Document:

<PAGE>
                                                                   EXHIBIT 4.6

                                SHOLODGE, INC.

                                     AND

                     DEUTSCHE BANK TRUST COMPANY AMERICAS
                                   TRUSTEE

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

                         FIFTH SUPPLEMENTAL INDENTURE

                        Dated as of _________ __, 2003

           Supplemental to Indenture dated as of November 15, 1996

<PAGE>

        FIFTH SUPPLEMENTAL INDENTURE, dated as of _________ __, 2003 (the
"Fifth Supplemental Indenture"), to the Indenture, dated as of November 15,
1996 (the "Indenture"), between ShoLodge, Inc., a corporation duly organized
under the laws of the State of Tennessee (the "Company"), having its principal
office at 130 Maple Drive North, Hendersonville, Tennessee 37075, and Bankers
Trust Company (n.k.a. Deutsche Bank Trust Company Americas), a New York
banking corporation (the "Trustee"), having a corporate trust office at
Corporate Trust and Agency Services, MS-NYC 60-2525, New York, NY 10005.

                           RECITALS OF THE COMPANY

        WHEREAS, the Company desires and has requested the Trustee to join it
in the execution and delivery of this Fifth Supplemental Indenture in order to
amend certain portions of the Indenture, on the terms set forth herein;

        WHEREAS, Section 14.2 of the Indenture provides that a supplemental
Indenture may be entered into by the Company and the Trustee for such purpose
with the consent of the holders of not less than fifty-one percent (51%) in
aggregate principal amount of the Notes then outstanding;

        WHEREAS, the holders of __% in aggregate principal amount of the Notes
currently outstanding have consented to the amendments to the Indenture
contained in this Fifth Supplemental Indenture;

        WHEREAS, all other conditions set forth in the Indenture for the
execution and delivery of this Fifth Supplemental Indenture have been complied
with; and

        WHEREAS, all things necessary to make this Fifth Supplemental
Indenture a valid agreement of the Company and the Trustee, in accordance with
its terms, and a valid amendment of, and supplement to, the Indenture have
been done;

        NOW THEREFORE:

        The Company mutually covenants and agrees with the Trustee, for the
equal and proportionate benefit of all holders of the Notes, that the
Indenture is supplemented and amended, to the extent and for the purposes
expressed herein, as follows:

        1.     In Section 1.1 of the Indenture, the definitions of "Annual
Amount Limitations", "Five Percent Limitation" and "Redemption Register" shall
be deleted in their entirety.

        2.     Section 4.12 of the Indenture entitled "Limitations on
Dividends and other Payments" shall be amended by adding the following sentence
at the end of the Section:

               Notwithstanding the provisions of Section 4.12 set forth above,
        from and after January 1, 2003, (x) the Company shall be permitted to
        repurchase shares of its capital stock up to $3,500,000 in addition to
        any Restricted Payments otherwise permitted by this Section 4.12 and (y)
        the Company shall not declare or pay any dividend or other distribution
        of property or assets in respect of the capital stock of the Company
        other than a dividend payable solely in shares of capital stock of the
        Company.

<PAGE>

        3.     Section 4.15 of the Indenture entitled "Minimum Consolidated
Net Worth" shall be replaced in its entirety with the following:

               "4.15 Minimum Consolidated Net Worth. The Company will not
        permit its Consolidated Net Worth on the last day of any fiscal
        quarter to be less than the sum of (i) $60,000,000, plus (ii) fifty
        percent (50%) of the Company's cumulative Consolidated Net Income
        since October 6, 1996."

        4.     Section 7.1 of the Indenture entitled "Redemption Right at
Holder's Option," shall be deleted in its entirety.

        5.     Section 7.2 of the Indenture entitled "Redemption Procedure"
shall be deleted in its entirety.

        6.     Section 7.3 of the Indenture entitled "Withdrawal" shall be
deleted in its entirety.

        7.     Section 7.4 of the Indenture entitled "Redemption Register"
shall be deleted in its entirety.

<PAGE>

        8.     Section 7.5 of the Indenture entitled "Deposit of Redemption
Price" shall be deleted in its entirety.

        9.     Trustee Disclaimer.  The Trustee makes no representations as to
the validity or sufficiency of this Fifth Supplemental Indenture and assumes
no responsibility for the recitals contained herein or therein which shall be
taken as the statements of the Company.

