Document:

EXHIBIT 10.65

EXHIBIT 10.65

WAIVER NO. 1

            This Waiver No. 1 (this “Waiver”), dated as of May 22, 2008, to AMENDED AND RESTATED LIMITED LIABILITY COMPANY OPERATING AGREEMENT, dated as
of September 23, 2004, as amended by Amendment No 1, dated as of November 3, 2005 (collectively, the "Agreement"), concerning VHS Holdings LLC (the "Company"), a Delaware limited liability company, is entered into by and among the Investor Members (as
defined in the Agreement) and the Management Members (as defined in the Agreement).

            WHEREAS, the Investor Members and the Management Members entered into the Agreement in connection with consummation of the Merger (as defined in the
Agreement);

            WHEREAS,for estate planning purposes, one of the Management Members, Charles N. Martin, Jr., wishes to transfer from time to time (collectively, the
“Martin GRAT Transfers”) some or all of his Class A Units (as defined in the Agreement) in the Company to one or more grantor retained annuity trusts (collectively, the “CNM GRATS”), with each such grantor retained annuity trust
being expected to have Charles N. Martin, Jr. as the sole trustee;

            WHEREAS, the principal beneficiaries of each of the CNM GRATS are expected to be solely (i) Charles N. Martin, Jr., (ii) a trust for the benefit of his sister
and (iii) a trust for the benefit of his issue, and since his sister and his issue are members of his Family Group (as defined in the Agreement), they each are Permitted Transferees (as defined in the Agreement) of Class A Units under the Agreement; and

            WHEREAS, Charles N. Martin, Jr. also wishes to provide in the CNM GRATS that, in the unlikely event he has no living issue at the time of the termination of
any of the CNM GRATS, that the contingent beneficiary of the CNM GRATS be the Martin Foundation, a private foundation of which he is the trustee and whose grantees can only be organizations exempt from federal taxation under Section 501(c)(3) of the Code (as defined
in the Agreement), but that under the Agreement the Martin Foundation is not a Permitted Transferee of Class A Units, absent this Waiver; and

            WHEREAS, the Investor Members and the Management Members wish to waive the provisions of the Agreement that prohibit the Martin Foundation from being a
contingent beneficiary of the CNM GRATS and otherwise approve the Martin GRAT Transfers.

            NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged and intending to be legally bound hereby, the parties to this Waiver hereby agree as follows:

            1.         Capitalized Terms. Unless otherwise defined herein, capitalized terms used herein and defined in the
Agreement are as defined in the Agreement.

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            2.         Waiver.  Any and all provisions of the Agreement that prohibit the Martin  GRAT Transfers
and/or the Martin Foundation from being a contingent beneficiary of the CNM GRATS are hereby waived, and each of the Martin GRAT Transfers and the Martin Foundation being a potential Transferee (as defined in the Agreement) of Class A Units from the CNM GRATS are
hereby approved by the parties hereto.

            3.         Governing Law. THIS WAIVER SHALL BE CONSTRUED IN ACCORDANCE WITH, AND GOVERNED BY, THE LAWS OF THE
STATE OF DELAWARE WITHOUT REGARD TO CONFLICTS OF LAWS PRINCIPLES WHICH WOULD RESULT IN THE APPLICATION OF THE LAWS OF ANOTHER JURISDICTION.

            4.         Counterparts. This Waiver may be executed in counterparts, each of which shall be deemed an original,
and all of which together shall constitute a single instrument.

            IN WITNESS WHEREOF, the parties hereto have executed this Waiver as of the date set forth above.

                                               
VHS HOLDINGS LLC

                                               
By:       /s/ Charles N. Martin, Jr.                     

                                                            
Name: Charles N. Martin, Jr.

                                                           
Title: Chairman & Chief Executive Officer

                                               
BLACKSTONE FCH CAPITAL PARTNERS IV L.P.

                                               
By:       Blackstone Management Associates IV L.L.C.,

                                                                       
as a General Partner

                                               
By:       /s/ Neil
Simpkins                                  

                                                            
Name:  Neil Simpkins

                                                           
Title:     Senior Managing Director

                                               
BLACKSTONE HEALTH COMMITMENT PARTNERS L.P.

