Document:

Fourteenth Supplemental Indenture

 Exhibit 4.3 
 FOURTEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of May 15, 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 U.S.
BANK NATIONAL ASSOCIATION, 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 25, 2007, providing for the issuance of the 8.875% Senior Notes due 2015 (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] 

					
	IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 15th day of May, 2012.
		
		 	 CHS/Community Health Systems, Inc.,
 a Delaware corporation

			
		 	By:	 	 /s/ Rachel A.
Seifert            

		 		 	 Rachel A. Seifert
 Executive
Vice President, Secretary & General Counsel

		
		 	 Affinity Health Systems, LLC,
 a Delaware limited liability company

			
		 	By:	 	 /s/ Rachel A.
Seifert            

		 		 	 Rachel A. Seifert
 Executive
Vice President and Secretary

		
		 	 Affinity Hospital, LLC,
 a Delaware limited liability company

			
		 	By:	 	 /s/ Rachel A.
Seifert            

		 		 	 Rachel A. Seifert
 Executive
Vice President and Secretary

		
		 	 U.S. Bank National Association,
 as Trustee

			
		 	By:	 	 /s/ Wally
Jones            

		 		 	 Wally Jones
 Vice
PresidentFifteenth Supplemental Indenture

 Exhibit 4.4 
 SUPPLEMENTAL INDENTURE FOR THE NOTES 
 CHS/COMMUNITY HEALTH SYSTEMS,
INC., 
 GUARANTORS PARTY HERETO 
 AND 
 U.S. BANK NATIONAL ASSOCIATION, 

as Trustee 
  

 
 SUPPLEMENTAL
INDENTURE 
 Dated as of July 18, 2012 
 to 
 Indenture 

Dated as of July 25, 2007 
 8 7/8% Senior Notes due 2015 

 This FIFTEENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”),
dated as of July 18, 2012, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “Company”), the guarantors listed on Schedule I hereto (the “Guarantors”) and U.S. BANK NATIONAL ASSOCIATION, a national
banking association, as Trustee (the “Trustee”), under the Indenture, dated as of July 25, 2007, as amended to date (the “Indenture”). Capitalized terms used herein and not otherwise defined shall have the meanings assigned
to them in the Indenture. 
 WITNESSETH: 

WHEREAS, the Company has issued its 8 7/8% Senior Notes Due 2015 (the “Notes”) pursuant to the Indenture; 

WHEREAS, the Company has offered to purchase for cash any and all outstanding Notes (the “Tender Offer”); 

WHEREAS, in connection with the Tender Offer, the Company has requested that Holders of the Notes deliver their consents with
respect to the deletion of certain provisions of the Indenture; 
 WHEREAS, Section 9.02 of the Indenture provides
that the Company and the Trustee may amend or supplement the Indenture and the Notes with the consent of the Holders of at least a majority in aggregate principal amount of the then outstanding Notes (including, without limitation, consents obtained
in connection with a tender offer or exchange offer for the Notes); 
 WHEREAS, the Holders of at least a majority in
aggregate principal amount of the outstanding Notes have duly consented to the proposed modifications set forth in this Supplemental Indenture in accordance with the Indenture (including Section 9.02 thereof); 

WHEREAS, the Company has heretofore delivered, or is delivering contemporaneously herewith, to the Trustee (i) a copy of
resolutions of the Board of Directors of the Company authorizing the execution of this Supplemental Indenture, (ii) evidence of the consent of the Holders set forth in the immediately preceding paragraph and (iii) the Officers’
Certificate and the Opinion of Counsel described in Section 9.06 of the Indenture; and 
 WHEREAS, all conditions
necessary to authorize the execution and delivery of this Supplemental Indenture and to make this Supplemental Indenture valid and binding have been complied with or have been done or performed. 