        10.    Governing Law. This Fifth Supplemental Indenture shall be
governed by the laws of the State of Tennessee as to all matters affecting the
duties, liabilities, privileges, rights and obligations of the Noteholders,
the Company and any agents of the foregoing, include but not limited to,
matters of validity, construction, effect and performance; however, the duties
and responsibilities of the Trustee shall be governed by the laws of the State
of New York.

        IN WITNESS WHEREOF, SHOLODGE, INC. has caused this Fifth Supplemental
Indenture to be signed and acknowledged by its Chairman of the Board,
President or one of its Vice Presidents, and its corporate seal to be affixed
hereunto, and the same to be attested by its Secretary; and Deutsche Bank
Trust Company Americas has caused this Fifth Supplemental Indenture to be
signed and acknowledged, and its corporate seal to be affixed hereunto, and
the same to be attested; all as of the day and year first above written.

                                                   SHOLODGE, INC.
Attest:
                                                By:
--------------------                               -----------------------
Secretary                                       Its:
                                                    ----------------------

[Corporate Seal]

                                                   DEUTSCHE BANK
                                                   TRUST COMPANY AMERICAS
Attest:

Attest:
                                                By:
--------------------                               -----------------------
Secretary                                       Its:
                                                    ----------------------

[Corporate Seal]<PAGE>

                                                                     EXHIBIT 4.1

                    7 1/2% Senior Subordinated Notes due 2013

CUSIP No. 743977 AF 7                                               $200,000,000

                           PROVINCE HEALTHCARE COMPANY

promises to pay to Cede & Co. or registered assigns, the principal sum of TWO
HUNDRED MILLION DOLLARS ($200,000,000) on June 1, 2013.

                  Interest Payment Dates:  June 1 and December 1

                  Record Dates:  May 15 and November 15

                  Dated:  May 27, 2003

                                     PROVINCE HEALTHCARE COMPANY

                                     By:
                                          --------------------------------------
                                     Name:
                                     Title:

                                     By:
                                          --------------------------------------
                                     Name:
                                     Title:

This is one of the Notes
referred to in the within-
mentioned Indenture:

U.S. BANK TRUST NATIONAL ASSOCIATION,
as Trustee

By:
     ---------------------------------
           Authorized Signature

<PAGE>

                    7 1/2% Senior Subordinated Notes due 2013

                  This Security is a Global Security within the meaning of the
Indenture hereinafter referred to and is registered in the name of the
Depository or a nominee of the Depository. This Security is exchangeable for
Securities registered in the name of a Person other than the Depository or its
nominee only in the limited circumstances described in the Indenture, and may
not be transferred except as a whole by the Depository to a nominee of the
Depository, by a nominee of the Depository to the Depository or another nominee
of the Depository or by the Depository or any such nominee to a successor
Depository or a nominee of such a successor Depository.

                  Unless and until it is exchanged in whole or in part for Notes
in definitive form, this Note may not be transferred except as a whole by the
Depository to a nominee of the Depository or by a nominee of the Depository to
the Depository or another nominee of the Depository or by the Depository or any
such nominee to a successor Depository or a nominee of such successor
Depository. Unless this certificate is presented by an authorized representative
of The Depository Trust Company (55 Water Street, New York, New York) ("DTC"),
to the issuer or its agent for registration of transfer, exchange or payment,
and any certificate issued is registered in the name of Cede & Co. or such other
name as may be requested by an authorized representative of DTC (and any payment
is made to Cede & Co. or such other entity as may be requested by an authorized
representative of DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR
OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the registered owner
hereof, Cede & Co., has an interest herein.

                  Capitalized terms used herein shall have the meanings assigned
to them in the Indenture referred to below unless otherwise indicated.

