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Exhibit 4.12
                           ALLIS-CHALMERS CORPORATION
                            2003 INCENTIVE STOCK PLAN
                              (as amended 12/29/04)

1. PURPOSE. The purpose of the Allis-Chalmers Corporation ("Corporation")
Incentive Stock Plan (the "Plan") is to encourage key employees, directors and
service providers of the Corporation and such subsidiaries of the Corporation as
the Administrator designates to acquire common stock of the Corporation (the
"Common Stock") or to receive monetary payments based on the value of such stock
or based upon achieving certain goals on a basis mutually advantageous to such
individuals and the Corporation and thus provide an incentive to contribute to
the success of the Corporation and align the interests of key employees,
directors and service providers with the interests of the shareholders of the
Corporation.

2. ADMINISTRATION. The Plan shall be administered by a committee of two or more
directors, which the board of directors of the Corporation shall appoint (the
"Administrator"). The directors appointed to such committee shall be
Non-Employee Directors as defined in Rule 16b-3 promulgated under the Securities
Exchange Act of 1934 ("Exchange Act") or any successor regulations.

The authority to select persons eligible to participate in the Plan, to grant
Benefits in accordance with the Plan, and to establish the timing, pricing,
amount and other terms and conditions of such grants (which need not be uniform
with respect to the various Participants or with respect to different grants to
the same Participant), may be exercised by the Administrator in its sole
discretion.

Subject to the provisions of the Plan, the Administrator shall have exclusive
authority to interpret and administer the Plan, to establish appropriate rules
relating to the Plan, to delegate some or all of its authority under the Plan
and to take all such steps and make all such determinations in connection with
the Plan and the Benefits granted pursuant to the Plan as he or she may deem
necessary or advisable.

The Board of Directors in its discretion may delegate and assign specified
duties and authority of the Administrator to any other committee and retain
other duties and authority. Also, the Board of Directors in its discretion may
appoint a separate committee of outside directors to make awards that satisfy
the requirements of Section 162(m) of the Internal Revenue Code.

3. SHARES RESERVED UNDER THE PLAN. Subject to the provisions of Section 12
(relating to adjustment for changes in capital stock) the maximum number of
shares that may be issued under this Plan shall be 2,400,000, which may be
authorized but unissued or treasury shares.

As used in this Section 3, the term Plan Maximum shall refer to the number of
shares of Common Stock that are available for grant of awards pursuant to the
Plan. Stock underlying outstanding options, stock appreciation rights, or
performance awards will reduce the Plan Maximum while such options, stock
appreciation rights or performance awards are outstanding. Shares underlying
expired, canceled or forfeited options, stock appreciation rights or performance
awards shall be added back to the Plan Maximum. When the exercise price of stock
options is paid by delivery of shares of Common Stock, or if the Administrator
approves the withholding of shares from a distribution in payment of the

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exercise price, the Plan Maximum shall be reduced by the net (rather than the
gross) number of shares issued pursuant to such exercise, regardless of the
number of shares surrendered or withheld in payment. If the Administrator
approves the payment of cash to an optionee equal to the difference between the
fair market value and the exercise price of stock subject to an option, or if a
stock appreciation right is exercised for cash or a performance award is paid in
cash the Plan Maximum shall be increased by the number of shares with respect to
which such payment is applicable. Restricted stock issued pursuant to the Plan
will reduce the Plan Maximum while outstanding even while subject to
restrictions. Shares of restricted stock shall be added back to the Plan Maximum
if such restricted stock is forfeited.

4. PARTICIPANTS. Participants will consist of such officers, key employees,
directors and service providers of the Corporation or any designated subsidiary
as the Administrator in its sole discretion shall determine. Designation of a
Participant in any year shall not require the Administrator to designate such
person to receive a Benefit in any other year or to receive the same type or
amount of Benefit as granted to the Participant in any other year or as granted
to any other Participant in any year. The Administrator shall consider such
factors as it deems pertinent in selecting Participants and in determining the
type and amount of their respective Benefits.

5. TYPES OF BENEFITS. The following Benefits may be granted under the Plan: (a)
stock appreciation rights ("SARs"); (b) restricted stock ("Restricted Stock");
(c) performance awards ("Performance Awards"); (d) incentive stock options
("ISOs"); (e) nonqualified stock options ("NQSOs"); and (f) Stock Units, all as
described below ("Benefits").

The Administrator may (a) award Benefits in the alternative so that acceptance
of or exercise of one Benefit cancels the right of a Participant to another and
(b) award Benefits in any combination or combinations and subject to any
condition or conditions consistent with the terms of the Plan that the
Administrator in its sole discretion shall determine.

