ARTICLE FOUR 

COVENANTS 
 Section 4.1.
Limitations on Liens 
 The Company covenants and agrees that neither it nor any of its Subsidiaries will issue,
incur, create, assume or guarantee (collectively, “incur”) any Debt secured by Liens upon property or assets (including the Collateral), unless at the time of and after giving effect to the incurrence of such Debt, the aggregate
amount of all such Secured Debt (including the aggregate principal amount of Notes outstanding at such time) shall not exceed the greater of (x) $9.5 billion and (y) the amount which would cause the Secured Debt Ratio to exceed 4.0 to
1.0. If any such Secured Debt (other than Permitted Credit Agreement Debt) is secured by property or assets other than the Collateral, the Notes shall be secured equally and ratably with, or prior to, such Debt; provided that up to
$500.0 million of such Secured Debt (“Other Secured Debt”) is not subject to the equal and ratable security requirement in this sentence. To the extent that the Company or any of its Subsidiaries incurs any additional Debt
permitted under this Section 4.1 (other than Other Secured Debt) that is secured by a Lien (pari passu to the Lien securing the Notes) or junior Lien on any property or assets, such Liens shall be subject to the Collateral Trust Agreement. 

The foregoing provisions shall not apply to any of the following: 

(1) Liens securing Permitted Credit Agreement Debt; 

(2) Liens in favor of the Company or a Domestic Hospital Subsidiary; 

(3) Liens existing on the Issue Date; 

  
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 (4) Liens in favor of a government or governmental entity that: 

(a) secure Debt that is guaranteed by the government or governmental entity, or 

(b) secure Debt incurred to finance all or some of the purchase price or cost of construction of goods, products or facilities
produced under contract or subcontract for the government or governmental entity; 
 (5) Liens arising in connection with the
transfer of tax benefits in accordance with Section 168(f)(8) of the Internal Revenue Code of 1954 (or any similar provision of law from time to time in effect); provided that such Liens (i) are incurred within 90 days (or
any longer period, not in excess of one year, as any such provision of law may from time to time permit) after the acquisition of the property or equipment subject to said Lien, (ii) do not extend to any other property or equipment, and
(iii) are solely for the purpose of said transfer of tax benefits; 
 (6) Liens created in substitution of or as
replacements for any Liens permitted by clauses (1) to (5) set forth above, provided that the property encumbered by any substitute or replacement Lien is similar in nature and value to the property encumbered by the Lien that
is being replaced, as determined in good faith by an Officer of the Company; and 
 (7) Any extension, renewal or replacement
(or successive extensions, renewals or replacements), in whole or in part, of any Lien referred to in the foregoing clauses (1) to (6) or any Lien incurred in compliance with the first paragraph of this Section 4.1, in any case inclusive
of any Debt secured thereby; provided that the principal amount of Debt secured thereby shall not exceed the principal amount of Debt so secured at the time of such extension, renewal or replacement, and that such extension, renewal or
replacement Lien shall be limited to all or part of the same property that secured the Lien extended, renewed or replaced (plus improvements on such property). 

Section 4.2. Limitations on Sale and Lease-Back Transactions 

The Company covenants and agrees that neither it nor any of its Subsidiaries will enter into any Sale and Lease-Back Transaction with another
Person, other than the Company or any Guarantor, unless: 
 (i) the Company or such Subsidiary could incur the Attributable
Debt in respect of such Sale and Lease-Back Transaction secured by a Lien on the property to be leased in compliance with Section 4.1 hereof; and 

(ii) the Company complies with Section 4.6 hereof. 

Notwithstanding the foregoing, the Company and any of its Subsidiaries may enter into any Sale and Lease-Back Transaction, provided
that the aggregate Attributable Debt in respect of all such Sale and Lease-Back Transactions does not exceed the greater of (x) $650.0 million and (y) 5% of Consolidated Total Assets. 

Section 4.3. Limitations on Issuances of Guarantees by Subsidiaries 

The Company will not permit any of its Subsidiaries to Guarantee any Debt (other than pursuant to any extension, renewal or replacement of any
Debt that was so guaranteed that does not increase the amount of the Company’s Debt that is so guaranteed) of the Company, unless at the time of and after giving effect to the issuance of such Debt, the aggregate amount of all such guaranteed
Debt (including the aggregate principal amount of Notes outstanding at such time) shall not exceed the greater of (x) $12.0 billion or (y) 5.0 times the aggregate amount of EBITDA for the most recent four consecutive fiscal quarters
ending prior to the date of determination; provided that, unless the Notes are secured by substantially all the property and assets (other than accounts receivable and cash) of the Guarantors on a first-priority basis, the aggregate amount of
all such Debt guaranteed by Guarantees that are not subordinated to the Guarantees of the Notes (including the aggregate principal amount of Notes outstanding at such time but excluding Guarantees of Permitted Credit Agreement Debt) shall not exceed
the greater of (a) $9.5 billion 

  
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and (b) taking into account only First-Priority Stock Secured Debt and Junior Stock Secured Debt instead of all Secured Debt, 4.0 times the aggregate amount of EBITDA for the most recent
four consecutive fiscal quarters ending prior to the date of determination. The foregoing restriction will not prohibit the issuance of Guarantees by any of the Company’s Subsidiaries in respect of Permitted Credit Agreement Debt. For
purposes of the foregoing restriction, Debt and EBITDA shall be calculated on a pro forma basis consistent with the definition of “Secured Debt Ratio.” 

Section 4.4. Additional Note Guarantees 

The Company shall cause each newly created or acquired direct or indirect Subsidiary organized in a jurisdiction in the United States that
(i) owns or operates a hospital or (ii) has a direct or indirect equity ownership interest in a Subsidiary that owns or operates a hospital, other than, in each of the cases (i) and (ii), any such Subsidiary that is a non-wholly-owned Subsidiary if the organizational documents thereof or related joint venture or similar agreements, or applicable law, would (A) prohibit the Guarantee of the Notes without the consent of the
equity holders thereof (other than the Company or its wholly owned Subsidiaries) or (B) upon the making of such Guarantee, trigger in favor of the equity holders thereof (other than the Company or its wholly owned Subsidiaries) rights in
respect of the Capital Stock of such Subsidiary, to execute and deliver to the Trustee a Note Guarantee pursuant to a supplemental indenture. The form of such Note Guarantee is attached as Exhibit E hereto. 

Section 4.5. SEC Reports 

If at any time the Company is no longer subject to the periodic reporting requirements of the Exchange Act for any reason, the Company will
nevertheless continue to file with the Commission for public availability within the time periods that would have been applicable if the Company were subject to such reporting requirements: 

(1) all quarterly and annual reports that would be required to be filed with the Commission on Forms 10-Q and 10-K if the Company were required to file such reports; and 

(2) all current reports that would be required to be filed with the Commission on
Form 8-K if the Company were required to file such reports. 
 All such reports shall be
prepared in all material respects in accordance with all of the rules and regulations applicable to such reports. Each annual report on Form 10-K shall include a report on the consolidated
financial statements of the Company and its Consolidated Subsidiaries by the Company’s independent registered public accounting firm. 

Section 4.6. Asset Dispositions 

The Company will not, and will not permit any of its Subsidiaries to, directly or indirectly, consummate any Asset Disposition unless: 

(1) the Company or such Subsidiary receives consideration at the time of such Asset Disposition at least equal to the fair
market value, as determined in good faith by the Company, of the shares and assets subject to such Asset Disposition; 
 (2)
at least 75% of the consideration received in such Asset Disposition by the Company or such Subsidiary is in the form of cash or cash equivalents; 

(3) an amount equal to 100% of the Net Available Cash from such Asset Disposition is applied by the Company or such Subsidiary,
as the case may be: 
 (A) to the extent the Company elects (or is required by the terms of any Debt), to prepay, repay,
redeem or purchase Senior Debt of the Company or of a Guarantor or Debt of a Subsidiary that is not a Guarantor (in each case other than Debt owed to the Company or one of its Subsidiaries) within one year from the later of the date of such Asset
Disposition or the receipt of such Net Available Cash; or 

  
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 (B) to the extent the Company elects, to acquire Additional Assets within
one year from the later of the date of such Asset Disposition or the receipt of such Net Available Cash; and 
 (4) to the
extent of the balance of such Net Available Cash after application in accordance with clauses (3)(A) or (3)(B) above, such balance is applied by the Company or such Subsidiary, as the case may be, to make an Asset Disposition Offer to
the Holders of the Notes (and to holders of other First-Priority Stock Secured Debt) to purchase Notes (and such other First-Priority Stock Secured Debt) pursuant to and subject to the conditions contained in this Section and Section 3.3
hereof; 
 provided, however, that in connection with any prepayment, repayment or purchase of Debt pursuant to clause (3)(A) or
(4) above, the Company or such Subsidiary shall permanently retire such Debt and shall cause the related loan commitment (if any) to be permanently reduced in an amount equal to the principal amount so prepaid, repaid or purchased;
provided, further, however, that, in the case of clause (3)(B) above, a binding commitment shall be treated as a permitted application of the Net Available Cash from the date of such commitment so long as the Company
or such Subsidiary enters into such commitment with the good faith expectation that such Net Available Cash will be applied to satisfy such commitment within 180 days of such commitment (an “acceptable commitment”);
provided, further, that if any acceptable commitment is later canceled or terminated for any reason before such Net Available Cash is applied, then such Net Available Cash shall be applied pursuant to clause (4) above. 

Notwithstanding the foregoing provisions of the preceding paragraph, the Company and such Subsidiaries will not be required to apply any Net
Available Cash in accordance with the preceding paragraph except to the extent that the aggregate Net Available Cash from all Asset Dispositions subject to the preceding paragraph which is not applied in accordance with the preceding paragraph
exceeds $100.0 million. Pending application of Net Available Cash pursuant to this Section 4.6, such Net Available Cash may be used in any other manner not prohibited by the Indenture. 

For purposes of this Section 4.6, the following are deemed to be cash or cash equivalents: 

(1) the assumption or discharge of Debt or other liabilities of the Company or any Subsidiary and the release of the Company or
such Subsidiary from all liability on such Debt or other liability in connection with such Asset Disposition; 
 (2)
securities or other obligations received by the Company or any Subsidiary from the transferee that are converted by the Company or such Subsidiary into cash within 180 days of the Asset Disposition, to the extent of the cash received in that
conversion; 
 (3) Additional Assets; and 

(4) Designated Non-Cash Consideration received by the Company or any of its
Subsidiaries in such Asset Disposition having an aggregate fair market value, taken together with all other Designated Non-Cash Consideration received pursuant to this proviso that is at that time outstanding,
not to exceed 5% of Consolidated 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 and without giving effect to subsequent changes in value. 

In the event of an Asset Disposition that requires the purchase of Notes (and other First-Priority Stock Secured Debt), the Company will
purchase Notes tendered pursuant to an Asset Disposition Offer by the Company for the Notes (and such other First-Priority Stock Secured Debt) at a purchase price of 100% of their principal amount (or, in the event such other First-Priority Stock
Secured Debt was issued with significant original issue discount, 100% of the accreted value thereof), without premium, plus accrued but unpaid interest and Special Interest, if any (or, in respect of such other First-Priority Stock Secured Debt,
such other price, not to exceed 100%, 

  
 -34- 

 
as may be provided for by the terms of such other First-Priority Stock Secured Debt), in accordance with the procedures (including prorating in the event of oversubscription) set forth in
Section 3.3 hereof. If there remains a balance of Net Available Cash after purchasing all securities tendered, then such balance may be used in any manner not prohibited by the Indenture. If the aggregate purchase price of the
securities tendered exceeds the Net Available Cash allotted to their purchase, the Company will select the securities to be purchased on a pro rata basis but in round denominations, which in the case of the Notes will be denominations of
$2,000 principal amount or any greater integral multiple of $1,000 in excess thereof. The Company shall not be required to make such an Asset Disposition Offer to purchase Notes (and other First-Priority Stock Secured Debt) pursuant to this
Section 4.6 if the Net Available Cash available therefor is less than $100.0 million (which lesser amount shall be carried forward for purposes of determining whether such an Asset Disposition Offer is required with respect to the Net
Available Cash from any subsequent Asset Disposition). Upon completion of such an Asset Disposition Offer, Net Available Cash will be deemed to be reduced by the aggregate amount of such Asset Disposition Offer. 