                  1.       INTEREST. Province Healthcare Company, a Delaware
corporation (the "Company") promises to pay interest on the principal amount of
this Note at 7 1/2% per annum from May 27, 2003 until June 1, 2013. The Company
shall pay interest, semi-annually in arrears on June 1 and December 1 of each
year, or if any such day is not a Business Day, on the next succeeding Business
Day (each an "Interest Payment Date"). Interest on the Notes will accrue from
the most recent date to which interest has been paid or, if no interest has been
paid, from the date of issuance; provided that if there is no existing Default
in the payment of interest, and if this Note is authenticated between a record
date referred to on the face hereof and the next succeeding Interest Payment
Date, interest shall accrue from such next succeeding Interest Payment Date;
provided further that the first Interest Payment Date shall be December 1, 2003.
The Company shall pay interest (including post-petition interest to the extent
allowed in any proceeding under any Bankruptcy Law) on overdue principal from
time to time on demand at a rate equal to the per annum rate on the Notes then
in effect; it shall pay interest (including post-petition interest to the extent
allowed in any proceeding under any Bankruptcy Law) on overdue installments of
interest (without regard to any applicable grace periods) from time to time on
demand at the same rate to the extent lawful. Interest will be computed on the
basis of a 360-day year of twelve 30-day months.

                                                                               2
<PAGE>

                  2.       METHOD OF PAYMENT. The Company will pay principal,
premium, if any, and interest on the Notes in money of the United States that at
the time of payment is legal tender for payment of public and private debts. The
Company, however, may pay principal, premium, if any, and interest by check
payable in such money. It may mail an interest check to a Holder's registered
address.

                  3.       PAYING AGENT, REGISTRAR AND SERVICE AGENT. Initially,
U.S. Bank Trust National Association, the Trustee under the Indenture, will act
as Paying Agent, Registrar and Service Agent. The Notes may be presented for
registration of transfer and exchange at the offices of the Registrar. The
Company may change any Paying Agent, Service Agent or Registrar without notice
to any Holder. The Company or any of its Subsidiaries may act in any such
capacity.

                  4.       INDENTURE. The Company issued the Notes under an
Indenture dated as of May 27, 2003 (the "Base Indenture") as supplemented by a
First Supplemental Indenture dated as of May 27, 2003 (the "Supplemental
Indenture" and, together with the Base Indenture, the "Indenture") among the
Company and the Trustee. The terms of the Notes include those stated in the
Indenture and those made part of the Indenture by reference to the Trust
Indenture Act of 1939, as amended (15 U.S. Code Sections 77aaa-77bbbb). The
Notes are subject to all such terms, and Holders are referred to the Indenture
and such Act for a statement of such terms. To the extent any provision of this
Note conflicts with the express provisions of the Indenture, the provisions of
the Indenture shall govern and be controlling. The Notes issued under the
Indenture are subordinated unsecured obligations of the Company limited to
$200,000,000 in aggregate principal amount.

                  5.       OPTIONAL REDEMPTION.

                  (a)      Except as set forth in paragraph (b) of this Section
5, the Company shall not have the option to redeem the Notes pursuant to this
Section 5 prior to June 1, 2008. On or after June 1, 2008, the Notes will be
subject to redemption at any time at the option of the Company, in whole or in
part, upon not less than 30 nor more than 60 days' notice, at the redemption
prices (expressed as percentages of principal amount) set forth below plus
accrued and unpaid interest, if any, to the applicable redemption date, if
redeemed during the twelve-month period beginning on June 1 of the years
indicated below (subject to the right of Holders of record on relevant record
dates to receive interest due on an interest payment date):

<TABLE>
<CAPTION>
          Year                                  Redemption Price
          ----                                  ----------------
          <S>                                   <C>
          2008                                      103.750%
          2009                                      102.500%
          2010                                      101.250%
          2011 and thereafter                       100.000%
</TABLE>

                  (b)      Notwithstanding the provisions of paragraph (a) of
this Section 5, at any time and from time to time prior to June 1, 2006, the
Company may on any one or more occasions redeem up to 35% of the aggregate
principal amount of Notes originally issued hereunder within 60 days of one or
more Public Equity Offerings with the net proceeds of such offering at a
redemption price of 107.500% of the principal amount thereof, plus accrued and

                                                                               3
<PAGE>

unpaid interest thereon, if any, to the redemption date (subject to the right of
Holders of record on relevant record dates to receive interest due on an
interest payment date); provided that, after giving effect to any such
redemption, at least 65% of the original aggregate principal amount of the Notes
remains outstanding.

