Document:

VANGUARD HEALTH SYSTEMS, INC.

Exhibit 4.2

SUPPLEMENTAL INDENTURE

            SECOND SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 30, 2012, among VANGUARD HEALTH HOLDING COMPANY II, LLC, a Delaware limited liability company
(the “Company”), VANGUARD HOLDING COMPANY II, INC., a Delaware corporation (the “Co-Issuer” and, together with the Company, the “Issuers”), the guarantors listed on the signature pages hereto (the
“Guarantors”) and U.S. BANK NATIONAL ASSOCIATION, as trustee under the Indenture referred to below (the “Trustee”).

WITNESSETH

            WHEREAS, the Issuers and the Guarantors have heretofore executed and delivered to the Trustee an indenture (as amended, supplemented (including by the first
supplemental indenture dated as of September 22, 2011) or otherwise modified, the “Indenture”), dated as of January 26, 2011, providing for the issuance of 7.750% Senior Notes due 2019 (the “Notes”);

            WHEREAS, the Issuers initially issued $350,000,000 aggregate principal amount of 7.750% Senior Notes due 2019 (the “Existing Notes”) under
the Indenture on January 26, 2011;

            WHEREAS, Section 2.14 of the Indenture provides that the Issuers, when authorized by a resolution of the Board of Directors of each Issuer, may issue
Additional Notes under the Indenture subject to certain conditions set forth in Section 2.14 of the Indenture;

            WHEREAS, the Issuers wish to issue an additional $375,000,000 aggregate principal amount of their 7.750% Senior Notes due 2019 as Additional Notes under the
Indenture (the “New Notes”);

            WHEREAS, Section 9.01 of the Indenture provides that without the consent of the Holders of the Notes issued under the Indenture, the Company and the
Trustee may enter into one or more indentures supplemental to the Indenture to make any change that does not adversely affect the legal rights of any such Holder;

            WHEREAS, the Issuers propose, without the consent of the Holders of the Notes, that certain terms of the Indenture be amended; and

            WHEREAS, the Trustee, the Issuers and the Guarantors are authorized to execute and deliver this Supplemental Indenture.

            NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Issuers, the
Guarantors and the Trustee mutually covenant and agree as follows:

            1.         Defined Terms.  Defined terms used herein without definition shall have the meanings assigned to
them in the Indenture.  The words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section
hereof.

            2.         Amount of New Notes.  The aggregate principal amount of New Notes to be authenticated and
delivered under this Supplemental Indenture on or about March 30, 2012 is $375,000,000.

            3.         Terms of New Notes.  The New Notes to be issued as Additional Notes under the Indenture and
pursuant to this Supplemental Indenture shall:

                        A.        be issued as part of the existing series
of Existing Notes previously issued under the Indenture and the New Notes and the Existing Notes shall be a single class for all purposes under the Indenture, including, without limitation, waivers, amendments, redemptions and offers to purchase;

                        B.         be issued on March 30, 2012 at a
purchase price of 99.25% of the principal amount and will accrue interest from February 1, 2012;

                        C.         be issuable in whole in the form of
one or more Global Notes to be held by the Depository and in the form, including appropriate transfer restriction legends, provided in Exhibit A1 and Exhibit A2, as applicable, to the Indenture;

                        D.        the New Notes shall initially bear, in the
case of New Notes sold under Rule 144A, the CUSIP number of 92203P AJ5 and ISIN number of US92203PAJ57, and, in the case of New Notes sold under Regulation S of the Securities Act, the CUSIP number of U92165 AE6 and ISIN number of USU92165AE62; and

                        E.         until a Registered Exchange Offer
has been consummated or a Shelf Registration Statement has been filed and becomes effective with respect to the New Notes, the New Notes shall be subject to the transfer restrictions applicable to a Restricted Global Note or Restricted Definitive Note, as applicable,
and shall have a different CUSIP number than that of the Existing Notes.

            4.         Guarantee Release Amendment.  Section 4.03(3) of the Indenture is hereby amended to read as
follows: “So long as Vanguard is a Guarantor, holds no material assets other than cash, Cash Equivalents and the Capital Stock of VHS Holdco I or the Issuers (and performs the related incidental activities associated with such ownership) and complies with the
requirements of Rule 3-10 of Regulation S-X promulgated by the Commission (or any successor provision), the reports, information and other documents required to be filed and furnished to Holders of the Notes pursuant to this Section 4.03 may, at the option of VHS
Holdco II, be filed by and be those of Vanguard rather than VHS Holdco II. VHS Holdco II shall be deemed to be in compliance with the provisions of this Section 4.03 if Vanguard shall have filed such reports, documents and other information with the Commission using
its Electronic Data Gathering, Analysis and Referral System or any successor system.”

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                        Section 6.01(8) of the Indenture is hereby amended to read as follows: “the
Guarantee of VHS Holdco I or any Guarantee of a Significant Subsidiary fails to be in full force and effect (except as contemplated by the terms thereof) or any Guarantor denies or disaffirms its obligations under its Guarantee and such Default continues for 10
days.”

                        Section 9.01(6) of the Indenture is herebyamended to read as follows: “to add a
Guarantee with respect to the Notes;”

                        Section 10.03 of the Indenture is hereby amended to delete the following sentence:
“Notwithstanding any other provision of this Indenture, Vanguard may be released from all of its obligations under its Guarantee and shall cease to be a Guarantor for all purposes under this Indenture, at the option of the Issuers and Vanguard at any time
following the Issue Date.”

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

            6.         GOVERNING LAW.  THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE
WITH, THE LAWS OF THE STATE OF NEW YORK.

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

            8.         Effect of Headings.  The section headings herein are for convenience only and shall not affect
the construction hereof.

            9.         Trustee Makes No Representation.  The Trustee makes no representation as to the validity or
sufficiency of this Supplemental Indenture.

[The rest of this page is intentionally blank]

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            IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly executed and attested, all as of the date first above
written.

Vanguard Health Holding Company II, LLC

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

Vanguard Holding Company II, Inc.

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

Vanguard Health Holding Company I, LLC,

 as Guarantor

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

Vanguard Health Systems, Inc.,

 as Guarantor

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

[Signature Page to Supplemental Indenture]

Abrazo Medical Group Urgent Care, LLC

BHS Physicians Alliance for ACE, LLC

Central Texas Corridor Hospital Company, LLC

Hospital Development of West Phoenix, Inc.

MacNeal Physicians Group, LLC

Vanguard Health Financial Company, LLC

Vanguard Health Management, Inc.

VHS Acquisition Corporation

VHS Acquisition Subsidiary Number 1, Inc.

VHS Acquisition Subsidiary Number 2, Inc.

VHS Acquisition Subsidiary Number 5, Inc.

VHS Acquisition Subsidiary Number 7, Inc.

VHS Acquisition Subsidiary Number 8, Inc.

VHS Acquisition Subsidiary Number 9, Inc.

VHS Acquisition Subsidiary Number 10, Inc.

VHS Acquisition Subsidiary Number 11, Inc.

VHS Acquisition Subsidiary Number 12, Inc.

VHS Chicago Market Procurement, LLC

VHS Genesis Labs, Inc.

VHS Holding Company, Inc.

VHS Imaging Centers, Inc.

VHS of Anaheim, Inc.

VHS of Arrowhead, Inc.

VHS of Huntington Beach, Inc.

VHS of Illinois, Inc.

VHS of Orange County, Inc.

VHS of Phoenix, Inc.

VHS of South Phoenix, Inc.

VHS Outpatient Clinics, Inc.

Baptist Medical Management Service Organization, LLC

Healthcare Compliance, L.L.C.

MacNeal Health Providers, Inc.

MacNeal Management Services, Inc.

Pros Temporary Staffing, Inc.

Watermark Physician Services, Inc.

VHS of Michigan, Inc.

VHS Children’s Hospital of Michigan, Inc.

VHS Detroit Businesses, Inc.

VHS Detroit Receiving Hospital, Inc.

VHS Detroit Ventures, Inc.

as Guarantors

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

[Signature Page to Supplemental Indenture]

VHS Harper-Hutzel Hospital, Inc.

VHS Huron Valley-Sinai Hospital, Inc.

VHS Rehabilitation Institute of Michigan, Inc.

VHS Sinai-Grace Hospital, Inc.

VHS University Laboratories, Inc.

VHS Westlake Hospital, Inc.

VHS West Suburban Medical Center, Inc.

VHS Acquisition Subsidiary Number 4, Inc.

Midwest Pharmacies, Inc.

VHS Arizona Heart Institute, Inc.

VHS Valley Management Company, Inc.,

as Guarantors

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

vhS San Antonio Partners, LLC, as Guarantor

By:       VHS Acquisition Subsidiary Number 5, Inc., its Member

By:       /s/ James H. Spalding              

             Name:  James H. Spalding

            Title:     Executive Vice President

[Signature Page to Supplemental Indenture]

Dated as of March 30, 2012

U.S. BANK NATIONAL ASSOCIATION

By:       /s/ Joshua A.
Hahn                              

             Joshua A. Hahn

            Assistant Vice President

            Authorized Signatory

[Signature Page to Supplemental Indenture]VANGUARD HEALTH SYSTEMS, INC.