The Company will comply, to the extent applicable, with the requirements of Section 14(e) of the Exchange Act and any other securities
laws or regulations in connection with the repurchase of Notes pursuant to this Section 4.6. To the extent that the provisions of any securities laws or regulations conflict with the provisions of Section 3.3 hereof or this
Section 4.6, the Company will comply with the applicable securities laws and regulations and will not be deemed to have breached its obligations under Section 3.3 hereof or this Section 4.6 by virtue of such compliance. 

Section 4.7. Offer to Repurchase Upon Change of Control 

(a) Upon the occurrence of a Change of Control, each Holder of Notes will have the right to require the Company to make an offer (a
“Change of Control Offer”) to repurchase all or any part (equal to $2,000 or an integral multiple of $1,000 in excess thereof) 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 Special Interest, if any, on the Notes repurchased, to the date of purchase (the “Change of Control Payment”). 

Within 30 days following any Change of Control, the Company will deliver a notice to each Holder and the Trustee describing the
transaction or transactions that constitute the Change of Control and stating: 
 (1) that the Change of Control Offer is
being made pursuant to this Section 4.7 and that all Notes tendered will 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 of such Change of Control (the “Change of Control Payment Date”); 

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

(4) that, unless the Company defaults in the payment of the Change of Control Payment, all Notes accepted for payment pursuant
to the Change of Control Offer will 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 will be required to surrender the Notes, with the form entitled “Option of Holder to Elect Purchase” attached to 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; 

(6) that Holders will 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; and 

  
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 (7) that Holders whose Notes are being purchased only in part will be issued
new Notes equal in principal amount to the unpurchased portion of the Notes surrendered, which unpurchased portion must be equal to $2,000 in principal amount or an integral multiple of $1,000 in excess thereof. 

The Company will 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 pursuant to a Change of Control Offer. To the extent that the provisions of any securities laws or
regulations conflict with the provisions of this Section 4.7, the Company will comply with the applicable securities laws and regulations and will not be deemed to have breached its obligations under this Section 4.7 by virtue of such
compliance. 
 (b) On the Change of Control Payment Date, the Company will, to the extent lawful: 

(1) accept for payment all Notes or portions of Notes properly tendered and not validly withdrawn 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 Company. 

The Paying Agent will promptly deliver to each Holder of Notes properly tendered the Change of Control Payment for such Notes, and the Trustee
will 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 such new Note issued for
surrendered but unpurchased Notes will be in a principal amount of $2,000 or an integral multiple of $1,000 in excess thereof. The Company will 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 4.7, the Company will 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 4.7 and purchases all Notes
properly tendered and not validly withdrawn under the Change of Control Offer. 
 (d) Notwithstanding anything to the contrary in this
Section 4.7, a Change of Control Offer may be made in advance of a Change of Control, conditional upon such 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. 
 (e) The Company may, with respect to the Notes, omit in any particular instance to comply with any term, provision or condition
set forth in this Section 4.7, if before the time for such compliance the Holders of at least a majority in principal amount of the outstanding Notes shall, by Act of such Holders, either waive such compliance in such instance or generally
waive compliance with such term, provision or condition, but no such waiver shall extend to or affect such term, provision or condition except to the extent so expressly waived, and, until such waiver shall become effective, the obligations of the
Company and the duties of the Trustee in respect of any such term, provision or condition shall remain in full force and effect. No supplemental indenture shall, without the consent of the Holder of each Outstanding Note affected thereby,
modify any of the provisions of this Section 4.7(e), except to increase the percentage required to waive compliance by the Company of the covenants referenced here, provided, however, that this clause shall not be deemed to
require the consent of any Holder with respect to changes in the references to “the Trustee” and concomitant changes in this Section 4.7(e). 

  
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 ARTICLE FIVE 

REMEDIES 
 Section 5.1.
Events of Default 
 “Event of Default”, wherever used herein with respect to the Notes, means any
one of the following events (whatever the reason for such Event of Default and whether it shall be voluntary or involuntary or be effected by operation of law or pursuant to any judgment, decree or order of any court or any order, rule or
regulation of any administrative or governmental body): 
 (1) default in the payment of any interest (including any Special
Interest) upon any Note when it becomes due and payable, and continuance of such default for a period of 30 days; or 

(2) default in the payment of the principal of (or premium, if any) on any Note at its Maturity; or 

(3) reserved; or 

(4) default in the performance, or breach, of any covenant or warranty of the Company or any Guarantor in the Indenture (other
than a covenant or warranty a default in whose performance or whose breach is elsewhere in this Section specifically dealt with or which has expressly been included in the Indenture solely for the benefit of series of Securities other than the
Notes), and continuance of such default or breach for a period of 90 days after there has been given, by registered or certified mail, to the Company by the Trustee or to the Company and the Trustee by the Holders of at least 25% in principal
amount of the Outstanding Notes a written notice specifying such default or breach and requiring it to be remedied and stating that such notice is a “Notice of Default” hereunder; or 

(5) a default under any bond, debenture, note or other evidence of Debt by the Company or any Guarantor (including a default
with respect to Securities of any series other than the Notes) having an aggregate principal amount outstanding in excess of the greater of (i) $100,000,000 and (ii) 5% of Consolidated Net Tangible Assets, whether such Debt now exists or
shall hereafter be created, which default shall constitute a failure to pay principal of such Debt when due and payable (other than as a result of acceleration), after expiration of any applicable grace period with respect thereto, or shall have
resulted in such Debt becoming or being declared due and payable prior to the date on which it would otherwise have become due and payable, without such Debt having been discharged, such failure to pay at maturity having been cured or paid or such
default or acceleration having been rescinded or annulled, within a period of 10 days after there shall have been given, by registered or certified mail, to the Company by the Trustee or to the Company and the Trustee by the Holders of at least
10% in principal amount of the Outstanding Notes a written notice specifying such default and requiring the Company or such Guarantor to cause such Debt to be discharged or cause such acceleration to be rescinded or annulled, as the case may be, and
stating that such notice is a “Notice of Default” hereunder; provided, however, that, subject to the provisions of Sections 601 and 602 of the Existing Indenture, the Trustee shall not be deemed to have knowledge of such
default unless either (A) a Responsible Officer of the Trustee shall have actual knowledge of such default or (B) the Trustee shall have received written notice thereof from the Company, from any Holder, from the holder of any such Debt or
from the trustee under any such mortgage, indenture or other instrument; or 
 (6) the entry by a court having jurisdiction
in the premises of (A) a decree or order for relief in respect of the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would constitute a Significant Subsidiary in an involuntary case or
proceeding under any applicable federal or state bankruptcy, insolvency, reorganization or other similar law or (B) a decree or order adjudging the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken
together, would constitute a Significant Subsidiary a bankrupt or insolvent, or approving as properly filed a petition seeking reorganization, arrangement, adjustment or composition of or in respect of the Company, any Guarantor that is a
Significant Subsidiary or any group of Guarantors that, taken 

  
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together, would constitute a Significant Subsidiary under any applicable federal or state law, or appointing a custodian, receiver, liquidator, assignee, trustee, sequestrator or other similar
official of the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would constitute a Significant Subsidiary or of any substantial part of their respective properties, or ordering the winding up
or liquidation of their respective affairs, and the continuance of any such decree or order for relief or any such other decree or order unstayed and in effect for a period of 60 consecutive days; or 

(7) the commencement by the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken
together, would constitute a Significant Subsidiary of a voluntary case or proceeding under any applicable federal or state bankruptcy, insolvency, reorganization or other similar law or of any other case or proceeding to be adjudicated a bankrupt
or insolvent, or the consent by it to the entry of a decree or order for relief in respect of it in an involuntary case or proceeding under any applicable federal or state bankruptcy, insolvency, reorganization or other similar law or to the
commencement of any bankruptcy or insolvency case or proceeding against it, or the filing by it of a petition or answer or consent seeking reorganization or relief under any applicable federal or state law, or the consent by it to the filing of such
petition or to the appointment of or taking possession by a custodian, receiver, liquidator, assignee, trustee, sequestrator or other similar official of the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that,
taken together, would constitute a Significant Subsidiary or of any substantial part of their respective properties, or the making by the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would
constitute a Significant Subsidiary of an assignment for the benefit of creditors, or the admission by it in writing of its inability to pay its debts generally as they become due, or the taking of corporate, limited liability company or partnership
action by the Company, any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would constitute a Significant Subsidiary in furtherance of any such action; or 

(8) failure by the Company to comply with the provisions of Sections 4.6 and 4.7 of this Thirty-First Supplemental
Indenture and continuance of such failure for a period of 30 days after there has been given, by registered or certified mail, to the Company by the Trustee or to the Company and the Trustee by the Holders of at least 25% in principal amount of
the Outstanding Notes a written notice specifying such default or breach and requiring it to be remedied and stating that such notice is a “Notice of Default”; or 

(9) with respect to any Collateral having a fair market value in excess of $100,000,000, (a) the security interest under
the Pledge Agreement, at any time, ceases to be in full force and effect for any reason other than in accordance with the terms of the Indenture and the Pledge Agreement and any other Stock Lien Security Document; (b) any security interest
created under the Pledge Agreement, such other Stock Lien Security Document relating to the Notes or the Indenture is declared invalid or unenforceable by a court of competent jurisdiction; or (c) the Company or any Subsidiary asserts, in any
pleading in any court of competent jurisdiction, that any security interest created under the Pledge Agreement, such other Stock Lien Security Document relating to the Notes or the Indenture is invalid or unenforceable; or 

(10) except as permitted by the Indenture or the Note Guarantees, the Note Guarantee of any Guarantor that is a Significant
Subsidiary or any group of Guarantors that, taken together, would constitute a Significant Subsidiary shall for any reason cease to be, or shall for any reason be asserted in writing by the Company or any Guarantor not to be, in full force and
effect and enforceable in accordance with its terms. 

  
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 ARTICLE SIX 

DEFEASANCE AND COVENANT DEFEASANCE 

Section 6.1. Defeasance and Discharge 

Upon the Company’s exercise of its option (if any) to have this Section 6.1 applied to the Notes, the Company and each of the
Guarantors shall be deemed to have been discharged from their Obligations with respect to the Notes and the Note Guarantees as provided in this Section 6.1 on and after the date the conditions set forth in Section 6.3 are satisfied
(hereinafter called “Defeasance”). For this purpose, such Defeasance means that the Company and the Guarantors shall be deemed to have paid and discharged the entire Debt represented by the Notes (including the Note Guarantees)
and to have satisfied all their other Obligations under the Notes, the Note Guarantees and the Indenture insofar as the Notes and the Note Guarantees are concerned (and the Trustee, at the expense of the Company, shall execute proper instruments
provided to it acknowledging the same), subject to the following which shall survive until otherwise terminated or discharged hereunder: (1) the rights of Holders of the Notes to receive, solely from the trust fund described in
Section 6.3 and as more fully set forth in such Section, payments in respect of the principal of and any premium and interest and Special Interest, if any, on the Notes when payments are due, (2) the Company’s Obligations with respect
to the Notes under Sections 304, 305, 306, 1002 and 1003 of the Existing Indenture and Section 2.5 of this Thirty-First Supplemental Indenture, (3) the rights, powers, trusts, duties and immunities of the Trustee hereunder and
(4) this Article Six. Subject to compliance with this Article Six, the Company may exercise its option (if any) to have this Section 6.1 applied to any Notes notwithstanding the prior exercise of its option (if any) to have
Section 6.2 applied to such Notes. 
 Section 6.2. Covenant Defeasance 

Upon the Company’s exercise of its option (if any) to have this Section 6.2 applied to the Notes, (1) the Company shall be
released from its Obligations under Sections 1006 through 1007 of the Existing Indenture, inclusive, and any covenants provided pursuant to Section 301(18), 901(2) or 901(7) of the Existing Indenture for the benefit of the
Holders of the Notes and (2) the occurrence of any event specified in Sections 5.1(4) (with respect to any of Sections 1006 through 1007 of the Existing Indenture, inclusive, and any such covenants provided pursuant to
Sections 4.1 through 4.7 of this Thirty-First Supplemental Indenture or Section 301(18), 901(2) or 901(7) of the Existing Indenture) and 5.1(5) and 5.1(8) shall be deemed not to be or result in an Event of Default, in
each case with respect to the Notes and Note Guarantees as provided in this Section 6.2 on and after the date the conditions set forth in Section 6.3 are satisfied (hereinafter called “Covenant Defeasance”). For this
purpose, such Covenant Defeasance means that, with respect to the Notes and Note Guarantees, the Company 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
specified Section (to the extent so specified in the case of Section 5.1(4)), whether directly or indirectly by reason of any reference elsewhere herein to any such Section or by reason of any reference in any such Section to any
other provision in the Indenture or in any other document, but the remainder of the Indenture and the Notes and Notes Guarantees shall be unaffected thereby. 

