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                                                                    EXHIBIT 10.4

                              SUBSIDIARIES GUARANTY

      SUBSIDIARIES GUARANTY (GENERAL), (as amended, modified or supplemented
from time to time, this "Guaranty"), dated as of September 23, 2004, made by and
among each of the undersigned guarantors (each a "Guarantor" and, together with
any other entity that becomes a guarantor hereunder pursuant to Section 26
hereof, the "Guarantors") in favor of Bank of America, N.A., as Administrative
Agent (together with any successor administrative agent, the "Administrative
Agent"), for the benefit of the Secured Creditors (as defined below). Except as
otherwise defined herein, all capitalized terms used herein and defined in the
Credit Agreement (as defined below) shall be used herein as therein defined.

                              W I T N E S S E T H :

      WHEREAS, Vanguard Health Holding Company I, LLC ("VHS Holdco I"), Vanguard
Health Holding Company II, LLC ("VHS Holdco II"), Vanguard Holding Company II,
Inc. (the "Co-Borrower" and, together with VHS Holdco II, the "Borrowers" and
each, a "Borrower"), the lenders from time to time party thereto (the
"Lenders"), the Administrative Agent, Citicorp North America, Inc., as
Syndication Agent, General Electric Capital Corporation, LaSalle Bank, National
Association and Wachovia Bank, National Association, as Co-Documentation Agents,
and Banc of America Securities LLC and Citigroup Global Markets Inc., as Joint
Lead Arrangers and Book Runners, have entered into a Credit Agreement, dated as
of September 23, 2004 (as amended, modified or supplemented from time to time,
the "Credit Agreement"), providing for the making of Loans to, and the issuance
of, and participation in, Letters of Credit for the account of the Borrowers,
all as contemplated therein (the Lenders, each Issuing Lender, the
Administrative Agent and the Collateral Agent and each other Agent are herein
called the "Lender Creditors");

      WHEREAS, each Borrower may at any time and from time to time enter into
one or more Interest Rate Protection Agreements or Other Hedging Agreements with
one or more Lenders or any affiliate thereof (each such Lender or affiliate,
even if the respective Lender subsequently ceases to be a Lender under the
Credit Agreement for any reason, together with such Lender's or affiliate's
successors and assigns, if any, collectively, the "Other Creditors");

      WHEREAS, VHS Holdco II, one or more Wholly-Owned Domestic Subsidiaries of
VHS Holdco II and any bank (and/or one or more of its banking affiliates)
reasonably acceptable to the Administrative Agent, in each case designated to
the Administrative Agent in writing by VHS Holdco II as a provider of Treasury
Services (as defined below), (collectively, the "Treasury Service Creditors"
and, together with the Lender Creditors and the Other Creditors, the "Secured
Creditors") in the future may enter into, a credit arrangement providing for
treasury, depositary or cash management services (including without limitation,
overnight overdraft services) to VHS Holdco II and such Wholly-Owned Domestic
Subsidiaries by the

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Treasury Service Creditors, and automated clearinghouse transfers of funds to
the Treasury Service Creditors, in each case pursuant to uncommitted lines of
credit (collectively, "Treasury Services," and with any written agreement
evidencing such credit arrangements (to the extent expressly stated therein that
the liabilities and indebtedness thereunder are "Obligations" for the purposes
of this Agreement), as amended, modified, supplemented, replaced or refinanced
from time to time, herein called the "Treasury Services Agreement").

      WHEREAS, each Guarantor is a direct or indirect Subsidiary of the
Borrower;

      WHEREAS, it is a condition precedent to (i) the making of Loans to the
Borrowers and the issuance of, and participation in, Letters of Credit for the
account of the Borrowers under the Credit Agreement, (ii) the Other Creditors
entering into Interest Rate Protection Agreements and Other Hedging Agreements
and (iii) the extension of the Treasury Services by Treasury Service Creditors,
that each Guarantor shall have executed and delivered to the Administrative
Agent this Guaranty; and

      WHEREAS, each Guarantor will obtain benefits from the incurrence of Loans
by the Borrowers and the issuance of, and participation in, Letters of Credit
for the account of the Borrowers under the Credit Agreement, the entering into
by each Borrower of Interest Rate Protection Agreements or Other Hedging
Agreements and the extension of Treasury Services to VHS Holdco II and its
Wholly-Owned Domestic Subsidiaries and, accordingly, desires to execute this
Guaranty in order to satisfy the condition described in the preceding paragraph
and to induce the Lenders to make Loans to the Borrowers and issue, and/or
participate in, Letters of Credit for the account of the Borrowers, the Other
Creditors to enter into Interest Rate Protection Agreements or Other Hedging
Agreements with each Borrower and the Treasury Service Creditors to extend
Treasury Services to VHS Holdco II and its Wholly-Owned Domestic Subsidiaries;

      NOW, THEREFORE, in consideration of the foregoing and other benefits
accruing to each Guarantor, the receipt and sufficiency of which are hereby
acknowledged, each Guarantor hereby makes the following representations and
warranties to the Administrative Agent for the benefit of the Secured Creditors
and hereby covenants and agrees with each other Guarantor and the Administrative
Agent for the benefit of the Secured Creditors as follows:

            1.    Each Guarantor, jointly and severally, irrevocably, absolutely
and unconditionally guarantees as a primary obligor and not merely as surety:

            (i)   to the Lender Creditors the full and prompt payment when due
      (whether at the stated maturity, by required prepayment, declaration,
      acceleration, demand or otherwise) of (x) the principal of, premium, if
      any, and interest on the Notes issued by, and the Loans made to, the
      Borrowers under the Credit Agreement, and all reimbursement obligations
      and Unpaid Drawings with respect to Letters of Credit and (y) all other
      obligations (including, without limitation, obligations which, but for the
      automatic stay under Section 362(a) of the Bankruptcy Code, would become
      due), liabilities and indebtedness owing by the Borrowers to the Lender
      Creditors under the Credit Agreement and each other Credit Document to
      which the Borrowers are a party (including, without limitation,
      indemnities, Fees and interest thereon (including, without

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      limitation, any interest accruing after the commencement of any
      bankruptcy, insolvency, receivership or similar proceeding at the rate
      provided for in the respective documentation, whether or not such interest
      is an allowed claim in any such proceeding)), whether now existing or
      hereafter incurred under, arising out of or in connection with the Credit
      Agreement and any such other Credit Document and the due performance and
      compliance by the Borrowers with all of the terms, conditions and
      agreements contained in all such Credit Documents (all such principal,
      premium, interest, liabilities, indebtedness and obligations under this
      clause (i), except to the extent consisting of obligations or liabilities
      with respect to Interest Rate Protection Agreements or Other Hedging
      Agreements, being herein collectively called the "Credit Document
      Obligations");

            (ii)  to each Other Creditor the full and prompt payment when due
      (whether at the stated maturity, by required prepayment, declaration,
      acceleration, demand or otherwise) of all obligations (including, without
      limitation, obligations which, but for the automatic stay under Section
      362(a) of the Bankruptcy Code, would become due), liabilities and
      indebtedness (including, without limitation, any interest accruing after
      the commencement of any bankruptcy, insolvency, receivership or similar
      proceeding at the rate provided for in the respective documentation,
      whether or not such interest is an allowed claim in any such proceeding)
      owing by the Borrowers under any Interest Rate Protection Agreement or
      Other Hedging Agreements, whether now in existence or hereafter arising,
      and the due performance and compliance by the Borrowers with all of the
      terms, conditions and agreements contained therein (all such obligations,
      liabilities and indebtedness being herein collectively called the "Other
      Obligations"); and

            (iii) to each Treasury Service Creditor the full and prompt payment
      when due (whether at the stated maturity, by required prepayment,
      declaration, acceleration, demand or otherwise) of all obligations,
      liabilities and indebtedness (including, without limitation, all interest
      that accrues after the commencement of any case, proceeding or other
      action relating to the bankruptcy, insolvency, reorganization or similar
      proceeding at the rate provided for in the respective documentation,
      whether or not such interest is allowed in any such proceeding) owing by
      VHS Holdco II or any of its Wholly-Owned Domestic Subsidiaries to the
      Treasury Service Creditors with respect to Treasury Services, whether now
      in existence or hereafter arising in each case under any Treasury Services
      Agreement (all such obligations, liabilities and indebtedness described in
      this clause (iii) being herein collectively called the "Treasury Service
      Obligations", and together with the Credit Document Obligations and the
      Other Obligations are herein collectively called the "Guaranteed
      Obligations").

Each Guarantor understands, agrees and confirms that this Guaranty is a
guarantee of payment and not of collection, and that the Secured Creditors may
enforce this Guaranty up to the full amount of the Guaranteed Obligations
against such Guarantor without proceeding against any other Guarantor, either
Borrower, or against any security for the Guaranteed Obligations, or under any
other guaranty covering all or a portion of the Guaranteed Obligations.

            2.    Additionally, each Guarantor, jointly and severally,
unconditionally, absolutely and irrevocably, guarantees the payment of any and
all Guaranteed Obligations of the

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Borrowers to the Secured Creditors whether or not due or payable by the
Borrowers upon the occurrence in respect of either Borrower of any of the events
specified in Section 10.A05 of the Credit Agreement, and unconditionally,
absolutely and irrevocably, jointly and severally, promises to pay such
Guaranteed Obligations to the Secured Creditors, or order, on demand, in lawful
money of the United States.

            3.    The liability of each Guarantor hereunder is primary,
absolute, joint and several, and unconditional and is exclusive and independent
of any security for or other guaranty of the Guaranteed Obligations of the
Borrowers whether executed by such Guarantor, any other Guarantor, any other
guarantor or by any other party, and the liability of each Guarantor hereunder
shall not be affected or impaired by any circumstance or occurrence whatsoever,
including, without limitation: (a) any direction as to application of payment by
either Borrower or by any other party, (b) any other continuing or other
guaranty, undertaking or maximum liability of a Guarantor or of any other party
as to the Guaranteed Obligations of the Borrower, (c) any payment on or in
reduction of any such other guaranty or undertaking, (d) any dissolution,
termination or increase, decrease or change in personnel by either Borrower, (e)
the failure of the Guarantor to receive any benefit from or as a result of its
execution, delivery and performance of this Guaranty, (f) any payment made to
any Secured Creditor on the Guaranteed Obligations which any Secured Creditor
repays either Borrower or any other Guarantor pursuant to court order in any
bankruptcy, reorganization, arrangement, moratorium or other debtor relief
proceeding, and each Guarantor waives any right to the deferral or modification
of its obligations hereunder by reason of any such proceeding, (g) any action or
inaction by the Secured Creditors as contemplated in Section 6 hereof or (h) any
invalidity, rescission, irregularity or unenforceability of all or any part of
the Guaranteed Obligations or of any security therefor.

            4.    The obligations of each Guarantor hereunder are independent of
the obligations of any other Guarantor, any other guarantor or any Borrower, and
a separate action or actions may be brought and prosecuted against each
Guarantor whether or not action is brought against any other Guarantor, any
other guarantor or either Borrower and whether or not any other Guarantor, any
other guarantor or either Borrower be joined in any such action or actions. Each
Guarantor waives (to the fullest extent permitted by applicable law) the
benefits of any statute of limitations affecting its liability hereunder or the
enforcement thereof. Any payment by either Borrower or other circumstance which
operates to toll any statute of limitations as to either Borrower shall, to the
maximum extent permitted by law, operate to toll the statute of limitations as
to each Guarantor.

            5.    Each Guarantor hereby waives (to the fullest extent permitted
by applicable law) notice of acceptance of this Guaranty and notice of any
liability to which it may apply, and waives promptness, diligence, presentment,
demand of payment, protest, notice of dishonor or nonpayment of any such
liabilities, suit or taking of other action by the Administrative Agent or any
other Secured Creditor against, and any other notice to, any party liable
thereon (including such Guarantor, any other Guarantor, any other guarantor, or
any Borrower) and the Guarantor further hereby waives any and all notice of the
creation, renewal, extension or accrual of any of the Guaranteed Obligations and
notice or proof of reliance by any Secured Creditor upon this Guaranty, and the
Guaranteed Obligations shall conclusively be deemed to have been created,
contracted or incurred, or renewed, extended, amended, modified, supplemented or
waived, in reliance upon this Guaranty.

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            6.    Any Secured Creditor may at any time and from time to time
without the consent of, or notice to, any Guarantor, without incurring
responsibility to such Guarantor, without impairing or releasing the obligations
or liabilities of such Guarantor hereunder, upon or without any terms or
conditions and in whole or in part:

            (a)   change the manner, place or terms of payment of, and/or
      change, increase or extend the time of payment of, renew, increase,
      accelerate or alter, any of the Guaranteed Obligations (including, without
      limitation, any increase or decrease in the rate of interest thereon or
      the principal amount thereof), any security therefor, or any liability
      incurred directly or indirectly in respect thereof, and the guaranty
      herein made shall apply to the Guaranteed Obligations as so changed,
      extended, increased, accelerated, renewed or altered;

            (b)   take and hold security for the payment of the Guaranteed
      Obligations and sell, exchange, release, surrender, impair, realize upon
      or otherwise deal with in any manner and in any order any property or
      other collateral by whomsoever at any time pledged or mortgaged to secure,
      or howsoever securing, the Guaranteed Obligations or any liabilities
      (including any of those hereunder) incurred directly or indirectly in
      respect thereof or hereof, and/or any offset thereagainst;

            (c)   exercise or refrain from exercising any rights against either
      Borrower, any other Credit Party, any Subsidiary thereof, any other
      guarantor of either Borrower or others or otherwise act or refrain from
      acting;

            (d)   release or substitute any one or more endorsers, Guarantors,
      other guarantors, either Borrower, or other obligors;

            (e)   settle or compromise any of the Guaranteed Obligations, any
      security therefor or any liability (including any of those hereunder)
      incurred directly or indirectly in respect thereof or hereof, and may
      subordinate the payment of all or any part thereof to the payment of any
      liability (whether due or not) of either Borrower to creditors of either
      Borrower other than the Secured Creditors;

            (f)   apply any sums by whomsoever paid or howsoever realized to any
      liability or liabilities of either Borrower to the Secured Creditors
      regardless of what liabilities of either Borrower remain unpaid;

            (g)   consent to or waive any breach of, or any act, omission or
      default under, any of the Interest Rate Protection Agreements or Other
      Hedging Agreements, the Credit Documents, the Treasury Services Agreement
      or any of the instruments or agreements referred to therein, or otherwise
      amend, modify or supplement any of the Interest Rate Protection Agreements
      or Other Hedging Agreements, the Credit Documents, the Treasury Services
      Agreement or any of such other instruments or agreements;

            (h)   act or fail to act in any manner which may deprive such
      Guarantor of its right to subrogation against either Borrower to recover
      full indemnity for any payments made pursuant to this Guaranty; and/or

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            (i)   take any other action or omit to take any other action which
      would, under otherwise applicable principles of common law, give rise to a
      legal or equitable discharge of such Guarantor from its liabilities under
      this Guaranty (including, without limitation, any action or omission
      whatsoever that might otherwise vary the risk of the Guarantor or
      constitute a legal or equitable defense to or discharge of the liabilities
      of a guarantor or surety or that might otherwise limit recourse against
      the Guarantor).

            7.    No invalidity, illegality, irregularity or unenforceability of
all or any part of the Guaranteed Obligations, the Credit Documents or any other
agreement or instrument relating to the Guaranteed Obligations or of any
security or guarantee therefor shall affect, impair or be a defense to this
Guaranty (other than the defense of payment in full in cash of the Guaranteed
Obligations), and this Guaranty shall be primary, absolute and unconditional
notwithstanding the occurrence of any event or the existence of any other
circumstances which might constitute a legal or equitable discharge of a surety
or guarantor except payment in full in cash of the Guaranteed Obligations.

            8.    This Guaranty is a continuing one and all liabilities to which
it applies or may apply under the terms hereof shall be conclusively presumed to
have been created in reliance hereon. No failure or delay on the part of any
Secured Creditor in exercising any right, power or privilege hereunder shall
operate as a waiver thereof, nor shall any single or partial exercise of any
right, power or privilege hereunder preclude any other or further exercise
thereof or the exercise of any other right, power or privilege. The rights and
remedies herein expressly specified are cumulative and not exclusive of any
rights or remedies which any Secured Creditor would otherwise have. No notice to
or demand on any Guarantor in any case shall entitle such Guarantor to any other
further notice or demand in similar or other circumstances or constitute a
waiver of the rights of any Secured Creditor to any other or further action in
any circumstances without notice or demand. It is not necessary for any Secured
Creditor to inquire into the capacity or powers of either Borrower or any of its
Subsidiaries or the officers, directors, partners or agents acting or purporting
to act on its or their behalf, and any indebtedness made or created in reliance
upon the professed exercise of such powers shall be guaranteed hereunder.

            9.    (a) Each Guarantor waives any right (except as shall be
required by applicable statute or law and cannot be waived) to require the
Secured Creditors to: (i) proceed against any Borrower, any other Guarantor, any
other guarantor of the Guaranteed Obligations or any other party; (ii) proceed
against or exhaust any security held from either Borrower, any other Guarantor,
any other guarantor of the Guaranteed Obligations or any other party; or (iii)
pursue any other remedy in the Secured Creditors' power whatsoever. Each
Guarantor waives any defense (other than a defense of payment) based on or
arising out of any defense of either Borrower, any other Guarantor, any other
guarantor of the Guaranteed Obligations or any other party other than payment in
full of the Guaranteed Obligations, including, without limitation, any defense
based on or arising out of the disability of either Borrower, any other
Guarantor, any other guarantor of the Guaranteed Obligations or any other party,
or the unenforceability of the Guaranteed Obligations or any part thereof from
any cause, or the cessation from any cause of the liability of either Borrower
other than payment in full of the Guaranteed Obligations. The Secured Creditors
may, at their election, foreclose on any collateral serving as security held by
the Administrative Agent, the Collateral Agent or the other Secured Creditors by
one or more judicial or nonjudicial sales, whether or not every aspect of any
such sale is commercially

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reasonable (to the extent such sale is permitted by applicable law), or
exercise any other right or remedy the Secured Creditors may have against either
Borrower or any other party, or any security, without affecting or impairing in
any way the liability of any Guarantor hereunder except to the extent the
Guaranteed Obligations have been paid in full in cash. Each Guarantor waives any
defense arising out of any such election by the Secured Creditors, even though
such election operates to impair or extinguish any right of reimbursement,
contribution, indemnification or subrogation or other right or remedy of such
Guarantor against the Borrower, any other guarantor of the Guaranteed
Obligations or any other party or any security.

