Document:

EX-4.8

 Exhibit 4.8 
 EXECUTION COPY 
 $1,000,000,000 

CHS/COMMUNITY HEALTH SYSTEMS, INC. 
 8.000% Senior Notes due 2019 
 REGISTRATION RIGHTS AGREEMENT

 November 22, 2011 
 Credit Suisse Securities (USA) LLC 
 As Representative of the Initial Purchasers 

c/o Credit Suisse Securities (USA) LLC 

      Eleven Madison Avenue 

      New York, New York 10010-3629 

Dear Sirs: 
 CHS/Community
Health Systems, Inc., a Delaware corporation (the “Company”), a wholly owned subsidiary of Community Health Systems, Inc., a Delaware corporation (“Holdings”), agrees with the several initial purchasers named in Schedule A hereto
(the “Initial Purchasers”), subject to the terms and conditions set forth in a purchase agreement, dated November 14, 2011 (the “Purchase Agreement”), to issue and sell to the several Initial Purchasers $1,000,000,000
aggregate principal amount of its 8.000% Senior Notes due 2019 (the “Initial Securities”) to be unconditionally guaranteed (the “Guarantees”) by Holdings and the subsidiary guarantors listed in Schedule I attached hereto (the
“Guarantors”). The Initial Securities will be issued pursuant to an indenture, dated as of November 22, 2011 (the “Indenture”), among the Company, the Guarantors named therein and U.S. Bank National Association, as Trustee
(the “Trustee”). As an inducement to the Initial Purchasers, the Company and the Guarantors agree with the Initial Purchasers, for the benefit of the holders of the Initial Securities (including, without limitation, the Initial
Purchasers), the Exchange Securities (as defined below) and the Private Exchange Securities (as defined below) (collectively the “Holders”), as follows: 
 1. Registered Exchange Offer. The Company shall, at its own cost, prepare and, not later than 120 days after (or if the 120th day is not a business day, the first business day thereafter) the date
of original issue of the Initial Securities (the “Issue Date”), file with the Securities and Exchange Commission (the “Commission”) a registration statement (the “Exchange Offer Registration Statement”) on an
appropriate form under the Securities Act of 1933, as amended (the “Securities Act”), with respect to a proposed offer (the “Registered Exchange Offer”) to the Holders of Transfer Restricted Securities (as defined in
Section 6 hereof), who are not prohibited by any law or policy of the Commission from participating in the Registered Exchange Offer, to issue and deliver to such Holders, in exchange for the Initial Securities, a like aggregate principal
amount of debt securities (the “Exchange Securities”) of the Company issued under the Indenture and substantially identical in all material respects to the Initial Securities (except for the transfer restrictions relating to the Initial
Securities and the provisions relating to the matters described in Section 6 hereof) and registered under the Securities Act. Unless not permitted by applicable law or Commission policy, the Company shall use commercially reasonable efforts to
(i) cause such Exchange Offer Registration Statement to become effective under the Securities Act within 210 days 

 
(or if the 210th day is not a business day, the first business day thereafter) after the Issue Date, (ii) shall keep the Exchange Offer Registration Statement effective for not less than 30
days (or longer, if required by applicable law) after the date notice of the Registered Exchange Offer is mailed to the Holders (such period being called the “Exchange Offer Registration Period”) and (iii) cause the Registered
Exchange Offer to be completed within 40 days after the Exchange Offer Registration Statement is declared effective. For purposes of this Agreement, “business day” shall mean a day other than a Saturday, Sunday or other day on which
banking institutions are authorized or required by law to close in New York City. 
 If the Company effects the Registered
Exchange Offer, the Company will be entitled to consummate the Registered Exchange Offer 30 days after the commencement thereof provided that the Company has accepted all the Initial Securities theretofore validly tendered in accordance with the
terms of the Registered Exchange Offer. 
 Following the declaration of the effectiveness of the Exchange Offer Registration
Statement, unless not permitted by applicable law or Commission policy, the Company shall promptly commence the Registered Exchange Offer, it being the objective of such Registered Exchange Offer to enable each Holder of Transfer Restricted
Securities (as defined in Section 6 hereof) electing to exchange the Initial Securities for Exchange Securities (assuming that such Holder is not an affiliate of the Company within the meaning of the Securities Act, acquires the Exchange
Securities in the ordinary course of such Holder’s business and has no arrangements with any person to participate in the distribution of the Exchange Securities and is not prohibited by any law or policy of the Commission from participating in
the Registered Exchange Offer) to trade such Exchange Securities from and after their receipt without any limitations or restrictions under the Securities Act and without material restrictions under the securities laws of the several states of the
United States. 
 The Company acknowledges that, pursuant to current interpretations by the Commission’s staff of
Section 5 of the Securities Act, in the absence of an applicable exemption therefrom, (i) each Holder which is a broker-dealer electing to exchange Initial Securities, acquired for its own account as a result of market making activities or
other trading activities, for Exchange Securities (an “Exchanging Dealer”), is required to deliver a prospectus containing the information set forth in (a) Annex A hereto on the cover, (b) Annex B hereto in the “Exchange
Offer Procedures” section and the “Purpose of the Exchange Offer” section, and (c) Annex C hereto in the “Plan of Distribution” section of such prospectus in connection with a sale of any such Exchange Securities
received by such Exchanging Dealer pursuant to the Registered Exchange Offer and (ii) an Initial Purchaser that elects to sell Exchange Securities acquired in exchange for Initial Securities constituting any portion of an unsold allotment is
required to deliver a prospectus containing the information required by Items 507 or 508 of Regulation S-K under the Securities Act, as applicable, in connection with such sale. 

The Company shall use commercially reasonable efforts to keep the Exchange Offer Registration Statement effective and to amend and
supplement the prospectus contained therein, in order to permit such prospectus to be lawfully delivered by all persons subject to the prospectus delivery requirements of the Securities Act for such period of time as such persons must comply with
such requirements in order to resell the Exchange Securities; provided, however, that (i) in the case where such prospectus and any amendment or supplement thereto must be delivered by an Exchanging Dealer or an Initial Purchaser, such period
shall be the lesser of 180 days and the date on which all Exchanging Dealers and the Initial Purchasers have sold all Exchange Securities held by them (unless such period is extended pursuant to Section 3(j) below) and (ii) the Company
shall make such prospectus and any amendment or supplement thereto, available to any broker-dealer for use in connection with any resale of any Exchange Securities for a period of not less than 90 days after the consummation of the Registered
Exchange Offer. 
 If, upon consummation of the Registered Exchange Offer, any Initial Purchaser holds Initial Securities
acquired by it as part of its initial distribution, the Company, simultaneously with the delivery of 

  
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the Exchange Securities pursuant to the Registered Exchange Offer, shall issue and deliver to such Initial Purchaser upon the written request of such Initial Purchaser, in exchange (the
“Private Exchange”) for the Initial Securities held by such Initial Purchaser, a like principal amount of debt securities of the Company issued under the Indenture and identical in all material respects (including the existence of
restrictions on transfer under the Securities Act and the securities laws of the several states of the United States, but excluding provisions relating to the matters described in Section 6 hereof) to the Initial Securities (the “Private
Exchange Securities”). The Initial Securities, the Exchange Securities and the Private Exchange Securities are herein collectively called the “Securities”. 
 In connection with the Registered Exchange Offer, the Company shall: 
 (a) mail to each Holder a copy of the prospectus forming part of the Exchange Offer Registration Statement, together with an appropriate letter of transmittal and related documents; 

(b) keep the Registered Exchange Offer open for not less than 30 days (or longer, if required by applicable law) after the
date notice thereof is mailed to the Holders; 
 (c) utilize the services of a depositary for the Registered
Exchange Offer with an address in the Borough of Manhattan, The City of New York, which may be the Trustee or an affiliate of the Trustee; 
 (d) permit Holders to withdraw tendered Securities at any time prior to the close of business, New York time, on the last business day on which the Registered Exchange Offer shall remain open; and

 (e) otherwise comply with all applicable laws. 