NOW, THEREFORE, in consideration of the foregoing and notwithstanding any provision of the Indenture which, absent this
Supplemental Indenture, might operate to limit such action, the parties hereto, intending to be legally bound hereby, agree as follows: 
 ARTICLE ONE 
 AMENDMENTS 

SECTION 1.01 Amendments. 
 (a) Subject to Section 7.02 hereof, the Indenture is hereby amended by deleting in their entireties Sections 4.02, 4.03, 4.04, 4.05, 4.06, 4.07, 4.08, 4.09, 4.10, 4.11, 4.12, 4.13, 4.14, 5.01(a)(3),
6.01(5), 6.01(6), 6.01(7), 6.01(8) and 6.01(9) of the Indenture. 
 (b) Effective as of the date hereof, none of
the Company, the Trustee or other parties to or beneficiaries of the Indenture shall have any rights, obligations or liabilities under such Sections or Clauses and such Sections or Clauses shall not be considered in determining whether an Event of
Default has occurred or whether the Company has observed, performed or complied with the provisions of the Indenture. 

SECTION 1.02 Amendment of Definitions. Subject to Section 2.01 hereof, the Indenture is hereby amended by deleting any
definitions from the Indenture with respect to which references would be eliminated as a result of the amendments of the Indenture pursuant to Section 1.01 hereof. 

 ARTICLE TWO 
 MISCELLANEOUS 
 SECTION 2.01 Effect of Supplemental Indenture.
Except as amended hereby, all of the terms of the Indenture shall remain and continue in full force and effect and are hereby confirmed in all respects. From and after the date of this Supplemental Indenture, all references to the Indenture (whether
in the Indenture or in any other agreements, documents or instruments) shall be deemed to be references to the Indenture as amended and supplemented by this Supplemental Indenture. 

SECTION 2.02 Effectiveness. The provisions of this Supplemental Indenture shall be effective only upon execution and
delivery of this instrument by the parties hereto. Notwithstanding the foregoing sentence, the provisions of this Supplemental Indenture shall become operative only upon the purchase by the Company of at least a majority in principal amount of the
outstanding Notes pursuant to the Tender Offer, with the result that the amendments to the Indenture effected by this Supplemental Indenture shall be deemed to be revoked retroactively to the date hereof if such purchase shall not occur. 

SECTION 2.02 Governing Law. THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS
SUPPLEMENTAL INDENTURE. 
 SECTION 2.03 No Representations by Trustee. The recitals contained herein shall be
taken as the statement of the Company, and the Trustee assumes no responsibility for the correctness or completeness of the same. 
 SECTION 2.04 Counterparts. This Supplemental Indenture may be executed in any number of counterparts, each of which shall be an original; but such counterparts shall constitute but one and
the same instrument. 
 (signature page follows) 

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

			
	CHS/COMMUNITY HEALTH SYSTEMS, INC.
		
	By:	 	 /s/ Rachel A. Seifert

	Name:	 	Rachel A. Seifert
	Title:	 	Executive Vice President, Secretary & General Counsel

 [Signature Page to Supplemental Indenture] 

 
			
	U.S. BANK NATIONAL ASSOCIATION
		
	By:	 	 /s/ Wally Jones

	Name:	 	Wally Jones
	Title:	 	Vice President

 [Signature Page to Supplemental Indenture] 

 SCHEDULE I 
 Guarantors: 
 Community Health Systems, Inc. 

Abilene Hospital, LLC 
 Abilene Merger, LLC

 Affinity Health Systems, LLC 

Affinity Hospital, LLC 
 Anna Hospital
Corporation 
 Berwick Hospital Company, LLC 
 Big Bend Hospital Corporation 
 Big Spring Hospital Corporation 

Birmingham Holdings II, LLC 
 Birmingham
Holdings, LLC 
 Blue Island Hospital Company, LLC 
 Blue Island Illinois Holdings, LLC 
 Bluefield Holdings, LLC 

Bluefield Hospital Company, LLC 
 Bluffton Health
System, LLC 
 Brownsville Hospital Corporation 
 Brownwood Hospital, L.P. 
 Brownwood Medical Center, LLC 