6. STOCK APPRECIATION RIGHTS. A SAR is the right to receive all or a portion of
the difference between the fair market value of a share of Common Stock at the
time of exercise of the SAR and the exercise price of the SAR established by the
Administrator, subject to such terms and conditions set forth in a SAR agreement
as may be established by the Administrator in its sole discretion. At the
discretion of the Administrator, SARs may be exercised (a) in lieu of exercise
of an option, (b) in conjunction with the exercise of an option, (c) upon lapse
of an option, (d) independent of an option or (e) each of the above in
connection with a previously awarded option under the Plan. If the option
referred to in (a), (b) or (c) above qualified as an ISO pursuant to Section 422
of the Internal Revenue Code of 1986 (Code), the related SAR shall comply with
the applicable provisions of the Code and the regulations issued thereunder. At
the time of grant, the Administrator may establish, in its sole discretion, a
maximum amount per share which will be payable upon exercise of a SAR, and may
impose conditions on exercise of a SAR. At the discretion of the Administrator,
payment for SARs may be made in cash or shares of Common Stock, or in a
combination thereof. SARs will be exercisable not later than ten years after the
date they are granted and will expire in accordance with the terms established
by the Administrator.

7. RESTRICTED STOCK. Restricted Stock is Common Stock issued or transferred
under the Plan (other than upon exercise of stock options or as Performance
Awards) at any purchase price less than the fair market value thereof on the
date of issuance or transfer, or as a bonus, subject to such terms and
conditions set forth in a Restricted Stock agreement as may be established by
the Administrator in its sole discretion. In the case of any Restricted Stock:

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(a) The purchase price, if any, will be determined by the Administrator.

(b) The period of restriction shall be established by the Administrator for any
grants of Restricted Stock;

(c) Restricted Stock may be subject to (i) restrictions on the sale or other
disposition thereof; (ii) rights of the Corporation to reacquire such Restricted
Stock at the purchase price, if any, originally paid therefor upon termination
of the employee's employment within specified periods; (iii) representation by
the recipient that he or she intends to acquire Restricted Stock for investment
and not for resale; and (iv) such other restrictions, conditions and terms as
the Administrator deems appropriate.

(d) The Participant shall be entitled to all dividends paid with respect to
Restricted Stock during the period of restriction and shall not be required to
return any such dividends to the Corporation in the event of the forfeiture of
the Restricted Stock.

(e) The Participant shall be entitled to vote the Restricted Stock during the
period of restriction.

(f) The Administrator shall determine whether Restricted Stock is to be
delivered to the Participant with an appropriate legend imprinted on the
certificate or if the shares are to be issued in the name of a nominee or
deposited in escrow pending removal of the restrictions.

8. PERFORMANCE AWARDS. Performance Awards are Common Stock, monetary units or
some combination thereof, to be issued without any payment therefor, in the
event that certain performance goals established by the Administrator are
achieved over a period of time designated by the Administrator, but not in any
event more than five years. The goals established by the Administrator may
include return on average total capital employed, earnings per share, increases
in share price or such other goals as may be established by the Administrator.
In the event the minimum corporate goal is not achieved at the conclusion of the
period, no payment shall be made to the Participant. Actual payment of the award
earned shall be in cash or in Common Stock or in a combination of both, as the
Administrator in its sole discretion determines. If Common Stock is used, the
Participant shall not have the right to vote and receive dividends until the
goals are achieved and the actual shares are issued.

9. INCENTIVE STOCK OPTIONS. ISOs are stock options to purchase shares of Common
Stock at not less than 100% of the fair market value of the shares on the date
the option is granted (110% if the optionee owns stock possessing more than 10%
of the combined voting power of all owners of stock of the Corporation or a
subsidiary), subject to such terms and conditions set forth in an option
agreement as may be established by the Administrator in its sole discretion that
conform to the requirements of Section 422 of the Code. Said purchase price may
be paid (a) by check or (b), in the discretion of the Administrator, by the
delivery of shares of Common Stock then owned by the Participant, or (c), in the
discretion of the Administrator, by a combination of any of the foregoing, in
the manner provided in the option agreement. The aggregate fair market value
(determined as of the time an option is granted) of the stock with respect to
which ISOs are exercisable for the first time by an optionee during any calendar
year (under all option plans of the Corporation and its subsidiary corporations)
shall not exceed $100,000 or such other maximum applicable to ISOs as may be in
effect from time to time under the Code. ISOs shall be granted only to employees
of the Corporation and designated subsidiaries. The maximum term of an ISO shall
be ten years from the date it was granted (five years if the optionee owns more
than 10% of the total combined voting power of all classes of stock of the
Corporation or a subsidiary). No ISO shall be awarded after the date preceding
the tenth anniversary of the effective date of the Plan.

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10. NONQUALIFIED STOCK OPTIONS. NQSOs are nonqualified stock options to purchase
shares of Common Stock at purchase prices established by the Administrator on
the date the options are granted, subject to such terms and conditions set forth
in an option agreement as may be established by the Administrator in its sole
discretion. The purchase price may be paid (a) by check or (b), in the
discretion of the Administrator, by the delivery of shares of Common Stock then
owned by the Participant, or (c), in the discretion of the Administrator, by a
combination of any of the foregoing, in the manner provided in the option
agreement. NQSOs shall be exercisable no later than ten years after the date
they are granted.

11. STOCK UNITS. A Stock Unit represents the right to receive a share of Common
Stock from the Corporation at a designated time in the future, subject to such
terms and conditions set forth in a Stock Unit agreement as may be established
by the Administrator in its sole discretion. The Participant generally does not
have the rights of a shareholder until receipt of the Common Stock. The
Administrator may in its discretion provide for payments in cash, or adjustment
in the number of Stock Units, equivalent to the dividends the Participant would
have received if the Participant had been the owner of shares of Common Stock
instead of the Stock Units.