Exhibit 4.3

REGISTRATION RIGHTS AGREEMENT

by and among

Vanguard Health Holding Company II, LLC,

Vanguard Holding Company II, Inc.,

Vanguard Health Systems, Inc.

and

the Other Guarantors Party Hereto

and

Merrill Lynch, Pierce, Fenner & Smith Incorporated

Barclays Capital Inc.

Citigroup Global Markets Inc.

Deutsche Bank Securities Inc.

Goldman, Sachs & Co.

J.P. Morgan Securities LLC

Morgan Stanley & Co. LLC

RBC Capital Markets, LLC

Wells Fargo Securities, LLC

Dated as of March 30, 2012

REGISTRATION RIGHTS AGREEMENT

            This Registration Rights Agreement (this “Agreement”) is made and entered into as of March 30, 2012, by and among Vanguard Health Holding Company
II, LLC, a Delaware limited liability company (the “Company”), and Vanguard Holding Company II, Inc., a Delaware corporation (together with the Company, the “Companies”), Vanguard Health Systems, Inc., a Delaware corporation (the
“Parent”), the other entities listed on the signature pages hereof as “Guarantors” (collectively, the “Guarantors”), and Merrill Lynch, Pierce, Fenner & Smith Incorporated and Barclays Capital Inc., on behalf of themselves and
as representatives of the several initial purchasers listed on Schedule I hereto (collectively, the “Initial Purchasers”), each of whom has agreed to purchase the Companies’ 7.750% Senior Notes due 2019 (the “Initial Notes”) fully and
unconditionally guaranteed by the Guarantors (the “Guarantees”) pursuant to the Purchase Agreement (as defined below).  The Initial Notes and the Guarantees attached thereto are herein collectively referred to as the “Initial
Securities.”  The Companies and the Guarantors are collectively referred to herein as the “Issuers.”

            This Agreement is made pursuant to the Purchase Agreement, dated March 27, 2012 (the “Purchase Agreement”), among the Companies, the Guarantors and
the Initial Purchasers (i) for the benefit of the Initial Purchasers and (ii) for the benefit of the holders from time to time of the Initial Securities, including the Initial Purchasers.  In order to induce the Initial Purchasers to purchase the Initial
Securities, the Issuers have agreed to provide the registration rights set forth in this Agreement.  The execution and delivery of this Agreement is a condition to the obligations of the Initial Purchasers set forth in Section 5(f) of the Purchase
Agreement.

            The parties hereby agree as follows:

            SECTION 1.   Definitions.  As used in this Agreement, the following capitalized terms shall have the following meanings:

            Additional Interest Payment Date:  With respect to the Initial Securities, each Interest Payment Date.

            Broker-Dealer:  Any broker or dealer registered under the Exchange Act.

            Business Day:  Any day other than a Saturday, Sunday or U.S. federal holiday or a day on which banking institutions or trust companies located in
New York, New York are authorized or obligated to be closed.

            Closing Date:  The date of this Agreement.

            Commission:  The Securities and Exchange Commission.

            Consummate:  A registered Exchange Offer shall be deemed “Consummated” for purposes of this Agreement upon the occurrence of (i) the
filing and effectiveness under the Securities Act of the Exchange Offer Registration Statement relating to the Exchange Securities to be issued in the Exchange Offer, (ii) the maintenance of such Registration Statement continuously effective and the keeping of the
Exchange Offer open for a period not less than the minimum pe-

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riod required pursuant to Section 3(b) hereof, and (iii) the delivery by the Issuers, to the Registrar under the Indenture of Exchange Securities in the same aggregate principal amount as the aggregate principal amount of
Initial Securities that were tendered by Holders thereof pursuant to the Exchange Offer.

            Exchange Act:  The Securities Exchange Act of 1934, as amended.

            Exchange Offer:  The registration by the Issuers under the Securities Act of the Exchange Securities pursuant to a Registration Statement pursuant
to which the Issuers offer the Holders of all outstanding Transfer Restricted Securities the opportunity to exchange all such outstanding Transfer Restricted Securities held by such Holders for Exchange Securities in an aggregate principal amount equal to the
aggregate principal amount of the Transfer Restricted Securities tendered in such exchange offer by such Holders.

            Exchange Offer Registration Statement:  The Registration Statement relating to the Exchange Offer, including the related Prospectus.

            Exempt Resales:  The transactions in which the Initial Purchasers propose to sell the Initial Securities to certain “qualified institutional
buyers,” as such term is defined in Rule 144A under the Securities Act and to certain non-U.S. persons pursuant to Regulation S under the Securities Act.

            Exchange Securities:  The 7.750% Senior Notes due 2019, of the same series under the Indenture as the Initial Notes and the Guarantees attached
thereto, to be issued to Holders in exchange for Transfer Restricted Securities pursuant to this Agreement.

            FINRA:  The Financial Industry Regulatory Authority.

            Holders:  As defined in Section 2(b) hereof.

            Indemnified Holder:  As defined in Section 8(a) hereof.

            Indenture:  That certain Indenture, dated as of January 26, 2011 as supplemented by the First Supplemental Indenture, dated as of September 22,
2011 (the “Base Indenture”), by and among the Issuers and U.S. Bank National Association, as trustee (the “Trustee”) as supplemented by a supplemental indenture dated as of the date hereof (the “Supplemental Indenture”), by and
among the Issuers and the Trustee, pursuant to which the Initial Securities are to be issued, as such Indenture may be further amended or supplemented from time to time in accordance with the terms thereof.

            Initial Purchasers:  As defined in the preamble hereto.

            Initial Notes:  As defined in the preamble hereto.

            Initial Placement:  The issuance and sale by the Companies of the Initial Securities to the Initial Purchasers pursuant to the Purchase
Agreement.

            Initial Securities.  As defined in the preamble hereto.

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            Interest Payment Date:  As defined in the Indenture and the Initial Securities.

            Person:  An individual, partnership, corporation, trust or unincorporated organization, or a government or agency or political subdivision
thereof.

            Prospectus:  The prospectus included in a Registration Statement, as amended or supplemented by any prospectus supplement and by all other
amendments thereto, including post-effective amendments, and all material incorporated by reference into such Prospectus.

            Registration Default:   As defined in Section 5 hereof.

            Registration Statement:  Any registration statement of the Issuers relating to (a) an offering of Exchange Securities pursuant to an Exchange Offer
or (b) the registration for resale of Transfer Restricted Securities pursuant to the Shelf Registration Statement, which is filed pursuant to the provisions of this Agreement, in each case, including the Prospectus included therein, all amendments and supplements
thereto (including post-effective amendments) and all exhibits and material incorporated by reference therein.

            Securities Act:  The Securities Act of 1933, as amended.

            Shelf Filing Deadline:  As defined in Section 4(a) hereof.

            Shelf Registration Statement:  As defined in Section 4(a) hereof.

            Shelf Suspension Period:  As defined in Section 4(a) hereof.

            Transfer Restricted Securities:  Each Initial Security, until the earliest to occur of (a) the date on which such Initial Security is exchanged in
the Exchange Offer for an Exchange Security entitled to be resold to the public by the Holder thereof without complying with the prospectus delivery requirements of the Securities Act, (b) the date on which such Initial Security has been effectively registered under
the Securities Act and disposed of in accordance with a Shelf Registration Statement, (c) the date on which such Initial Security is distributed to the public by a Broker-Dealer pursuant to the “Plan of Distribution” contemplated by the Exchange Offer
Registration Statement (including delivery of the Prospectus contained therein) and (d) the later of (x) the date which is two years after the date the Initial Securities were originally issued and (y) the date upon which such Initial Security (and the related
Guarantees) has been resold in compliance with Rule 144 under the Securities Act; provided that such Initial Security no longer bears any restrictive legend relating to the Securities Act and does not bear a restricted CUSIP number.

            Trust Indenture Act:  The Trust Indenture Act of 1939, as amended.

            Underwritten Registration or Underwritten Offering:  A registration in which securities of the Companies are sold to an underwriter for reoffering
to the public.

            SECTION 2.   Securities Subject to this Agreement.

            (a)        Transfer Restricted Securities.  The securities entitled to the benefits of this Agreement are the
Transfer Restricted Securities.

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            (b)        Holders of Transfer Restricted Securities.  A Person is deemed to be a holder of Transfer Restricted
Securities (each, a “Holder”) whenever such Person owns Transfer Restricted Securities.

            SECTION 3.   Registered Exchange Offer.

