Document:

EX-4.3

 Exhibit 4.3 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE
THEREOF. THIS SECURITY MAY NOT BE EXCHANGED IN WHOLE OR IN PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SECURITY IN WHOLE OR IN PART MAY BE REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN
THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. 
 Unless this certificate is presented by an authorized representative of The
Depository Trust Company, a limited-purpose trust company organized under the New York Banking Law (“DTC”), to the Company or its agent for registration of transfer, exchange or payment, and any certificate issued is registered in the name
of Cede & Co. or in such other name as is requested by an authorized representative of DTC (and any payment is made to Cede & Co. or to such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE
OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the registered owner hereof, Cede & Co., has an interest herein. 

STATE STREET CORPORATION 
 Floating
Rate Senior Notes Due 2020 
  

			
	No.     	  	$    
	CUSIP 857477AR4	  	Issue Date: August 18, 2015
	ISIN US857477AR48	  	

 State Street Corporation, a corporation duly organized and existing under the laws of The Commonwealth of
Massachusetts (herein called the “Company,” which term includes any successor Person under the Indenture hereinafter referred to), for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum
of      MILLION Dollars ($    ) on August 18, 2020, and to pay interest thereon from and including August 18, 2015, or from and including the most recent Interest Payment Date to which interest has
been paid or duly provided for, quarterly in arrears on February 18, May 18, August 18 and November 18 of each year (each, an “Interest Payment Date”), commencing November 18, 2015, and on the Maturity,
at the rate of Three-Month U.S. dollar LIBOR plus 0.900% per annum, reset quarterly, until the principal hereof is paid or made available for payment; provided, that if an Interest Payment Date falls on a day that is not a Business Day and a
London Business Day, then such date will be postponed to the next day that is both a Business Day and a London Business Day, except that, if the next such date falls in the next calendar month, then such date will be advanced to the immediately
preceding day that is both a Business Day and a London Business Day; and provided further, that if the Maturity is not a Business Day and a London Business Day, any payment of principal and interest otherwise due on such day will be made on the next
succeeding date that is a Business Day and a London Business Day, and no interest on such payment shall accrue for the period from and after such Maturity. The interest so payable, and punctually paid or duly provided for, on any Interest Payment
Date will, as provided in such Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which shall be the
February 3, May 3, August 3 and November 3, whether or not a London Business Day or a Business Day, next preceding such Interest Payment Date; provided, that interest paid on the Maturity shall be paid to the Person to
whom the principal will be payable. Any such interest not so punctually paid or duly provided for will forthwith cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one
or more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof shall be given to Holders of Securities of this series not less

 
than 10 days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange on which the Securities of this
series may be listed, and upon such notice as may be required by such exchange, all as more fully provided in said Indenture. 
 Payment of
the principal of (and premium, if any) and any such interest on this Security will be made at the office or agency of the Company maintained for that purpose in the City of Boston, Massachusetts, 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; provided, that for so long as this Security is a Global Security, payment of the principal of (and premium, if any) and any interest on this Security will be
made by the Paying Agent by wire transfer in immediately available funds in U.S. dollars at the office of the Paying Agent; provided further, that in the case of payments made at maturity of such Global Security, the Global Security is presented to
the Paying Agent in time for the Paying Agent to make such payments in accordance with its normal procedures. 
 Interest on this Security
will accrue from and including August 18, 2015. The initial interest period for this Security is the period from and including August 18, 2015 to, but excluding, the next Interest Reset Date (as defined below), and subsequent interest periods will
be the periods from and including an Interest Reset Date to, but excluding, the next Interest Reset Date. 
 Interest on this Security will
be computed on the basis of a 360-day year for the actual number of days elapsed. Interest will be reset on February 18, May 18, August 18 and November 18 of each year, commencing on November 18, 2015 (each, an
“Interest Reset Date”). If an Interest Reset Date for this Security falls on a day that is not a Business Day and a London Business Day, then such date will be postponed to the next day that is both a Business Day and a London Business
Day, except that, if the next such date falls in the next calendar month, then such date will be advanced to the immediately preceding day that is both a Business Day and a London Business Day. The LIBOR rate in effect for the initial interest
period will be 0.32445%. For subsequent interest periods, LIBOR will be determined by the calculation agent on the second London Business Day immediately preceding the first day of such interest period in the following manner: 

 

	 	•	 	LIBOR will be the offered rate per annum for three-month deposits in U.S. dollars, beginning on the first day of such period, as that rate appears on Reuters screen LIBOR01 (or any successor or replacement page) as of
approximately 11:00 A.M., London time, on the second London Business Day immediately preceding the first day of such interest period. 