                                   
            By:       Blackstone Management Associates IV L.L.C.,

                                                                       
as a General Partner

                                               
By:       /s/ Neil Simpkins                      

                                                            
Name:  Neil Simpkins

                                                           
Title:     Senior Managing Director

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BLACKSTONE CAPITAL PARTNERS IV – A L.P.

                                   
By:       Blackstone Management Associates IV L.L.C.,

                                                                       
as a General Partner

                                               
By:       /s/ Neil
Simplins                                   

                                                            
Name:  Neil Simpkins

                                                           
Title:     Senior Managing Director

                                               
BLACKSTONE FAMILY INVESTMENT PARTNERSHIP IV - A L.P.

                                               
By:       Blackstone Management Associates IV L.L.C.,

                                                                       
as a General Partner

                                               
By:       /s/ Neil
Simpkins                                  

                                                            
Name:  Neil Simpkins

                                                           
Title:     Senior Managing Director

                                               
MORGAN STANLEY CAPITAL PARTNERS III, L.P.

                                               
MORGAN STANLEY CAPITAL INVESTORS, L.P.

                                               
MSCP III 892 INVESTORS, L.P.

                                               
By:       MSCP III, LLC,

                                                           
as General Partner of each of the

                                                           
limited partnerships named above

                                               
By:       Metalmark Subadvisor LLC,

                                                           
as attorney-in-fact

                                               
By:       /s/ M. Fazle Husain                              

                                                            
Name:  M. Fazle Husain

                                                           
Title:     Managing Director

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MORGAN STANLEY DEAN WITTER CAPITAL

                                               
PARTNERS IV, L.P.

                                               
MORGAN STANLEY DEAN WITTER CAPITAL

                                               
INVESTORS IV, L.P.

                                               
MSDW IV 892 INVESTORS, L.P.

                                               
By:       MSDW Capital Partners IV, LLC,

                                                           
as General Partner of each of the

                                                           
limited partnerships named above

                                               
By:       Metalmark Subadvisor LLC,

                                                           
as attorney-in-fact

                                               
By:       /s/ M. Fazle Husain                              

                                                            
Name:  M. Fazle Husain

                                                           
Title:     Managing Director

                                               
FOR ALL MANAGEMENT MEMBERS

                                               
/s/ Charles N. Martin, Jr.                                 

                                                
Charles N. Martin, Jr.,

                                               
Individually and as Proxyholder for the

                                               
Management Members listed on Exhibit

                                               
A hereto, pursuant to Section 3.11 of the

                                               
Amended and Restated Limited Liability

                                               
Operating Agreement of VHS Holdings LLC

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EXHIBIT A

Cliff Adlerz

Carol A. Bailey

Reginald M. Ballantyne, III

Jonathan Bartlett

Carole Beauchamp

James C. Bonnette, M.D.

Mary A. Botticella

Bruce Buchanan

Bruce Chafin

Carl F. & Juanita B. Chafin

Mark Clayton

Alan N. Cranford

Dave Culberson

Jack Cumber

Ray Denson

Dominic Dominguez

Bruce Eady

Roger Faculak

Pamela Farrell

Debra Flores

Richard Francis

Robert Galloway

John Geer

John Geer, a/c/f Kathleen Cates Geer

John Geer, a/c/f Alene Hawkins Geer

John Geer, a/c/f James Oliver Geer

John Geer, a/c/f Emily Kathleen Roesel

John Geer, a/c/f Cloe Marguerite Roesel

Sonja Hagel

John Harrington

Andrew Harris

Larry Hough

Hough Trust, Leslie J. Hough, Trustee, U.A. dated 3/27/98

Dennis Jacobs

John Luke McGuinness, Jr. Trust, dated 4/23/99

Jim Johnston

Victor Jordon

Steven King

Dennis Knox

Anthony C. Krayer

Anthony C. Krayer Revocable Trust

Robert M. Martin

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Linn H. McCain

John R. McCaslin

Deborah T. McCormick

McPherson McMullan Associates, L.P.

