Document:

EX-4.2

 Exhibit 4.2 

ELEVENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 31, 2016, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a
Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”) and REGIONS BANK, as Trustee under the Indenture (the
“Trustee”). 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended, supplemented,
waived or otherwise modified (the “Indenture”), dated as of July 18, 2012, providing for the issuance of the 7.125% Senior Notes due 2020 (the “Securities”); 

WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental
Indenture, and to become a New Subsidiary Guarantor under the Indenture; and 
 WHEREAS, pursuant to Section 9.01(4) of the Indenture,
the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture. 
 NOW THEREFORE,
in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the
Holders of the Securities as follows: 
 SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the
meanings assigned to them in the Indenture. 
 SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the
Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor. 

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

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 
 SECTION 7. Effect of Headings. The Section
headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture.  

  
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		 	 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 31st day of March, 2016.
  

 
	
	 CHS/Community Health Systems, Inc.,
 a Delaware
corporation
  

	 By: /s/ James W. Doucette                

     James W. Doucette

     Senior Vice President and Treasurer

	  
 Laredo Texas Hospital Company, L.P.,

a Texas limited partnership
  

	 By: Webb Hospital Corporation, its general partner

 
     By: /s/ James W.
Doucette            
         James W. Doucette

        Senior Vice President and Treasurer

 

	 Regions Bank, as Trustee
  

By: /s/ Wallace
Duke                        

    Wallace Duke
     Vice
President

  
 2EX-4.3

 Exhibit 4.3 

ELEVENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 31, 2016, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a
Delaware corporation (the “Issuer”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “New Subsidiary Guarantor”), REGIONS BANK, as Trustee under the Indenture (the
“Trustee”) and Credit Suisse AG (the “Collateral Agent”). 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an Indenture as amended, supplemented,
waived or otherwise modified (the “Indenture”), dated as of August 17, 2012, providing for the issuance of the 5.125% Senior Secured Notes due 2018 (the “Securities”); 

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

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

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

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

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

SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE
OF NEW YORK.  
 SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency
of this Supplemental Indenture. 
 SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective
execution and delivery of this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic
transmission shall be deemed to be their original signatures for all purposes. 

  
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 SECTION 7. Benefits Acknowledged. The New Subsidiary Guarantor’s Note Guarantee is
subject to the terms and conditions set forth in the Indenture. The New Subsidiary Guarantor acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture
and that the guarantee and waivers made by it pursuant to its Note Guarantee are knowingly made in contemplation of such benefits. 

SECTION 8. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this
Supplemental Indenture. 
 [Signature page follows] 

  
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		 	 IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 31st day of March, 2016.
  

 
	
	 CHS/Community Health Systems, Inc.,
 a Delaware
corporation
  

	 By: /s/ James W. Doucette                

     James W. Doucette

     Senior Vice President and Treasurer

	  
 Laredo Texas Hospital Company, L.P.,

a Texas limited partnership
  

	 By: Webb Hospital Corporation, its general partner

 
     By: /s/ James W.
Doucette            
         James W. Doucette

        Senior Vice President and Treasurer

 

	 Regions Bank, as Trustee
  

By: /s/ Wallace
Duke                        

    Wallace Duke
     Vice
President

  
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	 Credit Suisse AG, Cayman Islands Branch, as Collateral Agent
  

By: /s/ Robert
Hetu                          

    Name: Robert Hetu

    Title: Authorized Signatory
  

By: /s/ Warren Van Heyst                

    Name: Warren Van Heyst

    Title: Authorized Signatory

  
 4EX-4.4

 Exhibit 4.4 

EIGHTH SUPPLEMENTAL INDENTURE, (this “Supplemental Indenture”) dated as of March 31, 2016, by and among CHS/Community
Health Systems, Inc., a Delaware corporation (“Issuer”), the party that is a signatory hereto as a Guarantor (the “Guaranteeing Subsidiary”), Credit Suisse AG, as Collateral Agent, and Regions Bank, as Trustee under the
Indenture referred to below. 
 W I T N E S S E T H: 

WHEREAS, each of the Issuer, the Guarantors and the Trustee have heretofore executed and delivered an indenture dated as of January 27,
2014 (as amended, supplemented, waived or otherwise modified, the “Indenture”), providing for the issuance on such date of an aggregate principal amount of $1,000,000,000 of 5.125% Senior Secured Notes due 2021 (the
“Notes”) of the Issuer; 
 WHEREAS, the Indenture provides that the Guaranteeing Subsidiary shall execute and deliver to
the Trustee and the Collateral Agent a supplemental indenture pursuant to which the Guaranteeing Subsidiary shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on the terms and conditions set forth
herein and under the Indenture (the “Note Guarantee”), each on the terms and conditions set forth herein; and 
 WHEREAS,
pursuant to Section 9.1 of the Indenture, the Issuer, any Guarantor and the Trustee are authorized to execute and deliver this Supplemental Indenture to amend or supplement the Indenture, without the consent of any Holder; 

NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged,
the Issuer, the Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the benefit of the Trustee, the Collateral Agent and the Holders of the Notes as follows: 

ARTICLE I 
 DEFINITIONS 

SECTION 1.1. Defined Terms. As used in this Supplemental Indenture, terms defined in the Indenture or in the preamble or recitals
hereto are used herein as therein defined. 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. 
 ARTICLE II 

AGREEMENT TO BE BOUND; GUARANTEE 

SECTION 2.1. Agreement to be Bound. The Guaranteeing Subsidiary hereby becomes a party to the Indenture as a “Guarantor” and
as such will have all of the rights and be subject to all of the obligations and agreements of a “Guarantor” under the Indenture. 