            (b)   Each Guarantor waives (except as shall be required by
applicable statute or law and cannot be waived) all presentments, demands for
performance, protests and notices, including, without limitation, notices of
nonperformance, notices of protest, notices of dishonor, notices of acceptance
of this Guaranty, and notices of the existence, creation or incurring of new or
additional indebtedness. Each Guarantor has knowledge and assumes all
responsibility for being and keeping itself informed of each Borrower's, and
each other Guarantor's financial condition, affairs and assets, and of all other
circumstances bearing upon the risk of nonpayment of the Guaranteed Obligations
and the nature, scope and extent of the risks which such Guarantor assumes and
incurs hereunder, and has adequate means to obtain from the Borrowers, and each
other Guarantor on an ongoing basis information relating thereto and each
Borrower's, and each other Guarantor's, ability to pay and perform its
respective Obligations, and agrees to assume the responsibility for keeping, and
to keep, so informed for so long as this Guaranty is in effect. Each Guarantor
acknowledges and agrees that (x) the Secured Creditors shall have no obligation
to investigate the financial condition or affairs of either Borrower, or any
other Guarantor for the benefit of such Guarantor nor to advise such Guarantor
of any fact respecting, or any change in, the financial condition, assets or
affairs of either Borrower, or any other Guarantor that might become known to
any Secured Creditor at any time, whether or not such Secured Creditor knows or
believes or has reason to know or believe that any such fact or change is
unknown to such Guarantor, or might (or does) increase the risk of such
Guarantor as guarantor hereunder, or might (or would) affect the willingness of
such Guarantor to continue as a guarantor of the Obligations hereunder and (y)
the Secured Creditors shall have no duty to advise any Guarantor of information
known to them regarding any of the aforementioned circumstances or risks.

            10.   The Secured Creditors agree (by their acceptance of the
benefits of this Guaranty) that this Guaranty may be enforced only by the action
of the Administrative Agent or the Collateral Agent, in each case acting upon
the instructions of the Required Secured Creditors (as defined in the Security
Agreement) and that no other Secured Creditor shall have any right individually
to seek to enforce or to enforce this Guaranty or to realize upon the security
to be granted by the Security Documents. The Secured Creditors further agree
that this Guaranty may not be enforced against any director, officer, employee,
partner, member or stockholder of any Guarantor (except to the extent such
partner, member or stockholder is also a Guarantor hereunder). It is understood
and agreed that the agreement in this Section 10 is among and solely for the
benefit of the Secured Creditors and that, if the Required Secured Creditors so
agree (without requiring the consent of any Guarantor), this Guaranty may be
directly enforced by any Secured Creditor.

            11.   In order to induce the Lenders to make Loans to, and issue
Letters of Credit for the account of, the Borrowers pursuant to the Credit
Agreement, to induce the Other

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Creditors to execute, deliver and perform the Interest Rate Protection
Agreements and Other Hedging Agreements and to induce the Treasury Service
Creditors to provide Treasury Services, each Guarantor represents, warrants and
covenants that:

            (a)   such Guarantor (i) is a duly organized and validly existing
      corporation, partnership or limited liability company, as the case may be,
      in good standing under the laws of the jurisdiction of its organization or
      formation, (ii) has the corporate, partnership or limited liability
      company power and authority, as the case may be, to own its property and
      assets and to transact the business in which it is engaged and presently
      proposes to engage and (iii) is duly qualified and is authorized to do
      business and, to the extent applicable, is in good standing in each
      jurisdiction where the conduct of its business requires such qualification
      except for failures to be so qualified which, individually or in the
      aggregate, would not reasonably be expected to have a material adverse
      effect on the business, assets, liabilities, operations or condition
      (financial or otherwise) of VHS Holdco I and its Subsidiaries taken as a
      whole;

            (b)   such Guarantor has the corporate, partnership or limited
      liability company power and authority, as the case may be, to execute,
      deliver and perform the terms and provisions of this Guaranty and each
      other Document (such term, for purposes of this Guaranty, to mean each
      Credit Document, each Interest Rate Protection Agreement and Other Hedging
      Agreement with an Other Creditor and each Treasury Services Agreement) to
      which it is a party and has taken all necessary corporate, partnership or
      limited liability company action, as the case may be, to authorize the
      execution, delivery and performance by it of this Guaranty and each such
      other Document.

            (c)   such Guarantor has duly executed and delivered this Guaranty
      and each other Document to which it is a party, and this Guaranty and each
      such other Credit Document constitutes the legal, valid and binding
      obligation of such Guarantor enforceable in accordance with its terms,
      except to the extent that the enforceability hereof or thereof may be
      limited by applicable bankruptcy, insolvency, reorganization, moratorium
      or other similar laws generally affecting creditors' rights and by
      equitable principles (regardless of whether enforcement is sought in
      equity or at law);

            (d)   neither the execution, delivery or performance by such
      Guarantor of this Guaranty or any other Documents to which it is a party,
      nor compliance by it with the terms and provisions thereof, nor the
      consummation of the transactions contemplated therein, (i) will contravene
      any provision of any applicable law, statute, rule or regulation or any
      applicable order, writ, injunction or decree of any court or governmental
      instrumentality, (ii) will conflict with or result in any breach of any of
      the terms, covenants, conditions or provisions of, or constitute a default
      under, any indenture, mortgage, deed of trust, credit agreement or loan
      agreement, or any other material agreement, contract or instrument, to
      which such Guarantors or any of its Subsidiaries is a party or by which it
      or any of its property or assets is bound or to which it may be subject,
      (iii) will violate any provision of the certificate of incorporation or
      by-laws (or equivalent organizational document(s)) of such Guarantor or
      any of its Subsidiaries or (iv) will result in the creation or imposition
      of (or the obligation to create or impose) any Lien (except pursuant to
      the Security Documents) upon any of the properties or assets of

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      such Guarantors or any of its Subsidiaries pursuant to the terms of any
      indenture, mortgage, deed of trust, credit agreement or loan agreement, or
      any other material agreement, contract or instrument, to which such
      Guarantors or any of its Subsidiaries is a party or by which it or any of
      its property or assets is bound or to which it may be subject except in
      the cases of preceding clause (i) through (iii), inclusive, to the extent
      that any such contravention, conflict, breach or violation referred in any
      such clause could not, either individually or in the aggregate, reasonably
      be expected to have a material adverse effect on the business, assets,
      liabilities, operations or condition (financial or otherwise) of VHS
      Holdco I and its Subsidiaries taken as a whole;

            (e)   no order, consent, approval, license, authorization or
      validation of, or filing, recording or registration with (except for (v)
      those filings that have been obtained or made and which remain in full
      force and effect, (w) the filing of UCC-1 financing statements, (x)
      filings with the United States Patent and Trademark Office and the United
      States Copyright Office and comparable offices in foreign jurisdictions
      and equivalent filings in foreign jurisdictions, (y) the recordation of
      the Mortgages and (z) such actions, consents and approvals the failure to
      be obtained or made which could not be reasonably be expected to have a
      material adverse effect on the business, assets, liabilities, operations
      or condition (financial or otherwise) of VHS Holdco I and its Subsidiaries
      taken as a whole), or exemption by, any governmental or public body or
      authority, or any subdivision thereof, is required to authorize, or is
      required in connection with, (i) the execution, delivery and performance
      of this Guaranty by such Guarantor or any other Document to which such
      Guarantor is a party or (ii) the legality, validity, binding effect or
      enforceability of this Guaranty or any other Document to which such
      Guarantor is a party;

            (f)   there are no actions, suits or proceedings (private or
      governmental) pending or, to such Guarantor's knowledge, threatened in
      writing (i) with respect to this Guaranty or any other Credit Documents to
      which such Guarantor is a party, (ii) on and as of the Initial Borrowing
      Date with respect to the Transaction, or (iii) with respect to such
      Guarantor that could reasonably be expected to have a material adverse
      effect on (a) the business, assets, liabilities, operations or condition
      (financial or otherwise) of VHS Holdco I and its Subsidiaries taken as a
      whole.

            12.   Each Guarantor covenants and agrees that on and after the
Effective Date and until the termination of the Total Commitments, all Interest
Rate Protection Agreements or Other Hedging Agreements and all Treasury Services
and the Treasury Services Agreement and until such time as no Note or Letter of
Credit remains outstanding (other than Letters of Credit, together with all
interest and Fees that have accrued and will accrue thereon through the stated
termination date of such Letters of Credit, which have been supported in a
manner satisfactory to the Letter of Credit Issuer in its sole and absolute
discretion) and no further Incremental Term Loan Commitments may be requested or
provided pursuant to the Credit Agreement and all Guaranteed Obligations have
been paid in full (other than indemnities described in Section 14.13 of the
Credit Agreement and analogous provisions in the Security Documents which are
not then due and payable), such Guarantor will comply, and will cause each of
its Subsidiaries to comply, with all of the applicable provisions, covenants and
agreements contained in Sections 8 and 9 of the Credit Agreement, and will take,
or will refrain from taking, as the case may be, all actions

                                       -9-
<PAGE>

that are necessary to be taken or not taken so that no violation of any
provision, covenant or agreement contained in Section 10A of the Credit
Agreement, and so that no Default or Event of Default, is caused by the actions
of such Guarantor or any of its Subsidiaries.

            13.   The Guarantors hereby jointly and severally agree to pay all
reasonable out-of-pocket costs and expenses of the Collateral Agent, the
Administrative Agent and each Secured Creditor in connection with the
enforcement of this Guaranty and the protection of the Secured Creditors' rights
hereunder and any amendment, waiver or consent relating hereto (including, in
each case, without limitation, the reasonable fees and disbursements of counsel
(including in-house counsel) employed by the Collateral Agent, the
Administrative Agent and each Secured Creditor).

            14.   This Guaranty shall be binding upon each Guarantor and its
successors and assigns and shall inure to the benefit of the Secured Creditors
and their successors and assigns.

            15.   Neither this Guaranty nor any provision hereof may be changed,
waived, discharged or terminated except with the written consent of each
Guarantor directly affected thereby (it being understood that the addition or
release of any Guarantor hereunder shall not constitute a change, waiver,
discharge or termination affecting any Guarantor other than the Guarantor so
added or released) and with the written consent of the Required Secured
Creditors; provided, that any change, waiver, modification or variance affecting
the rights and benefits of a single Class (as defined below) of Secured
Creditors (and not all Secured Creditors in a like or similar manner) shall also
require the written consent of the Requisite Creditors (as defined below) of
such Class of Secured Creditors (it being understood that the addition or
release of any Guarantor hereunder shall not constitute a change, waiver,
discharge or termination affecting any Guarantor other than the Guarantor so
added or released). For the purpose of this Guaranty, the term "Class" shall
mean each class of Secured Creditors, i.e., whether (x) the Lender Creditors as
holders of the Credit Document Obligations, (y) the Other Creditors as the
holders of the Other Obligations or (z) the Treasury Service Creditors as
holders of the Treasury Service Obligations. For the purpose of this Guaranty,
the term "Requisite Creditors" of any Class shall mean (x) with respect to the
Credit Document Obligations, the Required Lenders (or, to the extent required by
Section 14.12 of the Credit Agreement, each Lender), (y) with respect to the
Other Obligations, the holders of at least a majority of all obligations
outstanding from time to time under the Interest Rate Protection Agreements and
Other Hedging Agreements and (z) with respect to the Treasury Service
Obligations, the holders of at least a majority of all Treasury Service
Obligations outstanding from time to time.

            16.   Each Guarantor acknowledges that an executed (or conformed)
copy of each of the Credit Documents, Interest Rate Protection Agreements, the
Other Hedging Agreements and the Treasury Service Agreement (if any) has been
made available to its principal executive officers and such officers are
familiar with the contents thereof.

            17.   In addition to any rights now or hereafter granted under
applicable law (including, without limitation, Section 151 of the New York
Debtor and Creditor Law) and not by way of limitation of any such rights, upon
the occurrence and during the continuance of an Event of Default (such term to
mean and include any "Event of Default" as defined in the Credit

                                      -10-
<PAGE>

Agreement and any payment default under any Interest Rate Protection Agreement,
Other Hedging Agreement or Treasury Service Agreement, in each case continuing
after any applicable grace period), each Secured Creditor is hereby authorized,
at any time or from time to time, without notice to any Guarantor or to any
other Person, any such notice being expressly waived, to set off and to
appropriate and apply any and all deposits (general or special) and any other
indebtedness at any time held or owing by such Secured Creditor to or for the
credit or the account of such Guarantor, against and on account of the
obligations and liabilities of such Guarantor to such Secured Creditor under
this Guaranty, irrespective of whether or not such Secured Creditor shall have
made any demand hereunder and although said obligations, liabilities, deposits
or claims, or any of them, shall be contingent or unmatured. Each Secured
Creditor acknowledges and agrees that the provisions set forth in this Section
17 are subject to the sharing provisions set forth in Section 14.06 of the
Credit Agreement.

            18.   Except as otherwise specified herein, all notices, requests,
demands or other communications pursuant hereto shall be deemed to have been
duly given or made when delivered to the Person to which such notice, request,
demand or other communication is required or permitted to be given or made under
this Guaranty, and addressed to such party (i) in the case of any Lender
Creditor, as provided in its Administrative Questionnaire, (ii) in the case of
any Guarantor, c/o Vanguard Health Systems, Inc., at 20 Burton Hills Boulevard,
Suite 100, Nashville, TN 37215, Telephone No.: (615) 665-6000, Facsimile No.:
(615) 665-6099, Attention: Joseph D. Moore, (iii) in the case of any Other
Creditor, at such address as such Other Creditor shall have specified in writing
to the Guarantors and (iv) if to any Treasury Service Creditor, at such address
as such Treasury Service Creditor shall have specified in writing to the
Guarantors; or in any case at such other address as any of the Persons listed
above may hereafter notify the others in writing.

            19.   If any claim is ever made upon any Secured Creditor for
repayment or recovery of any amount or amounts received in payment or on account
of any of the Guaranteed Obligations and any of the aforesaid payees repays all
or part of said amount by reason of (i) any judgment, decree or order of any
court or administrative body having jurisdiction over such payee or any of its
property or (ii) any settlement or compromise of any such claim effected in good
faith by such payee with any such claimant (including either Borrower), then and
in such event each Guarantor agrees that any such judgment, decree, order,
settlement or compromise shall be binding upon such Guarantor, notwithstanding
any revocation hereof or the cancellation of any Note, any Interest Rate
Protection Agreement, any Other Hedging Agreement, any Treasury Service
Agreement or any other instrument evidencing any liability of either Borrower,
and such Guarantor shall be and remain liable to the aforesaid payees hereunder
for the amount so repaid or recovered to the same extent as if such amount had
never originally been received by any such payee.

            20.   (a) THIS GUARANTY AND THE RIGHTS AND OBLIGATIONS OF THE
SECURED CREDITORS AND OF THE UNDERSIGNED HEREUNDER SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE LAW OF THE STATE OF NEW YORK. Any legal action
or proceeding with respect to this Guaranty or any other Credit Document to
which any Guarantor is a party may be brought in the courts of the State of New
York or of the United States of America for the Southern District of New York,
in each case located within the County of New York, and, by execution and
delivery of this Guaranty,

                                      -11-
<PAGE>

each Guarantor hereby irrevocably accepts for itself and in respect of its
property, generally and unconditionally, the jurisdiction of the aforesaid
courts. Each Guarantor hereby further irrevocably waives any claim that any such
courts lack personal jurisdiction over such Guarantor, and agrees not to plead
or claim, in any legal action or proceeding with respect to this Guaranty or any
other Credit Document to which such Guarantor is a party brought in any of the
aforesaid courts, that any such court lacks jurisdiction over such Guarantor.
Each Guarantor further irrevocably consents to the service of process out of any
of the aforementioned courts in any such action or proceeding by the mailing of
copies thereof by registered or certified mail, postage prepaid, to each
Guarantor at its address set forth opposite its signature below, such service to
become effective 30 days after such mailing. Each Guarantor hereby irrevocably
waives any objection to such service of process and further irrevocably waives
and agrees not to plead or claim in any action or proceeding commenced hereunder
or under any other Credit Document to which such Guarantor is a party that such
service of process was in any way invalid or ineffective. Nothing herein shall
affect the right of any of the Secured Creditors to serve process in any other
manner permitted by law or to commence legal proceedings or otherwise proceed
against each Guarantor in any other jurisdiction.

            (b)   Each Guarantor hereby irrevocably waives (to the fullest
extent permitted by applicable law) any objection which it may now or hereafter
have to the laying of venue of any of the aforesaid actions or proceedings
arising out of or in connection with this Guaranty or any other Credit Document
to which such Guarantor is a party brought in the courts referred to in clause
(a) above and hereby further irrevocably waives and agrees not to plead or claim
in any such court that such action or proceeding brought in any such court has
been brought in an inconvenient forum.