            (a)        Unless the Exchange Offer shall not be permissible under applicable law or Commission policy (after
the procedures set forth in Section 6(a) hereof have been complied with), the Issuers shall use their reasonable best efforts to (i) cause to be filed with the Commission a Registration Statement under the Securities Act relating to the Exchange Securities and the
Exchange Offer, (ii) cause such Registration Statement to become effective at the earliest possible time, (iii) in connection with the foregoing, file (A) all pre-effective amendments to such Registration Statement as may be necessary in order to cause such
Registration Statement to become effective, (B) if applicable, a post-effective amendment to such Registration Statement pursuant to Rule 430A under the Securities Act and (C) cause all necessary filings in connection with the registration and qualification of the
Exchange Securities to be made under the state securities or blue sky laws of such jurisdictions as are necessary to permit Consummation of the Exchange Offer, and (iv) upon the effectiveness of such Registration Statement, commence the Exchange Offer.  The
Exchange Offer shall be on the appropriate form permitting registration of the Exchange Securities to be offered in exchange for the Transfer Restricted Securities and to permit resales of Initial Securities held by Broker-Dealers as contemplated by Section 3(c)
hereof.

            (b)        The Issuers shall cause the Exchange Offer Registration Statement to be effective continuously and shall keep the
Exchange Offer open for a period of not less than the minimum period required under applicable federal and state securities laws to Consummate the Exchange Offer; provided, however, that in no event shall such period be less than 20 Business Days after the
date notice of the Exchange Offer is mailed to the Holders.  The Issuers shall cause the Exchange Offer to comply with all applicable federal and state securities laws.  No securities other than the Exchange Securities shall be included in the Exchange
Offer Registration Statement.  The Issuers shall use their reasonable best efforts to cause the Exchange Offer to be Consummated on the earliest practicable date after the Exchange Offer Registration Statement has become effective, but in no event later than 360
days after the Closing Date (or if such 360th day is not a Business Day, the next succeeding Business Day).

            (c)        The Issuers shall indicate in a “Plan of Distribution” section contained in the Prospectus forming a
part of the Exchange Offer Registration Statement that any Broker-Dealer who holds Initial Securities that are Transfer Restricted Securities and that were acquired for its own account as a result of market-making activities or other trading activities (other than
Transfer Restricted Securities acquired directly from the Issuers), may exchange such Initial Securities pursuant to the Exchange Offer; however, such Broker-Dealer may be deemed to be an “underwriter” within the meaning of the Securities Act and must,
therefore, deliver a prospectus meeting the requirements of the Securities Act in connection with any resales of the Exchange Securities received by such Broker-Dealer in the Exchange Offer, which prospectus delivery requirement may be satisfied by the delivery by
such Broker-Dealer of the Prospectus contained in the Exchange Offer Registration Statement.  Such “Plan of Distribution” section shall also contain all other information with respect to such resales by Broker-Dealers that the Commission
may

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require in order to permit such resales pursuant thereto, but such “Plan of Distribution” shall not name any such Broker-Dealer or disclose the amount of Initial Securities held by any such Broker-Dealer except to
the extent required by the Commission as a result of a change in policy after the date of this Agreement.

            The Issuers shall use their reasonable best efforts to keep the Exchange Offer Registration Statement continuously effective, supplemented and amended as
required by the provisions of Section 6(c) hereof to the extent necessary to ensure that it is available for resales of Initial Securities acquired by Broker-Dealers for their own accounts as a result of market-making activities or other trading activities, and to
ensure that it conforms with the requirements of this Agreement, the Securities Act and the policies, rules and regulations of the Commission as announced from time to time, for a period ending on the earlier of (i) 180 days from the date on which the Exchange Offer
Registration Statement is declared effective and (ii) the date on which a Broker-Dealer is no longer required to deliver a prospectus in connection with market-making or other trading activities.

            The Issuers shall provide sufficient copies of the latest version of such Prospectus to Broker-Dealers promptly upon request at any time during such 180-day
(or shorter as provided in the foregoing sentence) period in order to facilitate such resales.

            SECTION 4.   Shelf Registration.

            (a)        Shelf Registration.  If (i) the Issuers are not required to file an Exchange Offer Registration
Statement or to consummate the Exchange Offer because the Exchange Offer is not permitted by applicable law or Commission policy (after the procedures set forth in Section 6(a) hereof have been complied with), (ii) for any reason the Exchange Offer is not Consummated
within 360 days after the Closing Date (or if such 360th day is not a Business Day, the next succeeding Business Day), or (iii) with respect to any Holder of Transfer Restricted Securities (A) such Holder is prohibited by applicable law or Commission policy from
participating in the Exchange Offer, or (B) such Holder may not resell the Exchange Securities acquired by it in the Exchange Offer to the public without delivering a prospectus and that the Prospectus contained in the Exchange Offer Registration Statement is not
appropriate or available for such resales by such Holder, or (C) such Holder is a Broker-Dealer and holds Initial Securities acquired directly from an Issuer or one of its affiliates, then, upon such Holder’s request, the Issuers shall

                        (x)        cause to be filed a shelf registration
statement pursuant to Rule 415 under the Securities Act, which may be an amendment to the Exchange Offer Registration Statement (in either event, the “Shelf Registration Statement”) on or prior to the earliest to occur of (1) the 90th day after the date
on which the Company determines that it is not required to file the Exchange Offer Registration Statement and (2) the 90th day after the date on which the Company receives notice from a Holder of Transfer Restricted Securities as contemplated by clause (ii) above
(such date being the “Shelf Filing Deadline”), which Shelf Registration Statement shall provide for resales of all Transfer Restricted Securities the Holders of which shall have provided the information required pursuant to Section 4(b) hereof;
and

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                        (y)        use their reasonable best efforts to
cause such Shelf Registration Statement to be declared effective by the Commission on or before the 90th day after the Shelf Filing Deadline (or if such 90th day is not a Business Day, the next succeeding Business Day).

            The Issuers shall use their reasonable best efforts to keep such Shelf Registration Statement continuously effective, supplemented and amended as required by
the provisions of Sections 6(b) and (c) hereof to the extent necessary to ensure that it is available for resales of Initial Securities by the Holders of Transfer Restricted Securities entitled to the benefit of this Section 4(a), and to ensure that it conforms with
the requirements of this Agreement, the Securities Act and the policies, rules and regulations of the Commission as announced from time to time, for a period of at least two years following the effective date of such Shelf Registration Statement (or shorter period
that will terminate when all the Initial Securities covered by such Shelf Registration Statement have been sold pursuant to such Shelf Registration Statement).

            Notwithstanding anything to the contrary in this Agreement, at any time the Issuers may delay the filing of any Shelf Registration Statement or delay or
suspend the effectiveness thereof, for a reasonable period of time, but not in excess of 60 consecutive days or more than three (3) times during any calendar year (each, a “Shelf Suspension Period”), if the Board of Directors and Board of
Representatives, as applicable, of the Companies determines reasonably and in good faith that the filing of any such initial Shelf Registration Statement or the continuing effectiveness thereof would require the disclosure of material non-public information that, in
the reasonable judgment of the Board of Directors and the Board of Representatives, as applicable, of the Companies, would be detrimental to the Issuers if so disclosed or would otherwise materially adversely affect a financing, acquisition, disposition, merger or
other material transaction or such action is required by applicable law.

            (b)        Provision by Holders of Certain Information in Connection with the Shelf Registration Statement.  No
Holder of Transfer Restricted Securities may include any of its Transfer Restricted Securities in any Shelf Registration Statement pursuant to this Agreement unless and until such Holder furnishes to the Issuers in writing, within 20 Business Days after receipt of a
request therefor, such information as the Issuers may reasonably request for use in connection with any Shelf Registration Statement or Prospectus or preliminary Prospectus included therein.  Each Holder as to which any Shelf Registration Statement is being
effected agrees to furnish promptly to the Issuers all information required to be disclosed in order to make the information previously furnished to the Issuers by such Holder not materially misleading.

            SECTION 5.   Additional Interest.  If (i) the Exchange Offer has not been Consummated within 360 days after the Closing Date or (ii) any
Registration Statement required by this Agreement is filed and declared effective but shall thereafter cease to be effective or fail to be usable for its intended purpose without being succeeded immediately by a post-effective amendment to such Registration Statement
that cures such failure and that is itself immediately declared effective (each such event referred to in clauses (i) and (ii), a “Registration Default”), the Issuers hereby agree that the interest rate borne by the Transfer Restricted Securities shall be
increased by 0.25% per annum during the 90-day period immediately following the occurrence of any Registration Default and shall increase by 0.25% per annum at the end of each subsequent 90-day period, but in no event shall such increase exceed 1.00% per annum. 
Following the cure

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of all Registration Defaults relating to any particular Transfer Restricted Securities, the interest rate borne by the relevant Transfer Restricted Securities will be reduced to the original interest rate borne by such
Transfer Restricted Securities; provided, however, that, if after any such reduction in interest rate, a different Registration Default occurs, the interest rate borne by the relevant Transfer Restricted Securities shall again be increased pursuant to the
foregoing provisions.  Notwithstanding any other provisions of this Section 5, the Issuers shall not be obligated to pay Additional Interest provided in this Section 5 during a Shelf Suspension Period permitted by Section 4 (a) hereof.