  

	 	•	 	If the rate described above does not so appear on the Reuters screen LIBOR01 (or any successor or replacement page), then LIBOR will be determined on the basis of the rates, at approximately 11:00 A.M., London time, on
the second London Business Day immediately preceding the first day of such interest period, at which deposits of the following kind are offered to prime banks in the London interbank market by four major banks in that market selected by the
calculation agent: three-month deposits in U.S. dollars, beginning on the first day of such interest period, and in a Representative Amount. The calculation agent will request the principal London office of each of these banks to provide a quotation
of its rate. If at least two quotations are provided, LIBOR for the second London Business Day immediately preceding the first day of such interest period will be the arithmetic mean of the quotations. 

	 	•	 	If fewer than two of the requested quotations described above are provided, LIBOR for the second London Business Day immediately preceding the first day of such interest period will be the arithmetic mean of the rates
for loans of the following kind to leading European banks quoted, at approximately 11:00 A.M., New York City time, on the second London Business Day immediately preceding the first day of such interest period, by major banks in New York City
selected by the calculation agent: three-month loans of U.S. dollars, beginning on the first day of such interest period, and in a Representative Amount. 

  

	 	•	 	If no quotation is provided as described above, then the calculation agent, after consulting such sources as it deems comparable to any of the foregoing quotations or display page, or any such source as it deems
reasonable from which to estimate LIBOR or any of the foregoing lending rates, shall determine LIBOR for the second London Business Day immediately preceding the first day of such interest period in its sole discretion. 

The calculation agent is State Street Bank and Trust Company unless and until such time as a successor is appointed. State Street may appoint
a different institution to serve as calculation agent from time to time after the original issue date of this Security without the consent of holders of this Security and without notice. The calculation agent’s determination of any interest
rate, and its calculation of the amount of interest for any interest period, will be on file at the Company’s principal offices, will be made available to any noteholder upon request and will be final and binding in the absence of manifest
error. 
 A “Business Day” means any other than a Saturday, Sunday or other day on which banking institutions in The City of New
York or The City of Boston are authorized or required by law or executive order to remain closed. 
 A “London Business Day” means
each Monday, Tuesday, Wednesday, Thursday and Friday that is not a day on which banking institutions in London generally are authorized or obligated by law, regulation or executive order to close and, in the case of any debt security for which LIBOR
is an interest rate basis, is also a day on which dealings in the applicable index currency are transacted in the London interbank market. 

A “Representative Amount” means an amount that, in the calculation agent’s judgment, is representative of a single transaction
in the relevant market at the relevant time. 
 The “Reuters screen” means the display on the Reuters 3000 Xtra service, or any
successor or replacement service. 
 All percentages resulting from any calculation of the interest rate on this Security will be
rounded, if necessary, to the nearest one hundred-thousandth of a percentage point, with five one-millionths of a percentage point rounded upwards (e.g., 9.876545% (or .09876545) being rounded to 9.87655% (or .0987655)), and all dollar
amounts used in or resulting from such calculations will be rounded to the nearest cent (with one-half cent being rounded upwards). 

The interest rate on this Security will in no event be higher than the maximum rate permitted by New York law as the same may be modified by
United States law of general application. 

 This Security is one of a duly authorized issue of securities of the Company (herein called the
“Securities”), issued and to be issued in one or more series under an Indenture, dated as of October 31, 2014 (herein called the “Indenture”), between the Company and U.S. Bank National Association, as trustee (herein called
the “Trustee,” which term includes any successor trustee under the Indenture), and reference is hereby made to the Indenture for a statement of the respective rights, limitations of rights, duties and immunities thereunder of the Company,
the Trustee, and the Holders of the Securities and of the terms upon which the Securities are, and are to be, authenticated and delivered. This Security is one of the series designated on the face hereof, in the initial principal amount of
$    . 
 The Indenture contains provisions for defeasance at any time of the entire indebtedness of this Security or
certain restrictive covenants and Events of Default with respect to this Security, in each case upon compliance with certain conditions set forth in the Indenture. 

If an Event of Default with respect to Securities of this series shall occur and be continuing, the principal of the Securities of this series
may be declared due and payable in the manner and with the effect provided in the Indenture. 
 The Indenture permits, with certain
exceptions as therein provided, the amendment thereof and the modification of the rights and obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and
the Trustee with the consent of the Holders of a majority in principal amount of the Securities at the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of specified percentages in
principal amount of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with certain provisions of the Indenture and certain past defaults under the
Indenture and their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer
hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 
 As
provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have the right to institute any proceeding with respect to the Indenture or for the appointment of a receiver or trustee or for any other remedy
thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default with respect to the Securities of this series, the Holders of not less than 25% in principal amount of the Securities of this
series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event of Default as Trustee and offered the Trustee reasonable indemnity, and the Trustee shall not have received from the
Holders of a majority in principal amount of Securities of this series at the time Outstanding a direction inconsistent with such request, and shall have failed to institute any such proceeding for 60 days after receipt of such notice, request and
offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the enforcement of any payment of principal hereof or any premium or interest hereon on or after the respective due dates expressed herein.