Bullhead City Hospital Corporation 
 Bullhead
City Hospital Investment Corporation 
 Carlsbad Medical Center, LLC 
 Centre Hospital Corporation 
 CHHS Holdings, LLC 

CHS Kentucky Holdings, LLC 
 CHS Pennsylvania
Holdings, LLC 
 CHS Virginia Holdings, LLC 
 CHS Washington Holdings, LLC 
 Clarksville Holdings, LLC 

Cleveland Hospital Corporation 
 Cleveland
Tennessee Hospital Company, LLC 
 Clinton Hospital Corporation 
 Coatesville Hospital Corporation 
 College Station Hospital, L.P. 

College Station Medical Center, LLC 
 College
Station Merger, LLC 
 Community GP Corp. 
 Community Health Investment Company, LLC 
 Community LP Corp. 

CP Hospital GP, LLC 
 CPLP, LLC 

Crestwood Hospital, LLC 
 Crestwood Hospital, LP,
LLC 
 CSMC, LLC 
 CSRA Holdings, LLC

 Deaconess Holdings, LLC 
 Deaconess
Hospital Holdings, LLC 
 Deming Hospital Corporation 
 Desert Hospital Holdings, LLC 
 Detar Hospital, LLC 

DHFW Holdings, LLC 
 DHSC, LLC 

[Schedule I to Supplemental Indenture] 

 Dukes Health System, LLC 
 Dyersburg Hospital Corporation 
 Emporia Hospital Corporation 

Evanston Hospital Corporation 
 Fallbrook
Hospital Corporation 
 Foley Hospital Corporation 
 Forrest City Arkansas Hospital Company, LLC 
 Forrest City Hospital Corporation 

Fort Payne Hospital Corporation 
 Frankfort
Health Partner, Inc. 
 Franklin Hospital Corporation 
 Gadsden Regional Medical Center, LLC 
 Galesburg Hospital Corporation 

Granbury Hospital Corporation 
 Granite City
Hospital Corporation 
 Granite City Illinois Hospital Company, LLC 
 Greenville Hospital Corporation 
 GRMC Holdings, LLC 

Hallmark Healthcare Company, LLC 
 Hobbs Medco,
LLC 
 Hospital of Barstow, Inc. 

Hospital of Fulton, Inc. 
 Hospital of Louisa,
Inc. 
 Hospital of Morristown, Inc. 

Jackson Hospital Corporation (KY) 
 Jackson
Hospital Corporation (TN) 
 Jourdanton Hospital Corporation 
 Kay County Hospital Corporation 
 Kay County Oklahoma Hospital Company, LLC 

Kirksville Hospital Company, LLC 
 Lakeway
Hospital Corporation 
 Lancaster Hospital Corporation 
 Las Cruces Medical Center, LLC 
 Lea Regional Hospital, LLC 

Lexington Hospital Corporation 
 Longview Clinic
Operations Company, LLC 
 Longview Medical Center, L.P. 
 Longview Merger, LLC 
 LRH, LLC 
 Lutheran Health Network of Indiana, LLC 
 Marion Hospital Corporation 

Martin Hospital Corporation 
 Massillon Community
Health System LLC 
 Massillon Health System LLC 
 Massillon Holdings, LLC 
 McKenzie Tennessee Hospital Company, LLC 

McNairy Hospital Corporation 
 MCSA, L.L.C.

 Medical Center of Brownwood, LLC 

Merger Legacy Holdings, LLC 
 MMC of Nevada, LLC

 Moberly Hospital Company, LLC 
 MWMC
Holdings, LLC 
 Nanticoke Hospital Company, LLC 
 National Healthcare of Leesville, Inc. 
 National Healthcare of Mt. Vernon, Inc. 