            (c)   EACH GUARANTOR AND EACH SECURED CREDITOR (BY ITS ACCEPTANCE OF
THE BENEFITS OF THIS GUARANTY) HEREBY IRREVOCABLY WAIVES ALL RIGHTS TO A TRIAL
BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM ARISING OUT OF OR RELATING TO
THIS GUARANTY, THE OTHER CREDIT DOCUMENTS TO WHICH SUCH GUARANTOR IS A PARTY OR
THE TRANSACTIONS CONTEMPLATED HEREBY OR THEREBY.

            21.   (a) In the event that all of the capital stock or other Equity
Interests of one or more Guarantors is sold or otherwise disposed of or
liquidated (x) at any time prior to the time at which all Credit Document
Obligations have been paid in full and all Commitments and Letters of Credit
under the Credit Agreement have been terminated in connection with a sale or
disposition permitted by Section 9.02 of the Credit Agreement, or is otherwise
released at the direction of the Required Lenders (or all the Lenders if
required by Section 14.12 of the Credit Agreement) or (y) at any time
thereafter, to the extent permitted by the other Secured Debt Agreements (as
defined in the Security Agreement), and in the case of clauses (x) and (y), the
proceeds of such sale, disposition or liquidation are applied in accordance with
the provisions of the Credit Agreement or such other Secured Debt Agreement, as
the case may be, to the extent required to be applied, such Guarantor shall,
upon consummation of such sale or other disposition (except to the extent that
such sale or disposition is to the Borrower or another Subsidiary thereof), be
released from this Guaranty automatically and without further action and this
Guaranty shall, as to each such Guarantor or Guarantors, terminate, and have no
further force or effect (it being understood and agreed that the sale of one or
more Persons that own,

                                      -12-
<PAGE>

directly or indirectly, all of the capital stock or other Equity Interests of
any Guarantor shall be deemed to be a sale of such Guarantor for the purposes of
this Section 21).

            (b)   In addition, one or more Guarantors may be released from the
provisions of this Guaranty in accordance with the express provisions of the
last sentence of Section 9.02 of the Credit Agreement and/or Section 9.13(b) of
the Credit Agreement, and after such release, this Guaranty shall, as to each
such Guarantor or Guarantors, terminate and have no further force or effect.

            (c)   At the time of any release pursuant to preceding clause (a) or
(b), the Borrower shall deliver to the Administrative Agent and the Collateral
Agent a certificate signed by a principal executive officer of the Borrower
stating that the release of the respective Guarantor is permitted pursuant to
Section 21(a) or (b), as the case may be, and setting forth in reasonable detail
compliance with the applicable requirements of the Credit Agreement (including,
without limitation, continued compliance with Section 9.17 of the Credit
Agreement).

            22.   To the extent that any Guarantor shall be required hereunder
to pay a portion of the Guaranteed Obligations which shall exceed the greater of
(i) the amount of the economic benefit actually received by such Guarantor from
the incurrence of the Loans and the issuance of Letters of Credit under the
Credit Agreement, the entering into of Interest Rate Protection Agreements and
Other Hedging Agreements relating to Other Obligations and the incurrence of
Treasury Service Obligations and/or the entering into of any Treasury Service
Agreement in connection therewith and (ii) the amount which such Guarantor would
otherwise have paid if such Guarantor had paid the aggregate amount of the
Guaranteed Obligations (excluding the amount thereof repaid by the Borrowers and
the other Guarantors) in the same proportion as such Guarantor's net worth at
the date enforcement hereunder is sought bears to the aggregate net worth of all
the Guarantors at the date enforcement hereunder is sought (the "Contribution
Percentage"), then such Guarantor shall have a right of contribution against
each other Guarantor who has made payments in respect of the Guaranteed
Obligations in an aggregate amount less than such other Guarantor's Contribution
Percentage of the aggregate payments made to and including the date enforcement
hereunder is sought by all Guarantors in respect of the Guaranteed Obligations;
provided that no Guarantor may take any action to enforce such right until the
Guaranteed Obligations have been paid in full, the Total Commitments, and all
Letters of Credit and all Treasury Services have been terminated and as further
Incremental Term Loan Commitments may be requested or provided pursuant to the
Credit Agreement, it being expressly recognized and agreed by all parties hereto
that any Guarantor's right of contribution arising pursuant to this Section 22
against any other Guarantor shall be expressly junior and subordinate to such
other Guarantor's obligations and liabilities in respect of the Guaranteed
Obligations and any other obligations owing under this Guaranty. All parties
hereto recognize and agree that, except for any right of contribution arising
pursuant to this Section 22, each Guarantor who makes any payment in respect of
the Guaranteed Obligations shall have no right of contribution or subrogation
against any other Guarantor in respect of such payment. Each of the Guarantors
recognizes and acknowledges that the rights to contribution arising hereunder
shall constitute an asset in favor of the party entitled to such contribution.
In this connection, each Guarantor has the right to waive its contribution right
against any Guarantor to the extent that after giving effect to such waiver such
Guarantor would remain solvent, in the determination of the Required Lenders.

                                      -13-
<PAGE>

            23. (A)   EACH GUARANTOR HEREBY ACKNOWLEDGES AND AFFIRMS THAT IT
UNDERSTANDS THAT TO THE EXTENT THE GUARANTEED OBLIGATIONS ARE SECURED BY REAL
PROPERTY LOCATED IN THE STATE OF CALIFORNIA, SUCH GUARANTOR SHALL BE LIABLE FOR
THE FULL AMOUNT OF THE LIABILITY HEREUNDER NOTWITHSTANDING FORECLOSURE ON SUCH
REAL PROPERTY BY TRUSTEE SALE OR ANY OTHER REASON IMPAIRING SUCH GUARANTOR'S,
THE COLLATERAL AGENT'S OR ANY SECURED CREDITORS' RIGHT TO PROCEED AGAINST EITHER
BORROWER OR ANY OTHER GUARANTOR OF THE GUARANTEED OBLIGATIONS.

                  (B)   EACH GUARANTOR HEREBY WAIVES, TO THE FULLEST EXTENT
PERMITTED BY APPLICABLE LAW, ALL RIGHTS AND BENEFITS UNDER SECTIONS 580A, 580B,
580D AND 726 OF THE CALIFORNIA CODE OF CIVIL PROCEDURE. EACH GUARANTOR HEREBY
FURTHER WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, WITHOUT
LIMITING THE GENERALITY OF THE FOREGOING OR ANY OTHER PROVISION HEREOF, ALL
RIGHTS AND BENEFITS WHICH MIGHT OTHERWISE BE AVAILABLE TO SUCH GUARANTOR UNDER
SECTIONS 2809, 2810, 2815, 2819, 2821, 2839, 2845, 2848, 2849, 2850, 2899 AND
3433 OF THE CALIFORNIA CIVIL CODE.

                  (C)   EACH GUARANTOR WAIVES ITS RIGHTS OF SUBROGATION AND
REIMBURSEMENT AND ANY OTHER RIGHTS AND DEFENSES AVAILABLE TO SUCH GUARANTOR BY
REASON OF SECTIONS 2787 TO 2855, INCLUSIVE, OF THE CALIFORNIA CIVIL CODE,
INCLUDING, WITHOUT LIMITATION, (1) ANY DEFENSES SUCH GUARANTOR MAY HAVE TO THIS
GUARANTY BY REASON OF AN ELECTION OF REMEDIES BY THE COLLATERAL AGENT OR THE
SECURED CREDITORS AND (2) ANY RIGHTS OR DEFENSES SUCH GUARANTOR MAY HAVE BY
REASON OF PROTECTION AFFORDED TO EITHER BORROWER PURSUANT TO THE ANTIDEFICIENCY
OR OTHER LAWS OF CALIFORNIA LIMITING OR DISCHARGING EITHER BORROWER'S
INDEBTEDNESS, INCLUDING, WITHOUT LIMITATION, SECTION 580A, 580B, 580D OR 726 OF
THE CALIFORNIA CODE OF CIVIL PROCEDURE. IN FURTHERANCE OF SUCH PROVISIONS, EACH
GUARANTOR HEREBY WAIVES ALL RIGHTS AND DEFENSES ARISING OUT OF AN ELECTION OF
REMEDIES BY THE COLLATERAL AGENT OR THE SECURED CREDITORS, EVEN THOUGH THAT
ELECTION OR REMEDIES, SUCH AS A NONJUDICIAL FORECLOSURE DESTROYS SUCH
GUARANTOR'S RIGHTS OF SUBROGATION AND REIMBURSEMENT AGAINST EITHER BORROWER BY
THE OPERATION OF SECTION 580D OF THE CALIFORNIA CODE OF CIVIL PROCEDURE OR
OTHERWISE.

                  (D)   EACH GUARANTOR WARRANTS AND AGREES THAT EACH OF THE
WAIVERS SET FORTH ABOVE IS MADE WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE AND
CONSEQUENCES AND THAT IF ANY OF SUCH WAIVERS ARE DETERMINED TO BE CONTRARY TO
ANY APPLICABLE LAW OR

                                      -14-
<PAGE>

PUBLIC POLICY, SUCH WAIVERS SHALL BE EFFECTIVE ONLY TO THE MAXIMUM EXTENT
PERMITTED BY LAW.

                  24.   This Guaranty may be executed in any number of
counterparts and by the different parties hereto on separate counterparts, each
of which when so executed and delivered shall be an original, but all of which
shall together constitute one and the same instrument. A set of counterparts
executed by all the parties hereto shall be lodged with each Borrower and the
Administrative Agent.

                  25.   All payments made by any Guarantor hereunder will be
made without setoff, counterclaim or other defense and on the same basis as
payments are made by the Borrowers under Sections 4.03 and 4.04 of the Credit
Agreement.

                  26.   It is understood and agreed that any Subsidiary of the
Borrower that, after the date hereof, desires to become a Guarantor hereunder or
is required to execute a counterpart of this Guaranty after the date hereof
pursuant to the Credit Agreement shall become a Guarantor hereunder by (x)
executing and delivering a counterpart hereof to the Administrative Agent or (y)
executing a Joinder Agreement substantially in the form of Exhibit M to the
Credit Agreement and delivering same to the Administrative Agent, in each case
in form and substance reasonably satisfactory to the Administrative Agent and
(y) taking all actions as specified in this Guaranty as would have been taken by
such Guarantor had it been an original party to this Guaranty, in each case with
all documents and actions required to be taken above to the reasonable
satisfaction of the Administrative Agent.

                  27.   Each Guarantor and each Secured Creditor (by its
acceptance of the benefits of this Guaranty) hereby confirms that it is its
intention that this Guaranty not constitute a fraudulent transfer or conveyance
for purposes of the Bankruptcy Code, the Uniform Fraudulent Conveyance Act of
any similar applicable Federal or state law. To effectuate the foregoing
intention, each Guarantor and each Secured Creditor (by its acceptance of the
benefits of this Guaranty) hereby irrevocably agrees that the Guaranteed
Obligations guaranteed by such Guarantor shall be limited to such amount as
will, after giving effect to such maximum amount and all other (contingent or
otherwise) liabilities of such Guarantor that are relevant under such laws
(excluding any guarantee by such Guarantor of any Existing Senior Subordinated
Notes, any New Senior Subordinated Notes, any Permitted Subordinated Notes or
any Permitted Senior Notes) and after giving effect to any rights to
contribution pursuant to any agreement providing for an equitable contribution
among such Guarantor and the other Guarantors, result in the Guaranteed
Obligations of such Guarantor in respect of such maximum amount not constituting
a fraudulent transfer or conveyance.

                  28.   It is understood and agreed that in order for a Treasury
Service Creditor to receive the benefits of this Guaranty, such Treasury Service
Creditor shall have executed an acknowledgment of the terms and conditions of
this Guaranty and delivered same to the Administrative Agent. It is further
understood and agreed by the parties hereto that the Treasury Services
Obligations are (i) "Senior Indebtedness" for the purposes of the Existing
Senior Subordinated Note Documents, (ii) "Senior Debt" for the purposes of the
New Senior Subordinated Note Documents or (iii) any similar term for the
purposes of any Permitted Senior Subordinated Note Documents.

                                      * * *

                                      -15-
<PAGE>

      IN WITNESS WHEREOF, each Guarantor has caused this Guaranty to be executed
and delivered as of the date first above written.

                               VHS ACQUISITION CORPORATION
                               VHS OF PHOENIX, INC.
                               VHS OUTPATIENT CLINICS, INC.
                               VHS OF ARROWHEAD, INC.
                               VHS OF SOUTH PHOENIX, INC.
                               VHS IMAGING CENTERS, INC.
                               VHS OF ANAHEIM, INC.
                               VHS OF ORANGE COUNTY, INC.
                               VHS HOLDING COMPANY, INC.
                               VHS OF HUNTINGTON BEACH, INC.
                               VHS OF ILLINOIS, INC.
                               MACNEAL HEALTH PROVIDERS, INC.
                               MACNEAL MANAGEMENT SERVICES, INC.
                               MIDWEST CLAIMS PROCESSING, INC.
                               PROS TEMPORARY STAFFING, INC.
                               WATERMARK PHYSICIAN SERVICES,INC.
                               VHS GENESIS LABS, INC.
                               MACNEAL MEDICAL RECORDS, INC.
                               VANGUARD HEALTH MANAGEMENT, INC.
                               VANGUARD HEALTH FINANCIAL COMPANY, INC.
                               VHS ACQUISITION SUBSIDIARY NUMBER 1, INC.
                               VHS ACQUISITION SUBSIDIARY NUMBER 2, INC.
                               VHS ACQUISITION SUBSIDIARY NUMBER 4, INC.
                               VHS ACQUISITION SUBSIDIARY NUMBER 5, INC.
                               VHS ACQUISITION SUBSIDIARY NUMBER 8, INC.
                               HOSPITAL DEVELOPMENT OF WEST PHOENIX,
                               INC., each as a Guarantor

                               By: /s/ Joseph D. Moore
                                   ---------------------------------------------
                                   Title:  Executive Vice President,
                                           Chief Financial Officer and Treasurer

                               Duly authorized to sign on behalf of
                               each of the foregoing entities

<PAGE>

                         THE ANAHEIM VHS LIMITED PARTNERSHIP,
                         as a Guarantor

                         By:  VHS of Anaheim, Inc., its General Partner

                         By: /s/ Joseph D. Moore
                             ---------------------------------------------
                             Title:  Executive Vice President,
                                     Chief Financial Officer and Treasurer

                         THE HUNTINGTON BEACH VHS LIMITED
                         PARTNERSHIP, as a Guarantor

                         By:  VHS of Huntington Beach, Inc., its General Partner

                         By: /s/ Joseph D. Moore
                             ---------------------------------------------
                             Title:  Executive Vice President,
                                     Chief Financial Officer and Treasurer

                         HEALTHCARE COMPLIANCE, L.L.C.,
                         as a Guarantor

                         By:  Vanguard Health Management, Inc., its Member

                         By: /s/ Joseph D. Moore
                             ---------------------------------------------
                             Title:  Executive Vice President,
                                     Chief Financial Officer and Treasurer

                         THE VHS ARIZONA IMAGING CENTERS
                         LIMITED PARTNERSHIP, as a Guarantor

                         By:  VHS Imaging Centers, Inc.,
                              its General Partner

                         By: /s/ Joseph D. Moore
                             ---------------------------------------------
                             Title:  Executive Vice President,
                                     Chief Financial Officer and Treasurer

<PAGE>

                         VHS SAN ANTONIO PARTNERS, L.P.,
                         as a Guarantor

                         By: VHS Acquisition Subsidiary Number 5,
                             Inc., as General Partner

                         By: /s/ Joseph D. Moore
                             ---------------------------------------------
                             Title:  Executive Vice President,
                                     Chief Financial Officer and Treasurer

<PAGE>

Accepted and Agreed to:

BANK OF AMERICA, N.A.,
as Administrative Agent

By: /s/ Kevin Wagley
    ---------------------------------------------
    Title: Principal<PAGE>

                                                                    EXHIBIT 10.5

                                PLEDGE AGREEMENT

            PLEDGE AGREEMENT (as amended, modified restated and/or supplemented
from time to time, this "Agreement"), dated as of September 23, 2004 among each
of the undersigned pledgors (each, a "Pledgor" and, together with any other
entity that becomes a pledgor hereunder pursuant to Section 30 hereof, the
"Pledgors") and Bank of America, N.A., as Collateral Agent (together with any
successor collateral agent, the "Pledgee"), for the benefit of the Secured
Creditors (as defined below). Except as otherwise defined herein, all
capitalized terms used herein and defined in the Credit Agreement (as defined
below) shall be used herein as therein defined.