            All obligations of the Issuers set forth in the preceding paragraph that are outstanding with respect to any Transfer Restricted Security at the time such
security ceases to be a Transfer Restricted Security shall survive until such time as all such obligations with respect to such security shall have been satisfied in full.

            SECTION 6.   Registration Procedures.

            (a)        Exchange Offer Registration Statement.  In connection with the Exchange Offer, the
Issuers shall comply with all of the provisions of Section 6(c) hereof, shall use their reasonable best efforts to effect such exchange to permit the sale of Transfer Restricted Securities being sold in accordance with the intended method or methods of distribution
thereof, and shall comply with all of the following provisions:

                        (i)         If in the reasonable opinion of
counsel to the Issuers there is a question as to whether the Exchange Offer is permitted by applicable law and it is advisable to do so, the Issuers hereby agree to seek a no-action letter or other favorable decision from the Commission allowing the Issuers to
Consummate an Exchange Offer for such Initial Securities.  The Issuers hereby agree to pursue the issuance of such a decision to the Commission staff level but shall not be required to take action to effect a change of Commission policy.  The Issuers hereby
agree, however, to (A) participate in telephonic conferences with the Commission, (B) deliver to the Commission staff an analysis prepared by counsel to the Issuers setting forth the legal bases, if any, upon which such counsel has concluded that such an Exchange
Offer should be permitted and (C) diligently pursue a resolution by the Commission staff of such submission.

                        (ii)        As a condition to its participation in
the Exchange Offer pursuant to the terms of this Agreement, each Holder of Transfer Restricted Securities shall furnish, upon the request of the Issuers, prior to the Consummation thereof, a written representation to the Issuers (which may be contained in the letter
of transmittal contemplated by the Exchange Offer Registration Statement) to the effect that (A) it is not an affiliate of the Issuers, (B) it is not engaged in, and does not intend to engage in, and has no arrangement or understanding with any Person to participate
in, a distribution of the Exchange Securities to be issued in the Exchange Offer and (C) it is acquiring the Exchange Securities in its ordinary course of business.  In addition, all such Holders of Transfer Restricted Securities shall otherwise cooperate in the
Issuers’ preparations for the Exchange Offer.  Each Holder including any Holder that is a Broker-Dealer, hereby acknowledges and agrees that any such Holder using the Exchange Offer to participate in a distribution of the securities to be acquired in the
Exchange Offer (1) could not under Commission policy as in

-8-

effect on the date of this Agreement rely on the position of the Commission enunciated in Morgan Stanley & Co., Inc. (available June 5, 1991) and Exxon Capital Holdings Corporation (available May 13, 1988),
as interpreted in the Commission’s letter to Shearman & Sterling dated July 2, 1993, and similar no-action letters (which may include any no-action letter obtained pursuant to clause (i) above), and (2) must comply with the registration and prospectus
delivery requirements of the Securities Act in connection with a secondary resale transaction and that such a secondary resale transaction should be covered by an effective registration statement containing the selling security holder information required by Item 507
or 508, as applicable, of Regulation S‐K if the resales are of Exchange Securities obtained by such Holder in exchange for Initial Securities acquired by such Holder directly from the Issuers.

            (b)        Shelf Registration Statement.  In connection with the Shelf Registration Statement, the Issuers shall
comply with all the provisions of Section 6(c) hereof and shall use their reasonable best efforts to effect such registration to permit the sale of the Transfer Restricted Securities being sold in accordance with the intended method or methods of distribution
thereof, and pursuant thereto the Issuers will as expeditiously as possible prepare and file with the Commission a Registration Statement relating to the registration on any appropriate form under the Securities Act, which form shall be available for the sale of the
Transfer Restricted Securities in accordance with the intended method or methods of distribution thereof.

            (c)        General Provisions.  In connection with any Registration Statement and any Prospectus required by
this Agreement to permit the sale or resale of Transfer Restricted Securities (including, without limitation, any Registration Statement and the related Prospectus required to permit resales of Initial Securities by Broker-Dealers), the Issuers shall:

                        (i)         use their reasonable best efforts
to keep such Registration Statement continuously effective and provide all requisite financial statements (including, if required by the Securities Act or any regulation thereunder, financial statements of the Guarantors for the period specified in Section 3 or 4
hereof, as applicable; upon the occurrence of any event that would cause any such Registration Statement or the Prospectus contained therein (A) to contain an untrue statement of material fact or omit to state a material fact necessary to make the statements therein
not misleading or (B) not to be effective and usable for resale of Transfer Restricted Securities during the period required by this Agreement, the Issuers shall file promptly an appropriate amendment to such Registration Statement or supplement to the Prospectus or
documents incorporated by reference, in the case of clause (A), correcting any such misstatement or omission, and, in the case of either clause (A) or (B), use their reasonable best efforts to cause such amendment to be declared effective and such Registration
Statement and the related Prospectus to become usable for their intended purpose(s) as soon as practicable thereafter;

                        (ii)        prepare and file with the Commission
such amendments and post-effective amendments to the applicable Registration Statement as may be necessary to keep the Registration Statement effective for the applicable period set forth in Section 3 or 4 hereof, as applicable, or such shorter period as will
terminate when all Transfer Restricted Securities covered by such Registration Statement have been sold; cause the Prospectus to be supple-

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mented by any required Prospectus supplement, and as so supplemented to be filed pursuant to Rule 424 under the Securities Act, and to comply fully with the applicable provisions of Rules 424 and 430A under the Securities Act
in a timely manner; and comply with the provisions of the Securities Act with respect to the disposition of all securities covered by such Registration Statement during the applicable period in accordance with the intended method or methods of distribution by the
sellers thereof set forth in such Registration Statement or supplement to the Prospectus;

                        (iii)       advise the underwriter(s), if any, and
selling Holders promptly and, if requested by such Persons, to confirm such advice in writing, (A) when the Prospectus or any Prospectus supplement or post-effective amendment has been filed, and, with respect to any Registration Statement or any post-effective
amendment thereto, when the same has become effective, (B) of any request by the Commission for amendments to the Registration Statement or amendments or supplements to the Prospectus or for additional information relating thereto, (C) of the issuance by the
Commission of any stop order suspending the effectiveness of the Registration Statement under the Securities Act or of the suspension by any state securities commission of the qualification of the Transfer Restricted Securities for offering or sale in any
jurisdiction, or the initiation of any proceeding for any of the preceding purposes and (D) of the existence of any fact or the happening of any event that makes any statement of a material fact made in the Registration Statement, the Prospectus, any amendment or
supplement thereto, or any document incorporated by reference therein untrue, or that requires the making of any additions to or changes in the Registration Statement or the Prospectus in order to make the statements therein not misleading.  If at any time the
Commission shall issue any stop order suspending the effectiveness of the Registration Statement, or any state securities commission or other regulatory authority shall issue an order suspending the qualification or exemption from qualification of the Transfer
Restricted Securities under state securities or blue sky laws, the Issuers shall use their reasonable best efforts to obtain the withdrawal or lifting of such order at the earliest possible time;

                        (iv)       furnish without charge to counsel for the
Initial Purchasers, each selling Holder named in any Registration Statement, and each of the underwriter(s), if any, at least one copy before filing with the Commission, of any Registration Statement or any Prospectus included therein or any amendments or supplements
to any such Registration Statement or Prospectus (including, if requested by any such Person, all documents incorporated by reference after the initial filing of such Registration Statement if not available on the Commission’s EDGAR database), which documents
will be subject to the review of the Initial Purchasers in connection with such sale, if any, for a period of at least five Business Days, and the Issuers will not file any such Registration Statement or Prospectus or any amendment or supplement to any such
Registration Statement or Prospectus (including all such documents incorporated by reference) to which an Initial Purchaser of Transfer Restricted Securities covered by such Registration Statement or the underwriter, if any, shall reasonably object in writing within
five Business Days after the receipt thereof (such objection to be deemed timely made upon confirmation of telecopy transmission within such period).  The objection of an Initial Purchaser or underwriter, if any, shall be deemed to be reasonable if such
Registration Statement, amendment, Prospectus or supplement, as applicable, as proposed to be filed, contains an untrue state-

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ment of a material fact or omits to state a material fact necessary to make the statements therein not misleading;

                        (v)        promptly prior to the filing of any
document that is to be incorporated by reference into a Registration Statement or Prospectus, provide copies of such document to the Initial Purchasers, each selling Holder named in any Registration Statement, and to the underwriter(s), if any, make the
Issuers’ representatives available for discussion of such document and other customary due diligence matters, and include such information in such document prior to the filing thereof as such selling Holders or underwriter(s), if any, reasonably may
request;