12. ADJUSTMENT PROVISIONS.

(a) If the Corporation shall at any time change the number of issued shares of
Common Stock without new consideration to the Corporation (such as by stock
dividends or stock splits), the total number of shares reserved for issuance
under this Plan and the number of shares covered by each outstanding Benefit
shall be adjusted so that the aggregate consideration payable to the
Corporation, if any, and the value of each such Benefit shall not be changed.
Benefits may also contain provisions for their continuation or for other
equitable adjustments after changes in the Common Stock resulting from
reorganization, sale, merger, consolidation, issuance of stock rights or
warrants, or similar occurrence.

(b) Notwithstanding any other provision of this Plan, and without affecting the
number of shares reserved or available hereunder, the Board of Directors may
authorize the issuance or assumption of Benefits in connection with any merger,
consolidation, acquisition of property or stock, or reorganization upon such
terms and conditions as it may deem appropriate.

13. CHANGE IN CONTROL. Notwithstanding any other provision of the Plan to the
contrary, in the event of a Change in Control of the Corporation, as defined
below, all outstanding SARs, ISOs and NQSOs shall be immediately fully vested
and exercisable and any restrictions on Restricted Stock issued under the Plan
shall lapse.

Change in Control means:

(a) The acquisition on or after March 6, 2003 by any individual, entity or
group, or a Person (within the meaning of Section 13(d)(3) or 14(d)(2) of the
Exchange Act) other than an Excluded Person (as defined below), of ownership of
more than 50% of either: (i) the then outstanding shares of Common Stock
("Outstanding Common Stock"); or (ii) the combined voting power of the then
outstanding voting securities of the Corporation entitled to vote generally in
the election of directors ("Outstanding Voting Securities");

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(b) Individuals who, as of the date of approval of the Plan by the Board of
Directors of the Corporation, constitute the Board of Directors of the
Corporation ("Incumbent Board") cease for any reason to constitute at least a
majority of the Board; provided, however, that any individual becoming a
director subsequent to the date hereof whose election, or nomination for
election by the Corporation's stockholders, was approved by a vote of at least a
majority of the directors then comprising the Incumbent Board shall be
considered as though such individual were a member of the Incumbent Board, but
excluding, as a member of the Incumbent Board, any such individual whose initial
assumption of office occurs as a result of either an actual or threatened
election contest (as such terms are used in Rule 14a-11 of Regulation 14A
promulgated under the Exchange Act) or other actual or threatened solicitation
of proxies or consents by or on behalf of a Person other than the Board; or

(c) Approval by the stockholders of the Corporation of a reorganization, merger
or consolidation, in each case, unless, following such reorganization, merger or
consolidation, (i) more than 50% of, respectively, the then outstanding shares
of common stock of the corporation resulting from such reorganization, merger or
consolidation and the combined voting power of the then outstanding voting
securities of such corporation entitled to vote generally in the election of
directors is then beneficially owned, directly or indirectly, by all or
substantially all of the individuals and entities who were the beneficial
owners, respectively, of the Outstanding Corporation Common Stock and
Outstanding Corporation Voting Securities immediately prior to such
reorganization, merger or consolidation, in substantially the same proportions
as their ownership, immediately prior to such reorganization, merger or
consolidation of the Outstanding Corporation Common Stock and Outstanding
Corporation Voting Securities, as the case may be, or at least a majority of the
members of the board of directors of the corporation resulting from such
reorganization, merger or consolidation were members of the Incumbent Board at
the time of the execution of the initial agreement providing for such
reorganization, merger or consolidation; or

(d) Approval by the stockholders of the Corporation of (i) a complete
liquidation or dissolution of the Corporation or (ii) the sale or other
disposition of all or substantially all of the assets of the Corporation, other
than to a corporation, with respect to which following such sale or other
disposition, (1) more than 50% of, respectively, the then outstanding shares of
common stock of such corporation and the combined voting power of the then
outstanding voting securities of such corporation entitled to vote generally in
the election for directors is then beneficially owned, directly or indirectly,
by all or substantially all of the individuals and entities who were the
beneficial owners, respectively, of the Outstanding Corporation Common Stock and
Outstanding Corporation Voting Securities immediately prior to such sale or
other disposition in substantially the same proportion as their ownership,
immediately prior to such sale or other disposition, of the Outstanding
Corporation Common Stock and Outstanding Corporation Voting Securities, as the
case may be,or (2) at least a majority of the members of the board of directors
of such corporation were members of the Incumbent Board at the time of the
execution of the initial agreement or action of the Board providing for such
sale or other disposition of assets of the Corporation.

Excluded Person means any Person who beneficially owns more than 10% of the
outstanding shares of the Corporation on the date hereof or at any time prior to
the first anniversary of the adoption of this plan.