                              W I T N E S S E T H:

            WHEREAS, Vanguard Health Holding Company I, LLC, Vanguard Health
Holding Company II, LLC ("VHS Holdco II"), Vanguard Holding Company II, Inc.
(the "Co-Borrower" and, together with VHS Holdco II, the "Borrowers" and each, a
"Borrower"), the lenders from time to time party thereto (the "Lenders"), Bank
of America, N.A., as Administrative Agent (together with any successor
Administrative Agent, the "Administrative Agent"), Citicorp North America, Inc.,
as Syndication Agent, General Electric Capital Corporation, LaSalle Bank,
National Association and Wachovia Bank, National Association, as
Co-Documentation Agents and Banc of America Securities LLC and Citigroup Global
Markets Inc., as Joint Lead Arrangers and Book Runners, have entered into a
Credit Agreement, dated as of September 23, 2004 (as amended, modified or
supplemented from time to time, the "Credit Agreement"), providing for the
making of Loans to, and the issuance of and participation in, Letters of Credit
for the account of the Borrowers, all as contemplated therein (the Lenders, each
Issuing Lender, the Administrative Agent, each other Agent and the Pledgee are
herein called the "Lender Creditors");

            WHEREAS, the Borrowers may at any time and from time to time enter
into one or more Interest Rate Protection Agreements or Other Hedging Agreements
with one or more Lenders or any affiliate thereof (each such Lender or
affiliate, even if the respective Lender subsequently ceases to be a Lender
under the Credit Agreement for any reason, together with such Lender's or
affiliate's successors and assigns, if any, collectively, the "Other Creditors,"
and together with the Lender Creditors, the "Secured Creditors");

            WHEREAS, pursuant to the each Guaranty, each Pledgor that is a party
thereto has guaranteed to the Secured Creditors the payment when due of all
Guaranteed Obligations as described in each such Guaranty;

            WHEREAS, VHS Holdco II, one or more Wholly-Owned Domestic
Subsidiaries of VHS Holdco II and any bank (and/or one or more of its banking
affiliates) reasonably acceptable to the Administrative Agent, in each case
designated to the Administrative Agent in writing by VHS Holdco II as a provider
of Treasury Services, (collectively, the "Treasury

<PAGE>

Service Creditors" and, together with the Lender Creditors and the Other
Creditors, the "Secured Creditors") in the future may enter into, a credit
arrangement providing for Treasury Services (with any written agreement
evidencing such credit arrangements (to the extent expressly stated therein that
the liabilities and indebtedness thereunder are "Obligations" for the purposes
of this Agreement), as amended, modified, supplemented, replaced or refinanced
from time to time, herein called the "Treasury Services Agreement");

            WHEREAS, it is a condition precedent to (i) the making of Loans to
the Borrowers, and the issuance of, and participation in, Letters of Credit for
the account of the Borrowers under the Credit Agreement, (ii) the Other
Creditors entering into Interest Rate Protection Agreements and Other Hedging
Agreements and (iii) extension of the Treasury Services by Treasury Service
Creditors, that each Assignor shall have executed and delivered to the
Collateral Agent this Agreement; and

            WHEREAS, each Pledgor will obtain benefits from the incurrence of
Loans by the Borrowers, and the issuance of, and participation in, Letters of
Credit for the account of the Borrowers under the Credit Agreement, the entering
into by each Borrower of Interest Rate Protection Agreements or Other Hedging
Agreements and the extension of Treasury Services to VHS Holdco II and its
Wholly-Owned Domestic Subsidiaries and, accordingly, desires to execute this
Agreement in order to satisfy the condition described in the preceding paragraph
and to induce the Lenders to make Loans to the Borrowers and issue, and/or
participate in, Letters of Credit for the account of the Borrowers, the Other
Creditors to enter into Interest Rate Protection Agreements or Other Hedging
Agreements with each Borrower and the Treasury Service Creditors to extend
Treasury Services to VHS Holdco II and its Wholly-Owned Domestic Subsidiaries;

            NOW, THEREFORE, in consideration of the foregoing and other benefits
accruing to each Pledgor, the receipt and sufficiency of which are hereby
acknowledged, each Pledgor hereby makes the following representations and
warranties to the Pledgee for the benefit of the Secured Creditors and hereby
covenants and agrees with the Pledgee for the benefit of the Secured Creditors
as follows:

            1. SECURITY FOR OBLIGATIONS. This Agreement is made by each Pledgor
for the benefit of the Secured Creditors to secure:

            (i) the full and prompt payment when due (whether at the stated
      maturity, by acceleration or otherwise) of all obligations, liabilities
      and indebtedness (including, without limitation, principal, premium,
      interest, reimbursement obligations under Letters of Credit, fees, costs
      and indemnities (including, without limitation, all interest that accrues
      after the commencement of any case, proceeding or other action relating to
      the bankruptcy, insolvency, reorganization or similar proceeding of any
      Pledgor at the rate provided for in the respective documentation, whether
      or not a claim for post-petition interest is allowed in any such
      proceeding)) of each Pledgor to the Lender Creditors, whether now existing
      or hereafter incurred under, arising out of, or in connection with, the
      Credit Agreement and the other Credit Documents to which such Pledgor is a
      party (including, in the case of each Assignor that is a Guarantor, all
      such obligations, liabilities and indebtedness of such Pledgor under the
      Guaranty to which it is a party) and

                                      -2-
<PAGE>

      the due performance and compliance by such Pledgor with all of the terms,
      conditions and agreements contained in the Credit Agreement and in such
      other Credit Documents (all such obligations, liabilities and indebtedness
      under this clause (i), except to the extent consisting of obligations or
      indebtedness with respect to Interest Rate Protection Agreements or Other
      Hedging Agreements, being herein collectively called the "Credit Document
      Obligations");

            (ii) the full and prompt payment when due (whether at the stated
      maturity, by acceleration or otherwise) of all obligations, liabilities
      and indebtedness (including, without limitation, all interest that accrues
      after the commencement of any case, proceeding or other action relating to
      the bankruptcy, insolvency, reorganization or similar proceeding of any
      Pledgor at the rate provided for in the respective documentation, whether
      or not a claim for post-petition interest is allowed in any such
      proceeding) owing by such Pledgor to the Other Creditors under, or with
      respect to (including, in the case of each Pledgor that is a Guarantor,
      all such obligations, liabilities and indebtedness of such Pledgor under
      the Guaranty to which it is a party), each Interest Rate Protection
      Agreement or Other Hedging Agreement, whether such Interest Rate
      Protection Agreement or Other Hedging Agreement is now in existence or
      hereafter arising, and the due performance and compliance by such Pledgor
      with all of the terms, conditions and agreements contained therein (all
      such obligations, liabilities and indebtedness described in this clause
      (ii) being herein collectively called the "Other Obligations");

            (iii) the full and prompt payment when due (whether at the stated
      maturity, by acceleration or otherwise) of all obligations, liabilities
      and indebtedness (including, without limitation, all interest that accrues
      after the commencement of any case, proceeding or other action relating to
      the bankruptcy, insolvency, reorganization or similar proceeding of any
      Pledgor at the rate provided for in the respective documentation, whether
      or not a claim for post-petition interest is allowed in any such
      proceeding) owing by such Pledgor to the Treasury Service Creditors with
      respect to Treasury Services, whether such Treasury Services are now in
      existence or hereafter arising in each case pursuant to any Treasury
      Services Agreement (all such obligations, liabilities and indebtedness
      described in this clause (iii) being herein collectively called the
      "Treasury Service Obligations");

            (iv) any and all sums advanced by the Pledgee in order to preserve
      the Collateral or preserve its security interest in the Collateral;

            (v) in the event of any proceeding for the collection or enforcement
      of any indebtedness, obligations, or liabilities of such Assignor referred
      to in clauses (i), (ii) and (iii) above, after an Event of Default shall
      have occurred and be continuing, the reasonable expenses of retaking,
      holding, preparing for sale or lease, selling or otherwise disposing of or
      realizing on the Collateral, or of any exercise by the Pledgee of its
      rights hereunder, together with reasonable attorneys' fees and court
      costs;

            (vi) all amounts paid by any Indemnitee as to which such Indemnitee
      has the right to reimbursement under Section 11 of this Agreement; and

                                      -3-
<PAGE>

            (vii) all amounts owing to any Agent pursuant to any of the Credit
      Documents in its capacity as such;

all such obligations, liabilities, indebtedness, sums and expenses set forth in
clauses (i) through (vii) of this Section 1 being herein collectively called the
"Obligations", it being acknowledged and agreed that the "Obligations" shall
include extensions of credit of the types described above, whether outstanding
on the date of this Agreement or extended from time to time after the date of
this Agreement.

            2. DEFINITIONS. (a) Unless otherwise defined herein, all capitalized
terms used herein and defined in the Credit Agreement shall be used herein as
therein defined. Reference to singular terms shall include the plural and vice
versa.

            (b) The following capitalized terms used herein shall have the
definitions specified below:

            "Administrative Agent" has the meaning set forth in the Recitals
hereto.

            "Adverse Claim" has the meaning given such term in Section
8-102(a)(1) of the UCC.

            "Agreement" has the meaning set forth in the first paragraph hereof.

            "Certificated Security" has the meaning given such term in Section
8-102(a)(4) of the UCC.

            "Clearing Corporation" has the meaning given such term in Section
8-102(a)(5) of the UCC.

            "Co-Borrower" has the meaning provided in the Recitals hereto.

            "Collateral" has the meaning set forth in Section 3.1 hereof.

            "Collateral Accounts" means any and all accounts established and
maintained by the Pledgee in the name of any Pledgor to which Collateral may be
credited.

            "Credit Agreement" has the meaning set forth in the Recitals hereto.

            "Credit Document Obligations" has the meaning set forth in Section 1
hereof.

            "Domestic Corporation" has the meaning set forth in the definition
of "Stock."

            "Event of Default" shall mean any Event of Default under, and as
defined in, the Credit Agreement and shall in any event include, without
limitation, any payment default on any of the Obligations after the expiration
of any applicable grace period.

            "Financial Asset" has the meaning given such term in Section
8-102(a)(9) of the UCC.

                                      -4-
<PAGE>

            "Foreign Corporation" has the meaning set forth in the definition of
"Stock."

            "Indemnitees" has the meaning set forth in Section 11 hereof.

            "Instrument" has the meaning given such term in Section 9-102(a)(47)
of the UCC.

            "Investment Property" has the meaning given such term in Section
9-102(a)(49) of the UCC.

            "Lender Creditors" has the meaning set forth in the Recitals hereto.

            "Lenders" has the meaning set forth in the Recitals hereto.

            "Limited Liability Company Assets" means all assets, whether
tangible or intangible and whether real, personal or mixed (including, without
limitation, all limited liability company capital and interest in other limited
liability companies), at any time owned or represented by any Limited Liability
Company Interest.

            "Limited Liability Company Interests" means the entire limited
liability company membership interest at any time owned by any Pledgor in any
limited liability company.

            "Non-Voting Stock" means all Equity Interests which are not Voting
Stock.

            "Notes" means all intercompany notes among the Borrower and its
Subsidiaries and all other promissory notes evidencing Indebtedness equal to or
greater than $1,000,000 from time to time issued to, or held by, any Pledgor.

            "Obligations" has the meaning set forth in Section 1 hereof.

            "Other Creditors" has the meaning set forth in the Recitals hereto.

            "Other Obligations" has the meaning set forth in Section 1(ii)
hereof.

            "Partnership Assets" means all assets, whether tangible or
intangible and whether real, personal or mixed (including, without limitation,
all partnership capital and interest in other partnerships), at any time owned
or represented by any Partnership Interest.

            "Partnership Interest" means the entire general partnership interest
or limited partnership interest at any time owned by any Pledgor in any general
partnership or limited partnership.

            "Pledged Notes" has the meaning set forth in Section 3.5 hereof.

            "Pledgee" has the meaning set forth in the first paragraph hereof.

            "Pledgor" has the meaning set forth in the first paragraph hereof.

            "Proceeds" has the meaning given such term in Section 9-102(a)(64)
of the UCC.

                                      -5-
<PAGE>

            "Required Lenders" has the meaning given such term in the Credit
Agreement.

            "Secured Creditors" has the meaning set forth in the Recitals
hereto.

            "Securities Intermediary" shall have the meaning given such term in
Section 8-102(14) of the UCC.

            "Secured Debt Agreements" shall mean and includes (i) this
Agreement, (ii) the other Credit Documents, (iii) the Interest Rate Protection
Agreements and Other Hedging Agreements entered into with any Other Creditors
and (iv) the Treasury Service Agreement.

            "Securities Act" means the Securities Act of 1933, as amended, as in
effect from time to time.

            "Security" and "Securities" has the meaning given such term in
Section 8-102(a)(15) of the UCC and shall in any event include all Stock and
Notes.

            "Security Entitlement" has the meaning given such term in Section
8-102(a)(17) of the UCC.

            "Stock" means (x) with respect to corporations incorporated under
the laws of the United States or any State or territory thereof (each a
"Domestic Corporation"), all of the issued and outstanding shares of capital
stock of any corporation at any time owned by any Pledgor of any Domestic
Corporation and (y) with respect to corporations not Domestic Corporations (each
a "Foreign Corporation"), all of the issued and outstanding shares of capital
stock at any time owned by any Pledgor of any Foreign Corporation.

            "Termination Date" has the meaning set forth in Section 20 hereof.

            "Treasury Service Agreement" has the meaning set forth in the
Recitals hereto.

            "Treasury Service Creditors" has the meaning set forth in the
Recitals hereto.

            "Treasury Service Obligations" has the meaning set forth in Section
1(iii) hereof.

            "Treasury Services" means treasury, depositary or cash management
services (including, without limitation overnight overdraft services) provided
to VHS Holdco II and its Wholly-Owned Domestic Subsidiaries by the Treasury
Service Creditors, and automated clearinghouse transfers of funds to, the
Treasury Service Creditors, in each case pursuant to uncommitted lines of
credit.

            "UCC" means the Uniform Commercial Code as in effect in the State of
New York from time to time; provided that all references herein to specific
sections or subsections of the UCC are references to such sections or
subsections, as the case may be, of the Uniform Commercial Code as in effect in
the State of New York on the date hereof.

            "Uncertificated Security" has the meaning given such term in Section
8-102(a)(18) of the UCC.

                                      -6-
<PAGE>

            "VHS Holdco II" has the meaning set forth in the Recitals hereto.

            "Voting Stock" means all classes of Equity Interests of any Foreign
Subsidiary entitled to vote.

            3. PLEDGE OF SECURITIES, ETC.

            3.1 Pledge. To secure the Obligations now or hereafter owed or to be
performed by such Pledgor, each Pledgor does hereby grant, pledge and assign to
the Pledgee for the benefit of the Secured Creditors, and does hereby create a
continuing security interest (subject to those Liens permitted to exist with
respect to the Collateral pursuant to the terms of all Secured Debt Agreements
then in effect) in favor of the Pledgee for the benefit of the Secured Creditors
in, all of its right, title and interest in and to the following, whether now
existing or hereafter from time to time acquired (collectively, the
"Collateral"):

            (a) each of the Collateral Accounts (to the extent a security
      interest therein is not created pursuant to the Security Agreement),
      including any and all assets of whatever type or kind deposited by such
      Pledgor in any such Collateral Account, whether now owned or hereafter
      acquired, existing or arising, including, without limitation, all
      Financial Assets, Investment Property, monies, checks, drafts,
      Instruments, Securities or interests therein of any type or nature
      deposited or required by the Credit Agreement or any other Secured Debt
      Agreement to be deposited in such Collateral Account, and all investments
      and all certificates and other Instruments (including depository receipts,
      if any) from time to time representing or evidencing the same, and all
      dividends, interest, distributions, cash and other property from time to
      time received, receivable or otherwise distributed in respect of or in
      exchange for any or all of the foregoing;

            (b) all Securities owned or held by such Pledgor from time to time
      and all options and warrants owned by such Pledgor from time to time to
      purchase Securities;

            (c) all Limited Liability Company Interests owned by such Pledgor
      from time to time and all of its right, title and interest in each limited
      liability company to which each such Limited Liability Company Interest
      relates, whether now existing or hereafter acquired, including, without
      limitation, to the fullest extent permitted under the terms and provisions
      of the documents and agreements governing such Limited Liability Company
      Interests and applicable law:

                  (A) all the capital thereof and its interest in all profits,
            losses, Limited Liability Company Assets and other distributions to
            which such Pledgor shall at any time be entitled in respect of such
            Limited Liability Company Interests;

                  (B) all other payments due or to become due to such Pledgor in
            respect of Limited Liability Company Interests, whether under any
            limited liability company agreement, operating agreement or
            otherwise, whether as contractual obligations, damages, insurance
            proceeds or otherwise;

                  (C) all of its claims, rights, powers, privileges, authority,
            options, security interests, liens and remedies, if any, under any
            limited liability company

                                      -7-
<PAGE>

            agreement or operating agreement, or at law or otherwise in respect
            of such Limited Liability Company Interests;

                  (D) all present and future claims, if any, of such Pledgor
            against any such limited liability company for moneys loaned or
            advanced, for services rendered or otherwise;

                  (E) all of such Pledgor's rights under any limited liability
            company agreement or operating agreement or at law to exercise and
            enforce every right, power, remedy, authority, option and privilege
            of such Pledgor relating to such Limited Liability Company
            Interests, including any power to terminate, cancel or modify any
            limited liability company agreement or operating agreement, to
            execute any instruments and to take any and all other action on
            behalf of and in the name of any of such Pledgor in respect of such
            Limited Liability Company Interests and any such limited liability
            company, to make determinations, to exercise any election
            (including, but not limited to, election of remedies) or option or
            to give or receive any notice, consent, amendment, waiver or
            approval, together with full power and authority to demand, receive,
            enforce, collect or receipt for any of the foregoing or for any
            Limited Liability Company Asset, to enforce or execute any checks,
            or other instruments or orders, to file any claims and to take any
            action in connection with any of the foregoing (with all of the
            foregoing rights only to be exercisable upon the occurrence and
            during the continuation of an Event of Default); and

                  (F) all other property hereafter delivered in substitution for
            or in addition to any of the foregoing, all certificates and
            instruments representing or evidencing such other property and all
            cash, securities, interest, dividends, rights and other property at
            any time and from time to time received, receivable or otherwise
            distributed in respect of or in exchange for any or all thereof;

            (d) all Partnership Interests owned by such Pledgor from time to
      time and all of its right, title and interest in each partnership to which
      each such Partnership Interest relates, whether now existing or hereafter
      acquired, including, without limitation, to the fullest extent permitted
      under the terms and provisions of the documents and agreements governing
      such Partnership Interests and applicable law:

                  (A) all the capital thereof and its interest in all profits,
            losses, Partnership Assets and other distributions to which such
            Pledgor shall at any time be entitled in respect of such Partnership
            Interests;

                  (B) all other payments due or to become due to such Pledgor in
            respect of Partnership Interests, whether under any partnership
            agreement, operating agreement or otherwise, whether as contractual
            obligations, damages, insurance proceeds or otherwise;

                  (C) all of its claims, rights, powers, privileges, authority,
            options, security interests, liens and remedies, if any, under any
            partnership agreement or

                                      -8-
<PAGE>

            operating agreement, or at law or otherwise in respect of such
            Partnership Interests;

                  (D) all present and future claims, if any, of such Pledgor
            against any such partnership for moneys loaned or advanced, for
            services rendered or otherwise;

                  (E) all of such Pledgor's rights under any partnership
            agreement or operating agreement or at law to exercise and enforce
            every right, power, remedy, authority, option and privilege of such
            Pledgor relating to such Partnership Interests, including any power
            to terminate, cancel or modify any partnership agreement or
            operating agreement, to execute any instruments and to take any and
            all other action on behalf of and in the name of any of such Pledgor
            in respect of such Partnership Interests and any such partnership,
            to make determinations, to exercise any election (including, but not
            limited to, election of remedies) or option or to give or receive
            any notice, consent, amendment, waiver or approval, together with
            full power and authority to demand, receive, enforce, collect or
            receipt for any of the foregoing or for any Partnership Asset, to
            enforce or execute any checks, or other instruments or orders, to
            file any claims and to take any action in connection with any of the
            foregoing (with all of the foregoing rights only to be exercisable
            upon the occurrence and during the continuation of an Event of
            Default); and

                  (F) all other property hereafter delivered in substitution for
            or in addition to any of the foregoing, all certificates and
            instruments representing or evidencing such other property and all
            cash, securities, interest, dividends, rights and other property at
            any time and from time to time received, receivable or otherwise
            distributed in respect of or in exchange for any or all thereof;

            (e) all Security Entitlements of such Pledgor from time to time in
      any and all of the foregoing;

            (f) all Financial Assets and Investment Property of such Pledgor
      from time to time; and

            (g) all Proceeds of any and all of the foregoing.