Section 6.3. Conditions to Legal or Covenant Defeasance 

The following shall be the conditions to the application of Section 6.1 or Section 6.2 to the Notes: 

(1) The Company shall irrevocably have deposited or caused to be deposited with the Trustee (or another trustee which satisfies
the requirements contemplated by Section 609 of the Existing Indenture and agrees to comply with the provisions of this Article Six applicable to it) as trust funds in trust for the purpose of making the following payments, specifically
pledged as security for, and dedicated solely to, the benefits of the Holders of the Notes, (A) money (in U.S. dollars which shall not be invested) in an amount, or (B) U.S. Government Obligations which, in the opinion of a nationally
recognized certified public accounting firm, through the scheduled payment of principal and interest in respect thereof in accordance with their terms will provide, not later than one day before the due date of any payment, money in an amount, or
(C) a combination thereof, in each case sufficient, in the opinion of a nationally recognized firm of independent public accountants expressed in a written certification thereof delivered to the Trustee, to pay and discharge, and which shall be
applied by the Trustee (or any such other qualifying trustee) to pay 

  
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and discharge, the principal of and any premium and interest and Special Interest, if any, on such Notes at Maturity, in accordance with the terms of the Indenture and the Notes. As used
herein, “U.S. Government Obligation” means (x) any security which is (i) a direct obligation of the United States of America for the payment of which the full faith and credit of the United States of America is pledged or
(ii) an obligation of a Person controlled or supervised by and acting as an agency or instrumentality of the United States of America the payment of which is unconditionally guaranteed as a full faith and credit obligation by the United States
of America, which, in either case (i) or (ii), is not callable or redeemable at the option of the issuer thereof, and (y) any depositary receipt issued by a bank (as defined in Section 3(a)(2) of the Securities Act) as custodian
with respect to any U.S. Government Obligation which is specified in clause (x) above and held by such bank for the account of the holder of such depositary receipt, or with respect to any specific payment of principal of or interest on
any U.S. Government Obligation which is so specified and held; 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 depositary receipt from any amount
received by the custodian in respect of the U.S. Government Obligation or the specific payment of principal or interest evidenced by such depositary receipt. 

(2) In the event of an election to have Section 6.1 apply to the Notes, the Company shall have delivered to the Trustee an
Opinion of Counsel stating that (A) the Company has received from, or there has been published by, the Internal Revenue Service a ruling or (B) since the date of this instrument, there has been a change in the applicable federal income tax
law, in either case (A) or (B) to the effect that, and based thereon such opinion shall confirm that, the beneficial owners of the Notes will not recognize gain or loss for federal income tax purposes as a result of the deposit, Defeasance
and discharge to be effected with respect to the Notes and will be subject to federal income tax on the same amount, in the same manner and at the same times as would be the case if such deposit, Defeasance and discharge were not to occur. 

(3) In the event of an election to have Section 6.2 apply to the Notes, the Company shall have delivered to the Trustee an
Opinion of Counsel to the effect that the Holders of the Notes will not recognize gain or loss for federal income tax purposes as a result of the deposit and Covenant Defeasance to be effected with respect to the Notes and will be subject to federal
income tax on the same amount, in the same manner and at the same times as would be the case if such deposit and Covenant Defeasance were not to occur. 

(4) The Company shall have delivered to the Trustee an Officers’ Certificate to the effect that the Notes, if then listed
on any securities exchange, will not be delisted as a result of such deposit. 
 (5) No event which is, or after notice or
lapse of time or both would become, an Event of Default with respect to the Notes shall have occurred and be continuing at the time of such deposit or, with regard to any such event specified in Sections 5.1(6) and (7), at any time on or
prior to the 90th day after the date of such deposit (it being understood that this condition shall not be deemed satisfied until after such 90th day). 

(6) Such Defeasance or Covenant Defeasance shall not cause the Trustee to have a conflicting interest within the meaning of the
Trust Indenture Act (assuming all Securities are in default within the meaning of such Act). 
 (7) Such Defeasance or
Covenant Defeasance shall not result in a breach or violation of, or constitute a default under, any other agreement or instrument to which the Company or any Guarantor is a party or by which it is bound. 

(8) Such Defeasance or Covenant Defeasance shall not result in the trust arising from such deposit constituting an investment
company within the meaning of the Investment Company Act unless such trust shall be registered under such Act or exempt from registration thereunder. 

  
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 (9) The Company shall have delivered to the Trustee an Officers’
Certificate and an Opinion of Counsel, each stating that all conditions precedent with respect to such Defeasance or Covenant Defeasance have been complied with. 

ARTICLE SEVEN 
 AMENDMENT,
SUPPLEMENT AND WAIVER 
 Without the consent of Holders of at least 75% in aggregate principal amount of the Notes then outstanding, an
amendment, supplement or waiver may not modify the Pledge Agreement, any other Stock Lien Security Document relating to the Notes or any of the provisions of the Indenture dealing with the pledge or the application of trust moneys, or otherwise
release any Collateral, in any manner materially adverse to the Holders (as determined by the Company in an Officers’ Certificate delivered to the Trustee) other than in accordance with the Indenture, the Pledge Agreement or the applicable
Stock Lien Security Document. 
 ARTICLE EIGHT 

COLLATERAL AND SECURITY 

Section 8.1. Equal and Ratable Sharing of Collateral by Holders of First-Priority Stock Secured Debt 

(a) Notwithstanding (i) anything to the contrary contained in the Stock Lien Security Documents; (ii) the time of incurrence of any
Series of First-Priority Stock Secured Debt; (iii) the order or method of attachment or perfection of any Liens securing any Series of First-Priority Stock Secured Debt; (iv) the time or order of filing or recording of financing
statements or other documents filed or recorded to perfect any Lien upon any Collateral; (v) the time of taking possession or control over any Collateral; (vi) that any First-Priority Stock Lien may not have been perfected or may be or
have become subordinated, by equitable subordination or otherwise, to any other Lien; or (vii) the rules for determining priority under any law governing relative priorities of Liens: 

(1) all First-Priority Stock Liens granted at any time by the Company or any other Pledgor shall secure, equally and ratably,
all present and future First-Priority Stock Secured Obligations; and 
 (2) all Proceeds of all First-Priority Stock Liens
granted at any time by the Company or any other Pledgor shall be allocated and distributed equally and ratably on account of the First-Priority Stock Secured Debt and other First-Priority Stock Secured Obligations. 

The foregoing provision is intended for the benefit of, and shall be enforceable as a third party beneficiary by, each present and future
holder of First-Priority Stock Secured Obligations, each present and future First-Priority Stock Lien Representative and the Collateral Trustee as holder of First-Priority Stock Liens. The First-Priority Stock Lien Representative of each future
Series of First-Priority Stock Secured Debt shall be required to deliver a Collateral Trust Joinder to the Collateral Trustee at the time of incurrence of such Series of First-Priority Stock Secured Debt, and the Company shall promptly
provide the Trustee with a copy of each such Collateral Trust Joinder; provided, however, that the failure to so deliver a copy of such Collateral Trust Joinder to the Trustee shall not affect the status of such future Debt as
First-Priority Stock Secured Debt if the other requirements contained in the Collateral Trust Agreement in connection with the incurrence of additional Secured Debt are complied with. 

(b) As provided in the Collateral Trust Agreement, the Liens securing the Junior Stock Secured Obligations, if any, are subject and
subordinate to the Liens securing the First-Priority Stock Secured Obligations. 
 (c) The Notes and the Existing Secured Notes are, and any
other First-Priority Stock Secured Debt permitted to be incurred after the date of this Thirty-First Supplemental Indenture will be, secured by First-Priority Stock Liens on the Collateral, which consists of the Capital Stock of each of the
Company’s Domestic Hospital Subsidiaries. To the extent that the Company or any of its Subsidiaries incurs any Debt (other than Permitted Credit Agreement Debt) that is secured by a first priority or junior Lien on any property or assets
of the Company or its Subsidiaries other than the Collateral, the Company will cause the Notes to be secured equally and ratably with, or prior to, such Debt and such Liens will be subject to the Collateral Trust Agreement; provided that the
Other Secured Debt is not subject to the equal and ratable security requirement in this sentence. 

  
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 Section 8.2. Stock Lien Security Documents 

The due and punctual payment of the principal of and interest and Special Interest, if any, on the Notes when and as the same shall be due and
payable, whether on an Interest Payment Date, at Maturity, by acceleration, repurchase, redemption or otherwise, and interest on the overdue principal of and interest and Special Interest (to the extent permitted by law), if any, on the Notes and
performance of all other obligations of the Company and the Guarantors to the Holders of Notes or the Trustee under the Indenture and the Notes, according to the terms hereunder or thereunder, are secured as provided in the Stock Lien Security
Documents which the Company, the Pledgors and/or the Trustee have entered into in connection with the execution of this Thirty-First Supplemental Indenture. Each Holder of Notes, by its acceptance thereof, consents and agrees to the terms of
the Stock Lien Security Documents (including, without limitation, the provisions providing for foreclosure and release of Collateral) as the same may be in effect or may be amended from time to time in accordance with its terms and authorizes and
directs the Collateral Trustee to enter into the Stock Lien Security Documents and to perform its obligations and exercise its rights thereunder in accordance therewith. The Company will deliver to the Trustee copies of all documents delivered
to the Collateral Trustee pursuant to the Stock Lien Security Documents, and will do or cause to be done all such acts and things as may be necessary or proper, or as may be required by the provisions of the Stock Lien Security Documents, to assure
and confirm to the Trustee and the Collateral Trustee the security interest in the Collateral contemplated hereby, by the Stock Lien Security Documents or any part thereof, as from time to time constituted, so as to render the same available for the
security and benefit of the Indenture and of the Notes secured hereby, according to the intent and purposes herein expressed. The Company will take, and will cause its Subsidiaries to take any and all actions reasonably required under
applicable law to cause the Stock Lien Security Documents to create and maintain, as security for the Obligations of the Company hereunder, a valid and enforceable perfected first priority Lien in and on all the Collateral, in favor of the
Collateral Trustee for the benefit of the Holders, superior to and prior to the rights of all third Persons (other than other holders of First-Priority Stock Secured Debt) and subject to no other Liens (other than Permitted Prior Liens). 

Each Holder of the Notes, by acceptance of the Notes, hereby authorizes the Trustee and the Collateral Trustee, as applicable, on behalf of
and for the benefit of the Holders, to be the agent for and representative of the Holders with respect to the Note Guarantees, the Collateral and the Stock Lien Security Documents. 

Anything contained in any of the Note Documents to the contrary notwithstanding, each Holder hereby agrees that no Holder or the Trustee shall
have any right individually to realize upon any of the Collateral, it being understood and agreed that all powers, rights and remedies of the Trustee hereunder may be exercised solely by the Trustee in accordance with the terms hereof and all
powers, rights and remedies in respect of the Collateral under the Stock Lien Security Documents may be exercised solely by the Collateral Trustee and its agents. 