As soon as practicable after the close of the Registered Exchange Offer or the Private Exchange, as the case may be, the Company shall:

 (x) accept for exchange all the Securities validly tendered and not withdrawn pursuant to the Registered
Exchange Offer and the Private Exchange; 
 (y) deliver to the Trustee for cancellation all the Initial
Securities so accepted for exchange; and 
 (z) cause the Trustee to authenticate and deliver promptly to each
Holder of the Initial Securities, Exchange Securities or Private Exchange Securities, as the case may be, equal in principal amount to the Initial Securities of such Holder so accepted for exchange. 

The Indenture will provide that the Exchange Securities will not be subject to the transfer restrictions set forth in the Indenture and
that all the Securities will vote and consent together on all matters as one class and that none of the Securities will have the right to vote or consent as a class separate from one another on any matter. 

Interest on each Exchange Security and Private Exchange Security issued pursuant to the Registered Exchange Offer and in the Private
Exchange will accrue from the last interest payment date on which interest was paid on the Initial Securities surrendered in exchange therefor or, if no interest has been paid on the Initial Securities, from the date of original issue of the Initial
Securities. 
 Each Holder participating in the Registered Exchange Offer shall be required to represent in writing (which may
be contained in the applicable letter of transmittal) to the Company that at the time of 

  
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the consummation of the Registered Exchange Offer (i) any Exchange Securities received by such Holder will be acquired in the ordinary course of business, (ii) such Holder will have no
arrangements or understanding with any person to participate in the distribution of the Securities or the Exchange Securities within the meaning of the Securities Act, (iii) such Holder is not an “affiliate,” as defined in Rule 405 of
the Securities Act, of the Company or if it is an affiliate, such Holder will comply with the registration and prospectus delivery requirements of the Securities Act to the extent applicable, (iv) if such Holder is not a broker-dealer, that it
is not engaged in, and does not intend to engage in, the distribution of the Exchange Securities and (v) if such Holder is a broker-dealer, that it will receive Exchange Securities for its own account in exchange for Initial Securities that
were acquired as a result of market-making activities or other trading activities and that it will be required to acknowledge that it will deliver a prospectus in connection with any resale of such Exchange Securities. 

Notwithstanding any other provisions hereof, the Company will ensure that (i) any Exchange Offer Registration Statement and any
amendment thereto and any prospectus forming part thereof and any supplement thereto complies as to form in all material respects with the Securities Act and the rules and regulations thereunder, (ii) any Exchange Offer Registration Statement
and any amendment thereto does not, when it becomes effective, contain an untrue statement of a material fact or omit to state a material fact required to be stated therein or necessary to make the statements therein not misleading and
(iii) any prospectus forming part of any Exchange Offer Registration Statement, and any supplement to such prospectus, does not include an untrue statement of a material fact or omit to state a material fact required to be stated therein or
necessary in order to make the statements therein, in the light of the circumstances under which they were made, not misleading. 
 2. Shelf Registration. If, (i) because of any change in law or in applicable interpretations thereof by the staff of the Commission, the Company is not permitted to effect a Registered
Exchange Offer, as contemplated by Section 1 hereof, (ii) the Registered Exchange Offer is not consummated within 280 days of the Issue Date, (iii) any Initial Purchaser so requests with respect to the Initial Securities (or the
Private Exchange Securities) not eligible to be exchanged for Exchange Securities in the Registered Exchange Offer and held by it following consummation of the Registered Exchange Offer or (iv) any Holder (A) is prohibited by applicable
law or Commission policy from participating in the Registered Exchange Offer, or (B) may not resell the Exchange Securities acquired by it in the Registered Exchange Offer to the public without delivering a prospectus, the Company shall take
the following actions: 
 (a) The Company shall, at its cost, as promptly as practicable (but in no event more
than 30 days after so required or requested pursuant to this Section 2) file with the Commission and thereafter shall use its reasonable best efforts to cause to be declared effective (unless it becomes effective automatically upon filing) a
registration statement (the “Shelf Registration Statement” and, together with the Exchange Offer Registration Statement, a “Registration Statement”) on an appropriate form under the Securities Act relating to the offer and sale
of the Transfer Restricted Securities (as defined in Section 6 hereof) by the Holders thereof (x) in the case of clause (i) above, on or prior to the 210th day after the Issue Date or (y) in the case of clause (ii), (iii) or
(iv) above, on or prior to the 90th day after the date on which such Shelf Registration Statement is required to be filed, in each case in accordance with the methods of distribution set forth in the Shelf Registration Statement and Rule 415
under the Securities Act (hereinafter, the “Shelf Registration”); provided, however, that no Holder (other than an Initial Purchaser) shall be entitled to have the Securities held by it covered by such Shelf Registration Statement unless
such Holder agrees in writing to be bound by all the provisions of this Agreement applicable to such Holder. 

(b) The Company shall use its reasonable best efforts to keep the Shelf Registration Statement continuously effective in
order to permit the prospectus included therein to be lawfully delivered by the Holders of the relevant Securities, until the earlier of (x) one year from the date 

  
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such Shelf Registration Statement is first declared effective and (y) the date on which all the Securities registered under the Shelf Registration Statement have been disposed of in
accordance therewith (the “Shelf Registration Period”). The Company shall be deemed not to have used its reasonable best efforts to keep the Shelf Registration Statement effective during the requisite period if it voluntarily takes any
action that would result in Holders of Securities covered thereby not being able to offer and sell such Securities during that period, unless (i) such action is required by applicable law or (ii) such action is taken by the Company in good
faith and for valid business reasons (not including avoidance of the Company’s obligations hereunder), including, but not limited to, the acquisition or divestiture of assets, so long as the Company promptly thereafter complies with the
requirements of Section 3(j) hereof, if applicable. 
 (c) Notwithstanding any other provisions of this
Agreement to the contrary, the Company shall cause the Shelf Registration Statement and the related prospectus and any amendment or supplement thereto, as of the effective date of the Shelf Registration Statement, amendment or supplement,
(i) to comply in all material respects with the applicable requirements of the Securities Act and the rules and regulations of the Commission and (ii) not to contain any untrue statement of a material fact or omit to state a material fact
required to be stated therein or necessary in order to make the statements therein, in light of the circumstances under which they were made, not misleading. 
 3. Registration Procedures. In connection with any Shelf Registration contemplated by Section 2 hereof and, to the extent applicable, any Registered Exchange Offer contemplated by
Section 1 hereof, the following provisions shall apply: 
 (a) The Company shall (i) furnish to each
Initial Purchaser, prior to the filing thereof with the Commission, a copy of the Registration Statement and each amendment thereof and each supplement, if any, to the prospectus included therein and, in the event that an Initial Purchaser (with
respect to any portion of an unsold allotment from the original offering) is participating in the Registered Exchange Offer or the Shelf Registration Statement, the Company shall use its reasonable best efforts to reflect in each such document, when
so filed with the Commission, such comments as such Initial Purchaser reasonably may propose; (ii) include the information set forth in Annex A hereto on the cover, in Annex B hereto in the “Exchange Offer Procedures” section and the
“Purpose of the Exchange Offer” section and in Annex C hereto in the “Plan of Distribution” section of the prospectus forming a part of the Exchange Offer Registration Statement and include the information set forth in Annex D
hereto in the Letter of Transmittal delivered pursuant to the Registered Exchange Offer; (iii) if requested by an Initial Purchaser in writing, include the information required by Items 507 or 508 of Regulation S-K under the Securities Act, as
applicable, in the prospectus forming a part of the Exchange Offer Registration Statement; (iv) include within the prospectus contained in the Exchange Offer Registration Statement a section entitled “Plan of Distribution,” reasonably
acceptable to the Initial Purchasers, which shall contain a summary statement of the positions taken or policies made by the staff of the Commission with respect to the potential “underwriter” status of any broker-dealer that is the
beneficial owner (as defined in Rule 13d-3 under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)) of Exchange Securities received by such broker-dealer in the Registered Exchange Offer (a “Participating
Broker-Dealer”), whether such positions or policies have been publicly disseminated by the staff of the Commission or such positions or policies, in the reasonable judgment of the Initial Purchasers based upon advice of counsel (which may be
in-house counsel), represent the prevailing views of the staff of the Commission; and (v) in the case of a Shelf Registration Statement, include in the prospectus included in the Shelf Registration Statement (or, if permitted by Commission Rule
430B(b), in a prospectus supplement that becomes a part thereof pursuant to Commission Rule 430B(f)) that is delivered to any Holder pursuant to Section 3(d) and (f), the names of the Holders, who propose to sell Securities pursuant to the
Shelf Registration Statement, as selling securityholders. 