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14. NONTRANSFERABILITY. Each Benefit granted under the Plan shall not be
transferable otherwise than by will or the laws of descent and distribution;
provided, however, NQSOs granted under the Plan may be transferred, without
consideration, to a Permitted Transferee (as defined below). Benefits granted
under the Plan shall be exercisable, during the Participant's lifetime, only by
the Participant or a Permitted Transferee. In the event of the death of a
Participant, exercise or payment shall be made only:

(a) By or to the Permitted Transferee, executor or administrator of the estate
of the deceased Participant or the person or persons to whom the deceased
Participant's rights under the Benefit shall pass by will or the laws of descent
and distribution; and

(b) To the extent that the deceased Participant or the Permitted Transferee, as
the case may be, was entitled thereto at the date of his death.

For purposes of this Section 14, Permitted Transferee shall include (i) one or
more members of the Participant's family, (ii) one or more trusts for the
benefit of the Participant and/or one or more members of the Participant's
family, or (iii) one or more partnerships (general or limited), corporations,
limited liability companies or other entities in which the aggregate interests
of the Participant and members of the Participant's family exceed 80% of all
interests. For this purpose, the Participant's family shall include only the
Participant's spouse, children and grandchildren.

15. TAXES. The Corporation shall be entitled to withhold the amount of any tax
attributable to any amounts payable or shares deliverable under the Plan after
giving the person entitled to receive such payment or delivery notice as far in
advance as practicable, and the Corporation may defer making payment or delivery
as to any Benefit if any such tax is payable until indemnified to its
satisfaction. The person entitled to any such delivery may, with the consent of
the Administrator, elect to have such withholding satisfied by a reduction of
the number of shares otherwise so deliverable, such reduction to be calculated
based on a closing market price on the date of such notice.

16. TENURE. A Participant's right, if any, to continue to serve the Corporation
and its subsidiaries as an officer, employee, or otherwise, shall not be
enlarged or otherwise affected by his or her designation as a Participant under
the Plan.

17. RULES OF CONSTRUCTION. The terms of the Plan shall be constructed in
accordance with the laws of the State of Delaware; provided that the terms of
the Plan as they relate to ISOs shall be construed first in accordance with the
meaning under and in a manner that will result in the Plan satisfying the
requirements of the provisions of the Code governing incentive stock options.

18. DURATION, AMENDMENT AND TERMINATION. No Benefit shall be granted more than
ten years after the date of adoption of this Plan; provided, however, that the
terms and conditions applicable to any Benefit granted within such period may
thereafter be amended or modified by mutual agreement between the Corporation
and the Participant or such other person as may then have an interest therein.
Also, by mutual agreement between the Corporation and a Participant hereunder,
stock options or other Benefits may be granted to such Participant in
substitution and exchange for, and in cancellation of, any Benefits previously
granted such Participant under this Plan.

The Board of Directors may amend the Plan from time to time or terminate the
Plan at any time. However, no action authorized by this paragraph shall reduce
the amount of any existing Benefit or change the terms and conditions thereof
without the Participant's consent. No amendment of the Plan shall, without

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approval of the stockholders of the Corporation, (a) increase the total number
of shares which may be issued under the Plan or increase the amount or type of
Benefits that may be granted under the Plan; or (b) modify the requirements as
to eligibility for Benefits under the Plan.

19. GRANTS TO DIRECTORS. The Administrator shall be authorized to award Benefits
in reasonable amounts as compensation for services provided by the directors of
the Company, including directors who serve on the Compensation Committee or
otherwise act as the Administrator. The foregoing sentence shall not be deemed
to limit or define the other circumstances in which Benefits may be awarded to
directors of the Company.

20. EFFECTIVE DATE. This Plan shall become effective as of the date it is
adopted by the Board of Directors of the Corporation subject only to approval by
the holders of a majority of the outstanding voting stock of the Corporation
within twelve months before or after the adoption of the Plan by the Board of
Directors. In the event that the shareholders fail to approve the Plan within
twelve (12) months after its adoption by the Board, any grants made pursuant to
the Plan or sales of Option Shares that have already occurred shall be
rescinded, and no additional grants, sales or awards shall be made thereafter
under the Plan.

                                       7VANGUARD HEALTH SYSTEMS, INC.

EXHIBIT 10.3

AMENDMENT NO. 1 TO ASSET SALE AGREEMENT

            This Amendment No. 1 to Asset Sale Agreement  (the “Amendment”) is made and entered into as of December 23, 2004 by and among Tenet MetroWest Healthcare System, Limited
Partnership, a Massachusetts limited partnership ("Tenet MW"), Saint Vincent Hospital, L.L.C., a Massachusetts limited liability company ("SVH") and OHM Services, Inc., a Massachusetts nonprofit corporation (“OHM”) (Tenet MW, SVH and OHM are collectively
referred to herein as "Seller") and VHS Acquisition Subsidiary Number 7, Inc., a Delaware corporation (“VHS7”) and VHS Acquisition Subsidiary Number 9, Inc., a Delaware corporation (“VHS9”) (VHS7 and VHS9 are collectively referred to herein as
"Purchaser").

RECITALS

            A.        Seller and VHS7 have entered into that certain Asset Sale Agreement dated as of October 11, 2004 (the “Agreement”) pursuant to which VHS7
agreed to acquire from Seller the Assets, and to assume from Seller the Assumed Obligations.