Section 8.3. Release of Security Interests 

(a) In accordance with the provisions of the Collateral Trust Agreement or as provided hereby, the Collateral Trustee’s Liens upon the
Collateral will be released: 
 (1) in whole, upon (A) payment in full and discharge of all outstanding Stock Secured
Debt and all other Stock Secured Obligations that are outstanding, due and payable at the time all of the Stock Secured Debt is paid in full and discharged and (B) termination or expiration of all commitments to extend credit under all Stock
Secured Debt Documents and the cancellation or termination or cash collateralization (at the lower of (1) 105% of the aggregate undrawn amount and (2) the percentage of the aggregate undrawn amount required for release of Liens under the
terms of the applicable Stock Secured Debt Documents) of all outstanding letters of credit, if any, issued pursuant to any Stock Secured Debt Documents; 

(2) as to any Collateral that is sold, transferred or otherwise disposed of by the Company or any other Pledgor (including by
way of merger or consolidation) to a Person that is not (either before or after such sale, transfer or disposition) the Company or a Guarantor in a transaction or other circumstance 

  
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that does not violate Section 4.6 hereof and is not prohibited by any of the other Stock Secured Debt Documents, at the time of such sale, transfer or other disposition or to the extent of
the interest sold, transferred or otherwise disposed of; provided, that the Collateral Trustee’s Liens upon the Collateral will not be released if the sale or disposition is subject to Section 801 of the Existing Indenture or
Section 9.4 hereof; 
 (3) as to any Collateral constituting pledged Capital Stock of a Subsidiary of the Company, upon
the sale or other disposition of any portion of such Collateral (including by way of merger or consolidation) in connection with a Permitted Joint Venture Transaction, but only with respect to the Capital Stock sold or otherwise disposed of;
provided, that the Collateral Trustee’s Liens upon the Collateral will not be released if the sale or disposition violates Section 801 of the Existing Indenture or Section 9.4 hereof; 

(4) as to any Collateral constituting pledged Capital Stock of a Subsidiary of the Company, upon liquidation and dissolution of
that Subsidiary in a transaction that is not prohibited by any of the Stock Secured Debt Documents; 
 (5) as to any
Collateral owned by a Guarantor, upon the release of that Guarantor from its Guarantee in accordance with the terms of the Stock Secured Debt Documents; 

(6) as to a release of any or all of the Collateral, if (A) consent to release of that Collateral has been given by the
requisite percentage or number of holders of each Series of Stock Secured Debt at the time outstanding as provided for in the applicable Stock Secured Debt Documents and (B) the Company has delivered an Officers’ Certificate to the
Collateral Trustee certifying that any such necessary consents have been obtained; and 
 (7) as otherwise permitted by the
Indenture and each other Stock Secured Debt Document. 
 (b) With respect to the Notes, the Collateral Trustee’s First-Priority Stock
Lien upon the Collateral will no longer secure the Notes outstanding under the Indenture or any other Obligations in respect of such Notes under the Indenture, and the right of the Holders of Notes and such Obligations to the benefits and Proceeds
of the Collateral Trustee’s First-Priority Stock Lien on the Collateral will terminate and be discharged: 
 (1) upon
satisfaction and discharge of the Indenture as set forth under Article Four of the Existing Indenture or Article Ten hereof; 

(2) upon a Defeasance or Covenant Defeasance of the Notes as set forth under Article Six hereof; 

(3) upon payment in full and discharge of all Notes Outstanding under the Indenture and all Obligations in respect of such
Notes that are outstanding, due and payable under the Indenture at the time the Notes are paid in full and discharged; or 

(4) in whole or in part, with the consent of the Holders of the requisite percentage of the Notes then outstanding in
accordance with Article Nine of the Existing Indenture, as supplemented by Article Seven of this Thirty-First Supplemental Indenture. 

In addition the Company shall deliver an Officers’ Certificate and an Opinion of Counsel to the Trustee stating that all conditions
precedent to the release of such First-Priority Stock Liens have been satisfied. 
 Section 8.4. Additional First-Priority Stock Secured
Debt 
 Subject to the provisions of the Indenture and the other Stock Lien Security Documents, the Company may incur
additional First-Priority Stock Secured Debt by issuing Additional Notes under the Indenture or issuing or increasing any other Series of First-Priority Stock Secured Debt. All additional First-Priority Stock Secured Debt

  
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will be pari passu with the Notes and will be secured by the Collateral equally and ratably with the Notes for as long as the Notes and the Note Guarantees are secured by the
Collateral. The additional First-Priority Stock Secured Debt will only be permitted to be secured by the Collateral if such Debt and the related Liens are permitted to be incurred under the Indenture, including Section 4.1 hereof. 

The Collateral Trust Agreement sets forth the procedures pursuant to which an additional series of Debt can become an additional
Series of First-Priority Stock Secured Debt that is entitled to be secured equally and ratably with the Notes by the Liens on the Collateral granted to the Collateral Trustee. The Indenture and all future First-Priority Stock Lien
Documents will be required to provide that, notwithstanding (i) anything to the contrary contained in the Stock Lien Security Documents; (ii) the time of incurrence of any Series of First-Priority Stock Secured Debt; (iii) the
order or method of attachment or perfection of any Liens securing any Series of First-Priority Stock Secured Debt; (iv) the time or order of filing or recording of financing statements or other documents filed or recorded to perfect any
Lien upon any Collateral; (v) the time of taking possession or control over any Collateral; (vi) that any First-Priority Stock Lien may not have been perfected or may be or have become subordinated, by equitable subordination or otherwise,
to any other Lien; or (vii) the rules for determining priority under any law governing relative priorities of Liens: 

(1) all First-Priority Stock Liens granted at any time by the Company or any other Pledgor secure, equally and ratably, all
present and future First-Priority Stock Secured Obligations; and 
 (2) all Proceeds of all First-Priority Stock Liens
granted at any time by the Company or any other Pledgor will be allocated and distributed equally and ratably on account of the First-Priority Stock Secured Debt and other First-Priority Stock Secured Obligations. 

The First-Priority Stock Lien Representative of each future Series of First-Priority Stock Secured Debt shall be required to deliver a
Collateral Trust Joinder to the Collateral Trustee at the time of incurrence of such Series of First-Priority Stock Secured Debt, and the Company shall promptly provide the Trustee with a copy of each such Collateral Trust Joinder;
provided, however, that the failure to so deliver a copy of such Collateral Trust Joinder to the Trustee shall not affect the status of such future Debt as First-Priority Stock Secured Debt if the other requirements contained in the
Collateral Trust Agreement in connection with the incurrence of additional Secured Debt are complied with. 
 The Company may also incur new
or additional Junior Stock Secured Debt in accordance with the provisions of the Indenture and the Collateral Trust Agreement. 
 Section 8.5.
Compliance with Trust Indenture Act 
 The Company shall comply with the provisions of TIA §314. The
Company shall deliver to the Trustee the Opinion of Counsel required in accordance with TIA §314(b) by no later than December 1 of each year commencing on December 1, 2019: 

(a) To the extent applicable, the Company shall cause TIA §313(b), relating to reports, and TIA §314(d), relating to the release of
property or securities or relating to the substitution therefor of any property or securities to be subjected to the Lien of the Stock Lien Security Documents, to be complied with. Any certificate or opinion required by TIA
§314(d) may be made by an Officer of the Company except in cases where TIA §314(d) requires that such certificate or opinion be made by an independent Person, which Person will be an independent engineer, appraiser or other
expert selected by the Company. 
 (b) Notwithstanding anything to the contrary in Section 8.5(a), the Company shall not be required to
comply with all or any portion of TIA §314(d) if it determines, in good faith based on advice of counsel, that under the terms of TIA §314(d) and/or any interpretation or guidance as to the meaning thereof of the Commission and
its staff, including “no action” letters or exemptive orders, all or any portion of TIA §314(d) is inapplicable to one or a series of released Collateral. 

  
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 Section 8.6. Collateral Trustee 

(a) The Company has appointed The Bank of New York Mellon Trust Company, N.A. to serve as the Collateral Trustee for the benefit of, among
others, the Holders of the Notes, the holders of the Existing Secured Notes and the holders of future Stock Secured Obligations. 
 (b) The
Collateral Trustee (directly or through co-trustees or agents) holds and will continue to hold, and is entitled to and will continue to be entitled to enforce, all Liens on the Collateral created by the Stock
Lien Security Documents. 
 (c) Except as provided in the Stock Lien Security Documents, the Collateral Trust Agreement or as directed by an
Act of Required Stock Secured Debtholders, the Collateral Trustee is not nor will it be obligated: 
 (1) to act upon
directions purported to be delivered to it by any Person in respect of the Collateral; 
 (2) to foreclose upon or otherwise
enforce any Lien on the Collateral; or 
 (3) to take any other action whatsoever with regard to any or all of the Stock Lien
Security Documents, the Liens created thereby or the Collateral. 
 Section 8.7. Further Assurances 

(a) The Company and each of the other Pledgors will do or cause to be done all acts and things that may be required to assure and confirm that
the Collateral Trustee holds, for the benefit of the holders of Stock Secured Obligations, duly created and enforceable and perfected Liens upon the Collateral (including any property or assets that are acquired or otherwise become Collateral after
the date hereof), in each case as contemplated by, and with the Lien priority required under, the Stock Secured Debt Documents. 
 (b) The
Company and each of the Pledgors shall promptly execute, acknowledge and deliver such security documents, instruments, certificates, notices and other documents, and take such other actions as may be reasonably required to create, perfect, protect,
assure or enforce the Liens and benefits intended to be conferred, in each case as contemplated by the Stock Secured Debt Documents for the benefit of the holders of Stock Secured Obligations. 

ARTICLE NINE 
 NOTE GUARANTEES

 Section 9.1. Guarantee 

(a) Subject to this Article Nine, each of the Guarantors hereby, jointly and severally, unconditionally guarantees to each Holder of a
Note authenticated and delivered by the Trustee and to the Trustee and its successors and assigns, irrespective of the validity and enforceability of the Indenture, the Notes or the Obligations of the Company hereunder or thereunder, that: 

(1) the principal of, premium and Special Interest, if any, and interest on, the Notes will be promptly paid in full when due,
whether at Maturity, by acceleration, redemption or otherwise, and interest on the overdue principal of and interest on the Notes, if any, if lawful, and all other Obligations of the Company to the Holders or the Trustee hereunder or thereunder will
be promptly paid in full or performed, all in accordance with the terms hereof and thereof; and 
 (2) in case of any
extension of time of payment or renewal of any Notes or any of such other Obligations, that same will be promptly paid in full when due or performed in accordance with the terms of the extension or renewal, whether at Stated Maturity, by
acceleration or otherwise. 

  
 -45- 

 Failing payment when due of any amount so guaranteed or any performance so guaranteed for
whatever reason, the Guarantors will be jointly and severally obligated to pay the same immediately. Each Guarantor agrees that this is a guarantee of payment and not a guarantee of collection. 

(b) The Guarantors hereby agree that their Obligations hereunder are unconditional, irrespective of the validity, regularity or enforceability
of the Notes or the Indenture, the absence of any action to enforce the same, 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 Company, 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 hereby waives diligence, presentment, demand of payment, filing of claims with a court in the event of
insolvency or bankruptcy of the Company, any right to require a proceeding first against the Company, protest, notice and all demands whatsoever and covenant that this Note Guarantee will not be discharged except by complete performance of the
obligations contained in the Notes and the Indenture. 
 (c) If any Holder, the Trustee or the Collateral Trustee is required by any court
or otherwise to return to the Company, the Guarantors or any custodian, trustee, liquidator or other similar official acting in relation to either the Company or the Guarantors, any amount paid by either to the Trustee, the Collateral Trustee or
such Holder, this Note Guarantee, to the extent theretofore discharged, will be reinstated in full force and effect. 
 (d) Each Guarantor
agrees that it will not be entitled to any right of subrogation in relation to the Holders in respect of any Obligations guaranteed hereby until payment in full of all Obligations guaranteed hereby. Each Guarantor further agrees that, as
between the Guarantors, on the one hand, and the Holders and the Trustee, on the other hand, (1) the Maturity of the Obligations guaranteed hereby may be accelerated as provided in Article Five of the Existing Indenture (as amended hereby)
for the purposes of this Note Guarantee, notwithstanding any stay, injunction or other prohibition preventing such acceleration in respect of the Obligations guaranteed hereby, and (2) in the event of any declaration of acceleration of such
Obligations as provided in Article Five of the Existing Indenture (as amended hereby), such Obligations (whether or not due and payable) will forthwith become due and payable by the Guarantors for the purpose of this Note Guarantee. The
Guarantors will have the right to seek contribution from any non-paying Guarantor so long as the exercise of such right does not impair the rights of the Holders under the Note Guarantee. 