 No reference herein to the Indenture and no provision of this Security or of the Indenture shall
alter or impair the obligation of the Company, which is absolute and unconditional, to pay the principal of and any premium and interest on this Security at the times, place and rate, and in the coin or currency, herein prescribed. 

As provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Security is registrable in the
Security Register, upon surrender of this Security for registration of transfer at the office or agency of the Company in any place where the principal of and any premium and interest on this Security are payable, duly endorsed by, or accompanied by
a written instrument of transfer in form satisfactory to the Company and the Security Registrar duly executed by, the Holder hereof or his attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like
tenor, or authorized denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 

The Securities of this series are issuable only in registered form without coupons in denominations of $2,000 and integral multiples of $1,000
in excess thereof. As provided in the Indenture and subject to certain limitations therein set forth, Securities of this series are exchangeable for a like aggregate principal amount of Securities of this series and of like tenor of a different
authorized denomination, as requested by the Holder surrendering the same. 
 No service charge shall be made for any such registration of
transfer or exchange, but the Company may require payment of a sum sufficient to cover any tax or other governmental charge payable in connection therewith. 

Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company or the Trustee
may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 

All terms used in this Security which are defined in the Indenture shall have the meanings assigned to them in the Indenture. 

Unless the certificate of authentication hereon has been executed by the Trustee by manual signature, this Security shall not be entitled to
any benefit under the Indenture or be valid or obligatory for any purpose. 
 - end of page - 

[Signatures appear on the following page] 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed under its
corporate seal. 
 Dated: August 18, 2015 
  

			
	STATE STREET CORPORATION
		
	By:	 	  

	Name:	 	
	Title:	 	
	
	Attest:
		
	By:	 	  

	Name:	 	
	Title:	 	

 [Signature Page to Senior Note No.    ] 

 TRUSTEE’S CERTIFICATE OF AUTHENTICATION 

This is one of the Securities of the series designated therein referred to in the within-mentioned Indenture. 

U.S. BANK NATIONAL ASSOCIATION, as Trustee 

Dated: August 18, 2015 
  

			
	By:	 	  

	Name:	 	
	Authorized Signatory

 [Trustee’s Certificate of Authentication to Senior Note No.    ]EX-4.1

 Exhibit 4.1 

ELEVENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of June 30, 2015, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a
Delaware corporation (the “Issuer”), each of the parties identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New Subsidiary Guarantor” and collectively, the “New Subsidiary
Guarantors”) and REGIONS BANK, as successor Trustee under the Indenture (the “Trustee”). 
 W I T N E S S E T H:

 WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended, supplemented,
waived or otherwise modified (the “Indenture”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 

WHEREAS, each of the undersigned New Subsidiary Guarantors has deemed it advisable and in its best interest to execute and deliver this
Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of the
Indenture, the Trustee, the Issuer and the New Subsidiary Guarantors are authorized to execute and deliver this Supplemental Indenture. 

NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the
Issuer, the New Subsidiary Guarantors and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows: 

SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.

 SECTION 2. Guaranties. Each New Subsidiary Guarantor hereby agrees to guarantee the Issuer’s obligations under the Securities
on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in
all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the
Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 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. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 

  
 1 

 SECTION 7. Effect of Headings. The Section headings herein are for convenience only and
shall not effect the construction of this Supplemental Indenture. 
 [Signature page follows] 

  
 2 

 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as
of this 30th day of June, 2015. 
  

							
		 	 CHS/Community Health Systems, Inc.,

a Delaware corporation
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	
			
		 	 Carolinas Holdings, LLC,
 a Delaware
limited liability company
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	
			
		 	 CHS Tennessee Holdings, LLC,
 a
Delaware limited liability company
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	
			
		 	 Gaffney H.M.A., LLC,
 a South
Carolina limited liability company
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	
			
		 	 Sunbury Hospital Company, LLC,
 a
Delaware limited liability company
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	
			
		 	 Tullahoma HMA, LLC,
 a Tennessee
limited liability company
	 	
				
		 	By:	 	  /s/ James W. Doucette                    	 	
		 		 	James W. Doucette	 	
		 		 	Senior Vice President and Treasurer	 	

  
 3 

 
			
	 Regions Bank, as Trustee

		
	 By:
	 	  /s/ Paul Williams                            
		 	Paul Williams
		 	Vice President

  
 4

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