            B.         VHS7 desires to acquire only those Assets and assume only those Assumed Obligations which relate to Saint Vincent Hospital (and not those which
relate to MetroWest Medical Center).  As a result, VHS7 desires to assign its rights to acquire the Assets which relate to MetroWest Medical Center and delegate VHS7’s duties to assume the Assumed Obligations which relate to MetroWest Medical Center to
VH9.

            C.        The parties desire to make VHS9 a party to the Agreement.

            D.        Seller and Purchaser desire to amend the Agreement to address certain matters that have arisen since the Effective Date of the Agreement.

            NOW, THEREFORE, in consideration of the foregoing premises and the mutual promises and covenants contained in this Amendment, and for their mutual reliance, the parties hereto agree as follows:

            1.         Defined Terms.  Except to the extent it is specifically indicated to the contrary in this Amendment, defined terms used in this
Amendment shall have the same meanings as in the Agreement.

            2.         Parties to the Agreement.  As of the date of this Amendment, Seller and Purchaser agree that VHS9 is hereby a party to the Agreement
and all references in the Agreement to the term “Purchaser” shall collectively be a reference to each of VHS7 and VHS9.  Vanguard Health Systems, Inc., by its signature below, does hereby acknowledge and agree that the “Obligations”, as
such term is defined in that certain Guaranty of Performance of Vanguard Health Systems, Inc. dated October 11, 2004 shall include,

without limitation, the obligations of VHS9 under the Agreement, as amended by this Amendment.

            3.         Effective Time.  The last sentence of Section 1.5 of the Agreement is hereby deleted in its entirety and replaced with the
following:

                        “The Closing with respect to each Hospital shall be deemed to have occurred and to be effective as between the parties
as of 11:59 p.m. (determined by reference to the local time zone in which the Hospital is located) on the Closing Date (the "Effective Time").”

            4.         Items to be Delivered by Purchaser at Closing.  The phrase “minus Six Hundred Thousand Dollars ($600,000)” is
hereby added to Section 1.7.1 of the Agreement immediately after the phrase “the Escrow Amount,”.

            5.         Medicare Provider Numbers.

                        (a)        Section 1.10(z) of the Agreement is hereby deleted in its entirety and replaced
with the following: 

                                    “(z)      
Seller’s current (i) Medicare provider agreements and provider numbers relating to the provision of acute care services or psychiatric services and (ii) Medicaid provider agreements and provider numbers;”

                        (b)        The following Section 1.11(j) is hereby added to the Agreement as follows:

                                    “(j)      
obligations arising under the Hospitals’ Medicare provider agreements and provider numbers (other than the Medicare provider agreements and provider numbers described in Section 1.10(z)) arising with respect to events or periods on and after the Effective
Time;”

                        (c)        The word “and” is hereby deleted at the end of Section 1.11(h) of
the Agreement and the phrase “; and” is hereby inserted at the end of Section 1.11(i) of the Agreement.

            6.         Employee Matters.

                        (a)        The following sentence is hereby inserted immediately following the third
sentence of Section 4.9 of the Agreement:

                                    “The distributions described in the immediately
preceding sentence shall include, without limitation, distributions of vested employer matching funds in 2005 for the benefit of the Hospitals’ Employees (other than the Retained Management Employees) who are employed by Seller on December 31, 2004 as required
by, and in accordance with, the terms of the Tenet 401(k) Retirement Savings Plan.”

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                        (b)        Section 9.8 of the Agreement is hereby deleted in its entirety and replaced
with the following:

                        “9.8      Employee Transition.  Purchaser acknowledges that Seller will, on the
Closing Date, provide each of the Hospitals’ Employees a payroll check (with respect to ordinary wages and salaries) covering all pay periods through the Closing Date, which check will include an amount based upon an estimate of time worked through the Closing
Date (the “Estimated Payment Amount”).  Within five (5) business days after the Closing Date, Seller shall deliver to Purchaser a statement (the “Settle-Up Statement”) setting forth, in reasonable detail, (a) the Estimated Payment Amount,
if any, for each of the Hospitals’ Employees and (b) for each of the Hospitals’ Employees who are among the Hired Employees the amount of pay, if any, which is due to such Hired Employees based on the actual time worked by each such employee during the
applicable payroll cycle ending on the Closing Date, less the Estimated Payment Amount which Seller made to each such employee on the Closing Date (the “Employee Settle-Up Payments”).  No later than the date of the next immediately following payroll
for the Hired Employees which occurs after Purchaser’s receipt of the Settle-Up Statement, Purchaser shall include the Employee Settle-Up Payments in the payroll check for each of the applicable Hired Employees; provided, however, if Purchaser receives the
Settle-Up Statement too late to make the Employee Settle-Up Payments in the next immediately following payroll after receipt of the Settle-Up Statement, Purchaser shall make the Employee Settle-Up Payments in the next immediately following payroll.  The amount
of the Employee Settle-Up Payments shall be included in the Final Balance Sheets delivered pursuant to Section 1.4.  As a result, Seller shall reimburse Purchaser the amount of the Employee Settle-Up Payments in accordance with the post-Closing Cash Purchase
Price adjustment of Section 1.4.”