  
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 (b) The Company shall give written notice to the Initial Purchasers, the
Holders of the Securities and any Participating Broker-Dealer from whom the Company has received prior written notice that it will be a Participating Broker-Dealer in the Registered Exchange Offer (which notice pursuant to clauses
(ii)-(v) hereof shall be accompanied by an instruction to suspend the use of the prospectus until the requisite changes have been made): 
 (i) when the Registration Statement or any amendment thereto has been filed with the Commission and when the Registration Statement or any post-effective amendment thereto has become effective;

 (ii) of any request by the Commission for amendments or supplements to the Registration Statement or the
prospectus included therein or for additional information; 
 (iii) of the issuance by the Commission of any stop
order suspending the effectiveness of the Registration Statement or the initiation of any proceedings for that purpose, of the issuance by the Commission of a notification of objection to the use of the form on which the Registration Statement has
been filed, and of the happening of any event that causes the Company to become an “ineligible issuer,” as defined in Commission Rule 405. 
 (iv) of the receipt by the Company or its legal counsel of any notification with respect to the suspension of the qualification of the Securities for sale in any jurisdiction or the initiation or
threatening of any proceeding for such purpose; and 
 (v) of the happening of any event during the period that
the Registration Statement is effective that requires the Company to make changes in the Registration Statement or the prospectus in order that the Registration Statement or the prospectus do not contain an untrue statement of a material fact nor
omit to state a material fact required to be stated therein or necessary to make the statements therein (in the case of the prospectus, in light of the circumstances under which they were made) not misleading. 

(c) The Company shall make every reasonable effort to obtain the withdrawal at the earliest possible time, of any order
suspending the effectiveness of the Registration Statement. 
 (d) The Company shall furnish to each Holder of
Securities included within the coverage of the Shelf Registration, without charge, at least one copy of the Shelf Registration Statement and any post-effective amendment or supplement thereto, including financial statements and schedules, and, if
the Holder so requests in writing, all exhibits thereto (including those, if any, incorporated by reference). The Company shall not, without the prior consent of the Initial Purchasers, make any offer relating to the Securities that would constitute
a “free writing prospectus,” as defined in Commission Rule 405. 
 (e) The Company shall deliver to
each Exchanging Dealer and each Initial Purchaser, and to any other Holder who so requests, without charge, at least one copy of the Exchange Offer Registration Statement and any post-effective amendment thereto, including financial statements and
schedules, and, if any Initial Purchaser or any such Holder requests, all exhibits thereto (including those incorporated by reference). 

  
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 (f) The Company shall, during the Shelf Registration Period, deliver to each
Holder of Securities included within the coverage of the Shelf Registration, without charge, as many copies of the prospectus (including each preliminary prospectus) included in the Shelf Registration Statement and any amendment or supplement
thereto as such person may reasonably request. The Company consents, subject to the provisions of this Agreement, to the use of the prospectus or any amendment or supplement thereto by each of the selling Holders of the Securities in connection with
the offering and sale of the Securities covered by the prospectus, or any amendment or supplement thereto, included in the Shelf Registration Statement. 
 (g) The Company shall deliver to each Initial Purchaser, any Exchanging Dealer, any Participating Broker-Dealer and such other persons required to deliver a prospectus following the Registered Exchange
Offer, without charge, as many copies of the final prospectus included in the Exchange Offer Registration Statement and any amendment or supplement thereto as such persons may reasonably request. The Company consents, subject to the provisions of
this Agreement, to the use of the prospectus or any amendment or supplement thereto by any Initial Purchaser, if necessary, any Participating Broker-Dealer and such other persons required to deliver a prospectus following the Registered Exchange
Offer in connection with the offering and sale of the Exchange Securities covered by the prospectus, or any amendment or supplement thereto, included in such Exchange Offer Registration Statement. 

(h) Prior to any public offering of the Securities pursuant to any Registration Statement, the Company shall use its
reasonable best efforts to register or qualify or cooperate with the Holders of the Securities included therein and their respective counsel in connection with the registration or qualification of the Securities for offer and sale under the
securities or “blue sky” laws of such states of the United States as any Holder of the Securities reasonably requests in writing and do any and all other acts or things necessary or advisable to enable the offer and sale in such
jurisdictions of the Securities covered by such Registration Statement; provided, however, that the Company shall not be required to (i) qualify generally to do business or as a dealer in Securities in any jurisdiction where it is not then so
qualified or (ii) take any action which would subject it to general service of process or to taxation in any jurisdiction where it is not then so subject. 
 (i) The Company shall cooperate with the Holders of the Securities to facilitate the timely preparation and delivery of certificates representing the Securities to be sold pursuant to any Registration
Statement free of any restrictive legends and in such denominations and registered in such names as the Holders may request a reasonable period of time prior to sales of the Securities pursuant to such Registration Statement. 

(j) Upon the occurrence of any event contemplated by paragraphs (ii) through (v) of Section 3(b) above
during the period for which the Company is required to maintain an effective Registration Statement, the Company shall promptly prepare and file a post-effective amendment to the Registration Statement or a supplement to the related prospectus and
any other required document so that, as thereafter delivered to Holders of the Securities or purchasers of Securities, the prospectus will not contain an untrue statement of a material fact or omit to state any material fact required to be stated
therein or necessary to make the statements therein, in light of the circumstances under which they were made, not misleading. If the Company notifies the Initial Purchasers, the Holders of the Securities and any known Participating Broker-Dealer in
accordance with paragraphs (ii) through (v) of Section 3(b) above to suspend the use of the prospectus until the requisite changes to the prospectus have been made, then the Initial Purchasers, the Holders of the Securities and any
such Participating Broker-Dealers shall suspend use of such prospectus, and the period of effectiveness of the Shelf Registration Statement provided for in Section 2(b) above and the Exchange Offer Registration Statement provided for in

  
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Section 1 above shall each be extended by the number of days from and including the date of the giving of such notice to and including the date when the Initial Purchasers, the Holders of
the Securities and any known Participating Broker-Dealer shall have received such amended or supplemented prospectus pursuant to this Section 3(j). During the period during which the Company is required to maintain an effective Shelf
Registration Statement pursuant to this Agreement, the Company will prior to the three-year expiration of that Shelf Registration Statement file, and use its reasonable best efforts to cause to be declared effective (unless it becomes effective
automatically upon filing) within a period that avoids any interruption in the ability of Holders of Securities covered by the expiring Shelf Registration Statement to make registered dispositions, a new registration statement relating to the
Securities, which shall be deemed the “Shelf Registration Statement” for purposes of this Agreement. 