                        (vi)       make available at reasonable times for
inspection by the Initial Purchasers, the managing underwriter(s), if any, participating in any disposition pursuant to such Registration Statement and any attorney or accountant retained by such Initial Purchasers or any of the underwriter(s), all pertinent
financial and other records, pertinent corporate documents and properties of each of the Issuers and cause the Issuers’ officers, directors and employees to supply all information reasonably requested by any such Holder, underwriter, attorney or accountant in
connection with such Registration Statement or any post-effective amendment thereto subsequent to the filing thereof and prior to its effectiveness, in each case, as shall be reasonably necessary to enable such persons to conduct an investigation within the meaning
of Section 11 of the Securities Act; provided, however, (A) that the foregoing inspection and information gathering shall be coordinated on behalf of the Initial Purchasers by Cahill Gordon & Reindel llp and on behalf of any other parties by one
counsel designated by and on behalf of such other parties as described in Section 7 hereof, and (B) that any information that is reasonably and in good faith designated by the Issuers in writing as confidential at the time of delivery of such information shall be
kept confidential by the Initial Purchasers, the Holders, or any such underwriter, attorney, accountant or other agent, unless (1) disclosure of such information is required by court or administrative order or is necessary to respond to inquiries of regulatory
authorities, (2) disclosure of such information is required by law (including any disclosure requirements pursuant to federal securities laws in connection with the filing of such Registration Statement or the use of any Prospectus), (3) such information becomes
generally available to the public other than as a result of a disclosure or failure to safeguard such information by such person or (4) such information becomes available to such Initial Purchaser, Holder, underwriter, attorney, accountant or other agent from a
source other than the Issuer and such source is not known by the relevant Initial Purchaser, Holder, underwriter, attorney, accountant or other agent to be bound by a confidentiality agreement or is not otherwise under a duty of trust to the Issuer;

                        (vii)      if requested by any selling Holders or the
underwriter(s), if any, promptly incorporate in any Registration Statement or Prospectus, pursuant to a supplement or post-effective amendment if necessary, such information as such selling Holders and underwriter(s), if any, may reasonably request to have included
therein, including, without limitation, information relating to the “Plan of Distribution” of the Transfer Restricted Securities, information with respect to the principal amount of Transfer Restricted Securities being sold to such underwriter(s), the
purchase price being paid therefor and any other terms of the offering of the Transfer Restricted Securities to be sold in such offer-

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ing; and make all required filings of such Prospectus supplement or post-effective amendment as soon as practicable after the Issuers are notified of the matters to be incorporated in such Prospectus supplement or
post-effective amendment;

                        (viii)      use reasonable best efforts to confirm that the
ratings assigned to the Initial Securities will apply to the Transfer Restricted Securities covered by the Registration Statement, if so requested by the Holders of a majority in aggregate principal amount of Initial Securities covered thereby or the underwriter(s),
if any;

                        (ix)       furnish to each Initial Purchaser, each
selling Holder and each of the underwriter(s), if any, without charge, at least one copy of the Registration Statement, as first filed with the Commission, and of each amendment thereto, including financial statements and schedules and if requested all documents
incorporated by reference therein and all exhibits (including exhibits incorporated therein by reference);

                        (x)        deliver to each selling Holder and each
of the underwriter(s), if any, without charge, as many copies of the Prospectus (including each preliminary prospectus) and any amendment or supplement thereto as such Persons reasonably may request; the Issuers hereby consent to the use of the Prospectus and any
amendment or supplement thereto by each of the selling Holders and each of the underwriter(s), if any, in connection with the offering and the sale of the Transfer Restricted Securities covered by the Prospectus or any amendment or supplement thereto;

                        (xi)       enter into such agreements (including an
underwriting agreement), and make such representations and warranties, and take all such other actions in connection therewith in order to expedite or facilitate the disposition of the Transfer Restricted Securities pursuant to any Registration Statement contemplated
by this Agreement, all to such extent as may be reasonably requested by an Initial Purchaser or by any Holder of Transfer Restricted Securities or underwriter in connection with any sale or resale pursuant to any Registration Statement contemplated by this Agreement;
and whether or not an underwriting agreement is entered into and whether or not the registration is an Underwritten Registration, the Issuers shall:

                                   
(A)       furnish to each Initial Purchaser, each selling Holder and each underwriter, if any, in such substance and scope as they may reasonably request and as are customarily made by issuers to underwriters in primary underwritten
offerings, upon the date of the effectiveness of the Shelf Registration Statement:

                                               
(1)        a certificate, dated the date of effectiveness of the Shelf Registration Statement signed by (y) the President or any Vice President and (z) a principal financial or accounting officer of each of the Issuers, confirming,
as of the date thereof, the matters set forth in paragraphs (i), (ii) and (iii) of Section 5(e) of the Purchase Agreement and such other matters as such parties may reasonably request;

                                               
(2)        an opinion, dated the date of effectiveness of the Shelf Registration Statement of counsel for the Issuers, in form, scope and substance

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reasonably satisfactory to the managing underwriter, addressed to the underwriters covering the matters customarily covered in opinions, reasonably requested in underwritten offerings, and in any event including a statement to
the effect that such counsel has participated in conferences with officers and other representatives of the Issuers the Initial Purchasers’ representatives and the Initial Purchasers’ counsel in connection with the preparation of such Registration
Statement and the related Prospectus and have considered the matters required to be stated therein and the statements contained therein, although such counsel has not independently verified the accuracy, completeness or fairness of such statements; and that such
counsel advises that, on the basis of the foregoing (relying as to materiality to a large extent upon facts provided to such counsel by officers and other representatives of the Issuers and without independent check or verification), no facts came to such
counsel’s attention that caused such counsel to believe that the Registration Statement, at the time such Registration Statement or any post-effective amendment thereto became effective, contained an untrue statement of a material fact or omitted to state a
material fact required to be stated therein or necessary to make the statements therein not misleading, or that the Prospectus contained in such Registration Statement as of its date contained an untrue statement of a material fact or omitted to state a material fact
necessary in order to make the statements therein, in light of the circumstances under which they were made, not misleading.  Without limiting the foregoing, such counsel may state further that such counsel assumes no responsibility for, and has not
independently verified, the accuracy, completeness or fairness of the financial statements, notes and schedules and other financial data included in any Registration Statement contemplated by this Agreement or the related Prospectus; and

                                               
(3)        a customary comfort letter, dated the date of effectiveness of the Shelf Registration Statement in form, scope and substance reasonably satisfactory to the managing underwriter, from the Issuers’ independent
accountants, in the customary form and covering matters of the type customarily requested to be covered in comfort letters by underwriters in connection with primary underwritten offerings;

                                   
(B)       set forth in full or incorporate by reference in the underwriting agreement, if any, the indemnification provisions and procedures of Section 8 hereof with respect to all parties to be indemnified pursuant to said Section;
and

                                   
(C)       deliver such other documents and certificates as may be reasonably requested by such parties to evidence compliance with Section 6(c)(xi)(A) hereof and with any customary conditions contained in the underwriting agreement or
other agreement entered into by the Issuers pursuant to this Section 6(c)(xi), if any.

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                        If at any time the representations and warranties of the Issuers contemplated in
Section 6(c)(xi)(A)(1) hereof cease to be true and correct, the Issuers shall so advise the Initial Purchasers and the underwriter(s), if any, and each selling Holder promptly and, if requested by such Persons, shall confirm such advice in writing;

                        (xii)      prior to any public offering of Transfer Restricted
Securities, cooperate with the selling Holders, the underwriter(s), if any, and their respective counsel in connection with the registration and qualification of the Transfer Restricted Securities under the state securities or blue sky laws of such jurisdictions as
the selling Holders or underwriter(s), if any, may reasonably request and do any and all other acts or things necessary or advisable to enable the disposition in such jurisdictions of the Transfer Restricted Securities covered by the Shelf Registration Statement;
provided, however, that none of the Issuers shall be required to register or qualify as a foreign corporation or other foreign entity where it is not then so qualified or to take any action that would subject it to the service of process in suits or to
taxation, other than as to matters and transactions relating to the Registration Statement, in any jurisdiction where it is not then so subject;

                        (xiii)      shall issue, upon the request of any Holder of
Initial Securities covered by and sold pursuant to the Shelf Registration Statement, Exchange Securities having an aggregate principal amount equal to the aggregate principal amount of Initial Securities surrendered to the Issuers by such Holder in exchange therefor
or being sold by such Holder; such Exchange Securities to be registered in the name of such Holder or in the name of the purchaser(s) of such Exchange Securities, as the case may be; in return, the Initial Securities held by such Holder shall be surrendered to the
Issuers for cancellation;

                        (xiv)     cooperate with the selling Holders and the
underwriter(s), if any, to facilitate the timely preparation and delivery of certificates representing Transfer Restricted Securities to be sold and not bearing any restrictive legends; and enable such Transfer Restricted Securities to be in such denominations and
registered in such names as the Holders or the underwriter(s), if any, may reasonably request at least two Business Days prior to any sale of Transfer Restricted Securities made by such Holders or underwriter(s);

                        (xv)      use their reasonable best efforts to cause the
Transfer Restricted Securities covered by the Registration Statement to be registered with or approved by such other governmental agencies or authorities as may be necessary to enable the seller or sellers thereof or the underwriter(s), if any, to consummate the
disposition of such Transfer Restricted Securities, subject to the proviso contained in Section 6(c)(xii) hereof;