[Schedule I to Supplemental Indenture] 

 National Healthcare of Newport, Inc. 
 Navarro Hospital, L.P. 
 Navarro Regional, LLC 

NC-DSH, LLC 
 Northampton Hospital Company, LLC

 Northwest Hospital, LLC 
 NOV
Holdings, LLC 
 NRH, LLC 
 Oak Hill
Hospital Corporation 
 Oro Valley Hospital, LLC 
 Palmer-Wasilla Health System, LLC 
 Payson Hospital Corporation 

Peckville Hospital Company, LLC 
 Pennsylvania
Hospital Company, LLC 
 Phillips Hospital Corporation 
 Phoenixville Hospital Company, LLC 
 Pottstown Hospital Company, LLC 

QHG Georgia Holdings II, LLC 
 QHG Georgia
Holdings, Inc. 
 QHG Georgia, LP 
 QHG
of Bluffton Company, LLC 
 QHG of Clinton County, Inc. 
 QHG of Enterprise, Inc. 
 QHG of Forrest County, Inc. 

QHG of Fort Wayne Company, LLC 
 QHG of
Hattiesburg, Inc. 
 QHG of Massillon, Inc. 
 QHG of South Carolina, Inc. 
 QHG of Spartanburg, Inc. 

QHG of Springdale, Inc. 
 QHG of Warsaw Company,
LLC 
 Quorum Health Resources, LLC 

Red Bud Hospital Corporation 
 Red Bud Illinois
Hospital Company, LLC 
 Regional Hospital of Longview, LLC 
 River Region Medical Corporation 
 Roswell Hospital Corporation 

Ruston Hospital Corporation 
 Ruston Louisiana
Hospital Company, LLC 
 SACMC, LLC 

Salem Hospital Corporation 
 San Angelo Community
Medical Center, LLC 
 San Angelo Medical, LLC 
 San Miguel Hospital Corporation 
 Scranton Holdings, LLC 

Scranton Hospital Company, LLC 
 Scranton Quincy
Holdings, LLC 
 Scranton Quincy Hospital Company, LLC 
 Shelbyville Hospital Corporation 
 Siloam Springs Arkansas Hospital Company, LLC 

Siloam Springs Holdings, LLC 
 Southern Texas
Medical Center, LLC 
 Spokane Valley Washington Hospital Company, LLC 
 Spokane Washington Hospital Company, LLC 
 Tennyson Holdings, LLC 

Tomball Texas Holdings, LLC 

[Schedule I to Supplemental Indenture] 

 Tomball Texas Hospital Company, LLC 
 Tooele Hospital Corporation 
 Triad Healthcare Corporation 

Triad Holdings III, LLC 
 Triad Holdings IV, LLC

 Triad Holdings V, LLC 
 Triad Nevada
Holdings, LLC 
 Triad of Alabama, LLC 

Triad of Oregon, LLC 
 Triad-ARMC, LLC

 Triad-El Dorado, Inc. 
 Triad-Navarro
Regional Hospital Subsidiary, LLC 
 Tunkhannock Hospital Company, LLC 
 VHC Medical, LLC 
 Vicksburg Healthcare, LLC 

Victoria Hospital, LLC 
 Victoria of Texas, L.P.

 Virginia Hospital Company, LLC 

Warren Ohio Hospital Company, LLC 
 Warren Ohio
Rehab Hospital Company, LLC 
 Watsonville Hospital Corporation 
 Waukegan Hospital Corporation 
 Waukegan Illinois Hospital Company, LLC 

Weatherford Hospital Corporation 
 Weatherford
Texas Hospital Company, LLC 
 Webb Hospital Corporation 
 Webb Hospital Holdings, LLC 
 Wesley Health System, LLC 

West Grove Hospital Company, LLC 
 WHMC, LLC

 Wilkes-Barre Behavioral Hospital Company, LLC 
 Wilkes-Barre Holdings, LLC 
 Wilkes-Barre Hospital Company, LLC 

Williamston Hospital Corporation 

Women & Children’s Hospital, LLC 

Woodland Heights Medical Center, LLC 
 Woodward
Health System, LLC 
 Youngstown Ohio Hospital Company, LLC 
 [Schedule I to Supplemental Indenture]

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