Section 9.2. Limitation on Guarantor 

By its execution of this Thirty-First Supplemental Indenture, each Guarantor, and by its acceptance of Notes, each Holder, hereby confirms that
it is the intention of all such parties that the Note Guarantee of such Guarantor not constitute a fraudulent transfer or conveyance for purposes of Bankruptcy Law, the Uniform Fraudulent Conveyance Act, the Uniform Fraudulent Transfer Act
or any similar federal or state law to the extent applicable to any Note Guarantee. To effectuate the foregoing intention, the Trustee, the Holders and the Guarantors hereby irrevocably agree that the Obligations of each Guarantor will be
limited to the maximum amount that will, after giving effect to such maximum amount and all other contingent and fixed liabilities of such Guarantor that are relevant under such laws, and after giving effect to any collections from, rights to
receive contribution from or payments made by or on behalf of any other Guarantor in respect of the Obligations of such other Guarantor under this Article Nine, result in the Obligations of such Guarantor under its Note Guarantee not
constituting a fraudulent transfer or conveyance. 
 Section 9.3. Execution and Delivery of Note Guarantee 

To evidence its Note Guarantee set forth in Section 9.1 hereof, each Guarantor hereby agrees that a notation of such Note Guarantee
substantially in the form attached as Exhibit E hereto will be endorsed by an Officer of such Guarantor on each Note authenticated and delivered by the Trustee and that this Thirty-First Supplemental Indenture will be
executed on behalf of such Guarantor by one of its Officers. 
 Each Guarantor hereby agrees that its Note Guarantee set forth in
Section 9.1 hereof will remain in full force and effect notwithstanding any failure to endorse on each Note a notation of such Note Guarantee. 

  
 -46- 

 If an Officer whose signature is on this Thirty-First Supplemental Indenture or on the Note
Guarantee no longer holds that office at the time the Trustee authenticates the Note on which a Note Guarantee is endorsed, the Note Guarantee will be valid nevertheless. 

The delivery of any Note by the Trustee, after the authentication thereof hereunder, will constitute due delivery of the Note Guarantee set
forth in this Thirty-First Supplemental Indenture on behalf of the Guarantors. 
 Section 9.4. Guarantors
May Consolidate, Etc., Only on Certain Terms 

(a) Except as otherwise provided in Section 9.5 hereof, no Guarantor shall, and the Company will not permit any Guarantor to, consolidate
with or merge with or into any other Person or convey, transfer or lease all or substantially all of its properties and assets to any Person, and no Guarantor shall, and the Company will not permit any Guarantor to, permit any Person to consolidate
with or merge into such Guarantor or convey, transfer or lease its properties and assets substantially as an entirety to such Guarantor, unless: 

(1) subject to Section 9.5 hereof, either such Guarantor shall be the surviving corporation of such consolidation or
merger or the resultant or successor corporation shall be a corporation organized and validly existing under the laws of the United States of America, any State thereof or the District of Columbia and shall expressly assume, by an indenture
supplemental hereto, executed and delivered to the Trustee, in form satisfactory to the Trustee, all of the Obligations of such Guarantor under the Indenture and such Guarantor’s Guarantee; and 

(2) immediately after giving effect to such transaction, no Event of Default, and no event which, after notice or lapse of time
or both, would become an Event of Default, shall have happened and be continuing, 
 provided, however, that a Guarantor may consolidate with,
or sell, convey or lease all or substantially all of its properties and assets to, or merge with or into, any other Person in connection with a Permitted Joint Venture Transaction. 

(b) The Company shall deliver to the Trustee an Officers’ Certificate and an Opinion of Counsel, each stating that such consolidation,
merger, conveyance, transfer or lease and, if a supplemental indenture is required in connection with such transaction, such supplemental indenture comply with this Article Nine and that all conditions precedent herein provided for relating to
such transaction have been complied with. 
 (c) In case of any such consolidation, merger, conveyance, transfer or lease and upon the
assumption by the successor Person, by supplemental indenture, executed and delivered to the Trustee and satisfactory in form to the Trustee, of the Note Guarantee endorsed upon the Notes and the due and punctual performance of all of the covenants
and conditions of the Indenture to be performed by the Guarantor, such successor Person will succeed to and be substituted for the Guarantor with the same effect as if it had been named herein as a Guarantor. Such successor Person thereupon may
cause to be signed any or all of the Note Guarantees to be endorsed upon all of the Notes issuable hereunder which theretofore shall not have been signed by the Company and delivered to the Trustee. All the Note Guarantees so issued will in all
respects have the same legal rank and benefit under the Indenture as the Note Guarantees theretofore and thereafter issued in accordance with the terms of the Indenture as though all of such Note Guarantees had been issued at the date of the
execution hereof. 
 Section 9.5. Releases 

(a) Upon the full and final payment and performance of all Obligations under the Indenture and the Notes, each Guarantor will be released and
relieved of any Obligations under its Note Guarantee. 
 (b) In the event of any sale or other disposition of all of the Capital Stock of
any Guarantor (including by way of merger or consolidation) or upon the sale or other disposition of all or substantially all the assets of that Guarantor to a Person that is not (either before or after giving effect to such transaction) the Company
or a Subsidiary of the Company in a transaction that is not prohibited by the Indenture, then such Guarantor will be 

  
 -47- 

 
released and relieved of any obligations under its Note Guarantee; provided that the Net Available Cash from such sale or other disposition is applied in accordance with the applicable
provisions of the Indenture, including without limitation Section 4.6 hereof. Upon delivery by the Company to the Trustee of an Officers’ Certificate and an Opinion of Counsel to the effect that such sale or other disposition was made
by the Company in accordance with the provisions of the Indenture, including without limitation Section 4.6 hereof, the Trustee will execute any documents reasonably required and provided to it in order to evidence the release of any Guarantor
from its obligations under its Note Guarantee. 
 (c) Upon the sale or other disposition of any portion of the Capital Stock of that
Guarantor (including by way of merger or consolidation) in connection with a Permitted Joint Venture Transaction, but only if (i) the organizational documents thereof or related joint venture or similar agreements, or applicable law, would
(A) prohibit such guarantee without the consent of the equity holders thereof (other than the Company or its wholly owned Subsidiaries) or (B) such guarantee would trigger in favor of the equity holders thereof (other than the Company or
its wholly owned Subsidiaries) rights in respect of the Capital Stock of such Subsidiary, and (ii) such Subsidiary does not guarantee any other capital markets Debt; provided, however, that the preceding clause (ii) shall be
deemed to be satisfied if such Subsidiary is no longer required to guarantee any capital markets Debt, such Guarantor will be released and relieved of any obligations under its Note Guarantee. 

(d) Upon liquidation and dissolution of any Guarantor in a transaction that is not prohibited by the Indenture, such Guarantor will be
released and relieved of any obligations under its Note Guarantee. 
 (e) Upon Defeasance of the Notes in accordance with Article Six
hereof or satisfaction and discharge of the Indenture in accordance with Article Ten hereof, each Guarantor will be released and relieved of any obligations under its Note Guarantee. 

Any Guarantor not released from its obligations under its Note Guarantee as provided in this Section 9.5 will remain liable for the full
amount of principal of and interest and premium and Special Interest, if any, on the Notes and for the other obligations of any Guarantor under the Indenture as provided in this Article Nine. 

ARTICLE TEN 
 SATISFACTION AND
DISCHARGE 
 Section 10.1. Satisfaction and Discharge of Thirty-First Supplemental Indenture 

This Thirty-First Supplemental Indenture shall upon Company Request cease to be of further effect (except as to any surviving rights of
registration of transfer or exchange of Securities herein expressly provided for in the Indenture), and the Trustee, at the expense of the Company, shall execute proper instruments acknowledging satisfaction and discharge of this Thirty-First
Supplemental Indenture, when 
 (1) either 

(A) all Notes theretofore authenticated and delivered (other than (i) Notes which have been destroyed, lost or stolen and
which have been replaced or paid as provided in Section 306 of the Existing Indenture and (ii) Notes for whose payment money has theretofore been deposited in trust or segregated and held in trust by the Company and thereafter repaid to
the Company or discharged from such trust, as provided in Section 1003 of the Existing Indenture) have been delivered to the Trustee for cancellation; or 

(B) all such Notes not theretofore delivered to the Trustee for cancellation (i) have become due and payable, or
(ii) will become due and payable at their Stated Maturity within one year, or (iii) are to be called for redemption within one year under arrangements satisfactory to the Trustee for the giving of notice of redemption by the Trustee in the
name, and at the expense, of the Company, and the Company, in the case of clause (i), (ii) or (iii) above, has deposited or caused to be deposited with the Trustee as trust funds in trust for the purpose money in an amount

  
 -48- 

 
sufficient to pay and discharge the entire indebtedness on such Notes not theretofore delivered to the Trustee for cancellation, for principal (and premium, if any) and interest to the date of
such deposit (in the case of Notes which have become due and payable) or to the Stated Maturity or Redemption Date, as the case may be; 

(2) the Company has paid or caused to be paid all other sums payable hereunder by the Company; and 

(3) the Company has delivered to the Trustee an Officers’ Certificate and an Opinion of Counsel, each stating that all
conditions precedent herein provided for relating to the satisfaction and discharge of this Thirty-First Supplemental Indenture have been complied with. 

Notwithstanding the satisfaction and discharge of this Thirty-First Supplemental Indenture, the obligations of the Company to the Trustee
under Section 607 of the Existing Indenture, the obligations of the Company to any Authenticating Agent under Section 614 of the Existing Indenture and, if money shall have been deposited with the Trustee pursuant to subclause (B) of
clause (1) of this Section 10.1, the obligations of the Trustee under Section 402 of the Existing Indenture and the last paragraph of Section 1003 of the Existing Indenture shall survive. 

Section 10.2. Application of Trust Money 

Subject to the provisions of the last paragraph of Section 1003 of the Existing Indenture, all money deposited with the Trustee pursuant
to Section 401 of the Existing Indenture shall be held in trust and applied by it, in accordance with the provisions of the Securities and this Indenture, to the payment, either directly or through any Paying Agent (including the Company acting
as its own Paying Agent) as the Trustee may determine, to the Persons entitled thereto, of the principal and any premium and interest for whose payment such money has been deposited with the Trustee. 

ARTICLE ELEVEN 
 MISCELLANEOUS

 Section 11.1. Conditions Precedent 

The effectiveness of this Thirty-First Supplemental Indenture is conditioned upon the receipt by the Trustee of the items specified in Sections
102 and 903 of the Existing Indenture. 
 Section 11.2. Relationship to Existing Indenture 

This Thirty-First Supplemental Indenture is a supplemental indenture within the meaning of the Existing Indenture. The Existing Indenture,
as supplemented and amended by this Thirty-First Supplemental Indenture, is in all respects ratified, confirmed and approved and, with respect to the Notes, the Existing Indenture, as supplemented and amended by this Thirty-First Supplemental
Indenture, shall be read, taken and construed as one and the same instrument. 
 Section 11.3. Modification of the Existing
Indenture 
 Except as expressly modified by this Thirty-First Supplemental Indenture, the provisions of the Existing
Indenture shall govern the terms and conditions of the Notes. 
 Section 11.4. Notices 

Any notice or communication by the Company, any Guarantor or the Trustee to the others is duly given if it is 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: 

  
 -49- 

 If to the Company and/or any Guarantor: 

Tenet Healthcare Corporation 
 1445 Ross Avenue, Suite 1400

 Dallas, TX 75202 
 Facsimile No.: (469) 893-8600 
 Attention: General Counsel 

With a copy to: 
 Gibson, Dunn & Crutcher LLP 

200 Park Avenue 
 New York, NY 10166-0193 

Facsimile No.: (212) 351-4035 

Attention: Barbara Becker 
 If to the Trustee: 

The Bank of New York Mellon Trust Company, N.A. 
 400 South Hope
Street, Suite 500 
 Los Angeles, CA 90071 
 Facsimile
No.: (213) 630-6298 
 Attention: Corporate Unit 

The Company, 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) will 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. 
 The Trustee agrees to accept and act upon instructions or
directions pursuant to this Indenture sent by unsecured e-mail, pdf, facsimile transmission or other similar unsecured electronic methods. If the party elects to give the Trustee e-mail or facsimile instructions (or instructions by a similar electronic method) and the Trustee in its discretion elects to act upon such instructions, the Trustee’s understanding of such instructions shall
be deemed controlling. 
 The Trustee shall not be liable for any losses, costs or expenses arising directly or indirectly from the
Trustee’s reliance upon and compliance with such instructions notwithstanding whether such instructions conflict or are inconsistent with a subsequent written instruction. The party providing electronic instructions agrees to assume all
risks arising out of the use of such electronic methods to submit instructions and directions to the Trustee, including without limitation the risk of the Trustee acting on unauthorized instructions, and the risk or interception and misuse by third
parties. 
 Any notice or communication to a Holder will 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 will also be so mailed to any Person described in Section 313(c) of the Trust Indenture
Act, to the extent required by the Trust Indenture Act. Failure to mail a notice or communication to a Holder or any defect in it will 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. 