      Notwithstanding anything to the contrary contained in this Section 3.1,
(w) Vanguard Health Management, Inc. shall not be required to pledge any Equity
Interests in Healthcare Airplane Group LLC; provided that (i) Healthcare
Airplane Group LLC shall be dissolved on or prior to December 31, 2004 or such
later date as the Collateral Agent may agree in its sole discretion and (ii) if
Healthcare Airplane Group LLC is not dissolved prior to such time, such Equity
Interests shall be pledged hereunder pursuant to the provisions hereof, (x) no
Pledgor shall be required to pledge any equity interests in any Health Care
Joint Venture acquired in accordance with Section 9.15 of the Credit Agreement
if the equity interests of such Health Care Joint Venture owned by all Pledgors
has an aggregate investment cost of less than $2,000,000, (y) the pledge
hereunder of the Equity Interests of any Foreign Subsidiary by a Pledgor (to the

                                      -9-
<PAGE>

extent that such Pledgor is not a Foreign Subsidiary) shall be limited solely to
no more than 65% of the Voting Stock and 100% of the Non-Voting Stock of such
Pledgor's "first tier" Foreign Subsidiaries and (z) the equity interests of such
Pledgor in The 6300 West Roosevelt Partnership and South Texas MRI Ltd. shall
not be required to be pledged hereunder so long as the requisite consents to
allow such pledge have not been obtained; provided that (i) the Pledgors agree
to use their commercially reasonable efforts to obtain such consents and (ii) if
any such consent is obtained, the Equity Interests of the entity for which such
consent has been obtained shall be pledged hereunder pursuant to the provisions
hereof.

            3.2. Procedures. (a) To the extent that any Pledgor at any time or
from time to time owns, acquires or obtains any right, title or interest in any
Collateral, such Collateral shall automatically (and without the taking of any
action by the respective Pledgor) be pledged pursuant to Section 3.1 of this
Agreement and, in addition thereto, such Pledgor shall (to the extent provided
below) take the following actions as set forth below (as promptly as practicable
and, in any event, within 10 days after it obtains such Collateral) for the
benefit of the Pledgee and the Secured Creditors:

            (i) with respect to a Certificated Security (other than a
      Certificated Security credited on the books of a Clearing Corporation or
      Securities Intermediary) such Pledgor shall physically deliver such
      Certificated Security to the Pledgee, endorsed to the Pledgee or endorsed
      in blank;

            (ii) with respect to an Uncertificated Security (other than an
      Uncertificated Security credited on the books of a Clearing Corporation or
      Securities Intermediary) such or Securities Intermediary), such Pledgor
      shall cause (or, in the case of an Uncertificated Security issued by a
      Person which is not a Subsidiary of such Pledgor, shall use its reasonable
      best efforts to cause) the issuer of such Uncertificated Security to duly
      authorize and execute, and deliver to the Pledgee, an agreement for the
      benefit of the Pledgee and the Secured Creditors substantially in the form
      of Annex H hereto (appropriately completed to the satisfaction of the
      Pledgee and with such modifications, if any, as shall be satisfactory to
      the Pledgee) pursuant to which such issuer agrees to comply with any and
      all instructions originated by the Pledgee without further consent by the
      registered owner and not to comply with instructions regarding such
      Uncertificated Security (and any Partnership Interests and Limited
      Liability Company Interests issued by such issuer) originated by any other
      Person other than a court of competent jurisdiction;

            (iii) with respect to a Partnership Interest or a Limited Liability
      Company Interest (other than a Partnership Interest or Limited Liability
      Interest credited on the books of a Clearing Corporation or Securities
      Intermediary), (1) if such Partnership Interest or Limited Liability
      Company Interest is represented by a certificate and is a Security for the
      purposes of the UCC, the procedure set forth in Section 3.2(a)(i) hereof,
      and (2) if such Partnership Interest or Limited Liability Company Interest
      is not represented by a certificate and is not a Security for the purposes
      of the UCC, the procedure set forth in Section 3.2(a)(ii) hereof; and

                                      -10-
<PAGE>

            (iv) with respect to any Note, physical delivery of such Note to the
      Pledgee, endorsed to the Pledgee or endorsed in blank.

            (b) In addition to the actions required to be taken pursuant to
Section 3.2(a) hereof, each Pledgor shall take the following additional actions
with respect to the Securities and Collateral:

            (i) with respect to all Collateral of such Pledgor whereby or with
      respect to which the Pledgee may obtain "control" thereof within the
      meaning of Section 8-106 of the UCC (or under any provision of the UCC as
      same may be amended or supplemented from time to time, or under the laws
      of any relevant State other than the State of New York), the respective
      Pledgor shall take all actions as may be reasonably requested from time to
      time by the Pledgee so that "control" of such Collateral is obtained (to
      the greatest extent feasible in the case of any Collateral constituting a
      partnership or membership interest in any Person which is not a Subsidiary
      of any Pledgor) and at all times held by the Pledgee, provided that no
      Pledgor shall be required to obtain a "control agreement" with a
      Securities Intermediary or a Clearing Corporation; and

            (ii) each Pledgor shall from time to time cause appropriate
      financing statements (on Form UCC-1 or other appropriate form) under the
      Uniform Commercial Code as in effect in the various relevant States,
      covering all Collateral hereunder (with the form of such financing
      statements to be satisfactory to the Pledgee), to be filed in the relevant
      filing offices so that at all times the Pledgee has a security interest in
      all Investment Property and other Collateral which is perfected by the
      filing of such financing statements (in each case to the maximum extent
      perfection by filing may be obtained under the laws of the relevant
      States, including, without limitation, Section 9-312(a) of the UCC).

            3.3 Subsequently Acquired Collateral. If any Pledgor shall acquire
(by purchase, stock dividend, distribution or otherwise) any additional
Collateral at any time or from time to time after the date hereof, such
Collateral shall automatically (and without any further action being required to
be taken) be subject to the pledge and security interests created pursuant to
Section 3.1 hereof and, furthermore, such Pledgor will thereafter take (or cause
to be taken) all action (as promptly as practicable and, in any event, within 15
Business Days after it obtains such Collateral) with respect to such Collateral
in accordance with the procedures set forth in Section 3.2 hereof, and will
promptly thereafter deliver to the Pledgee (i) a certificate executed by an
authorized officer of such Pledgor describing such Collateral and certifying
that the same has been duly pledged in favor of the Pledgee (for the benefit of
the Secured Creditors) hereunder and (ii) supplements to Annexes A through G
hereto as are necessary to cause such Annexes to be complete and accurate at
such time. Without limiting the foregoing, each Pledgor shall be required to
pledge hereunder any shares of stock at any time and from time to time after the
date hereof acquired by such Pledgor of any Foreign Subsidiary, provided that
(x) no Pledgor shall be required to pledge any equity interests in any Health
Care Joint Venture acquired in accordance with Section 9.15 of the Credit
Agreement if the equity interests of such Health Care Joint Venture owned by all
Pledgors has an aggregate investment cost of less than $2,000,000 and (y) the
pledge hereunder of the Equity Interests of any Foreign Subsidiary by a Pledgor
(to the extent that such Pledgor is not a Foreign Subsidiary) shall be limited
solely to no more than

                                      -11-
<PAGE>

65% of the Voting Stock and 100% of the Non-Voting Stock of such Pledgor's
"first tier" Foreign Subsidiaries.

            3.4 Transfer Taxes. Each pledge of Collateral under Section 3.1 or
Section 3.3 hereof shall be accompanied by any transfer tax stamps required in
connection with the pledge of such Collateral.

            3.5 Definition of Pledged Notes. All Notes at any time pledged or
required to be pledged hereunder are hereinafter called the "Pledged Notes."

            3.6 Certain Representations and Warranties Regarding the Collateral.
Each Pledgor represents and warrants that on the date hereof: (i) each
Subsidiary of such Pledgor, and the direct ownership thereof, is listed in Annex
B hereto; (ii) the Stock (and any warrants or options to purchase Stock) held by
such Pledgor consists of the number and type of shares of the stock (or warrants
or options to purchase any stock) of the corporations as described in Annex C
hereto; (iii) such Stock referenced in clause (ii) of this paragraph constitutes
that percentage of the issued and outstanding capital stock of the issuing
corporation as is set forth in Annex C hereto; (iv) the Notes held by such
Pledgor consist of the promissory notes described in Annex D hereto where such
Pledgor is listed as the lender; (v) the Limited Liability Company Interests
held by such Pledgor consist of the number and type of interests of the Persons
described in Annex E hereto; (vi) each such Limited Liability Company Interest
referenced in clause (v) of this paragraph constitutes that percentage of the
issued and outstanding equity interest of the issuing Person as set forth in
Annex E hereto; (vii) the Partnership Interests held by such Pledgor consist of
the number and type of interests of the Persons described in Annex F hereto;
(viii) each such Partnership Interest referenced in clause (vii) of this
paragraph constitutes that percentage or portion of the entire partnership
interest of the Partnership as set forth in Annex F hereto; (ix) the address of
each chief executive office of such Pledgor is listed on Annex G hereto; (x) the
Pledgor has complied with the respective procedure set forth in Section 3.2(a)
hereof with respect to each item of Collateral described in Annexes C through F
hereto; and (xi) on the date hereof, such Pledgor owns no other Securities,
Stock, Notes, Limited Liability Company Interests or Partnership Interests.

            4. APPOINTMENT OF SUB-AGENTS; ENDORSEMENTS, ETC. The Pledgee shall
have the right to appoint one or more sub-agents for the purpose of retaining
physical possession of the Collateral, which may be held (in the discretion of
the Pledgee) in the name of the relevant Pledgor, endorsed or assigned in blank
or in favor of the Pledgee or any nominee or nominees of the Pledgee or a
sub-agent appointed by the Pledgee.

            5. VOTING, ETC., WHILE NO EVENT OF DEFAULT. Unless and until there
shall have occurred and be continuing any Event of Default, each Pledgor shall
be entitled to exercise any and all voting and other consensual rights
pertaining to the Collateral owned by it, and to give consents, waivers or
ratifications in respect thereof; provided that, in each case, no vote shall be
cast or any consent, waiver or ratification given or any action taken or omitted
to be taken which would violate or result in a breach of any covenant contained
in any Secured Debt Agreement, or which would have the effect of impairing in
any material respect the value of the Collateral or any part thereof or the
position or interests of the Pledgee or any other Secured Creditor in the
Collateral, unless expressly permitted by the terms of the Secured Debt

                                      -12-
<PAGE>

Agreements. All such rights of each Pledgor to vote and to give consents,
waivers and ratifications shall cease in case an Event of Default has occurred
and is continuing, and Section 7 hereof shall become applicable.

            6. DIVIDENDS AND OTHER DISTRIBUTIONS. Unless and until there shall
have occurred and be continuing an Event of Default, all cash dividends, cash
distributions, cash Proceeds and other cash amounts payable in respect of the
Collateral shall be paid to the respective Pledgor. The Pledgee shall be
entitled to receive directly, and to retain as part of the Collateral:

            (i) all other or additional stock, notes, certificates, limited
      liability company interests, partnership interests, instruments or other
      securities or property paid or distributed by way of dividend or otherwise
      in respect of the Collateral (except for cash dividends, unless an Event
      of Default is continuing at the time of payment thereof);

            (ii) all other or additional stock, notes, certificates, limited
      liability company interests, partnership interests, instruments or other
      securities or property paid or distributed in respect of the Collateral by
      way of stock-split, spin-off, split-up, reclassification, combination of
      shares or similar rearrangement (except for cash dividends, unless an
      Event of Default is continuing at the time of payment thereof); and

            (iii) all other or additional stock, notes, certificates, limited
      liability company interests, partnership interests, instruments or other
      securities or property which may be paid in respect of the Collateral by
      reason of any consolidation, merger, exchange of stock, conveyance of
      assets, liquidation or similar corporate reorganization (except for cash
      dividends, unless an Event of Default is continuing at the time of payment
      thereof).

Nothing contained in this Section 6 shall limit or restrict in any way the
Pledgee's right to receive proceeds of the Collateral in any form in accordance
with Section 3 of this Agreement. All dividends, distributions or other payments
which are received by any Pledgor contrary to the provisions of this Section 6
or Section 7 hereof shall be received in trust for the benefit of the Pledgee,
shall be segregated from other property or funds of such Pledgor and shall be
forthwith paid over to the Pledgee as Collateral in the same form as so received
(with any necessary endorsement).

            7. REMEDIES IN CASE OF AN EVENT OF DEFAULT. If there shall have
occurred and be continuing an Event of Default, then and in every such case, the
Pledgee shall be entitled to exercise all of the rights, powers and remedies
(whether vested in it by this Agreement, any other Secured Debt Agreement or by
law) for the protection and enforcement of its rights in respect of the
Collateral, and the Pledgee shall be entitled to exercise all the rights and
remedies of a secured party under the UCC as in effect in any relevant
jurisdiction and also shall be entitled, without limitation, to exercise the
following rights, which each Pledgor hereby agrees to be commercially
reasonable:

            (i) to receive all amounts payable in respect of the Collateral
      otherwise payable under Section 6 hereof to the respective Pledgor;

                                      -13-
<PAGE>

            (ii) to transfer all or any part of the Collateral into the
      Pledgee's name or the name of its nominee or nominees;

            (iii) to accelerate any Pledged Note which may be accelerated in
      accordance with its terms, and take any other lawful action to collect
      upon any Pledged Note (including, without limitation, to make any demand
      for payment thereon);

            (iv) to vote (and exercise all rights and powers in respect of
      voting) all or any part of the Collateral (whether or not transferred into
      the name of the Pledgee) and give all consents, waivers and ratifications
      in respect of the Collateral and otherwise act with respect thereto as
      though it were the outright owner thereof (each Pledgor hereby irrevocably
      constituting and appointing the Pledgee the proxy and attorney-in-fact of
      such Pledgor, with full power of substitution to do so);

            (v) at any time and from time to time to sell, assign and deliver,
      or grant options to purchase, all or any part of the Collateral, or any
      interest therein, at any public or private sale, without demand of
      performance, advertisement, or notice of intention to sell or of the time
      or place of sale or adjournment thereof or to redeem or otherwise purchase
      or dispose (all of which are hereby waived by each Pledgor), for cash, on
      credit or for other property, for immediate or future delivery without any
      assumption of credit risk, and for such price or prices and on such terms
      as the Pledgee in its absolute discretion may determine, provided at least
      10 days' written notice of the time and place of any such sale shall be
      given to the respective Pledgor. The Pledgee shall not be obligated to
      consummate any such sale of Collateral regardless of whether any such
      notice of sale has theretofore been given. Each Pledgor hereby waives and
      releases to the fullest extent permitted by law any right or equity of
      redemption with respect to the Collateral, whether before or after sale
      hereunder, and all rights, if any, of marshalling the Collateral and any
      other security or the Obligations or otherwise. At any such sale, unless
      prohibited by applicable law, the Pledgee on behalf of the Secured
      Creditors may bid for and purchase all or any part of the Collateral so
      sold free from any such right or equity of redemption. Neither the Pledgee
      nor any other Secured Creditor shall be liable for failure to collect or
      realize upon any or all of the Collateral or for any delay in so doing nor
      shall any of them be under any obligation to take any action whatsoever
      with regard thereto; and

            (vi) to set-off any and all Collateral against any and all
      Obligations, and to withdraw any and all cash or other Collateral from any
      and all Collateral Accounts and to apply such cash and other Collateral to
      the payment of any and all Obligations.