                  6.       NOTICE OF REDEMPTION.

                  Notice of redemption will be mailed at least 30 days but not
more than 60 days before the redemption date to each Holder of the Notes to be
redeemed at such Holder's address of record. The Notes in denominations larger
than $1,000 may be redeemed in part but only in integral multiples of $1,000,
unless all the Notes held by a Holder are to be redeemed. In the event of a
redemption of less than all of the Notes, the Notes will be chosen for
redemption by the Trustee in accordance with the Indenture. On and after the
redemption date, interest ceases to accrue on the Notes or portions of them
called for redemption.

                  If this Note is redeemed subsequent to a Record Date with
respect to any Interest Payment Date specified above and on or prior to such
Interest Payment Date, then any accrued interest will be paid to the Person in
whose name this Note is registered at the close of business on such Record Date.

                  7.       MANDATORY REDEMPTION. Except as set forth in
paragraph 8 below, the Company shall not be required to repurchase or to make
mandatory redemption payments with respect to the Notes. There are no sinking
fund payments with respect to the Notes.

                  8.       REPURCHASE AT OPTION OF HOLDER. This Note is subject
to repurchase by the Company at the option of the Holder upon the circumstances
set forth in Sections 4.11 and 4.15 of the Indenture.

                  9.       SUBORDINATION. The payment of the principal of,
interest on or any other amounts due on the Notes is subordinated in right of
payment to all existing and future Senior Indebtedness of the Company, as
described in the Indenture. Each Holder, by accepting a Note, agrees to such
subordination and authorizes and directs the Trustee on its behalf to take such
action as may be necessary or appropriate to effectuate the subordination so
provided and appoints the Trustee as its attorney-in-fact for such purpose.

                  10.      DENOMINATIONS, TRANSFER, EXCHANGE. The Notes are in
registered form without coupons in minimum denominations of $1,000 and integral
multiples of $1,000 in excess thereof. The transfer of Notes may be registered
and Notes may be exchanged as provided in the Indenture. The Registrar and the
Trustee may require a Holder, among other things, to furnish appropriate
endorsements and transfer documents and the Company may require a Holder to pay
any taxes and fees required by law or permitted by the Indenture. The Company
need not exchange or register the transfer of any Note or portion of a Note
selected for redemption, except for the unredeemed portion of any Note being
redeemed in part. Also, the Company need not exchange or register the transfer
of any Notes for a period of 15 days before a selection of Notes to be redeemed
or during the period between a record date and the corresponding Interest
Payment Date.

                                                                               4
<PAGE>

                  11.      PERSONS DEEMED OWNERS. The registered Holder of a
Note may be treated as its owner for all purposes.

                  12.      AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain
exceptions, the Indenture with respect to the Notes or the Notes may be amended
or supplemented with the written consent of the Holders of a majority in
principal amount of the Notes and any existing default or compliance with any
provision of the Indenture with respect to the Notes or the Notes may be waived
with the consent of the Holders of a majority in principal amount of the Notes
(including, in each case, Additional Notes, if any). Without the consent of any
Holder of the Notes, the Indenture with respect to the Notes or the Notes may be
amended or supplemented to, in addition to other events more fully described in
the Indenture, cure any ambiguity, defect or inconsistency, provide for
uncertificated Notes in addition to or in place of certificated Notes, provide
for the assumption of the Company's obligations to Holders of the Notes in the
case of a merger or consolidation, make any change that would provide any
additional rights or benefits to the Holders of the Notes or that does not
adversely affect the legal rights under the Indenture of any such Holder, or
comply with requirements of the SEC in order to effect or maintain the
qualification of the Indenture under the TIA.