Linda J. Mild

Elizabeth Minkoff

Joseph D. Moore

Carol Murdock

Nancy Novick

Stephen L. Page

Harold H. Pilgrim, Jr.

Harold H. Pilgrim, III

Keith Pitts

Jerry Pressley

Mark Price

Jeanette Rasmussen

Phillip W. Roe

Tracy Ann Rogers

Anne L. Sanford

Tony W. Simpson

Angela Skalla

Gene A. Smith

Ronald P. Soltman

Neal Somaney

James H. Spalding

Shelly Stocker

Keith L. Swinney

Alan G. Thomas

Suzanne Towry

Michael Brooks Turkel

Davis W. Turner

Kent H. Wallace

Nicke Lynn Waters

Thomas M. Ways

William V.B. Webb

Beverly F. Weber

Baptist Health Services

2EXHIBIT 10.66

EXHIBIT 10.66

AMENDMENT NO. 5

TO

AMENDED AND RESTATED EMPLOYMENT AGREEMENT

            This Amendment No. 5 (this “Amendment’) to Amended and Restated Employment Agreement, dated as of June 30, 2008, but effective as of July 1, 2008
(the “Effective Date”), is made by and between Vanguard Health Systems, Inc., a Delaware corporation (the “Company”), and Joseph D. Moore (the “Executive”).

            WHEREAS, the Company and the Executive executed a certain Amended and Restated Employment Agreement dated as of September 23, 2004; as amended by
Amendment No. 1 dated as of December  1, 2004; as further amended by Amendment No. 2 dated as of December 1, 2005; as further amended by Amendment No. 3 dated as of October 1, 2007 but such Amendment No. 3 effective as of December 31, 2007;  and as further
amended by Amendment No. 4 dated as of November 7, 2007 (collectively, the “EA”),  to secure the services of the Executive initially  as the Company’s Chief Financial Officer, Treasurer and Executive Vice President and on and after
November 7, 2007, as  an Executive Vice President of the Company; and

            WHEREAS, the Company and the Executive wish to further amend the EA to reflect the Executive’s wish to reduce his hourly commitment of employment
services to the Company under the EA.

            NOW, THEREFORE, in consideration of the premises and the mutual covenants herein contained, the Company and the Executive hereby agree that the EA is
further amended as follows, such amendments effective as of the Effective Date:

            1.         Defined Terms.  Except for those terms defined above, the definitions of capitalized terms used
in this Amendment are as provided in the EA.

            2.         Amendment to Section 4.  Section 4 of the EA entitled “Duties and Reporting
Relationship” is hereby amended by adding the following new sentence at the end thereof:

                        The term “full time basis”, as used in the previous sentence of this
Section

                        4 shall mean 1,664 hours per year (or an average of 32 hours per week).

            3          Amendment to Section 6(a).  Section 6(a) of the EA entitled “Base Salary” is
hereby deleted and replaced with the following new Section 6(a):

                        (a).  Base Salary.  Commencing July 1, 2008, the
Executive’s base salary

                        hereunder shall be $466,796 per year, payable semi-monthly. The Board

                        shall review such base salary at least annually and make such adjustments

                        from time to time as it may deem advisable, but the base salary shall not at

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                        any time be reduced from the base salary in effect from time to time on

                        and July 1, 2008.

              4.        Amendment to Subsection (i) of Section 10(d).  The number “$550,000” found at
the end of Subsection (i) of Section 10(d) of the EA (which Section 10(d) is entitled “Termination by the Executive”) is hereby deleted and replaced with the number “$466,796”.

            5.         Ratification.  All other provisions of the EA remain unchanged and are hereby ratified by the
Company and the Executive.

            IN WITNESS WHEREOF, the Company has caused this Amendment to be executed by its duly authorized officer and the Executive has executed this Amendment,
each as of the day and year first set forth above.

                                                                       
Vanguard Health Systems, Inc.

                                                                       
By:       /s/ Ronald P. Soltman              

                                                                                    
Ronald P. Soltman

                                                                                   
Executive Vice President

                                                                       
Executive:

                                                                       
/s/ Joseph D. Moore                             

                                                                       
Joseph D. Moore

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