            8. REMEDIES, ETC., CUMULATIVE. Each and every right, power and
remedy of the Pledgee provided for in this Agreement or in any other Secured
Debt Agreement, or now or hereafter existing at law or in equity or by statute
shall be cumulative and concurrent and shall be in addition to every other such
right, power or remedy. The exercise or beginning of the exercise by the Pledgee
or any other Secured Creditor of any one or more of the rights, powers or
remedies provided for in this Agreement or any other Secured Debt Agreement or
now or hereafter existing at law or in equity or by statute or otherwise shall
not preclude the simultaneous or later exercise by the Pledgee or any other
Secured Creditor of all such other rights, powers or remedies, and no failure or
delay on the part of the Pledgee or any other Secured Creditor to

                                      -14-
<PAGE>

exercise any such right, power or remedy shall operate as a waiver thereof. No
notice to or demand on any Pledgor in any case shall entitle it to any other or
further notice or demand in similar or other circumstances or constitute a
waiver of any of the rights of the Pledgee or any other Secured Creditor to any
other or further action in any circumstances without notice or demand. The
Secured Creditors agree that this Agreement may be enforced only by the action
of the Pledgee, in each case, acting upon the instructions of the Required
Secured Creditors, and that no other Secured Creditor shall have any right
individually to seek to enforce or to enforce this Agreement or to realize upon
the security to be granted hereby, it being understood and agreed that such
rights and remedies may be exercised by the Pledgee for the benefit of the
Secured Creditors upon the terms of this Agreement and the Security Agreement.

            9. APPLICATION OF PROCEEDS. (1) All monies collected by the Pledgee
upon any sale or other disposition of the Collateral pursuant to the terms of
this Agreement, together with all other monies received by the Pledgee
hereunder, shall be applied in the manner provided in the Security Agreement.

            (b) It is understood and agreed that each Pledgor shall remain
jointly and severally liable with respect to its Obligations to the extent of
any deficiency between the amount of the proceeds of the Collateral pledged by
it hereunder and the aggregate amount of such Obligations.

            10. PURCHASERS OF COLLATERAL. Upon any sale of the Collateral by the
Pledgee hereunder (whether by virtue of the power of sale herein granted,
pursuant to judicial process or otherwise), the receipt of the Pledgee or the
officer making such sale shall be a sufficient discharge to the purchaser or
purchasers of the Collateral so sold, and such purchaser or purchasers shall not
be obligated to see to the application of any part of the purchase money paid
over to the Pledgee or such officer or be answerable in any way for the
misapplication or nonapplication thereof.

            11. INDEMNITY. Each Pledgor jointly and severally agrees (i) to
indemnify and hold harmless the Pledgee in such capacity and each other Secured
Creditor and their respective successors, assigns, employees, agents, affiliates
and servants (individually an "Indemnitee," and collectively the "Indemnitees")
from and against any and all claims, demands, losses, judgments and liabilities
(including liabilities for penalties) of whatsoever kind or nature, and (ii) to
reimburse each Indemnitee for all costs and expenses, including reasonable
attorneys' fees, in each case growing out of or resulting from this Agreement or
the exercise by any Indemnitee of any right or remedy granted to it hereunder or
under any other Secured Debt Agreement (but excluding any claims, demands,
losses, judgments and liabilities or expenses to the extent incurred by reason
of gross negligence or willful misconduct of such Indemnitee as determined by a
non-appealable decision by a court of competent jurisdiction). In no event shall
the Pledgee be liable, in the absence of gross negligence or willful misconduct
on its part, for any matter or thing in connection with this Agreement other
than to account for monies actually received by it in accordance with the terms
hereof. If and to the extent that the obligations of any Pledgor under this
Section 11 are unenforceable for any reason, such Pledgor hereby agrees to make
the maximum contribution to the payment and satisfaction of such obligations
which is permissible under applicable law. The indemnity obligations of each
Pledgor contained in this Section 11 shall continue in full force and effect
notwithstanding the full payment of all the

                                      -15-
<PAGE>

Notes issued under the Credit Agreement, the termination of all Interest Rate
Protection Agreements and Other Hedging Agreements and Letters of Credit, the
termination of all Treasury Services and repayment of all Treasury Service
Obligations, and the payment of all other Obligations and notwithstanding the
discharge thereof.

            12. PLEDGEE NOT A PARTNER OR LIMITED LIABILITY COMPANY MEMBER. (a)
Nothing herein shall be construed to make the Pledgee or any other Secured
Creditor liable as a member of any limited liability company or as a partner of
any partnership and neither the Pledgee nor any other Secured Creditor by virtue
of this Agreement or otherwise (except as referred to in the following sentence)
shall have any of the duties, obligations or liabilities of a member of any
limited liability company or of a partner of any partnership. The parties hereto
expressly agree that, unless the Pledgee shall become the absolute owner of
Collateral consisting of a Limited Liability Company Interest or Partnership
Interest pursuant hereto, this Agreement shall not be construed as creating a
partnership or joint venture among the Pledgee, any other Secured Creditor, and
Pledgor and/or any other Person.

            (b) Except as provided in the last sentence of paragraph (a) of this
Section 12, the Pledgee, by accepting this Agreement, did not intend to become a
member of any limited liability company or a partner of any partnership or
otherwise be deemed to be a co-venturer with respect to any Pledgor, any limited
liability company, partnership and/or any other Person either before or after an
Event of Default shall have occurred. The Pledgee shall have only those powers
set forth herein and the Secured Creditors shall assume none of the duties,
obligations or liabilities of a member of any limited liability company or as a
partner of any partnership or any Pledgor except as provided in the last
sentence of paragraph (a) of this Section 12.

            (c) The Pledgee and the other Secured Creditors shall not be
obligated to perform or discharge any obligation of any Pledgor as a result of
the pledge hereby effected.

            (d) The acceptance by the Pledgee of this Agreement, with all the
rights, powers, privileges and authority so created, shall not at any time or in
any event obligate the Pledgee or any other Secured Creditor to appear in or
defend any action or proceeding relating to the Collateral to which it is not a
party, or to take any action hereunder or thereunder, or to expend any money or
incur any expenses or perform or discharge any obligation, duty or liability
under the Collateral.

            13. FURTHER ASSURANCES; POWER-OF-ATTORNEY. (a) Each Pledgor agrees
that it will join with the Pledgee in authenticating and, at such Pledgor's own
expense, file and refile under the UCC or other applicable law such financing
statements, continuation statements and other documents, in form reasonably
acceptable to the Pledgee, in such offices as the Pledgee (acting on its own or
on the instructions of the Required Secured Creditors) may reasonably deem
necessary or advisable and wherever required or permitted by law in order to
perfect and preserve the Pledgee's security interest in the Collateral hereunder
and hereby authorizes the Pledgee to file financing statements and amendments
thereto relative to all or any part of the Collateral (including, without
limitation, (x) financing statements which list the Collateral specifically
and/or "all assets" as collateral and (y) "in lieu of" financing statements)
without the signature of such Pledgor where permitted by law, and agrees to do
such further acts and things and to execute and deliver to the Pledgee such
additional conveyances, assignments,

                                      -16-
<PAGE>

agreements and instruments as the Pledgee may reasonably require or deem
advisable to carry into effect the purposes of this Agreement or to further
assure and confirm unto the Pledgee its rights, powers and remedies hereunder or
thereunder.

            (b) Each Pledgor hereby constitutes and appoints the Pledgee its
true and lawful attorney-in-fact, irrevocably, with full authority in the place
and stead of such Pledgor and in the name of such Pledgor or otherwise, from
time to time after the occurrence and during the continuance of an Event of
Default, in the Pledgee's reasonable discretion, to act, require, demand,
receive and give acquittance for any and all monies and claims for monies due or
to become due to such Pledgor under or arising out of the Collateral, to endorse
any checks or other instruments or orders in connection therewith and to file
any claims or take any action or institute any proceedings and to execute any
instrument which the Pledgee may deem necessary or advisable to accomplish the
purposes of this Agreement, which appointment as attorney is coupled with an
interest.

            14. THE PLEDGEE AS COLLATERAL AGENT. The Pledgee will hold in
accordance with this Agreement all items of the Collateral at any time received
under this Agreement. It is expressly understood, acknowledged and agreed by
each Secured Creditor that by accepting the benefits of this Agreement each such
Secured Creditor acknowledges and agrees that the obligations of the Pledgee as
holder of the Collateral and interests therein and with respect to the
disposition thereof, and otherwise under this Agreement, are only those
expressly set forth in this Agreement. The Pledgee shall act hereunder on the
terms and conditions set forth herein and in Section 12 of the Credit Agreement.

            15. TRANSFER BY THE PLEDGORS. Except as permitted (i) prior to the
date all Credit Document Obligations have been paid in full and all Commitments
under the Credit Agreement have been terminated pursuant to the Credit Agreement
(and no further Incremental Term Loan Commitments may be requested or provided
under the Credit Agreement), and (ii) thereafter, pursuant to the other Secured
Debt Agreements, no Pledgor will sell or otherwise dispose of, grant any option
with respect to, or mortgage, pledge or otherwise encumber any of the Collateral
or any interest therein.

            16. REPRESENTATIONS, WARRANTIES AND COVENANTS OF THE PLEDGORS. (a)
Each Pledgor represents, warrants and covenants that:

            (i) it is the legal, beneficial and record owner of, and has good
      and marketable title to, all Collateral purported to be owned by it
      consisting of one or more Securities and that it has sufficient interest
      in all Collateral purported to be owned by it in which a security interest
      is purported to be created hereunder for such security interest to attach
      (subject, in each case, to no pledge, lien, mortgage, hypothecation,
      security interest, charge, option, Adverse Claim or other encumbrance
      whatsoever, except the liens and security interests created by this
      Agreement and Permitted Liens of the type described in Section 9.01(i),
      (ii) or (xxiii) of the Credit Agreement);

            (ii) it has full power, authority and legal right to pledge all the
      Collateral pledged by it pursuant to this Agreement;

                                      -17-
<PAGE>

            (iii) this Agreement has been duly authorized, executed and
      delivered by such Pledgor and constitutes a legal, valid and binding
      obligation of such Pledgor enforceable against such Pledgor in accordance
      with its terms, except to the extent that the enforceability hereof may be
      limited by applicable bankruptcy, insolvency, reorganization, moratorium
      or other similar laws generally affecting creditors' rights and by
      equitable principles (regardless of whether enforcement is sought in
      equity or at law);

            (iv) except to the extent already obtained or made, no consent of
      any other party (including, without limitation, any stockholder, partner,
      member or creditor of such Pledgor or any of its Subsidiaries) and no
      consent, license, permit, approval or authorization of, exemption by,
      notice or report to, or registration, filing or declaration with, any
      governmental authority is required to be obtained by such Pledgor in
      connection with (a) the execution, delivery or performance of this
      Agreement, (b) the validity or enforceability of this Agreement, (c) the
      perfection or enforceability of the Pledgee's security interest in the
      Collateral or (d) the exercise by the Pledgee of any of its rights or
      remedies provided herein, except (1) in the case of preceding clause (d),
      for compliance with or as may be required by applicable securities laws
      and (2) in the case of preceding clauses (a), (b) and (d), as could not,
      either individually or in the aggregate, be expected to have a material
      adverse effect on the business, assets, liabilities, operations or
      condition (financial or otherwise) of VHS Holdco I and its Subsidiaries
      taken as a whole;

            (v) the execution, delivery and performance of this Agreement (a)
      will not violate any provision of any applicable law or regulation or of
      any order, judgment, writ, award or decree of any court, arbitrator or
      governmental authority, domestic or foreign, applicable to such Pledgor,
      or of the certificate of incorporation, operating agreement, limited
      liability company agreement, partnership agreement or by-laws of such
      Pledgor or of any securities issued by such Pledgor or any of its
      Subsidiaries, or of any mortgage, deed of trust, indenture, lease, loan
      agreement, credit agreement or other material contract, agreement or
      instrument or undertaking to which such Pledgor or any of its Subsidiaries
      is a party or which purports to be binding upon such Pledgor or any of its
      Subsidiaries or upon any of their respective assets except to the extent
      that any such violation described in this clause (a) could not, either
      individually or in the aggregate, reasonably be expected to result in a
      material adverse effect on the business, assets, liabilities, operations
      or condition (financial or otherwise) of VHS Holdco I and its Subsidiaries
      taken as a whole and (b) will not result in the creation or imposition of
      (or the obligation to create or impose) any lien or encumbrance on any of
      the assets of such Pledgor or any of its Subsidiaries except as
      contemplated by this Agreement;

            (vi) all of the Collateral pledged by it that consists of
      Securities, Limited Liability Company Interests or Partnership Interests
      has been duly and validly issued and acquired, is fully paid and
      non-assessable and is subject to no options to purchase or similar rights;

            (vii) each of the Pledged Notes pledged by it constitutes, or when
      executed by the obligor thereof will constitute, the legal, valid and
      binding obligation of such obligor, enforceable in accordance with its
      terms, except to the extent that the enforceability thereof may be limited
      by applicable bankruptcy, insolvency, reorganization, moratorium or other
      similar laws generally affecting creditors' rights and by equitable
      principles

                                      -18-
<PAGE>

      (regardless of whether enforcement is sought in equity or at law); it
      being understood that the representation and warranty made by each Pledgor
      pursuant to this clause (vii) with respect to Pledge Notes issued by a
      Person that is not a Subsidiary of such Pledgor shall only be made to the
      best of such Pledgor knowledge;

            (viii) the pledge, collateral assignment and delivery to the Pledgee
      of the Collateral consisting of Certificated Securities, and Pledged Notes
      pursuant to this Agreement creates a valid and perfected first priority
      security interest in such Certificated Securities, and Pledged Notes, and
      the proceeds thereof, subject to no prior Lien or encumbrance or to any
      agreement purporting to grant to any third party a Lien or encumbrance on
      the property or assets of such Pledgor which would include the Securities,
      and the Pledgee is entitled to all the rights, priorities and benefits
      afforded by the UCC or other relevant law as enacted in any relevant
      jurisdiction to perfect security interests in respect of such Collateral;
      and

            (ix) "control" (as defined in Section 8-106 of the UCC) has been
      obtained by the Pledgee over all of such Pledgor's Collateral consisting
      of Securities (including, without limitation, Notes which are Securities)
      with respect to which such "control" may be obtained pursuant to Section
      8-106 of the UCC, except to the extent that the obligation of the
      applicable Pledgor to provide the Pledgee with "control" of such
      Collateral has not yet arisen under this Agreement; provided that in the
      case of the Pledgee obtaining "control" over Collateral consisting of a
      Security Entitlement, such Pledgor shall not be required to have taken all
      steps in its control so that the Pledgee obtains "control" over such
      Security Entitlement.

            (b) Each Pledgor covenants and agrees that it will defend the
Pledgee's right, title and security interest in and to such Pledgor's Collateral
and the proceeds thereof against the claims and demands of all persons
whomsoever; and each Pledgor covenants and agrees that it will have like title
to and right to pledge any other property at any time hereafter pledged to the
Pledgee by such Pledgor as Collateral hereunder and will likewise defend the
right thereto and security interest therein of the Pledgee and the other Secured
Creditors.

            (c) Each Pledgor which is a limited liability company or a
partnership (and each Pledgor which is a direct parent of any such limited
liability company or partnership) covenants and agrees that it will not, without
15 days prior written notice to the Pledgee, amend or modify (or allow to be
amended or modified) any limited liability company agreement, partnership
agreement or other organizational document of such limited liability company or
partnership in any manner which causes the Limited Liability Company Interests
or Partnership Interests of such limited liability company or partnership, as
the case may be, to be treated as a "security" governed under Article 8 of the
UCC; provided that nothing herein shall prohibit any Pledgor from creating or
acquiring limited liability companies or partnerships in compliance with the
Credit Agreement whose equity interests are treated as "securities" governed
under Article 8 of the UCC so long as the relevant procedures under Section 3.2
hereof are taken at the time of any such creation or acquisition.

            17. LEGAL NAMES; TYPE OF ORGANIZATION (AND WHETHER A REGISTERED
ORGANIZATION AND/OR A TRANSMITTING UTILITY); JURISDICTION

                                      -19-
<PAGE>

OF ORGANIZATION; LOCATION; ORGANIZATIONAL IDENTIFICATION NUMBERS; CHANGES
THERETO; ETC. The exact legal name of each Pledgor, the type of organization of
such Pledgor, whether or not such Pledgor is a Registered Organization, the
jurisdiction of organization of such Pledgor, such Pledgor's Location, the
organizational identification number (if any) of each Pledgor, and whether or
not such Pledgor is a Transmitting Utility, is listed on Annex A hereto for such
Pledgor. No Pledgor shall change its legal name, its type of organization, its
status as a Registered Organization (in the case of a Registered Organization),
its status as a Transmitting Utility or as a Person which is not a Transmitting
Utility, as the case may be, its jurisdiction of organization, its Location, or
its organizational identification number (if any), except that any such changes
shall be permitted (so long as not in violation of the applicable requirements
of the Secured Debt Agreements and so long as same do not involve (x) a
Registered Organization ceasing to constitute same or (y) any Pledgor changing
its jurisdiction of organization or Location from the United States or a State
thereof to a jurisdiction of organization or Location, as the case may be,
outside the United States or a State thereof) if (i) it shall have given to the
Pledgee not less than 15 days' prior written notice of each change to the
information listed on Annex A (as adjusted for any subsequent changes thereto
previously made in accordance with this sentence), together with a supplement to
Annex A which shall correct all information contained therein for such Pledgor,
and (ii) in connection with the respective such change or changes, it shall have
taken all action reasonably requested by the Pledgee to maintain the security
interests of the Pledgee in the Collateral intended to be granted hereby at all
times fully perfected and in full force and effect. In addition, to the extent
that any Pledgor does not have an organizational identification number on the
date hereof and later obtains one, such Pledgor shall promptly thereafter
deliver a notification to the Pledgee of such organizational identification
number and shall take all actions reasonably satisfactory to the Pledgee to the
extent necessary to maintain the security interest of the Pledgee in the
Collateral intended to be granted hereby fully perfected and in full force and
effect.