  
 -50- 

 If the Company mails a notice or communication to Holders, it will mail a copy to the
Trustee and each Agent at the same time. 
 Section 11.5. Governing Law; Submission to Jurisdiction 

This instrument shall be governed by and construed in accordance with the internal laws of the State of New York, without regard to conflicts
of laws principles thereof. The Company and each Guarantor hereby irrevocably submits to the jurisdiction of any New York State court sitting in the Borough of Manhattan in the City of New York or any Federal court sitting in the Borough of
Manhattan in the City of New York in respect of any suit, action or proceeding arising out of or relating to this Indenture, the Guarantees and the Notes, and irrevocably accepts for itself and in respect of its property, generally and
unconditionally, jurisdiction of the aforesaid courts. 
 Section 11.6. Counterparts 

This instrument may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, but all such
counterparts shall together constitute but one and the same instrument. Delivery of an executed counterpart of a signature page to this Agreement by telecopier, facsimile or other electronic transmission (i.e., a “pdf” or
“tif”) shall be effective as delivery of a manually executed counterpart thereof. 
 Section 11.7. Waiver of Jury
Trial 
 EACH OF THE COMPANY, THE GUARANTORS AND THE TRUSTEE HEREBY IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY
APPLICABLE LAW, ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO THIS INDENTURE, THE NOTE GUARANTEES, THE NOTES OR THE TRANSACTIONS CONTEMPLATED HEREBY. 

Section 11.8. Force Majeure 

In no event shall the Trustee be responsible or liable for any failure or delay in the performance of its obligations hereunder arising out of
or caused by, directly or indirectly, forces beyond its control, including, without limitation, strikes, work stoppages, accidents, acts of war or terrorism, civil or military disturbances, nuclear or natural catastrophes or acts of God, and
interruptions, loss or malfunctions of utilities, communications or computer (software and hardware) services; it being understood that the Trustee shall use reasonable efforts which are consistent with accepted practices in the banking industry to
resume performance as soon as practicable under the circumstances. 
 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. 

The Company agrees (i) to provide the Trustee with such reasonable information as it has in its possession to enable the Trustee to
determine whether any payments pursuant to the Indenture are subject to the withholding requirements described in Section 1471(b) of the US Internal Revenue Code of 1986 (the “Code”) or otherwise imposed pursuant to Sections
1471 through 1474 of the Code and any regulations, or agreements thereunder or official interpretations thereof (“Applicable Law”), and (ii) that the Trustee shall be entitled to make any withholding or deduction from payments
under the Indenture to the extent necessary to comply with Applicable Law. 
 (Signature Pages Follow) 

  
 -51- 

 Dated as of August 26, 2019 

 

			
	TENET HEALTHCARE CORPORATION
		
	By:	 	/s/ James E. Snyder, III
		 	Name: James E. Snyder, III
		 	Title: Vice President and Treasurer

  

			
	 AMERICAN MEDICAL (CENTRAL), INC.

AMI INFORMATION SYSTEMS GROUP, INC.

AMISUB (HEIGHTS), INC.

AMISUB (HILTON HEAD), INC.

AMISUB (SFH), INC.

AMISUB (TWELVE OAKS), INC.

AMISUB OF NORTH CAROLINA, INC.

AMISUB OF SOUTH CAROLINA, INC.

AMISUB OF TEXAS, INC.

ANAHEIM MRI HOLDING, INC.

ATLANTA MEDICAL CENTER, INC.

BROOKWOOD HEALTH SERVICES, INC.

CGH HOSPITAL, LTD., by: CORAL GABLES HOSPITAL, INC., as general partner

COASTAL CAROLINA MEDICAL CENTER, INC.

COMMUNITY HOSPITAL OF LOS GATOS, INC.

CORAL GABLES HOSPITAL, INC.

DELRAY MEDICAL CENTER, INC.

HEALTHCARE NETWORK DPH, INC.

EAST COOPER COMMUNITY HOSPITAL, INC.

FMC MEDICAL, INC.

FRYE REGIONAL MEDICAL CENTER, INC.

GOOD SAMARITAN MEDICAL CENTER, INC.

HEALTHCARE NETWORK CFMC, INC.

HEALTHCARE NETWORK HOLDINGS, INC.

HEALTHCORP NETWORK, INC.

HEALTHCARE NETWORK LOUISIANA, INC.

HEALTHCARE NETWORK MISSOURI, INC.

HEALTHCARE NETWORK TEXAS, INC.

HEALTH SERVICES CFMC, INC.

HEALTH SERVICES NETWORK HOSPITALS, INC.

HEALTH SERVICES NETWORK TEXAS, INC.

HIALEAH HOSPITAL, INC.

HILTON HEAD HEALTH SYSTEM, L.P., by: TENET PHYSICIAN SERVICES – HILTON HEAD, INC., as general partner

HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.

LIFEMARK HOSPITALS, INC.

LIFEMARK HOSPITALS OF FLORIDA, INC.

NEW MEDICAL HORIZONS, II, LTD, by: HEALTH SERVICES CFMC, INC., as general partner

NORTH FULTON MEDICAL CENTER, INC.

NORTH SHORE MEDICAL CENTER, INC.

ORNDA HOSPITAL CORPORATION

  
 Signature
Page to Thirty-First Supplemental Indenture 

			
	 PALM BEACH GARDENS COMMUNITY HOSPITAL, INC.

SAINT FRANCIS HOSPITAL — BARTLETT, INC.

SLH VISTA, INC.

SPALDING REGIONAL MEDICAL CENTER, INC.

SRRMC MANAGEMENT, INC.

ST. MARY’S MEDICAL CENTER, INC.

SYLVAN GROVE HOSPITAL, INC.

TENET CALIFORNIA, INC.

TENET FLORIDA, INC.

TENET HEALTHSYSTEM HAHNEMANN, L.L.C., by: TENET HEALTHSYSTEM PHILADELPHIA, INC., as managing member

TENET HEALTHSYSTEM MEDICAL, INC.

TENET HEALTHSYSTEM PHILADELPHIA, INC.

TENET HEALTHSYSTEM ST. CHRISTOPHER’S HOSPITAL FOR CHILDREN, L.L.C., by: TENET HEALTHSYSTEM PHILADELPHIA, INC., as
managing member
 TENET HOSPITALS LIMITED, by: HEALTHCARE NETWORK TEXAS, INC., as general partner

TENET PHYSICIAN SERVICES — HILTON HEAD, INC.

TH HEALTHCARE, LTD., by: LIFEMARK HOSPITALS, INC., as general partner

VHS ACQUISITION CORPORATION

VHS ACQUISITION SUBSIDIARY NUMBER 1, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 3, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 7, INC.

VHS ACQUISITION SUBSIDIARY NUMBER 9, INC.

VHS BROWNSVILLE HOSPITAL COMPANY, LLC

WEST BOCA MEDICAL CENTER, INC.

VHS CHILDREN’S HOSPITAL OF MICHIGAN, INC.

VHS DETROIT RECEIVING HOSPITAL, INC.

VHS HARLINGEN HOSPITAL COMPANY, LLC

VHS HARPER-HUTZEL HOSPITAL, INC.

VHS HURON VALLEY-SINAI HOSPITAL, INC.

VHS OF ARROWHEAD, INC.

VHS OF ILLINOIS, INC.

VHS REHABILITATION INSTITUTE OF MICHIGAN, INC.

VHS SAN ANTONIO PARTNERS, LLC, by: VHS ACQUISITION SUBSIDIARY NUMBER 5, INC., its managing member, and VHS HOLDING
COMPANY, INC.
 VHS SINAI-GRACE HOSPITAL, INC.

VHS VALLEY MANAGEMENT COMPANY, INC.

VHS WEST SUBURBAN MEDICAL CENTER, INC.

VHS WESTLAKE HOSPITAL INC.

VHS OF PHOENIX, INC.

VANGUARD HEALTH FINANCIAL COMPANY, LLC

VANGUARD HEALTH HOLDING COMPANY I, LLC

VANGUARD HEALTH HOLDING COMPANY II, LLC

VANGUARD HEALTH MANAGEMENT, INC.

VANGUARD HEALTH SYSTEMS, INC.

VHS OF MICHIGAN, INC.

		
	By:	 	/s/ James E. Snyder, III
		 	Name:  James E. Snyder, III
		 	Title:    Treasurer

  

  
 Signature
Page to Thirty-First Supplemental Indenture 

 
			
	 BBH BMC, LLC

BROOKWOOD BAPTIST HEALTH 1, LLC

DESERT REGIONAL MEDICAL CENTER, INC.

DOCTORS HOSPITAL OF MANTECA, INC.

DOCTORS MEDICAL CENTER OF MODESTO, INC.

FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER

JFK MEMORIAL HOSPITAL, INC.

LAKEWOOD REGIONAL MEDICAL CENTER, INC.

LOS ALAMITOS MEDICAL CENTER, INC.

PLACENTIA-LINDA HOSPITAL, INC.

SAN RAMON REGIONAL MEDICAL CENTER, LLC

SIERRA VISTA HOSPITAL, INC.

TWIN CITIES COMMUNITY HOSPITAL, INC.

VHS VALLEY HEALTH SYSTEM, LLC

		
	By:	 	/s/ James E. Snyder, III
		 	Name:  James E. Snyder, III
		 	Title:    Assistant Treasurer

  
 Signature
Page to Thirty-First Supplemental Indenture 

 
			
	THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A., as Trustee
		
	By:	 	/s/ Lawrence M. Kusch
		 	Name: Lawrence M. Kusch
		 	Title: Vice President

  
 Signature
Page to Thirty-First Supplemental Indenture 

 EXHIBIT A 

To Thirty-First Supplemental Indenture 

[Face of Note] 
 [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] 
 CUSIP/ISIN [        ] 

4.625% Senior Secured First Lien Notes Due 2024 
  

			
	No.[        ]	  	$ [         ]

 TENET HEALTHCARE CORPORATION 

promises to pay to [        ] or registered assigns, the principal sum of
[                ] DOLLARS on September 1, 2024. 
 Interest Payment
Dates: March 1 and September 1 
 Record Dates: February 15 and August 15 

Dated: August 26, 2019 
  

			
	TENET HEALTHCARE CORPORATION
		
	By:	 	 
		 	Name:
		 	Title:

  

			
	 This is one of the Notes referred to

in the within-mentioned Indenture:

	
	 THE BANK OF NEW YORK MELLON TRUST

COMPANY, N.A.,
 as Trustee

		
	By:	 	 
		 	Authorized Signatory

  
 A-1 

 [Back of Note] 

4.625% Senior Secured First Lien Notes Due 2024 

Capitalized terms used herein have the meanings assigned to them in the Indenture referred to below unless otherwise indicated. 

(1) INTEREST. Tenet Healthcare Corporation, a corporation duly organized and existing under the laws of the State of
Nevada (the “Company”), promises to pay interest on the principal amount of this Note at 4.625% per annum, from August 26, 2019 until September 1, 2024 (“Maturity”) and shall pay the Special Interest, if
any, payable pursuant to Section 2 of the Registration Rights Agreement referred to below. The Company will pay interest and Special Interest, if any, semi-annually in arrears on March 1 and September 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 will accrue from the most recent date to which interest has been paid or, if no
interest has been paid, from the date of issuance; provided that if there is no existing Event of Default in the payment of interest, and if this Note is authenticated between a record date referred to on the face hereof and the next
succeeding Interest Payment Date, interest shall accrue from such next succeeding Interest Payment Date; provided further that the first Interest Payment Date shall be March 1, 2020. Interest will be computed on the basis of a 360-day year of twelve 30-day months. 
 (2) METHOD OF
PAYMENT. The Company will pay interest on the Notes and Special Interest, if any, to the Persons who are registered Holders of Notes at the close of business on the February 15 or August 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. The Notes will be payable as to principal, premium and Special Interest, if any, and interest at the office or agency of
the Company maintained for such purpose within the City and State of New York, or payment of interest and Special Interest, if any, may be made by check mailed to the Holders at their respective addresses set forth in the register of Holders;
provided that payment by wire transfer of immediately available funds will be required with respect to principal of and interest, premium and Special Interest, if any, on, all Global Notes and all other Notes the Holders of which will have
provided wire transfer instructions to the Company or the Paying Agent. Such payment will 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. Until
otherwise designated by the Company, the office or agency of the Company in New York will be the office of the Trustee maintained for such purpose. 