                  13.      DEFAULTS AND REMEDIES. An Event of Default with
respect to the Notes occurs upon the occurrence of any of the following events:
(a) default in the payment of any interest on any Note when it becomes due and
payable, and continuance of such default for a period of 30 days, whether or not
such payment shall be prohibited by the subordination provisions of Article XIII
of the Indenture; (b) default in the payment of the principal of, or premium, if
any, on, any Note when the same becomes due and payable at Maturity (upon
acceleration, optional redemption, mandatory redemption, required purchase or
otherwise), whether or not such payment shall be prohibited by the subordination
provisions of Article XIII of the Indenture; (c) default in the performance, or
breach, of the provisions described in Section 5.1 of the Indenture, the failure
to make or consummate a Change in Control Offer in accordance with the
provisions of Section 4.15 of the Indenture or the failure to make or consummate
an Excess Proceeds Offer in accordance with the provisions of Section 4.11 of
the Indenture; (d) default in the performance, or breach, of any covenant or
warranty of the Company or any Guarantor contained in the Indenture or any Note
Guarantee (other than a default in the performance, or breach, of a covenant or
warranty which is specifically dealt with in clause (a), (b) or (c) hereof) and
continuance of such default or breach for a period of 30 days after written
notice shall have been given to the Company by the Trustee or to the Company and
the Trustee by the Holders of at least 25% in aggregate principal amount of the
Notes then outstanding; (e) (A) one or more defaults in the payment of principal
of or premium, if any, on Indebtedness of the Company or any Restricted
Subsidiary aggregating $10,000,000 or more, when the same becomes due and
payable at the Stated Maturity thereof, and such default or defaults shall have
continued after any applicable grace period and shall not have been cured or
waived or (B) Indebtedness of the Company or any Restricted Subsidiary
aggregating $10,000,000 or more shall have been accelerated or otherwise
declared due and payable, or required to be prepaid or repurchased (other than
by regularly

                                                                               5
<PAGE>

scheduled required prepayment) prior to the Stated Maturity thereof; (f) one or
more final, non-appealable judgments or orders shall be rendered against the
Company or any Restricted Subsidiary for the payment of money, either
individually or in an aggregate amount, in excess of $10,000,000 (net of any
amounts to the extent that they are covered by insurance) and shall not be
discharged or fully bonded and there shall have been a period of 60 consecutive
days during which a stay of enforcement of such judgment or order, by reason of
a pending appeal or otherwise, was not in effect; (g) any Note Guarantee of a
Material Subsidiary or group of Restricted Subsidiaries that, taken together,
would constitute a Material Subsidiary ceases to be in full force and effect or
is declared null and void or any Material Subsidiary or group of Restricted
Subsidiaries that, taken together, would constitute a Material Subsidiary denies
that it has any further liability under any Note Guarantee, or gives notice to
such effect (other than by reason of the termination of this Indenture or the
release of any such Note Guarantee in accordance with this Indenture); or (h)
certain events of bankruptcy or insolvency with respect to the Company or any
Material Subsidiary or group of Restricted Subsidiaries that taken together,
would constitute a Material Subsidiary.

                  If an Event of Default with respect to Securities of any
Series at the time outstanding occurs and is continuing (other than an Event of
Default referred to in clause (h) of the foregoing paragraph), then in every
such case the Trustee or the Holders of not less than 25% in principal amount of
the outstanding Securities of that Series may declare the principal amount (or,
if any Securities of that Series are Discount Securities, such portion of the
principal amount as may be specified in the terms of such Securities) of,
premium, if any, and accrued and unpaid interest, if any, on all of the
Securities of that Series to be due and payable immediately, by a notice in
writing to the Company (and to the Trustee if given by Holders), and upon any
such declaration such principal amount (or specified amount) and accrued and
unpaid interest, if any, shall become immediately due and payable. If an Event
of Default specified in clause (h) of the foregoing paragraph shall occur, the
principal amount (or specified amount) of, premium, if any, and accrued and
unpaid interest, if any, on all outstanding Securities shall ipso facto become
and be immediately due and payable without any declaration or other act on the
part of the Trustee or any Holder.

                  Subject to certain limitations, Holders of a majority in
principal amount of the then outstanding Notes may direct the Trustee in its
exercise of any trust or power. The Trustee may withhold from Holders of the
Notes notice of any continuing Default or Event of Default (except a Default or
Event of Default relating to the payment of principal or interest) if it
determines that withholding notice is in their interest. The Company is required
to deliver to the Trustee annually a statement regarding compliance with the
Indenture, and the Company is required, upon becoming aware of any Default or
Event of Default, to deliver to the Trustee a statement specifying such Default
or Event of Default and what action the Company is taking or proposes to take
thereto.