            18. PLEDGORS' OBLIGATIONS ABSOLUTE, ETC. The obligations of each
Pledgor under this Agreement shall be absolute and unconditional and shall
remain in full force and effect without regard to, and shall not be released,
suspended, discharged, terminated or otherwise affected by, any circumstance or
occurrence whatsoever (other than termination of this Agreement pursuant to
Section 20 hereof), including, without limitation:

            (i) any renewal, extension, amendment or modification of, or
      addition or supplement to or deletion from any Secured Debt Agreement
      (other than this Agreement in accordance with its terms), or any other
      instrument or agreement referred to therein, or any assignment or transfer
      of any thereof;

            (ii) any waiver, consent, extension, indulgence or other action or
      inaction under or in respect of any such agreement or instrument
      including, without limitation, this Agreement (other than a waiver,
      consent or extension with respect to this Agreement in accordance with its
      terms);

            (iii) any furnishing of any additional security to the Pledgee or
      its assignee or any acceptance thereof or any release of any security by
      the Pledgee or its assignee;

                                      -20-
<PAGE>

            (iv) any limitation on any party's liability or obligations under
      any such instrument or agreement or any invalidity or unenforceability, in
      whole or in part, of any such instrument or agreement or any term thereof;
      or

            (v) any bankruptcy, insolvency, reorganization, composition,
      adjustment, dissolution, liquidation or other like proceeding relating to
      any Pledgor or any Subsidiary of any Pledgor, or any action taken with
      respect to this Agreement by any trustee or receiver, or by any court, in
      any such proceeding, whether or not such Pledgor shall have notice or
      knowledge of any of the foregoing.

            19. REGISTRATION, ETC. If at any time when the Pledgee shall
determine to exercise its right to sell all or any part of the Collateral
consisting of Securities, Limited Liability Company Interests or Partnership
Interests pursuant to Section 7 hereof, and such Collateral or the part thereof
to be sold shall not, for any reason whatsoever, be effectively registered under
the Securities Act, as then in effect, the Pledgee may, in its sole and absolute
discretion, sell such Collateral or part thereof by private sale in such manner
and under such circumstances as the Pledgee may deem necessary or advisable in
order that such sale may legally be effected without such registration. Without
limiting the generality of the foregoing, in any such event the Pledgee, in its
sole and absolute discretion (i) may proceed to make such private sale
notwithstanding that a registration statement for the purpose of registering
such Collateral or part thereof shall have been filed under such Securities Act,
(ii) may approach and negotiate with a single possible purchaser to effect such
sale, and (iii) may restrict such sale to a purchaser who will represent and
agree that such purchaser is purchasing for its own account, for investment, and
not with a view to the distribution or sale of such Collateral or part thereof.
In the event of any such sale, the Pledgee shall incur no responsibility or
liability for selling all or any part of the Collateral at a price which the
Pledgee, in its sole and absolute discretion, may in good faith deem reasonable
under the circumstances, notwithstanding the possibility that a substantially
higher price might be realized if the sale were deferred until the registration
as aforesaid.

            20. TERMINATION; RELEASE. (a) On the Termination Date (as defined
below), this Agreement and the security interest created hereby shall terminate
(provided that all indemnities set forth herein including, without limitation,
in Section 11 hereof shall survive any such termination) and the Pledgee, at the
request and expense of such Pledgor, will execute and deliver to such Pledgor a
proper instrument or instruments (including UCC termination statements)
acknowledging the satisfaction and termination of this Agreement (including,
without limitation, UCC termination statements and instruments of satisfaction,
discharge and/or reconveyance), and will assign, transfer and deliver to such
Pledgor (without recourse and without any representation or warranty) such of
the Collateral as may be in the possession of the Pledgee and as has not
theretofore been sold or otherwise applied or released pursuant to this
Agreement, together with any monies at the time held by the Pledgee or any of
its sub-agents hereunder and, with respect to any Collateral consisting of an
Uncertificated Security, a Partnership Interest or a Limited Liability Company
Interest (other than an Uncertificated Security, Partnership Interest or Limited
Liability Company Interest credited on the books of a Clearing Corporation or
Securities Intermediary), a termination of the agreement relating thereto
executed and delivered by the issuer of such Uncertificated Security pursuant to
Section 3.2(a)(ii) or by the respective partnership or limited liability company
pursuant to Section

                                      -21-
<PAGE>

3.2(a)(iii)(2). As used in this Agreement, "Termination Date" shall mean the
date upon which the Commitments under the Credit Agreement have been terminated,
all Interest Rate Protection Agreements and Other Hedging Agreements entitled to
the benefits of this Agreement have been terminated, all Treasury Services have
been terminated and all outstanding obligations thereunder and under the
Treasury Services Agreement have been paid in full, no Letter of Credit or Note
(as defined in the Credit Agreement) is outstanding (and all Loans have been
paid in full), all Letters of Credit have been terminated, no further
Incremental Term Loan Commitments may be requested by the Borrower or provided
by any Lender or any other Person, and all other Obligations (other than
indemnities described in Section 11 hereof and described in Section 14.01 of the
Credit Agreement, and any other indemnities set forth in any other Security
Documents, in each case which are not then due and payable) then due and payable
have been paid in full.

            (b) In the event that any part of the Collateral is sold,
transferred or otherwise disposed of (to a Person other than a Credit Party) (x)
at any time prior to the time at which all Credit Document Obligations have been
paid in full and all Commitments and Letters of Credit under the Credit
Agreement have been terminated (and no further Incremental Term Loan Commitments
may be requested or provided under the Credit Agreement), in connection with a
sale or disposition permitted by Section 9.02 of the Credit Agreement or is
otherwise released at the direction of the Required Lenders (or all the Lenders
if required by Section 14.12 of the Credit Agreement) or (y) at any time
thereafter, to the extent permitted by the other Secured Debt Agreements, and in
the case of clauses (x) and (y), the proceeds of such sale, transfer or other
disposition (or from such release) are applied in accordance with the terms of
the Credit Agreement or such other Secured Debt Agreement, as the case may be,
to the extent required to be so applied, the Pledgee, at the request and expense
of such Pledgor, will promptly execute and deliver such documentation, including
termination or partial release statements and the like in connection therewith
and assign, transfer and deliver to such Pledgor (without recourse and without
any representation or warranty) such of the Collateral as is then being (or has
been) so sold, transferred or otherwise disposed of or released and as may be in
the possession of the Pledgee (or, in the case of Collateral held by any
sub-agent designated pursuant to Section 4 hereof, such sub-agent) and has not
theretofore been released pursuant to this Agreement. Furthermore, upon the
release of any Subsidiary Guarantor from the Subsidiaries Guaranty in accordance
with the provisions thereof, such Pledgor (and the Collateral at such time
pledged by the respective Pledgor pursuant hereto) shall be released from this
Agreement).

            (c) At any time that any Pledgor desires that the Pledgee assign,
transfer and deliver Collateral (and releases therefor) as provided in the
foregoing Section 20(a) or (b), it shall deliver to the Pledgee (and the
relevant sub-agent, if any, designated pursuant to Section 4 hereof) a
certificate signed by an authorized officer of such Pledgor stating that the
release of the respective Collateral is permitted pursuant to such Section 20(a)
or (b). At any time that the Borrower or the respective Pledgor desires that a
Subsidiary of the Borrower which has been released from the Subsidiaries
Guaranty be released hereunder as provided in the last sentence of Section
20(b), it shall deliver to the Pledgee a certificate executed by a principal
executive officer of the Borrower and the respective Pledgor stating that the
release of the respective Pledgor (and its Collateral) is permitted pursuant to
such Section 20(b).

                                      -22-
<PAGE>

            (d) The Pledgee shall have no liability whatsoever to any other
Secured Creditor as the result of any release of Collateral by it in accordance
with (or which the Collateral Agent in the absence of gross negligence and
willful misconduct believes to be in accordance with) this Section 20.

            21. NOTICES, ETC. Except as otherwise specified herein, all notices,
requests, demands or other communications to or upon the respective parties
hereto shall be sent or delivered by mail, telegraph, telex, telecopy, cable or
courier service and all such notices and communications shall, when mailed,
telegraphed, telexed, telecopied, or cabled or sent by courier, be effective
when deposited in the mails, delivered to the telegraph company, cable company
or overnight courier, as the case may be, or sent by telex or telecopier, except
that notices and communications to the Pledgee or any Pledgor shall not be
effective until received by the Pledgee or such Pledgor, as the case may be. All
notices and other communications shall be in writing and addressed as follows:

            (a) if to any Pledgor, at;

                c/o Vanguard Health Systems, Inc.
                20 Burton Hills Boulevard
                Suite 100
                Nashville, TN 37215
                Telephone No.: (615) 665-6000
                Facsimile No.: (615) 665-6099
                Attention: Joseph D. Moore

            (b) if to the Pledgee, at:

                Bank of America, N.A.
                Agency Management
                Mail Code: CA5-701-05-19
                1455 Market Street
                San Francisco, CA 94103-1399
                Attention: Annie Cuenco
                Telephone: (415) 436-4008
                Facsimile: (415) 503-5007
                Email: anna.cuenco@bankofamerica.com

                With a copy to:
                Bank of America, N.A.
                Mail Code: NC1-007-17-11
                100 N. Tryon Street
                Charlotte, NC 28255-0001
                Attention: Kevin R. Wagley
                Telephone: (704) 388-6006
                Facsimile: (704) 409-0097

                                      -23-
<PAGE>

                  Email: Kevin.r.wagley@bankofamerica.com

            (c) if to any Lender Creditor, either (x) to the Administrative
      Agent, at the address of the Administrative Agent specified in the Credit
      Agreement, or (y) at such address as such Lender Creditor shall have
      specified in its Administrative Questionnaire;

            (d) if to any Other Creditor, at such address as such Other Creditor
      shall have specified in writing to the Pledgors and the Pledgee;

            (e) if to any Treasury Service Creditor, at such address as such
      Treasury Service Creditor shall have specified in writing to the Pledgors
      and the Pledgee

            (f) or at such other address or addressed to such other individual
      as shall have been furnished in writing by any Person described above to
      the party required to give notice hereunder.

            22. WAIVER; AMENDMENT. Except as provided in Sections 20 and 30
hereof, none of the terms and conditions of this Agreement may be changed,
waived, modified or varied in any manner whatsoever except in accordance with
the requirements specified in the Security Agreement.

            23. SUCCESSORS AND ASSIGNS. This Agreement shall create a continuing
security interest in the Collateral and shall (i) remain in full force and
effect, subject to release and/or termination as set forth in Section 20, (ii)
be binding upon each Pledgor, its successors and assigns; provided, however,
that no Pledgor shall assign any of its rights or obligations hereunder without
the prior written consent of the Pledgee (with the prior written consent of the
Required Secured Creditors), and (iii) inure, together with the rights and
remedies of the Pledgee hereunder, to the benefit of the Pledgee, the other
Secured Creditors and their respective successors, transferees and assigns. All
agreements, statements, representations and warranties made by each Pledgor
herein or in any certificate or other instrument delivered by such Pledgor or on
its behalf under this Agreement shall be considered to have been relied upon by
the Secured Creditors and shall survive the execution and delivery of this
Agreement and the other Secured Debt Agreements regardless of any investigation
made by the Secured Creditors or on their behalf.

            24. HEADINGS DESCRIPTIVE. The headings of the several Sections of
this Agreement are inserted for convenience only and shall not in any way affect
the meaning or construction of any provision of this Agreement.

            25. GOVERNING LAW; SUBMISSION TO JURISDICTION; VENUE; WAIVER OF JURY
TRIAL. (a) THIS AGREEMENT AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES
HEREUNDER SHALL BE CONSTRUED IN ACCORDANCE WITH AND BE GOVERNED BY THE LAW OF
THE STATE OF NEW YORK. ANY LEGAL ACTION OR PROCEEDING WITH RESPECT TO THIS
AGREEMENT OR ANY OTHER CREDIT DOCUMENT MAY BE BROUGHT IN THE COURTS OF THE STATE
OF NEW YORK OR OF THE UNITED STATES FOR THE SOUTHERN DISTRICT OF NEW YORK, IN
EACH CASE WHICH ARE LOCATED IN THE COUNTY OF NEW YORK, AND, BY EXECUTION AND
DELIVERY OF THIS

                                      -24-
<PAGE>

AGREEMENT, EACH PLEDGOR HEREBY IRREVOCABLY ACCEPTS FOR ITSELF AND IN RESPECT OF
ITS PROPERTY, GENERALLY AND UNCONDITIONALLY, THE NON-EXCLUSIVE JURISDICTION OF
THE AFORESAID COURTS. EACH PLEDGOR HEREBY FURTHER IRREVOCABLY WAIVES ANY CLAIM
THAT ANY SUCH COURTS LACK PERSONAL JURISDICTION OVER SUCH PLEDGOR, AND AGREES
NOT TO PLEAD OR CLAIM IN ANY LEGAL ACTION OR PROCEEDING WITH RESPECT TO THIS
AGREEMENT OR ANY OTHER CREDIT DOCUMENT BROUGHT IN ANY OF THE AFORESAID COURTS
THAT ANY SUCH COURT LACKS PERSONAL JURISDICTION OVER SUCH PLEDGOR. EACH PLEDGOR
FURTHER IRREVOCABLY CONSENTS TO THE SERVICE OF PROCESS OUT OF ANY OF THE
AFOREMENTIONED COURTS IN ANY SUCH ACTION OR PROCEEDING BY THE MAILING OF COPIES
THEREOF BY REGISTERED OR CERTIFIED MAIL, POSTAGE PREPAID, TO ANY SUCH PLEDGOR AT
ITS ADDRESS FOR NOTICES AS PROVIDED IN SECTION 21 ABOVE, SUCH SERVICE TO BECOME
EFFECTIVE 30 DAYS AFTER SUCH MAILING. EACH PLEDGOR HEREBY IRREVOCABLY WAIVES ANY
OBJECTION TO SUCH SERVICE OF PROCESS AND FURTHER IRREVOCABLY WAIVES AND AGREES
NOT TO PLEAD OR CLAIM IN ANY ACTION OR PROCEEDING COMMENCED HEREUNDER OR UNDER
ANY OTHER CREDIT DOCUMENT THAT SUCH SERVICE OF PROCESS WAS IN ANY WAY INVALID OR
INEFFECTIVE. NOTHING HEREIN SHALL AFFECT THE RIGHT OF THE PLEDGEE UNDER THIS
AGREEMENT, OR ANY SECURED CREDITOR, TO SERVE PROCESS IN ANY OTHER MANNER
PERMITTED BY LAW OR TO COMMENCE LEGAL PROCEEDINGS OR OTHERWISE PROCEED AGAINST
ANY PLEDGOR IN ANY OTHER JURISDICTION.

            (b) EACH PLEDGOR HEREBY IRREVOCABLY WAIVES ANY OBJECTION WHICH IT
MAY NOW OR HEREAFTER HAVE TO THE LAYING OF VENUE OF ANY OF THE AFORESAID ACTIONS
OR PROCEEDINGS ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT OR ANY OTHER
CREDIT DOCUMENT BROUGHT IN THE COURTS REFERRED TO IN CLAUSE (A) ABOVE AND HEREBY
FURTHER IRREVOCABLY WAIVES AND AGREES NOT TO PLEAD OR CLAIM IN ANY SUCH COURT
THAT ANY SUCH ACTION OR PROCEEDING BROUGHT IN ANY SUCH COURT HAS BEEN BROUGHT IN
AN INCONVENIENT FORUM.

            (c) EACH OF THE PARTIES TO THIS AGREEMENT HEREBY IRREVOCABLY WAIVES
ALL RIGHT TO A TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM ARISING
OUT OF OR RELATING TO THIS AGREEMENT, THE OTHER CREDIT DOCUMENTS OR THE
TRANSACTIONS CONTEMPLATED HEREBY OR THEREBY.

            26. PLEDGOR'S DUTIES. It is expressly agreed, anything herein
contained to the contrary notwithstanding, that each Pledgor shall remain liable
to perform all of the obligations, if any, assumed by it with respect to the
Collateral and the Pledgee shall not have any obligations or liabilities with
respect to any Collateral by reason of or arising out of this Agreement, except
for the safekeeping of Collateral actually in the Pledgee's possession, nor

                                      -25-
<PAGE>

shall the Pledgee be required or obligated in any manner to perform or fulfill
any of the obligations of any Pledgor under or with respect to any Collateral.

            27. COUNTERPARTS. This Agreement may be executed in any number of
counterparts and by the different parties hereto on separate counterparts, each
of which when so executed and delivered shall be an original, but all of which
shall together constitute one and the same instrument. A set of counterparts
executed by all the parties hereto shall be lodged with each Pledgor and the
Pledgee.

            28. SEVERABILITY. Any provision of this Agreement which is
prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction,
be ineffective to the extent of such prohibition or unenforceability without
invalidating the remaining provisions hereof, and any such prohibition or
unenforceability in any jurisdiction shall not invalidate or render
unenforceable such provision in any other jurisdiction.

            29. RECOURSE. This Agreement is made with full recourse to each
Pledgor and pursuant to and upon all the representations, warranties, covenants
and agreements on the part of such Pledgor contained herein and in the other
Secured Debt Agreements and otherwise in writing in connection herewith or
therewith.

            30. ADDITIONAL PLEDGORS. It is understood and agreed that any
Subsidiary of the Borrower that is required to become a party to this Agreement
after the date hereof pursuant to the requirements of the Credit Agreement or
any other Credit Document, shall become a Pledgor hereunder by (x) executing a
counterpart hereof and delivering same to the Pledgee or a Joinder Agreement
substantially in the form of Exhibit M to the Credit Agreement, (y) delivering
supplements to Annexes A through G, hereto as are necessary to cause such
annexes to be complete and accurate with respect to such additional Pledgor on
such date and (z) taking all actions as specified in this Agreement as would
have been taken by such Pledgor had it been an original party to this Agreement,
in each case with all documents required above to be delivered to the Pledgee
and with all documents and actions required above to be taken to the reasonable
satisfaction of the Pledgee.