(k) Not later than the effective date of the applicable Registration Statement, the Company will provide a CUSIP number
for the Initial Securities, the Exchange Securities or the Private Exchange Securities, as the case may be. 

(l) The Company will comply with all rules and regulations of the Commission to the extent and so long as they are
applicable to the Registered Exchange Offer or the Shelf Registration and will make generally available to its security holders (or otherwise provide in accordance with Section 11(a) of the Securities Act) an earnings statement satisfying the
provisions of Section 11(a) of the Securities Act, no later than 45 days after the end of a 12-month period (or 90 days, if such period is a fiscal year) beginning with the first month of the Company’s first fiscal quarter commencing after
the effective date of the Registration Statement, which statement shall cover such 12-month period. 
 (m) The
Company shall cause the Indenture to be qualified under the Trust Indenture Act of 1939, as amended, in a timely manner and containing such changes, if any, as shall be necessary for such qualification. In the event that such qualification would
require the appointment of a new trustee under the Indenture, the Company shall appoint a new trustee thereunder pursuant to the applicable provisions of the Indenture. 

(n) The Company may require each Holder of Securities to be sold pursuant to the Shelf Registration Statement to furnish
to the Company such information regarding the Holder and the distribution of the Securities as the Company may from time to time reasonably require for inclusion of the Holder in the Shelf Registration Statement, including requiring the Holder to
properly complete and execute such selling security Holder notice and questionnaires, and any amendments or supplements thereto, as the Company may reasonably deem necessary or appropriate, and the Company may exclude from such registration the
Securities of any Holder that fails to furnish such information within a reasonable time after receiving such request. 
 (o) The Company shall enter into such customary agreements (including, if requested, an underwriting agreement in customary form) and take all such other action, if any, as any Holder of the Securities
shall reasonably request in order to facilitate the disposition of the Securities pursuant to any Shelf Registration. 
 (p) In the case of any Shelf Registration, the Company shall (i) make reasonably available for inspection by the Holders of the Securities, any underwriter participating in any disposition pursuant
to the Shelf Registration Statement and any attorney, accountant or other agent retained by the Holders of the Securities or any such underwriter at all reasonable times and in a reasonable manner all relevant financial and other records, pertinent
corporate documents and properties of the Company and (ii) cause the Company’s officers, directors, employees, accountants and auditors to supply all relevant information reasonably requested by the Holders of

  
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the Securities or any such underwriter, attorney, accountant or agent in connection with the Shelf Registration Statement, in each case, as shall be reasonably necessary to enable such persons,
to conduct a reasonable investigation within the meaning of Section 11 of the Securities Act; provided, however, that the foregoing inspection and information gathering shall be coordinated on behalf of the Initial Purchasers by you and on
behalf of the other parties, by one counsel designated by and on behalf of such other parties as described in Section 4 hereof; and provided further, however, that any information that is designated in writing by the Company, in good faith, as
confidential at the time of delivery of such information shall be kept confidential by each such person, unless (A) the disclosure of such information is necessary to avoid or correct a material misstatement or material omission in such
Registration Statement or prospectus, (B) such disclosure is made in connection with a court proceeding, to any governmental or regulatory authority having jurisdiction over each such person or their respective affiliates, or is reasonably
necessary in order to establish a “due diligence” defense” pursuant to Section 11 of the Securities Act or (C) such information becomes available to the public generally or through a third party without an accompanying
obligation of confidentiality. 
 (q) In the case of any Shelf Registration, the Company, if requested by any
Holder of Securities covered thereby, shall cause (i) its counsel to deliver an opinion and updates thereof relating to the Securities in customary form (which counsel and opinions (in form, scope and substance) shall be reasonably satisfactory
to the managing underwriters, if any) addressed to such Holders and the managing underwriters, if any, thereof and dated, in the case of the initial opinion, the effective date of such Shelf Registration Statement covering such matters as are
customarily covered in opinions given in connection with underwritten offerings and such other matters as may be reasonably requested by such holders and managing underwriters, if any; (ii) its officers to execute and deliver all customary
documents and certificates and updates thereof requested by any underwriters of the applicable Securities and (iii) its independent public accountants and the independent public accountants with respect to any other entity for which financial
information is provided in the Shelf Registration Statement to provide to the selling Holders of the applicable Securities and any underwriter therefor a comfort letter in customary form and covering matters of the type customarily covered in
comfort letters in connection with primary underwritten offerings, subject to receipt of appropriate documentation as contemplated, and only if permitted, by AU Section 634 of the Interim Accounting Standards of the Public Company Accounting
Oversight Board. 
 (r) In the case of the Registered Exchange Offer, if requested by any Initial Purchaser or
any known Participating Broker-Dealer, the Company shall cause (i) its counsel to deliver to such Initial Purchaser or such Participating Broker-Dealer a signed opinion in the form set forth in Sections 7(c) and 7(d) of the Purchase Agreement
with such changes as are customary in connection with the preparation of a Registration Statement and (ii) its independent public accountants and the independent public accountants with respect to any other entity for which financial
information is provided in the Registration Statement to deliver to such Initial Purchaser or such Participating Broker-Dealer a comfort letter, in customary form, meeting the requirements as to the substance thereof as set forth in Sections 7(a)
and 7(h) of the Purchase Agreement, with appropriate date changes. 
 (s) If a Registered Exchange Offer or a
Private Exchange is to be consummated, upon delivery of the Initial Securities by Holders to the Company (or to such other Person as directed by the Company) in exchange for the Exchange Securities or the Private Exchange Securities, as the case may
be, the Company shall mark, or caused to be marked, on the Initial Securities so exchanged that such Initial Securities are being canceled in exchange for the Exchange Securities or the Private Exchange Securities, as the case may be; in no event
shall the Initial Securities be marked as paid or otherwise satisfied. 

  
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 (t) The Company will use its reasonable best efforts to (a) if the
Initial Securities have been rated prior to the initial sale of such Initial Securities, confirm such ratings will apply to the Securities covered by a Registration Statement, or (b) if the Initial Securities were not previously rated, cause
the Securities covered by a Registration Statement to be rated with the appropriate rating agencies, if so requested by Holders of a majority in aggregate principal amount of Securities covered by such Registration Statement, or by the managing
underwriters, if any. 
 (u) In the event that any broker-dealer registered under the Exchange Act shall
underwrite any Securities or participate as a member of an underwriting syndicate or selling group or “assist in the distribution” (within the meaning of the Conduct Rules (the “Rules”) of the Financial Industry Regulatory
Authority, Inc. thereof, whether as a Holder of such Securities or as an underwriter, a placement or sales agent or a broker or dealer in respect thereof, or otherwise, the Company will cooperate with such broker-dealer in complying with the
requirements of such Rules, including, without limitation, by (i) if such Rules, including Rule 5121, shall so require, engaging a “qualified independent underwriter” (as defined in Rule 5121) to participate in the preparation of the
Registration Statement relating to such Securities, to exercise usual standards of due diligence in respect thereto and, if any portion of the offering contemplated by such Registration Statement is an underwritten offering or is made through a
placement or sales agent, to recommend the yield of such Securities, (ii) indemnifying any such qualified independent underwriter to the extent of the indemnification of underwriters provided in Section 5 hereof and (iii) providing
such information to such broker-dealer as may be required in order for such broker-dealer to comply with the requirements of the Rules. 
 (v) The Company shall use its commercially reasonable efforts to take all other steps necessary to effect the registration of the Securities covered by a Registration Statement contemplated hereby.