                        (xvi)     if any fact or event contemplated by Section 6(c)(iii)(D)
hereof shall exist or have occurred, prepare a supplement or post-effective amendment to the Registration Statement or related Prospectus or any document incorporated therein by reference or file any other required document so that, as thereafter delivered to the
purchasers of Transfer Restricted Securities, the Prospectus will not contain an untrue statement of a material fact or omit to state any material fact necessary in order to make the statements therein, in light of the circumstances under which they were made, not
misleading;

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                        (xvii)     provide a CUSIP number for all Initial Securities not
later than the effective date of the Registration Statement covering such Initial Securities and provide the Trustee under the Indenture with printed certificates for such Initial Securities which are in a form eligible for deposit with The Depository Trust
Company;

                        (xviii)    cooperate and assist in any filings required to be made with
the FINRA and in the performance of any due diligence investigation by any underwriter (including any “qualified independent underwriter”) that is required to be retained in accordance with the rules and regulations of the FINRA;

                       
(xix)                 otherwise use their reasonable best efforts to comply with all applicable rules and regulations of the Commission, and make generally available to its security
holders, as soon as practicable, a consolidated earning statement meeting the requirements of Rule 158 (which need not be audited) for the twelve-month period (A) commencing at the end of any fiscal quarter in which Transfer Restricted Securities are sold to
underwriters in a firm commitment or best efforts Underwritten Offering or (B) if not sold to underwriters in such an offering, beginning with the first month of the Parent‘s first fiscal quarter commencing after the effective date of the Registration
Statement;

                        (xx)      cause the Indenture to be qualified under the Trust
Indenture Act not later than the effective date of the first Registration Statement required by this Agreement, and, in connection therewith, cooperate with the Trustee and the Holders of Initial Securities to effect such changes to the Indenture as may be required
for such Indenture to be so qualified in accordance with the terms of the Trust Indenture Act; and to execute and use their reasonable best efforts to cause the Trustee to execute, all documents that may be required to effect such changes and all other forms and
documents required to be filed with the Commission to enable such Indenture to be so qualified in a timely manner; and

                        (xxi)     provide promptly (if not already available on the
Commission’s EDGAR database) to each Holder upon request each document filed with the Commission pursuant to the requirements of Section 13 and Section 15 of the Exchange Act.

            Each Holder agrees by acquisition of a Transfer Restricted Security that, upon receipt of any notice from the Issuers of the existence of any fact of the kind
described in Section 6(c)(iii)(D) hereof, such Holder will forthwith discontinue disposition of Transfer Restricted Securities pursuant to the applicable Registration Statement until such Holder’s receipt of the copies of the supplemented or amended Prospectus
contemplated by Section 6(c)(xvi) hereof, or until it is advised in writing (the “Advice”) by the Issuers that the use of the Prospectus may be resumed, and has received copies of any additional or supplemental filings that are incorporated by reference
in the Prospectus.  If so directed by the Issuers, each Holder will deliver to the Issuers (at the Issuers’ expense) all copies, other than permanent file copies then in such Holder’s possession, of the Prospectus covering such Transfer Restricted
Securities that was current at the time of receipt of such notice.  In the event the Issuers shall give any such notice, the time period regarding the effectiveness of such Registration Statement set forth in Section 3 or 4 hereof, as applicable, shall be
extended by the number of days during the period from and including the date of the giving of such notice pursuant to Section 6(c)(iii)(D) hereof to and including the date when each selling Holder covered by such Registration Statement shall have received the
copies

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of the supplemented or amended Prospectus contemplated by Section 6(c)(xvi) hereof or shall have received the Advice; provided, however, that no such extension shall be taken into account in determining whether
Additional Interest is due pursuant to Section 5 hereof or the amount of such Additional Interest.

            SECTION 7.   Registration Expenses.

            All expenses incident to the Issuers’ performance of or compliance with this Agreement will be borne by the Issuers, jointly and severally, regardless of
whether a Registration Statement becomes effective, including, without limitation: (i) all registration and filing fees and expenses (including filings made by any Initial Purchaser or Holder with the FINRA (and, if applicable, the fees and expenses of any
“qualified independent underwriter” and its counsel that may be required by the rules and regulations of the FINRA)); (ii) all fees and expenses of compliance with federal securities and state securities or blue sky laws; (iii) all expenses of printing
(including printing of Prospectuses), messenger and delivery services and telephone; (iv) all fees and disbursements of counsel for the Issuers; and (v) all application and filing fees in connection with listing the Exchange Securities on a securities exchange or
automated quotation system pursuant to the requirements thereof, if applicable; all fees and disbursements of independent certified public accountants of the Issuers (including the expenses of any special audit and comfort letters required by or incident to such
performance).

            Each of the Issuers will, in any event, bear its internal expenses (including, without limitation, all salaries and expenses of its officers and employees
performing legal or accounting duties), the expenses of any annual audit and the fees and expenses of any Person, including special experts, retained by the Issuers.

            SECTION 8.   Indemnification.

            (a)        The Issuers, jointly and severally, agree to indemnify and hold harmless (i) each Holder and (ii) each Person, if
any, who controls (within the meaning of Section 15 of the Securities Act or Section 20 of the Exchange Act) any Holder (any of the Persons referred to in this clause (ii) being hereinafter referred to as a “controlling person”) and (iii) the respective
officers, directors, partners, employees, representatives and agents of any Holder or any controlling person (any Person referred to in clause (i), (ii) or (iii) may hereinafter be referred to as an “Indemnified Holder”), to the fullest extent lawful,
from and against any and all losses, claims, damages, liabilities, judgments, actions and expenses (including, without limitation, and as incurred, reimbursement of all reasonable costs of investigating, preparing, pursuing, settling, compromising, paying or
defending any claim or action, or any investigation or proceeding by any governmental agency or body, commenced or threatened, including the reasonable fees and expenses of counsel to any Indemnified Holder), joint or several, directly or indirectly caused by,
related to, based upon, arising out of or in connection with (1) any untrue statement or alleged untrue statement of a material fact contained in any Registration Statement or any omission or alleged omission to state therein a material fact required to be stated
therein or necessary in order to make the statements therein not misleading, or (2) any untrue statement or alleged untrue statement of a material fact contained in any Prospectus (or any amendment or supplement thereto), or any omission or alleged omission to state
therein a material fact necessary in order to make the statements therein, in the light of the circumstances under which they were made, not misleading, except

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insofar as such losses, claims, damages, liabilities or expenses are caused by an untrue statement or omission or alleged untrue statement or omission that is made in reliance upon and in conformity with information relating
to any of the Holders furnished in writing to the Issuers by any of the Holders expressly for use therein.  This indemnity agreement shall be in addition to any liability which the Issuers may otherwise have.

            In case any action or proceeding (including any governmental or regulatory investigation or proceeding) shall be brought or asserted against any of the
Indemnified Holders with respect to which indemnity may be sought against the Issuers, such Indemnified Holder (or the Indemnified Holder controlled by such controlling person) shall promptly notify the Issuers in writing; provided, however, that the failure
to give such notice shall not relieve any of the Issuers of their obligations pursuant to this Agreement except to the extent they are materially prejudiced as a proximate result of such failure.  In case any such action is brought against any Indemnified Holder
and such Indemnified Holder seeks or intends to seek indemnity from the Issuers, the Issuers will be entitled to participate in and, to the extent that they shall elect, jointly with all other indemnifying parties similarly notified, by written notice delivered to
the Indemnified Holder promptly after receiving the aforesaid notice from such Indemnified Holder, to assume the defense thereof with counsel reasonably satisfactory to such Indemnified Holder; provided, however, if the defendants in any such action include
both the Indemnified Holder and the Issuers and the Indemnified Holder shall have reasonably concluded (based on the advice of counsel) that a conflict may arise between the positions of the Issuers and the Indemnified Holder in conducting the defense of any such
action or that there may be legal defenses available to it and/or other Indemnified Holders which are different from or additional to those available to the Issuers, the Indemnified Holder or Holders shall have the right to select separate counsel to assume such
legal defenses and to otherwise participate in the defense of such action on behalf of such Indemnified Holder or Holders.  Upon receipt of notice from the Issuers to such Indemnified Holder of the Issuers’ election so to assume the defense of such action
and approval by the Indemnified Holder of counsel, the Issuers will not be liable to such Indemnified Holder under this Section 8 for any legal or other expenses subsequently incurred by such Indemnified Holder in connection with the defense thereof unless (i) the
Indemnified Holder shall have employed separate counsel in accordance with the proviso to the next preceding sentence (it being understood, however, that the Issuers shall not be liable for the expenses of more than one separate counsel (together with local counsel
(in each jurisdiction)), approved by the Issuers (Indemnified Holder or Holders, in the case of 8(b) and 8(c) hereof), representing the Indemnified Holders who are parties to such action) or (ii) the Issuers shall not have employed counsel reasonably satisfactory to
the Indemnified Holder to represent the Indemnified Holder within a reasonable time after notice of commencement of the action, in each of which cases the fees and expenses of counsel shall be at the expense of the Issuers.  It is understood and agreed that the
Issuers shall not, in connection with any proceeding or related proceeding in the same jurisdiction, be liable for the reasonable fees and expenses of more than one separate firm (together with any local counsel) for all Indemnified Holders.  Each Indemnified
Holder, as a condition to indemnification hereunder, shall use all reasonable efforts to cooperate with the Issuers in the defense of any such action or claim. The Issuers shall not be liable for any settlement of any such action or proceeding effected without the
Issuers’ prior written consent, but if settled with such consent or if there is a final judgment for the plaintiff, the Issuers agree to indemnify and hold harmless any Indemnified Holder from and against any loss, claim, damage, liability or expense by reason
of such settlement or judgment.  The Issuers shall not, without the prior written consent of each Indemni-