(3) PAYING AGENT AND REGISTRAR. Initially, the corporate trust department of The Bank of New York Mellon Trust
Company, N.A., the Trustee under the Indenture, will act as Paying Agent and Registrar. The Company may change any Paying Agent or Registrar without notice to any Holder. The Company or any of its Subsidiaries may not act in any such
capacity. 
 (4) INDENTURE AND SECURITY DOCUMENTS. The Company issued the Notes under an Indenture, dated as of November 6,
2001, between the Company and The Bank of New York, as predecessor trustee to the Trustee, as supplemented by the Thirty-First Supplemental Indenture (the “Thirty-First Supplemental Indenture”), dated as of August 26, 2019 (as
so supplemented, the “Indenture”), among the Company, 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 Trust Indenture
Act. The Notes are subject to all such terms, and Holders are referred to the Indenture and such Act 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 secured first-lien Obligations of the Company. The Notes are secured by a first-priority pledge of the Collateral pursuant to the Stock Lien Security
Documents referred to in the Indenture. The Indenture does not limit the aggregate principal amount of Notes that may be issued thereunder. 

(5) OPTIONAL REDEMPTION. 

(a) At any time prior to September 1, 2021, the Company may redeem the Notes, in whole or in part, at any time, at its option, at a
Redemption Price calculated by the Company equal to 100% of the principal amount of the Notes being redeemed plus the Applicable Premium as of the Redemption Date, plus accrued and unpaid interest thereon and Special Interest, if any, to, but not
including, the Redemption Date. 

  
 A-2 

 (b) On and after September 1, 2021, the Company may redeem the Notes, in whole or in
part, at its option, at the following Redemption Prices (expressed as percentages of the principal amount thereof), plus accrued and unpaid interest, if any, to the Redemption Date (subject to the right of Holders of record on the relevant record
date to receive interest on the relevant interest payment date), if redeemed during the 12-month period (or, in the case of the period commencing on September 1, 2023 such
12-month period and thereafter) commencing on September 1 of the years set forth below: 
  

					
	 Year
	  	Percentage	 
		
	 2021
	  	 	102.313	% 
		
	 2022
	  	 	101.156	% 
		
	 2023 and thereafter
	  	 	100.000	% 

 (c) At any time or from time to time prior to September 1, 2021, the Company, at its option, may redeem
up to 40% of the aggregate principal amount of the Notes issued under the Indenture, with the net cash proceeds of one or more Qualified Equity Offerings at a Redemption Price equal to 104.625% of the principal amount of the Notes, to be redeemed,
plus accrued and unpaid interest (including Special Interest, if any) thereon, if any, to the Redemption Date; provided that (1) at least 50% of the aggregate principal amount of the Notes issued under the Indenture remains outstanding
immediately after the occurrence of such redemption and (2) the redemption occurs within 180 days of the closing of any such Qualified Equity Offering. 

(6) MANDATORY REDEMPTION. 

The Company is not required to make mandatory redemption or sinking fund payments with respect to the Notes. 

(7) REPURCHASE AT THE OPTION OF HOLDER. 

(a) Upon the occurrence of a Change of Control, each Holder of Notes will have the right to require the Company to make an offer (a
“Change of Control Offer”) to repurchase all or any part (equal to $2,000 or an integral multiple of $1,000 in excess thereof) 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 Special Interest, if any, on the Notes repurchased, to the date of purchase (the “Change of Control Payment”). Within 30 days following any
Change of Control, the Company will deliver a notice to each Holder setting forth the procedures governing the Change of Control Offer as required by the Indenture. 

(b) In the event of an Asset Disposition that requires the purchase of Notes (and other First-Priority Stock Secured Debt), the Company will
purchase Notes tendered pursuant to an offer (an “Asset Disposition Offer”) by the Company for the Notes (and such other First-Priority Stock Secured Debt) at a purchase price of 100% of their principal amount (or, in the event such
other First-Priority Stock Secured Debt was issued with significant original issue discount, 100% of the accreted value thereof), without premium, plus accrued but unpaid interest and Special Interest, if any (or, in respect of such other
First-Priority Stock Secured Debt, such other price, not to exceed 100%, as may be provided for by the terms of such other First-Priority Stock Secured Debt), in accordance with the procedures (including prorating in the event of oversubscription)
set forth in Section 3.3 of the Thirty-First Supplemental Indenture. If there remains a balance of Net Available Cash after purchasing all securities tendered, then such balance may be used in any manner not prohibited by the Indenture. If
the aggregate purchase price of the securities tendered exceeds the Net Available Cash allotted to their purchase, the Company will select the securities to be purchased on a pro rata basis but in round denominations, which in the case of the
Notes will be denominations of $2,000 principal amount or any greater integral multiple of $1,000 in excess thereof. Notwithstanding the foregoing, the Company shall not be required to make such an Asset Disposition Offer

  
 A-3 

 
to purchase Notes (and other First-Priority Stock Secured Debt) if the Net Available Cash available therefor is less than $100.0 million (which lesser amount shall be carried forward for
purposes of determining whether such an Asset Disposition Offer is required with respect to the Net Available Cash from any subsequent Asset Disposition). Upon completion of such an Asset Disposition Offer, Net Available Cash will be deemed to
be reduced by the aggregate amount of such Asset Disposition Offer. Holders of Notes that are the subject of an offer to purchase will receive an Asset Disposition Offer from the Company 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. 
 (8) NOTICE
OF REDEMPTION. Notice of redemption will be delivered at least 15 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 delivered 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, unless all of the Notes held by a Holder are to be redeemed. 
 (9)
DENOMINATIONS, TRANSFER, EXCHANGE. The Notes are in registered form without coupons in denominations of $2,000 and integral multiples of $1,000 in excess thereof. 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 Company may require a Holder to pay any taxes
and fees required by law or permitted by the Indenture. The Company 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 Company 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 or the Note
Guarantees 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 Event of
Default or compliance with any provision of the Indenture or the Notes or the Note Guarantees 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 or the Note Guarantees may be amended
or supplemented to cure any ambiguity, defect or inconsistency, to provide for uncertificated Notes in addition to or in place of certificated Notes, to provide for the assumption of the Company’s or a Guarantor’s obligations to Holders of
the Notes and Note Guarantees in case of a merger or consolidation, 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 or to comply with the requirements of the Commission in order to effect or maintain the qualification of the Indenture under the Trust Indenture Act. 

(12) EVENTS OF DEFAULT AND REMEDIES. Events of Default include: (i) default for 30 days in the
payment when due of interest on, or Special Interest, if any, with respect to the Notes; (ii) default in the payment when due of the principal of, or premium, if any, on, the Notes when the same becomes due and payable at Maturity;
(iii) failure by the Company for 30 days after notice to the Company by the Trustee or the Holders of at least 25% in aggregate principal amount of the Notes including Additional Notes, if any, then outstanding to comply with
Section 4.6 or 4.7 of the Thirty-First Supplemental Indenture; (iv) failure by the Company or any Guarantor for 90 days after notice to the Company by the Trustee or the Holders of at least 25% in aggregate principal amount of the
Notes including Additional Notes, if any, then outstanding to comply with the covenants or warranties in the Indenture; (v) default under certain other agreements relating to Debt of the Company or any Guarantor which default results in the
acceleration of such Debt prior to its express maturity; (vi) certain events of bankruptcy or insolvency with respect to the Company or any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would
constitute a Significant Subsidiary; (vii) with respect to Collateral having a 

  
 A-4 

 
fair market value in excess of $100.0 million, the security interest created under the Pledge Agreement, any other Stock Lien Security Document or the Indenture is held in any judicial
proceeding to be unenforceable or invalid or the security interest in the Pledge Agreement ceases for any reason to be in full force and effect for any reason other than in accordance with the terms of the Indenture and the Pledge Agreement and any
other Stock Lien Security Document or the Company or any Subsidiary asserts, in any pleading in a judicial proceeding, that any security interest created under the Pledge Agreement, any other Stock Lien Security Document or the Indenture is invalid
or unenforceable; and (viii) except as permitted by the Indenture or the Note Guarantees, any Note Guarantee of any Guarantor that is a Significant Subsidiary or any group of Guarantors that, taken together, would constitute a Significant
Subsidiary ceases for any reason to be in full force and effect and enforceable or the Company or any Guarantor denies or disaffirms the Guarantor’s obligations under such Guarantor’s Note Guarantee. 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, all outstanding Notes will 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 Trustee may withhold from Holders of the Notes
notice of any continuing Event of Default (except an Event of Default relating to the payment of principal or interest or premium or Special Interest, if any) if it determines that withholding notice is in their interest. 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 Event of Default and its consequences under the Indenture
except a continuing Event of Default in the payment of interest or premium or Special Interest, if any, on, or the principal of, the Notes. The Company is required to deliver to the Trustee annually a statement regarding compliance with the
Indenture, and the Company is required, upon becoming aware of any Event of Default, to deliver to the Trustee a statement specifying such Event of Default. 

(13) TRUSTEE DEALINGS WITH COMPANY. The Trustee, in its individual or any other capacity, may make loans to, accept
deposits from, and perform services for the Company or its Affiliates, and may otherwise deal with the Company or its Affiliates, as if it were not the Trustee. 

(14) NO RECOURSE AGAINST OTHERS. A director, officer, employee, incorporator or stockholder of the Company or any of
the Guarantors, as such, will not have any liability for any obligations of the Company or the Guarantors under the Notes, the Note 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. 

(15) AUTHENTICATION. This Note will not be valid until authenticated by the manual signature of the Trustee or an
authenticating agent. 
 (16) 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).

 (17) 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 will have all the rights set forth in the Exchange and Registration Rights Agreement dated as of August 26, 2019,
among the Company, the Guarantors and the other parties named on the signature pages thereof or, in the case of Additional Notes, Holders of Restricted Global Notes and Restricted Definitive Notes will have the rights set forth in one or more
registration rights agreements, if any, among the Company, the Guarantors and the other parties thereto, relating to rights given by the Company and the Guarantors to the purchasers of any Additional Notes (collectively, the “Registration
Rights Agreement”). 

  
 A-5 

 (18) CUSIP NUMBERS. Pursuant to a recommendation promulgated by
the Committee on Uniform Security Identification Procedures, the Company has 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. 

(19) GOVERNING LAW. THE INTERNAL LAW OF THE STATE OF NEW YORK WILL GOVERN AND BE USED TO CONSTRUE THE INDENTURE,
THIS NOTE AND THE NOTE GUARANTEES WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY. 

The Company will 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: 
 Tenet Healthcare Corporation 

1445 Ross Avenue, Suite 1400 

Dallas, TX 75202 

Attention: Investor Relations 

  
 A-6 

 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 Company. 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).  

  
 A-7 

 Option of Holder to Elect Purchase 

If you want to elect to have this Note purchased by the Company pursuant to Section 4.6 or 4.7 of the Thirty-First Supplemental
Indenture, check the appropriate box below: 

☐  Section 4.6                ☐ 
 Section 4.7 
 If you want to elect to have only part of the Note purchased by the Company pursuant to Section 4.6 or Section 4.7 of the
Thirty-First Supplemental Indenture, state the amount you elect to have purchased: 
 $ 

 

			
	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).  

  
 A-8 

 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: 
  

																	
	 Date of Exchange
	  	Amount of
decrease in
Principal Amount
of this Global Note	 	  	Amount of
increase in
Principal
Amount of this
Global Note	 	  	Principal Amount
of this Global
Note following such
decrease
(or increase)	 	  	Signature of
authorized officer
of Trustee or
Custodian	 
		  				  				  				  			
		  				  				  				  			
		  				  				  				  			

  

	*	 This schedule should be included only if the Note is issued in global form. 