 4. Registration Expenses. The Company shall bear all fees and expenses incurred in connection with the performance of
its obligations under Sections 1 through 3 hereof (including the reasonable fees and expenses, if any, of Cravath, Swaine & Moore LLP, counsel for the Initial Purchasers, incurred in connection with the Registered Exchange Offer), whether
or not the Registered Exchange Offer or a Shelf Registration is filed or becomes effective, and, in the event of a Shelf Registration, shall bear or reimburse the Holders of the Securities covered thereby for the reasonable fees and disbursements of
one firm of counsel designated by the Holders of a majority in principal amount of the Initial Securities covered thereby to act as counsel for the Holders of the Initial Securities in connection therewith. 

5. Indemnification. (a) The Company agrees to indemnify and hold harmless each Holder of the Securities, any Participating
Broker-Dealer and each person, if any, who controls such Holder or such Participating Broker-Dealer within the meaning of the Securities Act or the Exchange Act (each Holder, any Participating Broker-Dealer and such controlling persons are referred
to collectively as the “Indemnified Parties”) from and against any losses, claims, damages or liabilities, joint or several, or any actions in respect thereof (including, but not limited to, any losses, claims, damages, liabilities or
actions relating to purchases and sales of the Securities) to which each Indemnified Party may become subject under the Securities Act, the Exchange Act or otherwise, insofar as such losses, claims, damages, liabilities or actions arise out of or
are based upon any untrue statement or alleged untrue statement of a material fact contained in a Registration Statement or prospectus or in any amendment or supplement thereto or in any preliminary prospectus or “issuer free writing
prospectus,” as defined in Commission Rule 433 (“Issuer FWP”), relating to a Shelf Registration, or arise out of, or are based upon, the omission or alleged omission to state therein a material fact required to be stated therein or
necessary to make the statements therein not misleading, and shall reimburse, as incurred, the Indemnified Parties for any legal or other expenses reasonably incurred by them in connection with investigating or defending any such loss, claim,
damage, 

  
 10 

 
liability or action in respect thereof; provided, however, that (i) the Company shall not be liable in any such case to the extent that such loss, claim, damage or liability arises out of or
is based upon any untrue statement or alleged untrue statement or omission or alleged omission made in a Registration Statement or prospectus or in any amendment or supplement thereto or in any preliminary prospectus or Issuer FWP relating to a
Shelf Registration in reliance upon and in conformity with written information pertaining to such Indemnified Party and furnished to the Company by or on behalf of such Indemnified Party specifically for inclusion therein and (ii) with respect
to any untrue statement or omission or alleged untrue statement or omission made in any preliminary prospectus relating to a Shelf Registration Statement, the indemnity agreement contained in this subsection (a) shall not inure to the benefit
of any Holder or Participating Broker-Dealer from whom the person asserting any such losses, claims, damages or liabilities purchased the Securities concerned, to the extent that a prospectus relating to such Securities was required to be delivered
(including through satisfaction of the conditions of Commission Rule 172) by such Holder or Participating Broker-Dealer under the Securities Act in connection with such purchase and any such loss, claim, damage or liability of such Holder or
Participating Broker-Dealer results from the fact that there was not conveyed to such person, at or prior to the time of the sale of such Securities to such person, an amended or supplemented prospectus or, if permitted by Section 3(d), an
Issuer FWP correcting such untrue statement or omission or alleged untrue statement or omission if the Company had previously furnished copies thereof to such Holder or Participating Broker-Dealer; provided further, however, that this indemnity
agreement will be in addition to any liability which the Company may otherwise have to such Indemnified Party. The Company shall also indemnify underwriters, their officers and directors and each person who controls such underwriters within the
meaning of the Securities Act or the Exchange Act to the same extent as provided above with respect to the indemnification of the Holders of the Securities if requested by such Holders. 

(b) Each Holder of the Securities, severally and not jointly, will indemnify and hold harmless the Company and each person, if any, who
controls the Company within the meaning of the Securities Act or the Exchange Act from and against any losses, claims, damages or liabilities or any actions in respect thereof, to which the Company or any such controlling person may become subject
under the Securities Act, the Exchange Act or otherwise, insofar as such losses, claims, damages, liabilities or actions arise out of or are based upon any untrue statement or alleged untrue statement of a material fact contained in a Registration
Statement or prospectus or in any amendment or supplement thereto or in any preliminary prospectus or Issuer FWP relating to a Shelf Registration, or arise out of or are based upon the omission or alleged omission to state therein a material fact
necessary to make the statements therein not misleading, but in each case only to the extent that the untrue statement or omission or alleged untrue statement or omission was made in reliance upon and in conformity with written information
pertaining to such Holder and furnished to the Company by or on behalf of such Holder specifically for inclusion therein; and, subject to the limitation set forth immediately preceding this clause, shall reimburse, as incurred, the Company for any
legal or other expenses reasonably incurred by the Company or any such controlling person in connection with investigating or defending any loss, claim, damage, liability or action in respect thereof. This indemnity agreement will be in addition to
any liability which such Holder may otherwise have to the Company or any of its controlling persons. 
 (c) Promptly after
receipt by an indemnified party under this Section 5 of notice of the commencement of any action or proceeding (including a governmental investigation), such indemnified party will, if a claim in respect thereof is to be made against the
indemnifying party under this Section 5, notify the indemnifying party of the commencement thereof; but the failure to notify the indemnifying party shall not relieve the indemnifying party from any liability that it may have under subsection
(a) or (b) above except to the extent that it has been materially prejudiced (through the forfeiture of substantive rights or defenses) by such failure; and provided further that the failure to notify the indemnifying party shall not
relieve it from any liability that it may have to an indemnified party otherwise than under subsection (a) or (b) above. In case any such action is brought against any indemnified party, and it notifies the indemnifying party of the
commencement thereof, the indemnifying party will be entitled to participate 

  
 11 

 
therein and, to the extent that it may wish, jointly with any other indemnifying party similarly notified, to assume the defense thereof, with counsel reasonably satisfactory to such indemnified
party (who shall not, except with the consent of the indemnified party, be counsel to the indemnifying party), and after notice from the indemnifying party to such indemnified party of its election so to assume the defense thereof the indemnifying
party will not be liable to such indemnified party under this Section 5 for any legal or other expenses, other than reasonable costs of investigation, subsequently incurred by such indemnified party in connection with the defense thereof. No
indemnifying party shall, without the prior written consent of the indemnified party, provided that such consent is not unreasonably withheld or delayed; effect any settlement of any pending or threatened action in respect of which any indemnified
party is or could have been a party and indemnity could have been sought hereunder by such indemnified party unless such settlement (i) includes an unconditional release of such indemnified party from all liability on any claims that are the
subject matter of such action, and (ii) does not include a statement as to or an admission of fault, culpability or a failure to act by or on behalf of any indemnified party. 