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fied Holder, settle or compromise or consent to the entry of judgment in or otherwise seek to terminate any pending or threatened action, claim, litigation or proceeding in respect of which indemnification or contribution may
be sought hereunder (whether or not any Indemnified Holder is a party thereto), unless such settlement, compromise, consent or termination (i) includes an unconditional release of each Indemnified Holder from all liability arising out of such action, claim,
litigation or proceeding and (ii) does not include any statements as to or any findings of fault, culpability or failure to act by or on behalf of any Indemnified Holder.

            (b)        Each Holder of Transfer Restricted Securities agrees, severally and not jointly, to indemnify and hold harmless
the Issuers and their respective directors, officers, partners, employees, representatives, and agents of the Issuers who sign a Registration Statement, and any Person controlling (within the meaning of Section 15 of the Securities Act or Section 20 of the Exchange
Act) any Issuer, and the respective officers, directors, partners, employees, representatives and agents of each such Person, to the same extent as the foregoing indemnity from Issuers to each of the Indemnified Holders, but only with respect to claims and actions
based on information relating to such Holder furnished in writing by such Holder expressly for use in any Registration Statement.  In case any action or proceeding shall be brought against the Issuers or their respective directors, officers, partners, employees,
representatives, and agents or any such controlling person in respect of which indemnity may be sought against a Holder of Transfer Restricted Securities, such Holder shall have the rights and duties given the Issuers, and the Issuers, their respective directors,
officers, partners, employees, representatives, and agents and such controlling person shall have the rights and duties given to each Holder by the preceding paragraph.

            (c)        If the indemnification provided for in this Section 8 is unavailable to an indemnified party under Section 8(a)
or (b) hereof (other than by reason of exceptions provided in those Sections, including by reason of failure to notify the Issuers of indemnification obligations thereunder to the extent that they are materially prejudiced as a proximate result of such failure) in
respect of any losses, claims, damages, liabilities, judgments, actions or expenses referred to therein, then each applicable indemnifying party, in lieu of indemnifying such indemnified party, shall contribute to the amount paid or payable by such indemnified party
as a result of such losses, claims, damages, liabilities or expenses in such proportion as is appropriate to reflect the relative benefits received by the Issuers, on the one hand, and the Holders, on the other hand, from the Initial Placement (which in the case of
the Issuers shall be deemed to be equal to the total gross proceeds to the Issuers from the Initial Placement), the amount of Additional Interest which did not become payable as a result of the filing of the Registration Statement resulting in such losses, claims,
damages, liabilities, judgments actions or expenses, and such Registration Statement, or if such allocation is not permitted by applicable law, the relative fault of the Issuers, on the one hand, and the Holders, on the other hand, in connection with the statements
or omissions which resulted in such losses, claims, damages, liabilities or expenses, as well as any other relevant equitable considerations.  The relative fault of the Issuers on the one hand and of the Indemnified Holder on the other shall be determined by
reference to, among other things, whether the untrue or alleged untrue statement of a material fact or the omission or alleged omission to state a material fact relates to information supplied by any Issuer, on the one hand, or the Indemnified Holders, on the other
hand, and the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent such statement or omission.  The amount paid or payable by a party as a result of the losses, claims, damages, liabilities and expenses referred
to above shall be deemed to include, subject to the limitations set forth in the second paragraph of

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Section 8(a) hereof, any legal or other fees or expenses reasonably incurred by such party in connection with investigating or defending any action or claim.

            The Issuers and each Holder of Transfer Restricted Securities agree that it would not be just and equitable if contribution pursuant to this Section 8(c) were
determined by pro rata allocation (even if the Holders were treated as one entity for such purpose) or by any other method of allocation which does not take account of the equitable considerations referred to in the immediately preceding paragraph.  The amount
paid or payable by an indemnified party as a result of the losses, claims, damages, liabilities or expenses referred to in the immediately preceding paragraph shall be deemed to include, subject to the limitations set forth above, any legal or other expenses
reasonably incurred by such indemnified party in connection with investigating or defending any such action or claim.  Notwithstanding the provisions of this Section 8, none of the Holders (and its related Indemnified Holders) shall be required to contribute, in
the aggregate, any amount in excess of the amount by which the net proceeds received by such Holder from the sale of the Initial Securities pursuant to a Registration Statement exceeds the amount of any damages which such Holder has otherwise been required to pay by
reason of such untrue or alleged untrue statement or omission or alleged omission.  No Person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any Person who was not guilty
of such fraudulent misrepresentation.  The Holders’ obligations to contribute pursuant to this Section 8(c) are several in proportion to the respective principal amount of Initial Securities held by each of the Holders hereunder and not joint.

            SECTION 9.   Rule 144A.  Each of the Issuers hereby agrees with each Holder, for so long as any Transfer Restricted Securities remain
outstanding, to make available to any Holder or beneficial owner of Transfer Restricted Securities in connection with any sale thereof and any prospective purchaser of such Transfer Restricted Securities from such Holder or beneficial owner, the information required
by Rule 144A(d)(4) under the Securities Act in order to permit resales of such Transfer Restricted Securities pursuant to Rule 144A under the Securities Act.

            SECTION 10. Participation in Underwritten Registrations.  No Holder may participate in any Underwritten Registration hereunder unless such Holder
(a) agrees to sell such Holder’s Transfer Restricted Securities on the basis provided in any underwriting arrangements approved by the Persons entitled hereunder to approve such arrangements and (b) completes and executes all reasonable questionnaires, powers
of attorney, indemnities, underwriting agreements, lock-up letters and other documents required under the terms of such underwriting arrangements.

            SECTION 11. Selection of Underwriters.   The Holders of Transfer Restricted Securities covered by the Shelf Registration Statement who desire to do
so may sell such Transfer Restricted Securities in an Underwritten Offering.  In any such Underwritten Offering, the investment banker(s) and managing underwriter(s) that will administer such offering will be selected by the Holders of a majority in aggregate
principal amount of the Transfer Restricted Securities included in such offering; provided, however, that such investment banker(s) and managing underwriter(s) must be reasonably satisfactory to the Issuers.

            SECTION 12. Miscellaneous.

-19-

            (a)        Remedies.  Each of the Issuers hereby agrees that monetary damages would not be adequate compensation
for any loss incurred by reason of a breach by it of the provisions of this Agreement and hereby agree to waive the defense in any action for specific performance that a remedy at law would be adequate.

            (b)        No Inconsistent Agreements.  Each of the Issuers will not on or after the date of this Agreement
enter into any agreement with respect to its securities that is inconsistent with the rights granted to the Holders in this Agreement or otherwise conflicts with the provisions hereof.  None of the Issuers has previously entered into any agreement granting any
registration rights with respect to its securities to any Person pursuant to which any such Person would have the right to include any securities in any Registration Statement to be filed with the Commission as required under this Agreement.  The rights granted
to the Holders hereunder do not in any way conflict with and are not inconsistent with the rights granted to the holders of the Issuers’ other securities under any agreement in effect on the date hereof.

            (c)        Adjustments Affecting the Securities.  The Issuers will not take any action, or permit any change to
occur, with respect to the Initial Securities that would materially and adversely affect the ability of the Holders to Consummate any Exchange Offer.

            (d)        Amendments and Waivers.  The provisions of this Agreement may not be amended, modified or
supplemented, and waivers or consents to or departures from the provisions hereof may not be given unless the Issuers (i) in the case of Section 5 hereof and this Section 12(d)(i), have obtained the written consent of Holders of all outstanding Transfer Restricted
Securities and (ii) in the case of all other provisions hereof, have obtained the written consent of Holders of a majority of the outstanding principal amount of Transfer Restricted Securities (excluding any Transfer Restricted Securities held by the Issuers or their
respective Affiliates).  Notwithstanding the foregoing, a waiver or consent to departure from the provisions hereof that relates exclusively to the rights of Holders whose securities are being tendered pursuant to the Exchange Offer and that does not affect
directly or indirectly the rights of other Holders whose securities are not being tendered pursuant to such Exchange Offer may be given by the Holders of a majority of the outstanding principal amount of Transfer Restricted Securities being tendered or registered;
provided, however, that, with respect to any matter that directly or indirectly affects the rights of any Initial Purchaser hereunder, the Issuers shall obtain the written consent of each such Initial Purchaser with respect to which such amendment,
qualification, supplement, waiver, consent or departure is to be effective.