            7.         Post-Closing Matters.

                        (a)        Section 9.1 of the Agreement is hereby deleted in its entirety and replaced
with the following:

                        “9.1      Excluded Assets and Excluded Liabilities. 

                                    (a)        Subject
to Section 11.2 hereof, any asset (including Accounts Receivable) or any liability, all other remittances and all mail and other communications that is an Excluded Asset or an Excluded Liability (i) pursuant to the terms of this Agreement, (ii) as otherwise
determined by the parties' mutual written agreement or (iii) absent such agreement, as determined by adjudication by a court or similar tribunal, and which comes into the possession, custody or control of Purchaser (or its respective successors-in-interest, assigns
or affiliates) shall within ten (10) business days following receipt be transferred, assigned or conveyed by Purchaser (and its respective successors-in-interest, assigns and affiliates) to Seller at Seller’s cost.  Until such transfer, assignment and
conveyance, Purchaser (and its respective successors-in-interest, assigns and affiliates) shall not have any right, title or interest in or obligation or responsibility with respect to such asset or liability except that Purchaser shall hold such

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asset in trust for the benefit of Seller.  Purchaser (and its respective successors-in-interest, assigns and affiliates) shall have neither the right to offset amounts payable to Seller under this Section 9.1(a) against, nor the right to contest its
obligation to transfer, assign and convey to Seller because of, outstanding claims, liabilities or obligations asserted by Purchaser against Seller including but not limited to pursuant to the post-Closing Cash Purchase Price adjustment of Section 1.4 and the
indemnification provisions of Section 10.2.

                                    (b)        Subject
to Section 11.2 hereof, any asset (including accounts receivable generated by Purchaser with respect to services provided by Purchaser on or after the Effective Time) or any liability, all other remittances and all mail and other communications that is an Asset or an
Assumed Obligation (i) pursuant to the terms of this Agreement, (ii) as otherwise determined by the parties' mutual written agreement or (iii) absent such agreement, as determined by adjudication by a court or similar tribunal, and which comes into the possession,
custody or control of Seller (or its respective successors-in-interest, assigns or affiliates) shall within ten (10) business days following receipt be transferred, assigned or conveyed by Seller (and its respective successors-in-interest, assigns and affiliates) to
Purchaser at Purchaser’s cost.  Until such transfer, assignment and conveyance, Seller (and its respective successors-in-interest, assigns and affiliates) shall not have any right, title or interest in or obligation or responsibility with respect to such
asset or liability except that Seller shall hold such asset in trust for the benefit of Purchaser.  Seller (and its respective successors-in-interest, assigns and affiliates) shall have neither the right to offset amounts payable to Purchaser under this Section
9.1(b) against, nor the right to contest its obligation to transfer, assign and convey to Purchaser because of, outstanding claims, liabilities or obligations asserted by Seller against Purchaser including but not limited to pursuant to the post-Closing Cash Purchase
Price adjustment of Section 1.4 and the indemnification provisions of Section 10.3.

                                    (c)        With
respect to payment received by Purchaser or Seller on account of Transition Services or Non-Acute Transition Services, respectively, Sections 9.1(a) and 9.1(b) above shall be subject to the provisions of Sections 11.3 and 11.4, respectively.  The terms of this
Article 9 shall not be subject to the time limitations contained in Section 10.1 of this Agreement.”

                        (b)        The following Sections 9.9 through 9.13 are hereby added to the Agreement as
follows:

                        “9.9      Medicare Bad Debts.  With respect to any service provided at the
Hospitals as to which Purchaser takes assignment of Seller’s provider number, Seller shall be entitled to receive Medicare bad debt reimbursement associated with services furnished prior to the Effective Time.

                        9.10     Fluoroscopy Equipment.  Prior to the Closing Date, Tenet MW ordered new fluoroscopy
equipment for the Leonard Morse Hospital campus of MetroWest Medical Center, as more particularly described on Schedule 9.10.  To the extent Purchaser incurs any of the costs of the purchase and installation of such equipment, Seller shall reimburse Purchaser
within twenty (20) days after receiving written notice thereof from

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Purchaser, which written notice shall include reasonable supporting documentation.  In no event shall Seller’s obligations set forth in this Section 9.10 exceed Seven Hundred Eighty Five Thousand Five Hundred Twenty One Dollars ($785,521).

                        9.11     Americans with Disabilities Settlement.  As soon as practicable after the Closing
Date, Seller shall give notice to the court and the plaintiffs described in the Notice and Stipulation re: Second Amended Exhibit A to Consent Decree; Order, a copy of which is contained in Schedule 9.11, so that the Hospitals shall no longer be subject to the terms
of Seller’s and/or Seller’s affiliates’ nationwide settlement agreement regarding the Americans with Disabilities Act.

                        9.12     Medical Staff Funds.  As of December 23, 2004, SVH holds, on behalf of the Medical
Staff of Saint Vincent Hospital, funds totaling $35,954.00.  At the Closing the amount payable to Seller pursuant to Section 1.7.1 shall be reduced by $35,954.00.  After the Closing Date, Purchaser shall continue to hold such funds on behalf of, and for the
benefit of, the Medical Staff of Saint Vincent Hospital.