(d) If the indemnification provided for in this Section 5 is unavailable or insufficient to hold harmless an indemnified party under
subsections (a) or (b) above, then each indemnifying party shall contribute to the amount paid or payable by such indemnified party as a result of the losses, claims, damages or liabilities (or actions in respect thereof) referred to in
subsection (a) or (b) above (i) in such proportion as is appropriate to reflect the relative benefits received by the indemnifying party or parties on the one hand and the indemnified party on the other from the exchange of the
Securities, pursuant to the Registered Exchange Offer, or (ii) if the allocation provided by the foregoing clause (i) is not permitted by applicable law, in such proportion as is appropriate to reflect not only the relative benefits
referred to in clause (i) above but also the relative fault of the indemnifying party or parties on the one hand and the indemnified party on the other in connection with the statements or omissions that resulted in such losses, claims, damages
or liabilities (or actions in respect thereof) as well as any other relevant equitable considerations. The relative fault of the parties 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 the Company on the one hand or such Holder or such other indemnified party, as the case may be, on the other, and the parties’
relative intent, knowledge, access to information and opportunity to correct or prevent such statement or omission. The amount paid by an indemnified party as a result of the losses, claims, damages or liabilities referred to in the first sentence
of this subsection (d) shall be deemed to include any legal or other expenses reasonably incurred by such indemnified party in connection with investigating or defending any action or claim which is the subject of this subsection (d).
Notwithstanding any other provision of this Section 5(d), the Holders of the Securities shall not be required to contribute any amount in excess of the amount by which the net proceeds received by such Holders from the sale of the Securities
pursuant to a Registration Statement exceeds the amount of damages which such Holders have 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. For purposes of this paragraph (d), each person, if any,
who controls such indemnified party within the meaning of the Securities Act or the Exchange Act shall have the same rights to contribution as such indemnified party and each person, if any, who controls the Company within the meaning of the
Securities Act or the Exchange Act shall have the same rights to contribution as the Company. 
 (e) The agreements contained in
this Section 5 shall survive the sale of the Securities pursuant to a Registration Statement and shall remain in full force and effect, regardless of any termination or cancellation of this Agreement or any investigation made by or on behalf of
any indemnified party. 
 6. Additional Interest Under Certain Circumstances. (a) Additional interest (the
“Additional Interest”) with respect to the Initial Securities shall be assessed as follows if any of the following events occur (each such event in clauses (i) through (vi) below a “Registration Default”): 

(i) if the Company fails to file an Exchange Offer Registration Statement with the Commission on or prior to the 120th day
after the Issue Date; 

  
 12 

 (ii) if the Exchange Offer Registration Statement is not declared effective
by the Commission on or prior to the 210th day after the Issue Date or, if obligated to file a Shelf Registration Statement pursuant to clause (i) of Section 2 above, a Shelf Registration Statement is not declared effective by the
Commission on or prior to the 210th day after the Issue Date; 
 (iii) if the Exchange Offer is not consummated
on or before the 40th day after the Exchange Offer Registration Statement is declared effective; 
 (iv) if
obligated to file the Shelf Registration Statement pursuant to clause (ii), (iii) or (iv) of Section 2 above, the Company fails to file the Shelf Registration Statement with the Commission on or prior to the 30th day (the “Shelf
Filing Date”) after the date on which the obligation to file a Shelf Registration Statement arises; 
 (v)
if obligated to file a Shelf Registration Statement pursuant to clause (ii), (iii) or (iv) of Section 2 above, the Shelf Registration Statement is not declared effective on or prior to the 90th day after the Shelf Filing Date; or

 (vi) if after either the Exchange Offer Registration Statement or the Shelf Registration Statement, as the
case may be, is declared (or becomes automatically) effective and during the period when such Exchange Offer Registration Statement or Shelf Registration Statement is required to be kept effective, (A) such Registration Statement ceases to be
effective; or (B) such Registration Statement or the related prospectus ceases to be usable (except as permitted in paragraph (b)) in connection with resales of Transfer Restricted Securities because either (1) any event occurs as a result
of which the related prospectus forming part of such Registration Statement would include any untrue statement of a material fact or omit to state any material fact necessary to make the statements therein in the light of the circumstances under
which they were made not misleading, (2) it shall be necessary to amend such Registration Statement or supplement the related prospectus, to comply with the Securities Act or the Exchange Act or the respective rules thereunder, or (3) such
Registration Statement is a Shelf Registration Statement that has expired before a replacement Shelf Registration Statement has become effective. 
 Additional Interest shall accrue on the Initial Securities over and above the interest set forth in the title of the Securities from and including the date on which any such Registration Default shall
occur to but excluding the date on which all such Registration Defaults have been cured, at a rate of 0.25% per annum for the first 90-day period immediately following the occurrence of a Registration Default, and such rate will increase by an
additional 0.25% per annum with respect to each subsequent 90-day period until all Registration Defaults have been cured, up to a maximum additional interest rate of 1.0% per annum. 

(b) A Registration Default referred to in Section 6(a)(vi)(B) hereof shall be deemed not to have occurred and be continuing in
relation to a Shelf Registration Statement or the related prospectus if (i) such Registration Default has occurred solely as a result of (x) the filing of a post-effective amendment to such Shelf Registration Statement to incorporate
annual audited financial information with respect to the Company where such post-effective amendment is not yet effective and needs to be declared effective to permit Holders to use the related prospectus or (y) other material events, with
respect to the Company that would need to be described in such Shelf Registration Statement or the related prospectus and (ii) in the case of clause (y), the Company is proceeding promptly and in good faith to amend or supplement such Shelf
Registration Statement and related prospectus to describe such events; provided, however, that in any case if such Registration Default occurs for a continuous period in excess of 30 days, Additional Interest shall be payable in accordance with the
above paragraph from the day such Registration Default occurs until such Registration Default is cured. 

  
 13 

 (c) Any amounts of Additional Interest due pursuant to clause (i) through (vi) of
Section 6(a) above will be payable in cash on the regular interest payment dates with respect to the Initial Securities. The amount of Additional Interest will be determined by multiplying the applicable Additional Interest rate by the
principal amount of the Initial Securities, multiplied by a fraction, the numerator of which is the number of days such Additional Interest rate was applicable during such period (determined on the basis of a 360-day year comprised of twelve 30-day
months), and the denominator of which is 360. 
 (d) “Transfer Restricted Securities” means each Security until
(i) the date on which such Security has been exchanged by a person other than a broker-dealer for a freely transferable Exchange Security in the Registered Exchange Offer, (ii) following the exchange by a broker-dealer in the Registered
Exchange Offer of an Initial Security for an Exchange Security, the date on which such Exchange Security is sold to a purchaser who receives from such broker-dealer on or prior to the date of such sale a copy of the prospectus contained in the
Exchange Offer Registration Statement, (iii) the date on which such Initial Security has been effectively registered under the Securities Act and disposed of in accordance with the Shelf Registration Statement, (iv) the date on which such
Initial Securities are distributed to the public pursuant to Rule 144 under the Securities Act or (v) the earliest date that is no less than two years after the Issue Date and on which such Security (except for Securities held by an affiliate
of the Company) may be resold in reliance on paragraph (b)(1) of Rule 144 under the Securities Act. 
 7. Rules 144 and
144A. The Company shall use its reasonable best efforts to file the reports required to be filed by it under the Securities Act and the Exchange Act in a timely manner and, if at any time the Company is not required to file such reports, it
will, upon the reasonable request of any Holder of Initial Securities, make publicly available other information so long as necessary to permit sales of their securities pursuant to Rules 144 and 144A. The Company covenants that it will take such
further action as any Holder of Initial Securities may reasonably request, all to the extent required from time to time to enable such Holder to sell Initial Securities without registration under the Securities Act within the limitation of the
exemptions provided by Rules 144 and 144A (including the requirements of Rule 144A(d)(4)). The Company will provide a copy of this Agreement to prospective purchasers of Initial Securities identified to the Company by the Initial Purchasers upon
request. Upon the request of any Holder of Initial Securities, the Company shall deliver to such Holder a written statement as to whether it has complied with such requirements. Notwithstanding the foregoing, nothing in this Section 7 shall be
deemed to require the Company to register any of its securities pursuant to the Exchange Act. 
 8. Underwritten
Registrations. If any of the Transfer Restricted Securities covered by any Shelf Registration are to be sold in an underwritten offering, the investment banker or investment bankers and manager or managers that will administer the offering
(“Managing Underwriters”) will be selected by the Holders of a majority in aggregate principal amount of such Transfer Restricted Securities to be included in such offering. 