  
 A-9 

 EXHIBIT B 

To Thirty-First Supplemental Indenture 

FORM OF CERTIFICATE OF TRANSFER 

Tenet Healthcare Corporation 
 1445 Ross Avenue, Suite 1400

 Dallas, TX 75202 
 Attention: Investor Relations 

The Bank of New York Mellon Trust Company, N.A. 
 400 South Hope
Street, Suite 500 
 Los Angeles, CA 90071 

Attention: Corporate Unit 
  

	 	Re:	 4.625% Senior Secured First Lien Notes Due 2024 

Reference is hereby made to the Indenture, dated as of November 6, 2001, between Tenet Healthcare Corporation, as issuer (the
“Company”), and The Bank of New York Mellon Trust Company, N.A., as successor trustee to The Bank of New York, as supplemented by the Thirty-First Supplemental Indenture, dated as of August 26, 2019, among the Company, the
Guarantors party thereto and the Trustee (as so supplemented, the “Indenture”). 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.    ☐ Check if Transferee will 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 will 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.    ☐ Check if Transferee will take delivery of a beneficial
interest in the Regulation S 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 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

  
 B-1 

 
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. Upon consummation of the proposed transfer in accordance with the terms of the Indenture, the transferred beneficial interest or Definitive Note will be subject to the restrictions on Transfer enumerated
in the Private Placement Legend printed on the Regulation S Global Note and/or the Restricted Definitive Note and in the Indenture and the Securities Act. 

3.    ☐ Check and complete if Transferee will take delivery of a beneficial interest in 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)    ☐ such
Transfer is being effected pursuant to and in accordance with Rule 144 under the Securities Act; 
 OR 

(b)    ☐ such Transfer is being effected to the Company or a subsidiary thereof; 

OR 

(c)    ☐ 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)    ☐ such Transfer is being effected 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) if such Transfer is in respect of a principal amount of Notes at the time of transfer of less than $250,000, 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 will be subject to the restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted Definitive Notes and in the
Indenture and the Securities Act. 
 4.    ☐ Check if Transferee will take delivery of a beneficial
interest in an Unrestricted Global Note or of an Unrestricted Definitive Note. 
 (a)    ☐ 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 will 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-2 

 (b)    ☐ 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 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 will 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)    ☐ 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 will 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 Company. 
  

	
	      

	[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)	 ☐ a beneficial interest in the. 

 

	 	(i)	 ☐ 144A Global Note
(CUSIP                ), or 

  

	 	(ii)	 ☐ Regulation S Global Note
(CUSIP                ), or 

  

	 	(b)	 ☐ a Restricted Definitive Note. 

 

	2.	 After the Transfer the Transferee will hold: 

[CHECK ONE] 
  

	 	(a)	 ☐ a beneficial interest in the: 

 

	 	(i)	 ☐ 144A Global Note
(CUSIP                ), or 

  

	 	(ii)	 ☐ Regulation S Global Note
(CUSIP                ), or 

  

	 	(iii)	 ☐ Unrestricted Global Note
(CUSIP                ); or 

  

	(b)	 ☐ a Restricted Definitive Note; or 

 

	(c)	 ☐ an Unrestricted Definitive Note, 

in accordance with the terms of the Indenture. 

  
 Annex A - 1 

 EXHIBIT C 

To Thirty-First Supplemental Indenture 

FORM OF CERTIFICATE OF EXCHANGE 

Tenet Healthcare Corporation 
 1445 Ross Avenue, Suite 1400

 Dallas, TX 75202 
 Attention: Investor Relations 

The Bank of New York Mellon Trust Company, N.A. 
 400 South Hope
Street, Suite 500 
 Los Angeles, CA 90071 

Attention: Corporate Unit 
 Re: 4.625%
Senior Secured First Lien Notes Due 2024 

(CUSIP                ) 

Reference is hereby made to the Indenture, dated as of November 6, 2001, between Tenet Healthcare Corporation, as issuer (the
“Company”), and The Bank of New York Mellon Trust Company, N.A., as successor trustee to The Bank of New York, as supplemented by the Thirty-First Supplemental Indenture, dated as of August 26, 2019, among the Company, the
Guarantors party thereto and the Trustee (as so supplemented, the “Indenture”). 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)    ☐ 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)    ☐ 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 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)    ☐ 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 

  
 C-1 

 
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)    ☐ 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)    ☐ 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 will 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)    ☐ 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] 144A Global Note, Regulation S 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 will 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. 

This certificate and the statements contained herein are made for your benefit and the benefit of the Company. 

 

	
	      

	[Insert Name of Transferor]

  

			
	By:	 	      

		 	Name:
		 	Title:

  

			
	Dated:	 	      

  
 C-2 

 EXHIBIT D 

To Thirty-First Supplemental Indenture 

FORM OF CERTIFICATE FROM TRANSFEREE 

Tenet Healthcare Corporation 
 1445 Ross Avenue, Suite 1400

 Dallas, TX 75202 
 Attention: Investor Relations 

The Bank of New York Mellon Trust Company, N.A. 
 400 South Hope
Street, Suite 500 
 Los Angeles, CA 90071 

Attention: Corporate Unit 
 Re: 4.625%
Senior Secured First Lien Notes Due 2024 
 Reference is hereby made to the Indenture, dated as of November 6, 2001, between Tenet
Healthcare Corporation, as issuer (the “Company”), and The Bank of New York Mellon Trust Company, N.A., as successor trustee to The Bank of New York, as supplemented by the Thirty-First Supplemental Indenture, dated as of
August 26, 2019, among the Company, the Guarantors party thereto and the Trustee (as so supplemented, the “Indenture”). 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)	 ☐ a beneficial interest in a Global Note, or 

 

	 	(b)	 ☐ 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 will do so only (A) to the Company; (B) under a registration statement that has been declared effective under the Securities Act; (C) to a Person that we reasonably believe is a “Qualified Institutional Buyer” (as defined
in Rule 144A under the Securities Act) that is purchasing for its own account or for the account of another Qualified Institutional Buyer and to whom notice is given that the transfer is being made in reliance on Rule 144A, all in
compliance with Rule 144A (if available); (D) in an offshore transaction complying with Rule 903 or Rule 904 of Regulation S under the Securities Act; or (E) under any other available exemption from the registration
requirements of the Securities Act. 
 3. We understand that, prior to any transfer of the Notes pursuant to clause (E) of
paragraph 2, we will be required to furnish to the Company such legal opinions as the Company may require and may rely upon to confirm that such transfer is being made pursuant to an exemption from, or in a transaction not subject to, the
registration requirements of the Securities Act. We further understand that the Notes purchased by us will bear a legend to the foregoing effect. We understand that we may also be required to furnish to you and the Company such
certifications and other information as you or the Company may require and may rely upon to confirm that any transfer is being made pursuant to an exemption from, or in a transaction not subject to, the registration requirements of the Securities
Act. 

  
 D-1 

 4. We 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 not acquiring the Notes with a view towards any distribution thereof in a transaction that would violate the Securities Act or the
securities laws of any state of the United States or any other applicable jurisdiction. We are acquiring the Notes or beneficial interest therein purchased by us for our own account or for one or more accounts as to each of which we exercise
sole investment discretion and on behalf of which we have the full power to make the foregoing acknowledgments, representations and agreements. 

You and the Company 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. We understand that you and the Company and others will rely upon the truth and accuracy of the foregoing
acknowledgments, representations and agreements and agree that, if any of the foregoing acknowledgments, representations and agreements is no longer accurate, we will promptly notify you and the Company of such inaccuracy. 

 

	
	      

	[Insert Name of Transferor]

  

			
	By:	 	      

		 	Name:
		 	Title:

  

			
	Dated:	 	      

  
 D-2 

 EXHIBIT E 

To Thirty-First Supplemental Indenture 

[FORM OF NOTATION OF GUARANTEE] 

For value received, each Guarantor (which term includes any successor Person under the Indenture) has, jointly and severally, unconditionally
guaranteed, to the extent set forth in the Indenture and subject to the provisions in the Indenture dated as of November 6, 2001, between Tenet Healthcare Corporation, as issuer (the “Company”), and The Bank of New York Mellon
Trust Company, N.A., as successor trustee to The Bank of New York (the “Trustee”), as supplemented by the Thirty-First Supplemental Indenture, dated as of August 26, 2019 (the “Thirty-First Supplemental
Indenture”), among the Company, the Guarantors party thereto and the Trustee (as so supplemented, the “Indenture”), (a) the due and punctual payment of the principal of, premium and Special Interest, if any, and
interest on, the Notes, whether at Maturity, by acceleration, redemption or otherwise, the due and punctual payment of interest on overdue principal of and interest on the Notes, if any, if lawful, and the due and punctual performance of all other
Obligations of the Company to the Holders or the Trustee all in accordance with the terms of the Indenture and (b) in case of any extension of time of payment or renewal of any Notes or any of such other Obligations, that the same will be
promptly paid in full when due or performed in accordance with the terms of the extension or renewal, whether at Stated Maturity, by acceleration or otherwise. The obligations of the Guarantors to the Holders of Notes and to the Trustee
pursuant to this Note Guarantee and the Indenture are expressly set forth in Article Nine of the Thirty-First Supplemental Indenture and reference is hereby made to the Indenture for the precise terms of the Note Guarantee. 

Capitalized terms used but not defined herein have the meanings given to them in the Indenture. 

 

	
	      

	[NAME OF GUARANTOR(S)]

  

			
	By:	 	      

		 	Name:
		 	Title:

  

			
	Dated:	 	      

  
 E-1 

 EXHIBIT F 

To Thirty-First Supplemental Indenture 

[FORM OF SUPPLEMENTAL INDENTURE 

TO BE DELIVERED BY SUBSEQUENT GUARANTORS] 

SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of [    ],
20[    ], among [    ] (the “Guaranteeing Subsidiary”), a subsidiary of Tenet Healthcare Corporation (or its permitted successor), a corporation duly organized and existing under the laws
of the State of Nevada (the “Company”), the Company, the other Guarantors (as defined in the Indenture referred to herein) and The Bank of New York Mellon Trust Company, N.A., as trustee under the Indenture referred to below (the
“Trustee”). 
 W I T N E S S E T H 

WHEREAS, the Company has heretofore executed and delivered to the Trustee an indenture, dated as of November 6, 2001 (the “Base
Indenture”), between the Company and The Bank of New York, as predecessor trustee to the Trustee, as supplemented by the Thirty-First Supplemental Indenture, dated as of August 26, 2019 (the “Thirty-First Supplemental
Indenture”), among the Company, the Guarantors party thereto and the Trustee (as so supplemented, the “Indenture”), providing for the issuance of 4.625% Senior Secured First Lien Notes due 2024 (the
“Notes”); 
 WHEREAS, the Indenture provides that under certain circumstances the Guaranteeing Subsidiary shall execute and
deliver to the Trustee a supplemental indenture pursuant to which the Guaranteeing Subsidiary shall unconditionally guarantee all of the Company’s Obligations under the Notes and the Indenture on the terms and conditions set forth herein (the
“Note Guarantee”); and 
 WHEREAS, pursuant to Section 901 of the Base Indenture, the Trustee is 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 Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes as follows: 

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. 

2. AGREEMENT TO GUARANTEE. The Guaranteeing Subsidiary hereby agrees to provide an unconditional Guarantee on the terms and subject to the
conditions set forth in the Note Guarantee and in the Indenture including but not limited to Article Nine of the Thirty-First Supplemental Indenture. 

4. NO RECOURSE AGAINST OTHERS. No past, present or future director, officer, employee, incorporator, stockholder or agent of the
Guaranteeing Subsidiary, as such, shall have any liability for any obligations of the Company or any Guaranteeing Subsidiary under the Notes, any Note Guarantees, the Indenture or this Supplemental Indenture or for any claim based on, in respect of,
or by reason of, such obligations or their creation. Each Holder of the 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. Such waiver may
not be effective to waive liabilities under the federal securities laws and it is the view of the SEC that such a waiver is against public policy. 

5. NEW YORK LAW TO GOVERN. THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE
WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES OF CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION WOULD BE REQUIRED THEREBY. 

6. COUNTERPARTS. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but
all of them together represent the same agreement. 

  
 F-1 

 7. EFFECT OF HEADINGS. The Section headings herein are for convenience only and
shall not affect the construction hereof. 
 8. THE TRUSTEE. The Trustee shall not be responsible in any manner whatsoever for or in
respect of the validity or sufficiency of this Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Guaranteeing Subsidiary and the Company. 

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[    ] 

 

			
	[GUARANTEEING SUBSIDIARY]
		
	By:	 	 
		 	Name:
		 	Title:

  

			
	TENET HEALTHCARE CORPORATION
		
	By:	 	 
		 	Name:
		 	Title:

  

			
	[EXISTING GUARANTORS]
		
	By:	 	 
		 	Name:
		 	Title:

  

			
	 THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A.
as Trustee

		
	By:	 	 
		 	Authorized Signatory

  
 F-2

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