                  14.      SUBSIDIARY GUARANTEES. Payment of principal of,
premium, if any, and interest (including interest on overdue principal, if any,
and interest, if lawful) on the

                                                                               6
<PAGE>

Notes may be guaranteed under certain circumstances on an unsecured, senior
subordinated basis by the Guarantors pursuant to Section 4.17 and Article XII of
the Indenture.

                  15.      TRUSTEE DEALINGS WITH COMPANY. The Trustee, in its
individual or any other capacity, may make loans to, accept deposits from, and
perform services for the Company or its Affiliates, and may otherwise deal with
the Company or its Affiliates, as if it were not the Trustee.

                  16.      NO RECOURSE AGAINST OTHERS. No past, present or
future director, officer, employee, incorporator or stockholder, as such, of the
Company or any Guarantor shall have any liability for any obligations of the
Company or any Guarantor under the Notes, the Subsidiary Guarantees or the
Indenture or for any claim based on, in respect of or by reason of such
obligations or their creation. Each Holder by accepting a Note and the related
Subsidiary Guarantees waives and releases all such liability. The waiver and
release are part of the consideration for the issuance of the Notes.

                  17.      AUTHENTICATION. This Note shall not be valid until
authenticated by the manual signature of the Trustee or an authenticating agent.

                  18.      ABBREVIATIONS. Customary abbreviations may be used in
the name of a Holder or an assignee, such as: TEN COM (= tenants in common), TEN
ENT (= tenants by the entireties), JT TEN (= joint tenants with right of
survivorship and not as tenants in common), CUST (= Custodian), and U/G/M/A (=
Uniform Gifts to Minors Act).

                  19.      CUSIP NUMBERS. Pursuant to a recommendation
promulgated by the Committee on Uniform Security Identification Procedures, the
Company has caused CUSIP numbers to be printed on the Notes and the Trustee may
use CUSIP numbers in notices of redemption as a convenience to Holders. No
representation is made as to the accuracy of such numbers either as printed on
the Notes or as contained in any notice of redemption and reliance may be placed
only on the other identification numbers placed thereon.

                  The Company shall furnish to any Holder upon written request
and without charge a copy of the Indenture. Requests may be made to:

                           Province Healthcare Company
                           105 Westwood Place, Suite 400
                           Brentwood, Tennessee 37027
                           Attention:  Howard T. Wall III, Esq.

                                                                               7
<PAGE>

                                 ASSIGNMENT FORM

         To assign this Note, fill in the form below: (I) or (we) assign and
transfer this Note to

--------------------------------------------------------------------------------
                  (Insert assignee's soc. sec. or tax I.D. no.)

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

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

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

--------------------------------------------------------------------------------
              (Print or type assignee's name, address and zip code)

and irrevocably appoint ________________________________________________________
to transfer this Note on the books of the Company. The agent may substitute
another to act for him.

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

Date:
       ---------------

Your Signature:
                ----------------------------------------------------------------

(Sign exactly as your name appears on the face of this Note)

                                                                               8
<PAGE>

                       OPTION OF HOLDER TO ELECT PURCHASE

                  If you want to elect to have this Note purchased by the
Company pursuant to Section 4.11 or 4.15 of the Indenture, check the box below:

                           / / Section  4.11

                           / / Section  4.15

                  If you want to elect to have only part of the Note purchased
by the Company pursuant to Section 4.15 of the Indenture, state the amount you
elect to have purchased: $________

Date:                           Your Signature:
     -----------------------                     -------------------------------
                                (Sign exactly as your name appears on the Note)

                                Tax Identification No.:
                                                       -------------------------

                                                                               9

<PAGE>

                         SCHEDULE OF EXCHANGES OF NOTES

                  The following exchanges of a part of this Global Note for
other Notes have been made:

<TABLE>
<CAPTION>
                            Amount of              Amount of          Principal Amoutn of       Signature of
                           decrease in             increase in         this Global Note      authorized officer
                        Principal Amount        Principal Amount         decrease (or           of Trustee or
Date of Exchange       of this Global Note    of this Global Note          increase)            Service Agent
----------------       -------------------    -------------------     --------------------   -----------------
<S>                    <C>                    <C>                     <C>                    <C>

</TABLE>

                                                                              10

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