Document:

Fourth Supplemental Indenture 8.000% Senior Notes

 Exhibit 4.5 

 
 FOURTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”),
dated as of September 30, 2012, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), each of the parties identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New
Subsidiary Guarantor” and collectively, the “New Subsidiary Guarantors”) and REGIONS BANK, as successor Trustee under the Indenture (the “Trustee”). 

W I T N E S S E T H: 
 WHEREAS the Issuer has heretofore executed and delivered to the Trustee, as successor trustee, an Indenture (the “Indenture”), dated as of November 22, 2011, providing for the
issuance of the 8.000% Senior Notes due 2019 (the “Securities”); 
 WHEREAS, each of the undersigned New
Subsidiary Guarantors 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 Guarantors 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 Guarantors 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. Each 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. 
 SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 

 
 [Signature page follows] 

  
 1 

									
		 	IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30th day of September, 2012.
			
		 		 	 CHS/Community Health Systems, Inc.,
 a Delaware corporation

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President, Secretary & General Counsel
		 		 	  
  
 Northwest Arkansas Hospitals, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Holdings, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Hospital Company, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 Regions Bank, as Trustee

		 		 	  
 By:
	 	  
   /s/ Paul
Williams
	 	
		 		 		 	Paul Williams	 	
		 		 		 	Vice President	 	

  
 2First Supplemental Indenture 7.125% Senior Notes

 Exhibit 4.6 

 
 FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated
as of September 30, 2012, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), each of the parties identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New
Subsidiary Guarantor” and collectively, the “New Subsidiary Guarantors”) and REGIONS BANK, as Trustee under the Indenture (the “Trustee”). 

 
 W I T N E S S E T H: 

WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture (the “Indenture”), dated as of
July 18, 2012, providing for the issuance of the 7.125% Senior Notes due 2020 (the “Securities”); 

WHEREAS, each of the undersigned New Subsidiary Guarantors 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 Guarantors 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 Guarantors 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. Each 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. 
 SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 

 
 [Signature page follows] 

  
 1 

									
		 	IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30th day of September, 2012. 
			
		 		 	 CHS/Community Health Systems, Inc.,
 a Delaware corporation

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President, Secretary & General Counsel
		 		 	  
  
 Northwest Arkansas Hospitals, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Holdings, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Hospital Company, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 Regions Bank, as Trustee

		 		 	  
 By:
	 	  
   /s/ Paul
Williams
	 	
		 		 		 	Paul Williams	 	
		 		 		 	Vice President	 	

  
 2First Supplemental Indenture 5.125% Senior Secured Notes

 Exhibit 4.7 

 
 FIRST SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated
as of September 30, 2012, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Issuer”), each of the parties identified as a New Subsidiary Guarantor on the signature pages hereto (each, a “New
Subsidiary Guarantor” and collectively, the “New Subsidiary Guarantors”) and REGIONS BANK, as Trustee under the Indenture (the “Trustee”). 

 
 W I T N E S S E T H: 

WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture (the “Indenture”), dated as of
August 17, 2012, providing for the issuance of the 5.125% Senior Secured Notes due 2018 (the “Securities”); 
 WHEREAS, each of the undersigned New Subsidiary Guarantors 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 Guarantors 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 Guarantors 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. Each 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. 
 SECTION 7. Effect of Headings. The Section headings
herein are for convenience only and shall not effect the construction of this Supplemental Indenture. 
 [Signature page
follows] 

  
 1 

									
		 	IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30th day of September, 2012.
			
		 		 	 CHS/Community Health Systems, Inc.,
 a Delaware corporation

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President, Secretary & General Counsel
		 		 	  
  
 Northwest Arkansas Hospitals, LLC,
 a Delaware limited liability company
	 	
		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Holdings, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 York Pennsylvania Hospital Company, LLC,
 a Delaware limited liability company

		 		 	  
 By:
	 	  
   /s/ Rachel A.
Seifert
	 	
		 		 		 	Rachel A. Seifert	 	
		 		 		 	Executive Vice President and Secretary
		 		 	  
  
 Regions Bank, as Trustee
	 	
		 		 	  
 By:
	 	  
   /s/ Paul
Williams
	 	
		 		 		 	Paul Williams	 	
		 		 		 	Vice President	 	

  
 2

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