No person may participate in any underwritten registration hereunder unless such person (i) agrees to sell such person’s
Transfer Restricted Securities on the basis reasonably provided in any underwriting arrangements approved by the persons entitled hereunder to approve such arrangements and (ii) completes and executes all questionnaires, powers of attorney,
indemnities, underwriting agreements and other documents reasonably required under the terms of such underwriting arrangements. 

9. Miscellaneous.  
 (a) Amendments and Waivers. The provisions of this Agreement may not be amended, modified or supplemented, and waivers or consents to departures from the provisions hereof may not be given, except
by the Company and the written consent of the Holders of a majority in principal amount of the Securities affected by such amendment, modification, supplement, waiver or consents. 

  
 14 

 (b) Notices. All notices and other communications provided for or permitted hereunder
shall be made in writing by hand delivery, first-class mail, facsimile transmission, or air courier which guarantees overnight delivery: 
 (1) if to a Holder of the Securities, at the most current address given by such Holder to the Company. 
 (2) if to the Initial Purchasers; 
 Credit Suisse Securities (USA) LLC 

Eleven Madison Avenue 
 New York, NY 10010-3629 
 Fax No.: (212) 325-4296 

Attention: LCD-IBD Group 
 with a copy to: 
 Cravath, Swaine & Moore LLP 

Worldwide Plaza 

825 Eighth Avenue 
 New York, NY 10019 
 Attention: William J. Whelan III, Esq. 

(3) if to the Company, at its address as follows: 
 CHS/Community Health System, Inc. 
 4000 Meridian Boulevard 

Franklin, TN 37067 
 Attention: General Counsel 
 with a copy to: 

Kirkland & Ellis LLP 
 153 East 53rd Street 
 New York, NY 10022 

Attention: Joshua Korff, Esq. 
 All such notices and communications shall be deemed to have been duly given: at the time delivered by hand, if personally delivered; three business days after being deposited in the mail, postage prepaid,
if mailed; when receipt is acknowledged by recipient’s facsimile machine operator, if sent by facsimile transmission; and on the day delivered, if sent by overnight air courier guaranteeing next day delivery. 

(c) No Inconsistent Agreements. The Company has not, as of the date hereof, entered into, nor shall it, on or after the date
hereof, enter into, any agreement with respect to its securities that is inconsistent with the rights granted to the Holders herein or otherwise conflicts with the provisions hereof. 

(d) Successors and Assigns. This Agreement shall be binding upon the Company and its successors and assigns. 

  
 15 

 (e) 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. 

(f) Headings. The headings in this Agreement are for convenience of reference only and shall not limit or otherwise affect the
meaning hereof. 
 (g) Governing Law. THIS AGREEMENT SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF
THE STATE OF NEW YORK WITHOUT REGARD TO PRINCIPLES OF CONFLICTS OF LAWS. 
 (h) Severability. If 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. 
 (i) Securities Held by the Company. Whenever the consent or approval
of Holders of a specified percentage of principal amount of Securities is required hereunder, Securities held by the Company or its affiliates (other than subsequent Holders of Securities if such subsequent Holders are deemed to be affiliates solely
by reason of their holdings of such Securities) shall not be counted in determining whether such consent or approval was given by the Holders of such required percentage. 
 [Remainder of this page intentionally left blank] 

  
 16 

 If the foregoing is in accordance with your understanding of our agreement, please sign and
return to the Company a counterpart hereof, whereupon this instrument, along with all counterparts, will become a binding agreement among the several Initial Purchasers, the Company and the Guarantors in accordance with its terms. 

 

					
	Very truly yours,
	
	CHS/COMMUNITY HEALTH SYSTEMS, INC.
		
	By: 	 	 /s/ W. Larry Cash

		 	Name:	 	W. Larry Cash
		 	Title:	 	Executive Vice President, Chief Financial Officer and Director
	
	COMMUNITY HEALTH SYSTEMS, INC.
		
	By: 	 	 /s/ W. Larry Cash

		 	Name:	 	W. Larry Cash
		 	Title:	 	Executive Vice President, Chief Financial Officer and Director

 [Signature Page to Registration Rights Agreement] 

			
	ABILENE HOSPITAL, LLC	  	CLEVELAND TENNESSEE HOSPITAL COMPANY, LLC
		
	ABILENE MERGER, LLC	  	CLINTON HOSPITAL CORPORATION
		
	ANNA HOSPITAL CORPORATION	  	COATESVILLE HOSPITAL CORPORATION
		
	BERWICK HOSPITAL COMPANY, LLC	  	COLLEGE STATION HOSPITAL, L.P.
		
	BIG BEND HOSPITAL CORPORATION	  	COLLEGE STATION MEDICAL CENTER, LLC
		
	BIG SPRING HOSPITAL CORPORATION	  	COLLEGE STATION MERGER, LLC
		
	BIRMINGHAM HOLDINGS II, LLC	  	COMMUNITY GP CORP.
		
	BIRMINGHAM HOLDINGS, LLC	  	COMMUNITY HEALTH INVESTMENT COMPANY, LLC
		
	BLUEFIELD HOLDINGS, LLC	  	COMMUNITY HEALTH SYSTEMS, INC.
		
	BLUEFIELD HOSPITAL COMPANY, LLC	  	COMMUNITY LP CORP.
		
	BLUFFTON HEALTH SYSTEM, LLC	  	CP HOSPITAL GP, LLC
		
	BROWNSVILLE HOSPITAL CORPORATION	  	CPLP, LLC
		
	BROWNWOOD HOSPITAL, L.P.	  	CRESTWOOD HOSPITAL, LLC
		
	BROWNWOOD MEDICAL CENTER, LLC	  	CRESTWOOD HOSPITAL, LP, LLC
		
	BULLHEAD CITY HOSPITAL CORPORATION	  	CSMC, LLC
		
	BULLHEAD CITY HOSPITAL INVESTMENT CORPORATION	  	CSRA HOLDINGS, LLC
		
	CARLSBAD MEDICAL CENTER, LLC	  	DEACONESS HOLDINGS, LLC
		
	CENTRE HOSPITAL CORPORATION	  	DEACONESS HOSPITAL HOLDINGS, LLC
		
	CHHS HOLDINGS, LLC	  	DEMING HOSPITAL CORPORATION
		
	CHS KENTUCKY HOLDINGS, LLC	  	DESERT HOSPITAL HOLDINGS, LLC
		
	CHS PENNSYLVANIA HOLDINGS, LLC	  	DETAR HOSPITAL, LLC
		
	CHS VIRGINIA HOLDINGS, LLC	  	DHFW HOLDINGS, LLC
		
	CHS WASHINGTON HOLDINGS, LLC	  	DHSC, LLC
		
	CLARKSVILLE HOLDINGS, LLC	  	DUKES HEALTH SYSTEM, LLC
		
	CLEVELAND HOSPITAL CORPORATION	  	DYERSBURG HOSPITAL CORPORATION

  