            (e)        Notices.  All notices and other communications provided for or permitted hereunder shall be made in
writing by hand-delivery, first-class mail (registered or certified, return receipt requested), telex, telecopier, or air courier guaranteeing overnight delivery:

                        (i)         if to a Holder, at the address set
forth on the records of the Registrar under the Indenture, with a copy to the Registrar under the Indenture; and

                        (ii)        if to the Issuers

                                    Vanguard Health
Systems, Inc.

                                    20 Burton Hills Boulevard

-20-

                                    Suite 100

                                    Nashville, Tennessee 37215

                                    Facsimile:  (615) 665-6197

                                    Attention:  James H. Spalding, Esq., General
Counsel

                        (iii)       with a copy to:

                                    Simpson Thacher
& Bartlett LLP

                                    425 Lexington Avenue

                                    New York, New York 10017

                                    Facsimile:  (212) 455-2502

                                    Attention:  Risë B. Norman, Esq.

            All such notices and communications shall be deemed to have been duly given:  at the time delivered by hand, if personally delivered; five Business Days
after being deposited in the mail, postage prepaid, if mailed; when answered back, if telexed; when receipt acknowledged, if telecopied; and on the next Business Day, if timely delivered to an air courier guaranteeing overnight delivery.

            Copies of all such notices, demands or other communications shall be concurrently delivered by the Person giving the same to the Trustee at the address
specified in the Indenture.

            (f)         Successors and Assigns.  This Agreement shall inure to the benefit of and be binding upon the
successors and assigns of each of the parties, including, without limitation, and without the need for an express assignment, subsequent Holders of Transfer Restricted Securities; provided, however, that this Agreement shall not inure to the benefit of or be
binding upon a successor or assign of a Holder unless and to the extent such successor or assign acquired Transfer Restricted Securities from such Holder.

            (g)        Counterparts.  This Agreement may be executed in any number of counterparts and by the parties hereto
in separate counterparts, each of which when so executed shall be deemed to be an original and all of which taken together shall constitute one and the same agreement.

            (h)        Headings.  The headings in this Agreement are for convenience of reference only and shall not limit
or otherwise affect the meaning hereof.

            (i)         Governing Law.  THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS
OF THE STATE OF NEW YORK.  EACH OF THE PARTIES HEREBY WAIVES ANY RIGHT TO TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT.

            (j)         Severability.  In the event that any one or more of the provisions contained herein, or the
application thereof in any circumstance, is held invalid, illegal or unenforceable, the validity, legality and enforceability of any such provision in every other respect and of the remaining provisions contained herein shall not be affected or impaired
thereby.

-21-

            (k)        Entire Agreement.  This Agreement, together with the Purchase Agreement and the Indenture, is
intended by the parties as a final expression of their agreement and intended to be a complete and exclusive statement of the agreement and understanding of the parties hereto in respect of the subject matter contained herein.  There are no restrictions,
promises, warranties or undertakings, other than those set forth or referred to herein with respect to the registration rights granted by the Issuers with respect to the Transfer Restricted Securities.  This Agreement supersedes all prior agreements and
understandings between the parties with respect to such subject matter.

[Signature Pages Follow]

-22-

SCHEDULE I

Merrill Lynch, Pierce, Fenner & Smith Incorporated

Barclays Capital Inc.

Citigroup Global Markets Inc.

Deutsche Bank Securities Inc.

Goldman, Sachs & Co.

J.P. Morgan Securities LLC

Morgan Stanley & Co. LLC

RBC Capital Markets, LLC

Wells Fargo Securities, LLC

Schedule I

            IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above.

                                                                       
Vanguard Health Holding Company II, LLC

                                                                       
By:       /s/ James H. Spalding              

                                                                                    
Name: James H. Spalding

                                                                                   
Title: Executive Vice President

                                                                                   
Vanguard Holding Company II, Inc.

                                                                                   
By:       /s/ James H. Spalding              

                                                                                    
Name: James H. Spalding

                                                                                   
Title: Executive Vice President

                                                                                   
Vanguard Health Holding Company I, LLC, as Guarantor

                                                                                   
By:       /s/ James H. Spalding              

                                                                                                
Name: James H. Spalding

                                                                                               
Title: Executive Vice President

                                                                                   
Vanguard Health Systems, Inc., as Guarantor

                                                                                   
By:       /s/ James H. Spalding              

                                                                                                
Name: James H. Spalding

                                                                                               
Title: Executive Vice President

22

                                                                                   
Abrazo Medical Group Urgent Care, LLC

                                                                                   
BHS Physicians Alliance for ACE, LLC

                                                                                    
Central Texas Corridor Hospital Company, LLC

                                                                                   
Hospital Development of West Phoenix, Inc.

                                                                                   
MacNeal Physicians Group, LLC

                                   
                                               
Vanguard Health Financial Company, LLC

                                                                                   
Vanguard Health Management, Inc.

                                                                                   
VHS Acquisition Corporation

                                                                                   
VHS Acquisition Subsidiary Number 1, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 2, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 5, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 7, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 8, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 9, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 10, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 11, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 12, Inc.

                                                                                   
VHS Chicago Market Procurement, LLC

                                                                                   
VHS Genesis Labs, Inc.

                                                                                   
VHS Holding Company, Inc.

                                                                                   
VHS Imaging Centers, Inc.

                                                                                   
VHS of Anaheim, Inc.

                                                                                   
VHS of Arrowhead, Inc.

                                                                                   
VHS of Huntington Beach, Inc.

                                                                                   
VHS of Illinois, Inc.

                                                                                   
VHS of Orange County, Inc.

                                                                                   
VHS of Phoenix, Inc.

                                                                                   
VHS of South Phoenix, Inc.

                                                                                   
VHS Outpatient Clinics, Inc.

                                                                                   
Baptist Medical Management Service Organization, LLC

                                                                                   
Healthcare Compliance, L.L.C.

                                                                                   
MacNeal Health Providers, Inc.

                                                                                   
MacNeal Management Services, Inc.

                                                                                   
Pros Temporary Staffing, Inc.

                                                                                   
Watermark Physician Services, Inc.

                                                                                   
VHS of Michigan, Inc.

                                                                                   
VHS Children’s Hospital of Michigan, Inc.

                                                                                   
VHS Detroit Businesses, Inc.

                                                                                   
VHS Detroit Receiving Hospital, Inc.

                                                                                   
VHS Detroit Ventures, Inc.

                                                                                   
as Guarantors

                                                                                   
By:       /s/ James H. Spalding              

                                                                                                
Name: James H. Spalding

                                                                                               
Title: Executive Vice President

-23-

                                                                                   
VHS Harper-Hutzel Hospital, Inc.

                                                                                   
VHS Huron Valley-Sinai Hospital, Inc.

                                                                                   
VHS Rehabilitation Institute of Michigan, Inc.

                                                                                   
VHS Sinai-Grace Hospital, Inc.

                                                                                   
VHS University Laboratories, Inc.

                                                                                   
VHS Westlake Hospital, Inc.

                                                                                   
VHS West Suburban Medical Center, Inc.

                                                                                   
VHS Acquisition Subsidiary Number 4, Inc.

                                                                                   
Midwest Pharmacies, Inc.

                                                                                   
VHS Arizona Heart Institute, Inc.

                                                                                   
VHS Valley Management Company, Inc.,

                                                                                   
as Guarantors

                                                                                   
By:       /s/ James H. Spalding              

                                                                                                
Name: James H. Spalding

                                                                                               
Title: Executive Vice President

                                                                                   
VHS San Antonio Partners, LLC, as Guarantor

                                                                                   
By:       VHS Acquisition Subsidiary Number 5, Inc.,

                                                                                               
its Member

                                                                                   
By:       /s/ James H. Spalding              

                        
                                                                       
Name: James H. Spalding

                                                                                               
Title: Executive Vice President

-24-

            The foregoing Registration Rights Agreement is hereby confirmed and accepted as of the date first above written:

Merrill Lynch, Pierce, Fenner & Smith Incorporated

Barclays Capital Inc.

Citigroup Global Markets Inc.

Deutsche Bank Securities Inc.

Goldman, Sachs & Co.

J.P. Morgan Securities LLC

Morgan Stanley & Co. Incorporated

RBC Capital Markets, LLC

Wells Fargo Securities, LLC

By:       Merrill Lynch, Pierce, Fenner & Smith Incorporated,

            as a Representative of the Initial Purchasers

By:       /s/ Sarang Gadkari      

             Name: Sarang Gadkari

            Title: Managing Director

By:       Barclays Capital Inc.,

            as a Representative of the Initial Purchasers

By:       /s/ John Skrobe           

             Name: John Skrobe

            Title: Managing Director

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