                        9.13     Mary Ann Morse Healthcare Corp.  Prior to the Closing Date, Tenet MW and Mary Ann
Morse Healthcare Corp. (“MAMHC”) have been negotiating, as a result of MAMHC’s invocation of the provisions contained in Section 4.4 of the Ground Lease dated April 30, 1996, the conveyance to MAMHC of that certain real property described on
Schedule 9.13 hereto (the “MAMHC Real Property”).  Except as set forth below in this Section 9.13, the MAMHC Real Property shall be among the Excluded Assets.  To the extent Tenet MW and MAMHC are unable to complete such conveyance on or prior
to the Closing Date, such Ground Lease shall be among the Excluded Assets and Tenet MW shall thereafter use its reasonable commercial efforts to complete such conveyance as soon as practicable after the Closing Date.  If, however, as of July 1, 2005, Tenet MW
and MAMHC have not yet completed such conveyance, Tenet MW shall, without any additional cost to Purchaser (other than Purchaser’s obligations to bear one-half of the costs described in Sections 12.12(a) and 12.12(d) of the Agreement) promptly thereafter convey
the MAMHC Real Property to Purchaser and Purchaser shall assume all of Tenet MW’s obligations under such Ground Lease.  Purchaser’s rights and interest thereafter to the MAMHC Real Property shall be subject to the terms of such Ground Lease,
including, without limitation, the provisions contained in Section 4.4 thereof.”

            8.         Transition Patients.

                        (a)        The following sentence is hereby added to the beginning of Section 11.3 of the
Agreement immediately after the heading “Transition Patients”:

                        “Notwithstanding any provision to the contrary contained in this Section 11.3, the terms of this Section 11.3 shall
only apply with respect to Seller’s provider agreements and provider numbers which have been rejected by Purchaser (which provider agreements and provider numbers are described in Section 1.10(z)).”

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                        (b)        The following Section 11.4 is hereby added to the Agreement as follows:

                        “11.4    Non-Acute Transition Services.  To compensate Seller for services rendered and
medicine, drugs, and supplies provided before the Effective Time with respect to any portion of the Hospitals as to which Purchaser takes assignment of Seller’s provider numbers and/or provider agreements (the "Non-Acute Transition Services") with respect to
patients whose medical care is paid for, in whole or in part, by Medicare, Medicaid, TRICARE, Blue Cross or any other third party payor who pays on a DRG, case rate or other similar arrangement, and who are admitted to any of the Hospitals prior to the Effective Time
but who are not discharged until on or after the Effective Time ("Governmental Program Non-Acute Transition Patients"), the parties shall take the following action:

                                    (a)        As soon
as practicable after the Closing Date, Seller shall deliver to Purchaser a statement itemizing the Non-Acute Transition Services provided by Seller with respect to the operation of the Hospitals prior to the Effective Time to Governmental Program Non-Acute Transition
Patients.  For the Non-Acute Transition Services, Purchaser shall pay to Seller an amount equal to (i) the per diem, the case rate payment or other payments received by Purchaser on behalf of a Governmental Program Non-Acute Transition Patient, multiplied by a
fraction (the "Fraction"), the numerator of which shall be the total charges for the Non-Acute Transition Services provided to such Governmental Program Non-Acute Transition Patient by Seller and the denominator of which shall be the sum of the total charges for the
Non-Acute Transition Services provided to such Governmental Program Non-Acute Transition Patient by Seller plus the total charges for the Non-Acute Transition Services provided to such Governmental Program Non-Acute Transition Patient by Purchaser on and after the
Effective Time minus (ii) copayments made by the Governmental Program Non-Acute Transition Patient to Seller.  The parties shall reconcile the payments within ninety (90) calendar days after both the tentative and final Medicare cost report settlement and any
other payor settlement affecting the Governmental Program Non-Acute Transition Patients (the "Reconciliation").

                                    (b)        Subject
to Section 11.4(d), payments made pursuant to Section 11.4(a) shall be made to Seller monthly, on the twenty-fifth (25th) day of each month, for payments received by Purchaser during the previous month, accompanied by copies of remittances and other supporting
documentation as is reasonably requested by Seller.  Any other payments required to be made by Seller to Purchaser, or by Purchaser to Seller, as the case may be, as a result of (i) the Reconciliation, (ii) a notice of program reimbursement with respect to the
operations of any Hospital or (iii) other notice from a governmental agency or third party payor with respect to Transition Services shall be made within thirty (30) calendar days after the Reconciliation or the receipt of any such notice, as applicable.  In the
event that Purchaser and Seller are unable to agree on the amount to be paid to Seller or Purchaser, as the case may be, under this Section 11.4, then such amount shall be determined by the Independent Auditor at their joint expense.

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                                    (c)        The
parties acknowledge that all charges for outpatient and other cost-based services shall be made (i) by Seller for all periods prior to the Effective Time and (ii) by Purchaser for all periods on and after the Effective Time.