SECTION 2.2. Guarantee. The Guaranteeing Subsidiary agrees, on a joint and several basis with all the existing Guarantors, to fully,
unconditionally and irrevocably Guarantee to each Holder of the Notes, the Trustee and the Collateral Agent the Guaranteed Obligations pursuant to Article X of the Indenture as and to the extent provided for therein. 

  
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 ARTICLE III 

MISCELLANEOUS 
 SECTION 3.1.
Notices. All notices and other communications to the Guarantors shall be given as provided in the Indenture. 
 SECTION 3.2.
Merger and Consolidation. The Guaranteeing Subsidiary shall not sell or otherwise dispose of all or substantially all of its assets to, or consolidate with or merge with or into, another Person (other than the Issuer or any Restricted
Subsidiary that is a Guarantor or becomes a Guarantor concurrently with the transaction) except in accordance with Section 4.1(e) of the Indenture. 

SECTION 3.3. Release of Guarantee. The Note Guarantees hereunder may be released in accordance with Section 10.2 of the
Indenture. 
 SECTION 3.4. Parties. Nothing expressed or mentioned herein is intended or shall be construed to give any Person, firm
or corporation, other than the Holders and the Trustee, any legal or equitable right, remedy or claim under or in respect of this Supplemental Indenture or the Indenture or any provision herein or therein contained 

SECTION 3.5. Governing Law. This Supplemental Indenture shall be governed by, and construed in accordance with, the laws of the State
of New York. 
 SECTION 3.6. Severability. In case any provision in this Supplemental Indenture shall be invalid, illegal or
unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby and such provision shall be ineffective only to the extent of such invalidity, illegality or unenforceability.

 SECTION 3.7. Benefits Acknowledged. The Guaranteeing Subsidiary’s Note Guarantee is subject to the terms and conditions set
forth in the Indenture. The Guaranteeing Subsidiary acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Indenture and this Supplemental Indenture and that the guarantee and waivers made
by it pursuant to its Note Guarantee are knowingly made in contemplation of such benefits. 
 SECTION 3.8. 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 of Notes heretofore or hereafter authenticated and delivered shall be bound hereby. 

SECTION 3.9. The Trustee and the Collateral Agent. Neither the Trustee nor the Collateral Agent make any representation or warranty as
to the validity or sufficiency of this Supplemental Indenture or with respect to the recitals contained herein, all of which recitals are made solely by the other parties hereto. 

SECTION 3.10. Counterparts. The parties hereto may sign any number of copies of this Supplemental Indenture. Each signed copy shall be
an original, but all of them together represent the same agreement. The exchange of copies of this Supplemental Indenture and of signature pages by facsimile or other electronic transmission shall constitute effective execution and delivery of
this Supplemental Indenture as to the parties hereto and may be used in lieu of the original Supplemental Indenture for all purposes. Signatures of the parties hereto transmitted by facsimile or other electronic transmission shall be deemed to be
their original signatures for all purposes. 

  
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 SECTION 3.11. Execution and Delivery. The Guaranteeing Subsidiary agrees that its Note
Guarantee shall remain in full force and effect notwithstanding any absence on each Note of a notation of any such Note Guarantee. 

SECTION 3.12. Headings. The headings of the Articles and the Sections in this Supplemental Indenture are for convenience of reference
only and shall not be deemed to alter or affect the meaning or interpretation of any provisions hereof. 
 [Signature page follows]

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

			
	Laredo Texas Hospital Company, L.P.,
	 a Texas limited partnership
  

	 By: Webb Hospital Corporation, its general partner

 

	        By:	 	/s/ James W. Doucette            
		 	James W. Doucette
		 	Senior Vice President and Treasurer

  
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	Acknowledged by:
	
	CHS/Community Health Systems, Inc.
		
	By:	 	/s/ James W. Doucette                    
		 	James W. Doucette
		 	Senior Vice President and Treasurer

  
 5 

 
					
	Regions Bank,	 	
	 as Trustee
  
	 	
	By:	 	   /s/ Wallace
Duke                    
	 	
		 	Wallace Duke	 	
		 	Vice President	 	

  
 6 

 
			
	Credit Suisse AG, Cayman Islands Branch,
	as Collateral Agent
		
	By:	 	  /s/ Robert Hetu                      
		 	Name: Robert Hetu
		 	Title: Authorized Signatory
		
	By:	 	  /s/ Warren Van Heyst            
		 	Name: Warren Van Heyst
		 	Title: Authorized Signatory

  
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