            31. LIMITED OBLIGATIONS. It is the desire and intent of each Pledgor
and the Secured Creditors that this Agreement shall be enforced against each
Pledgor to the fullest extent permissible under the laws applied in each
jurisdiction in which enforcement is sought. Notwithstanding anything to the
contrary contained herein, in furtherance of the foregoing, it is noted that the
obligations of each Pledgor constituting a Subsidiary Guarantor have been
limited as provided in the Subsidiaries Guaranty.

            32. TREASURY SERVICES OBLIGATIONS AS "SENIOR DEBT". The parties
hereto hereby acknowledge and agree that the Treasury Services Obligations are
(i) "Senior Indebtedness" for the purposes of the Existing Senior Subordinated
Note Documents, (ii) "Senior Debt" for the purposes of the New Senior
Subordinated Note Documents or (iii) any similar term for the purposes of any
Permitted Senior Subordinated Note Documents.

                                     * * * *

                                      -26-
<PAGE>

            IN WITNESS WHEREOF, each Pledgor and the Pledgee have caused this
Agreement to be executed by their duly elected officers duly authorized as of
the date first above written.

                        VANGUARD HEALTH HOLDING COMPANY I, LLC
                        VANGUARD HOLDING COMPANY I, INC.
                        VANGUARD HEALTH HOLDING COMPANY II, LLC
                        VANGUARD HOLDING COMPANY II, INC.
                        VHS ACQUISITION CORPORATION
                        VHS OF PHOENIX, INC.
                        VHS OUTPATIENT CLINICS, INC.
                        VHS OF ARROWHEAD, INC.
                        VHS OF SOUTH PHOENIX, INC.
                        VHS IMAGING CENTERS, INC.
                        VHS OF ANAHEIM, INC.
                        VHS OF ORANGE COUNTY, INC.
                        VHS HOLDING COMPANY, INC.
                        VHS OF HUNTINGTON BEACH, INC.
                        VHS OF ILLINOIS, INC.
                        MACNEAL HEALTH PROVIDERS, INC.
                        MACNEAL MANAGEMENT SERVICES, INC.
                        MIDWEST CLAIMS PROCESSING, INC.
                        PROS TEMPORARY STAFFING, INC.
                        WATERMARK PHYSICIAN SERVICES,INC.
                        VHS GENESIS LABS, INC.
                        MACNEAL MEDICAL RECORDS, INC.
                        VANGUARD HEALTH MANAGEMENT, INC.
                        VANGUARD HEALTH FINANCIAL COMPANY, INC.
                        VHS ACQUISITION SUBSIDIARY NUMBER 1, INC.
                        VHS ACQUISITION SUBSIDIARY NUMBER 2, INC.
                        VHS ACQUISITION SUBSIDIARY NUMBER 4, INC.
                        VHS ACQUISITION SUBSIDIARY NUMBER 5, INC.
                        VHS ACQUISITION SUBSIDIARY NUMBER 8, INC.
                        HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.

                        each as a Pledgor

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

                        Duly authorized to sign on behalf of
                        each of the foregoing entities

<PAGE>

                        THE ANAHEIM VHS LIMITED PARTNERSHIP,
                        as a Pledgor

                        By: VHS of Anaheim, Inc., its General Partner

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

                        THE HUNTINGTON BEACH VHS LIMITED PARTNERSHIP,
                        as a Pledgor

                        By: VHS of Huntington Beach, Inc., its General Partner

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

                        HEALTHCARE COMPLIANCE, L.L.C.,
                        as a Pledgor

                        By: Vanguard Health Management, Inc., its Member

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

                        THE VHS ARIZONA IMAGING CENTERS LIMITED
                        PARTNERSHIP, as a Pledgor

                        By: VHS Imaging Centers, Inc., its General Partner

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

<PAGE>

                        VHS SAN ANTONIO PARTNERS, L.P.,
                        as a Pledgor

                        By: VHS Acquisition Subsidiary Number 5,
                            Inc., as General Partner

                        By: /s/ Joseph D. Moore
                            ---------------------------------------------
                            Title: Executive Vice President,
                                   Chief Financial Officer and Treasurer

Accepted and Agreed to:

BANK OF AMERICA, N.A.,
 as Administrative Agent

By: /s/ Kevin Wagley
    -------------------------
    Title: Principal

BANK OF AMERICA, N.A.,
 as Collateral Agent

By: /s/ Kevin Wagley
    -------------------------
    Title: Principal

<PAGE>

                                                                         Annex A
                                                                              to
                                                                PLEDGE AGREEMENT

                  SCHEDULE OF LEGAL NAMES, TYPE OF ORGANIZATION
                  (AND WHETHER A REGISTERED ORGANIZATION AND/OR
             A TRANSMITTING UTILITY), JURISDICTION OF ORGANIZATION,
               LOCATION AND ORGANIZATIONAL IDENTIFICATION NUMBERS

<TABLE>
<CAPTION>
                                                                                 Pledgor's
                                                                               Organization
                                                                              Identification
                       Registered                       Pledgor's Location      Number (or,
Exact Legal Name of   Organization?   Jurisdiction of   (for purposes of NY   if it has none,      Transmitting
   Each Pledgor         (Yes/No)       Organization      UCC Section 9-307)    so indicate)     Utility? (Yes/No)
   ------------         --------       ------------     -------------------    ------------     -----------------
<S>                   <C>             <C>               <C>                   <C>               <C>
</TABLE>

<PAGE>

                                                                         ANNEX B
                                                                              to
                                                                PLEDGE AGREEMENT

                            SCHEDULE OF SUBSIDIARIES

<TABLE>
<CAPTION>
                                                        Jurisdiction of
     Entity                 Ownership                    Organization
     ------                 ---------                    ------------
<S>                         <C>                         <C>
</TABLE>

<PAGE>

                                                                         ANNEX C
                                                                              to
                                                                PLEDGE AGREEMENT

                                SCHEDULE OF STOCK

1.    [PLEDGOR]

<TABLE>
<CAPTION>
                                                                                                   Sub-clause of
Name of                                                                                            Section 3.2(a)
Issuing                  Type of           Number of          Certificate       Percentage           of Pledge
Corporation               Shares            Shares               No.(1)          Owned(2)            Agreement
-----------               ------            ------               ------          --------            ---------
<S>                      <C>              <C>                 <C>               <C>                <C>
</TABLE>

2.    [ADDITIONAL PLEDGOR(S)]

<TABLE>
<CAPTION>
                                                                                                   Sub-clause of
Name of                                                                                            Section 3.2(a)
Issuing                  Type of           Number of          Certificate       Percentage           of Pledge
Corporation               Shares            Shares                No.             Owned              Agreement
-----------               ------            ------                ---             -----              ---------
<S>                      <C>              <C>                 <C>               <C>                <C>
</TABLE>

------------------------

(1)   Specify if uncertificated.

(2)   Specify for each Foreign Subsidiary the percentage owned of (x) Voting
      Stock and (y) Non-Voting Stock.

<PAGE>

                                                                         ANNEX D
                                                                              to
                                                                PLEDGE AGREEMENT

                                SCHEDULE OF NOTES

1.    [PLEDGOR]

<TABLE>
<CAPTION>
                                                                                            Sub-clause of
                                                                                           Section 3.2(a)
          Amount                  Maturity Date                 Obligor                  of Pledge Agreement
          ------                  -------------                 -------                  -------------------
<S>                               <C>                           <C>                      <C>
</TABLE>

2.    [ADDITIONAL PLEDGOR(S)]

<TABLE>
<CAPTION>
                                                                                            Sub-clause of
                                                                                           Section 3.2(a)
          Amount                  Maturity Date                 Obligor                  of Pledge Agreement
          ------                  -------------                 -------                  -------------------
<S>                               <C>                           <C>                      <C>
</TABLE>

<PAGE>

                                                                         ANNEX E
                                                                              to
                                                                PLEDGE AGREEMENT

                 SCHEDULE OF LIMITED LIABILITY COMPANY INTERESTS

1.    [PLEDGOR]

<TABLE>
<CAPTION>
       Name of                                              Sub-clause of
   Issuing Limited       Type of                            Section 3.2(a)
  Liability Company      Interest     Percentage Owned   of Pledge Agreement
  -----------------      --------     ----------------   -------------------
<S>                      <C>          <C>                <C>
</TABLE>

2.    [ADDITIONAL PLEDGOR(S)]

<TABLE>
<CAPTION>
       Name of                                              Sub-clause of
   Issuing Limited       Type of                            Section 3.2(a)
  Liability Company      Interest     Percentage Owned   of Pledge Agreement
  -----------------      --------     ----------------   -------------------
<S>                      <C>          <C>                <C>
</TABLE>

<PAGE>

                                                                         ANNEX F
                                                                              to
                                                                PLEDGE AGREEMENT

                        SCHEDULE OF PARTNERSHIP INTERESTS

1.    [PLEDGOR]

<TABLE>
<CAPTION>
                                                            Sub-clause of
       Name of          Type of                             Section 3.2(a)
Issuing Partnership     Interest      Percentage Owned   of Pledge Agreement
-------------------     --------      ----------------   -------------------
<S>                     <C>           <C>                <C>
</TABLE>

2.    [ADDITIONAL PLEDGOR(S)]

<TABLE>
<CAPTION>
                                                            Sub-clause of
       Name of          Type of                             Section 3.2(a)
Issuing Partnership     Interest      Percentage Owned   of Pledge Agreement
-------------------     --------      ----------------   -------------------
<S>                     <C>           <C>                <C>
</TABLE>

<PAGE>

                                                                         ANNEX G
                                                                              to
                                                                PLEDGE AGREEMENT

                       SCHEDULE OF CHIEF EXECUTIVE OFFICES

<TABLE>
<CAPTION>
  Name of Pledgor                     Address(es) of Chief Executive Office(1)
  ---------------                     -------------------------------------
<S>                                   <C>
</TABLE>

-------------------

(1)   For each Pledgor, list the address of its chief executive office on the
      date of the Security Agreement and each other location (if any) of its
      chief executive office in the four calendar months preceding said date.

<PAGE>

                                                                         ANNEX H
                                                                              to
                                                                PLEDGE AGREEMENT

    Form of Agreement Regarding Uncertificated Securities, Limited Liability
                   Company Interests and Partnership Interests

            AGREEMENT (as amended, modified, restated and/or supplemented from
time to time, this "Agreement"), dated as of [_______ __, 20__], among the
undersigned pledgor (the "Pledgor"), Bank of America, N.A., not in its
individual capacity but solely as Collateral Agent (the "Pledgee"), and
[__________], as the issuer of the Uncertificated Securities, Limited Liability
Company Interests and/or Partnership Interests (each as defined below) (the
"Issuer").

                              W I T N E S S E T H :

            WHEREAS, the Pledgor, certain of its affiliates and the Pledgee have
entered into a Pledge Agreement, dated as of September 23, 2004 (as amended,
modified, restated and/or supplemented from time to time, the "Pledge
Agreement"), under which, among other things, in order to secure the payment of
the Obligations (as defined in the Pledge Agreement), the Pledgor has or will
pledge to the Pledgee for the benefit of the Secured Creditors (as defined in
the Pledge Agreement), and grant a security interest in favor of the Pledgee for
the benefit of the Secured Creditors in, all of the right, title and interest of
the Pledgor in and to any and all ["uncertificated securities" (as defined in
Section 8-102(a)(18) of the Uniform Commercial Code, as adopted in the State of
New York) ("Uncertificated Securities")] [Partnership Interests (as defined in
the Pledge Agreement)] [Limited Liability Company Interests (as defined in the
Pledge Agreement)], from time to time issued by the Issuer, whether now existing
or hereafter from time to time acquired by the Pledgor (with all of such
[Uncertificated Securities] [Partnership Interests] [Limited Liability Company
Interests] being herein collectively called the "Issuer Pledged Interests"); and

            WHEREAS, the Pledgor desires the Issuer to enter into this Agreement
in order to perfect the security interest of the Pledgee under the Pledge
Agreement in the Issuer Pledged Interests, to vest in the Pledgee control of the
Issuer Pledge Interests and to provide for the rights of the parties under this
Agreement;

            NOW THEREFORE, in consideration of the premises and the mutual
promises and agreements contained herein, and for other valuable consideration,
the receipt and sufficiency of which are hereby acknowledged, the parties hereto
hereby agree as follows:

            1. The Pledgor hereby irrevocably authorizes and directs the Issuer,
and the Issuer hereby agrees, to comply with any and all instructions and orders
originated by the Pledgee (and its successors and assigns) regarding any and all
of the Issuer Pledged Interests without the further consent by the registered
owner (including the Pledgor), and, following its receipt of a notice from the
Pledgee stating that the Pledgee is exercising exclusive control of the Issuer
Pledged Interests, not to comply with any instructions or orders regarding any
or all of the

<PAGE>

                                                                         Annex H
                                                                          Page 2

Issuer Pledged Interests originated by any person or entity other than the
Pledgee (and its successors and assigns) or a court of competent jurisdiction.

            2. The Issuer hereby certifies that (i) no notice of any security
interest, lien or other encumbrance or claim affecting the Issuer Pledged
Interests (other than the security interest of the Pledgee) has been received by
it, and (ii) the security interest of the Pledgee in the Issuer Pledged
Interests has been registered in the books and records of the Issuer.

            3. The Issuer hereby represents and warrants that (i) the pledge by
the Pledgor of, and the granting by the Pledgor of a security interest in, the
Issuer Pledged Interests to the Pledgee, for the benefit of the Secured
Creditors, does not violate the charter, by-laws, partnership agreement,
membership agreement or any other agreement governing the Issuer or the Issuer
Pledged Interests, and (ii) the Issuer Pledged Interests consisting of capital
stock of a corporation are fully paid and nonassessable.

            4. All notices, statements of accounts, reports, prospectuses,
financial statements and other communications to be sent to the Pledgor by the
Issuer in respect of the Issuer will also be sent to the Pledgee at the
following address:

               Bank of America, N.A.
               Agency Management
               Mail Code: CA5-701-05-19
               1455 Market Street
               San Francisco, CA 94103-1399
               Attention: Annie Cuenco
               Telephone: (415) 436-4008
               Facsimile: (415) 503-5007
               Email: anna.cuenco@bankofamerica.com

               With a copy to:
               Bank of America, N.A.
               Mail Code: NC1-007-17-11
               100 N. Tryon Street
               Charlotte, NC 28255-0001
               Attention: Kevin R. Wagley
               Telephone: (704) 388-6006
               Facsimile: (704) 409-0097
               Email: Kevin.r.wagley@bankofamerica.com

            5. Following its receipt of a notice from the Pledgee stating that
the Pledgee is exercising exclusive control of the Issuer Pledged Interests and
until the Pledgee shall have delivered written notice to the Issuer that all of
the Obligations have been paid in full and this Agreement is terminated, the
Issuer will send any and all redemptions, distributions, interest or other
payments in respect of the Issuer Pledged Interests from the Issuer for the
account of the Pledgee only by wire transfers to such account as the Pledgee
shall instruct.

<PAGE>

                                                                         Annex H
                                                                          Page 3

            6. Except as expressly provided otherwise in Sections 4 and 5, all
notices, instructions, orders and communications hereunder shall be sent or
delivered by mail, telegraph, telex, telecopy, cable or overnight courier
service and all such notices and communications shall, when mailed, telexed,
telecopied, cabled or sent by overnight courier, be effective when deposited in
the mails or delivered to overnight courier, prepaid and properly addressed for
delivery on such or the next Business Day, or sent by telex or telecopier,
except that notices and communications to the Pledgee or the Issuer shall not be
effective until received. All notices and other communications shall be in
writing and addressed as follows:

            (a) if to the Pledgor, at:

                c/o Vanguard Health Systems, Inc.
                20 Burton Hills Boulevard
                Suite 100
                Nashville, TN 37215
                Telephone No.: (615) 665-6000
                Facsimile No.: (615) 665-6099
                Attention: Joseph D. Moore

            (b) if to the Pledgee, at the address given in Section 4 hereof;

            (c) if to the Issuer, at:

                ___________________________
                ___________________________
                ___________________________

or at such other address as shall have been furnished in writing by any Person
described above to the party required to give notice hereunder. As used in this
Section 6, "Business Day" means any day other than a Saturday, Sunday, or other
day in which banks in New York are authorized to remain closed.

            7. This Agreement shall be binding upon the successors and assigns
of the Pledgor and the Issuer and shall inure to the benefit of and be
enforceable by the Pledgee and its successors and assigns. This Agreement may be
executed in any number of counterparts, each of which shall be an original, but
all of which shall constitute one instrument. In the event that any provision of
this Agreement shall prove to be invalid or unenforceable, such provision shall
be deemed to be severable from the other provisions of this Agreement which
shall remain binding on all parties hereto. None of the terms and conditions of
this Agreement may be changed, waived, modified or varied in any manner
whatsoever except in writing signed by the Pledgee, the Issuer and the Pledgor.

            8. This Agreement shall be governed by and construed in accordance
with the laws of the State of New York, without regard to its principles of
conflict of laws.

<PAGE>

                                                                         Annex H
                                                                          Page 4

            IN WITNESS WHEREOF, the Pledgor, the Pledgee and the Issuer have
caused this Agreement to be executed by their duly elected officers duly
authorized as of the date first above written.

                               [________________________],
                                 as Pledgor

                               By_________________________________________
                                 Name:
                                 Title:

                               BANK OF AMERICA, N.A.,
                                 not in its individual capacity but solely as
                                 Collateral Agent and Pledgee

                               By_________________________________________
                                 Name:
                                 Title:

                               [________________________],
                                 as the Issuer

                               By_________________________________________
                                 Name:
                                 Title:

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