                                    (d)       
Notwithstanding the first sentence of Section 11.4(b), Purchaser shall make a distribution to Seller within ten (10) business days if at any time during the applicable calendar month the funds to be distributed to Seller pursuant to Section 11.4(a) exceed One Hundred
Fifty Thousand Dollars ($150,000).  The amount of such distribution shall be all amounts payable to Seller pursuant to Section 11.4(a) which have not been previously distributed to Seller.  All such distributions shall be made by wire transfer of
immediately available funds to Seller to the account(s) specified by Seller to Purchaser in writing from time to time.

                                    (e)       
Purchaser (and its respective successors-in-interest, assigns and affiliates) shall have neither the right to offset amounts payable to Seller under this Section 11.4 against, nor the right to contest its obligation to transfer, assign and convey to Seller because
of, outstanding claims, liabilities or obligations asserted by Purchaser against Seller including but not limited to pursuant to the post-closing Cash Purchase Price adjustment of Section 1.4 and the indemnification provisions of Section 10.2.

                                    (f)        
If the Hospitals’ fiscal intermediary requires or requests that Seller and Purchaser use a billing method for services rendered to Governmental Program Non-Acute Transition Patients that differs from the method described in this Section 11.4, Seller and
Purchaser shall comply with the fiscal intermediary’s requirement or request and shall equitably adjust the aggregate reimbursement received by Seller and Purchaser for such services to ensure that each party receives the same proportion of the aggregate
reimbursement as such party would have received had the parties followed the method described above in this Section 11.4.”

            9.         Indemnification Limitations.

                        (a)        The following Section 10.2.2(a)(x) is hereby added to Section 10.2.2(a) of the
Agreement:

                        “(x)      be made to the extent such claim relates to the physical condition of the roof of
any building located in Framingham, Massachusetts or Natick, Massachusetts which is a part of the Assets, including, without limitation, any damage caused to any such building, the Assets or the Hospitals as a result of any such roof failing to be
watertight.”

                        (b)        The word “and” is hereby deleted at the end of Section
10.2.2(a)(viii) of the Agreement and the phrase “; and” is hereby inserted at the end of Section 10.2.2(a)(ix) of the Agreement.

            10.       Allocation of Purchase Price.  The fourth through eighth sentences of Section 11.1(b) of the Agreement are hereby deleted in their entirety.

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            11.       Effect on Agreement; General Provisions.  Except as set forth in this Amendment, the terms and provisions of the Agreement are hereby ratified
and declared to be in full force and effect.  This Amendment shall become effective upon its execution, which may occur in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same
instrument.  Captions and paragraph headings are used herein for convenience only, are not a part of this Amendment or the Agreement as amended by this Amendment and shall not be used in construing either document.  Other than the reference to the Agreement
contained in the first recital of this Amendment, each reference to the Agreement and any agreement contemplated thereby or executed in connection therewith, whether or not accompanied by reference to this Amendment, shall be deemed a reference to the Agreement as
amended by this Amendment.

[REMAINDER OF PAGE IS BLANK]

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            IN WITNESS WHEREOF, the parties have caused this Amendment to be executed in multiple originals by their authorized officers or authorized signatories, all as of the day and year first above
written.

                                                                       
PURCHASER:

                                                                       
VHS Acquisition Subsidiary Number 7, Inc.,

                                                                       
a Delaware corporation

                                                                       
By:  /s/ Keith B.
Pitts                                       

                                                                       
Name:  Keith B.
Pitts                                       

                                                                       
Its:  Executive Vice President                           

                                                                       
VHS Acquisition Subsidiary Number 9, Inc.,

                                                                       
a Delaware corporation

                                                                       
By:  /s/ Keith B.
Pitts                                       

                                                                       
Name:  Keith B.
Pitts                                       

                                                                       
Its:  Executive Vice President                           

                                                                       
SELLER:

                                                                       
Tenet MetroWest Healthcare System, Limited

                                                                       
Partnership, a Massachusetts limited

                                                                       
partnership

                                                                       
By:  Tenet HealthSystem MW, Inc., its

                                   
                                    general partner

                                                                       
By:  /s/ Robert
Smith                                        

                                                                       
Name:  Robert
Smith                                       

                                                                       
Its:  Authorized Signatory                                 

                                                                       
Saint Vincent Hospital, L.L.C., a

                                                                       
Massachusetts limited liability company

                                                                       
By:  Saint Vincent Hospital, Inc., its

                                                           
            managing member

                                                                       
By:  /s/ Robert
Smith                                        

                                                                       
Name:  Robert
Smith                                       

                                                                       
Its:  Authorized Signatory                                 

[SIGNATURES CONTINUED ON NEXT PAGE]

9

                                                                       
OHM Services, Inc., a Massachusetts

                                                                       
nonprofit corporation

                                                                       
By:  /s/ Robert
Smith                                        

                                                                       
Name:  Robert
Smith                                       

                                                                       
Its:  Authorized Signatory                                 

Vanguard Health Systems, Inc.,

a Delaware corporation, but only for purposes of

Section 2 of this Amendment

By:  /s/ Keith B.
Pitts                                       

 Name:  Keith B.
Pitts                                       

 Title:  Vice
Chairman                                       

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