					
	By: 	 	 /s/ Rachel A. Seifert

		 	Name:	 	RACHEL A. SEIFERT
		 	Title:	 	EXECUTIVE VICE PRESIDENT

 Acting on behalf of each of the Guarantors set forth above 

[Signature Page to Registration Rights Agreement] 

			
	EMPORIA HOSPITAL CORPORATION	  	KAY COUNTY HOSPITAL CORPORATION
		
	EVANSTON HOSPITAL CORPORATION	  	KAY COUNTY OKLAHOMA HOSPITAL COMPANY, LLC
		
	FALLBROOK HOSPITAL CORPORATION	  	KIRKSVILLE HOSPITAL COMPANY, LLC
		
	FOLEY HOSPITAL CORPORATION	  	LAKEWAY HOSPITAL CORPORATION
		
	FORREST CITY ARKANSAS HOSPITAL COMPANY, LLC	  	LANCASTER HOSPITAL CORPORATION
		
	FORREST CITY HOSPITAL CORPORATION	  	LAS CRUCES MEDICAL CENTER, LLC
		
	FORT PAYNE HOSPITAL CORPORATION	  	LEA REGIONAL HOSPITAL, LLC
		
	FRANKFORT HEALTH PARTNER, INC.	  	LEXINGTON HOSPITAL CORPORATION
		
	FRANKLIN HOSPITAL CORPORATION	  	LONGVIEW MERGER, LLC
		
	GADSDEN REGIONAL MEDICAL CENTER, LLC	  	LRH, LLC
		
	GALESBURG HOSPITAL CORPORATION	  	LUTHERAN HEALTH NETWORK OF INDIANA, LLC
		
	GRANBURY HOSPITAL CORPORATION	  	MARION HOSPITAL CORPORATION
		
	GRANITE CITY HOSPITAL CORPORATION	  	MARTIN HOSPITAL CORPORATION
		
	GRANITE CITY ILLINOIS HOSPITAL COMPANY, LLC	  	MASSILLON COMMUNITY HEALTH SYSTEM LLC
		
	GREENVILLE HOSPITAL CORPORATION	  	MASSILLON HEALTH SYSTEM LLC
		
	GRMC HOLDINGS, LLC	  	MASSILLON HOLDINGS, LLC
		
	HALLMARK HEALTHCARE COMPANY, LLC	  	MCKENZIE TENNESSEE HOSPITAL COMPANY, LLC
		
	HOBBS MEDCO, LLC	  	MCNAIRY HOSPITAL CORPORATION
		
	HOSPITAL OF BARSTOW, INC.	  	MCSA, L.L.C.
		
	HOSPITAL OF FULTON, INC.	  	MEDICAL CENTER OF BROWNWOOD, LLC
		
	HOSPITAL OF LOUISA, INC.	  	MERGER LEGACY HOLDINGS, LLC
		
	HOSPITAL OF MORRISTOWN, INC.	  	MMC OF NEVADA, LLC
		
	JACKSON HOSPITAL CORPORATION (KY)	  	MOBERLY HOSPITAL COMPANY, LLC
		
	JACKSON HOSPITAL CORPORATION (TN)	  	MWMC HOLDINGS, LLC
		
	JOURDANTON HOSPITAL CORPORATION	  	NANTICOKE HOSPITAL COMPANY, LLC

  

					
	By: 	 	 /s/ Rachel A. Seifert

		 	Name:	 	RACHEL A. SEIFERT
		 	Title:	 	EXECUTIVE VICE PRESIDENT

 Acting on behalf of each of the Guarantors set forth above 

[Signature Page to Registration Rights Agreement] 

			
	NATIONAL HEALTHCARE OF LEESVILLE, INC.	  	QHG OF FORT WAYNE COMPANY, LLC
		
	NATIONAL HEALTHCARE OF MT. VERNON, INC.	  	QHG OF HATTIESBURG, INC.
		
	NATIONAL HEALTHCARE OF NEWPORT, INC.	  	QHG OF MASSILLON, INC.
		
	NAVARRO HOSPITAL, L.P.	  	QHG OF SOUTH CAROLINA, INC.
		
	NAVARRO REGIONAL, LLC	  	QHG OF SPARTANBURG, INC.
		
	NC-DSH, LLC	  	QHG OF SPRINGDALE, INC.
		
	NORTHAMPTON HOSPITAL COMPANY, LLC	  	QHG OF WARSAW COMPANY, LLC
		
	NORTHWEST HOSPITAL, LLC	  	QUORUM HEALTH RESOURCES, LLC
		
	NOV HOLDINGS, LLC	  	RED BUD HOSPITAL CORPORATION
		
	NRH, LLC	  	RED BUD ILLINOIS HOSPITAL COMPANY, LLC
		
	OAK HILL HOSPITAL CORPORATION	  	REGIONAL HOSPITAL OF LONGVIEW, LLC
		
	ORO VALLEY HOSPITAL, LLC	  	RIVER REGION MEDICAL CORPORATION
		
	PALMER-WASILLA HEALTH SYSTEM, LLC	  	ROSWELL HOSPITAL CORPORATION
		
	PAYSON HOSPITAL CORPORATION	  	RUSTON HOSPITAL CORPORATION
		
	PENNSYLVANIA HOSPITAL COMPANY, LLC	  	RUSTON LOUISIANA HOSPITAL COMPANY, LLC
		
	PHILLIPS HOSPITAL CORPORATION	  	SACMC, LLC
		
	PHOENIXVILLE HOSPITAL COMPANY, LLC	  	SALEM HOSPITAL CORPORATION
		
	POTTSTOWN HOSPITAL COMPANY, LLC	  	SAN ANGELO COMMUNITY MEDICAL CENTER, LLC
		
	QHG GEORGIA HOLDINGS II, LLC	  	SAN ANGELO MEDICAL, LLC
		
	QHG GEORGIA HOLDINGS, INC.	  	SAN MIGUEL HOSPITAL CORPORATION
		
	QHG GEORGIA, LP	  	SCRANTON HOLDINGS, LLC
		
	QHG OF BLUFFTON COMPANY, LLC	  	SCRANTON HOSPITAL COMPANY, LLC
		
	QHG OF CLINTON COUNTY, INC.	  	SHELBYVILLE HOSPITAL CORPORATION
		
	QHG OF ENTERPRISE, INC.	  	SILOAM SPRINGS ARKANSAS HOSPITAL COMPANY, LLC
		
	QHG OF FORREST COUNTY, INC.	  	SILOAM SPRINGS HOLDINGS, LLC

  

					
	By: 	 	 /s/ Rachel A. Seifert

		 	Name:	 	RACHEL A. SEIFERT
		 	Title:	 	EXECUTIVE VICE PRESIDENT

 Acting on behalf of each of the Guarantors set forth above 

[Signature Page to Registration Rights Agreement] 

			
	SOUTHERN TEXAS MEDICAL CENTER, LLC	  	WATSONVILLE HOSPITAL CORPORATION
		
	SPOKANE VALLEY WASHINGTON HOSPITAL COMPANY, LLC	  	WAUKEGAN HOSPITAL CORPORATION
		
	SPOKANE WASHINGTON HOSPITAL COMPANY, LLC	  	WAUKEGAN ILLINOIS HOSPITAL COMPANY, LLC
		
	TENNYSON HOLDINGS, LLC	  	WEATHERFORD HOSPITAL CORPORATION
		
	TOMBALL TEXAS HOLDINGS, LLC	  	WEATHERFORD TEXAS HOSPITAL COMPANY, LLC
		
	TOMBALL TEXAS HOSPITAL COMPANY, LLC	  	WEBB HOSPITAL CORPORATION
		
	TOOELE HOSPITAL CORPORATION	  	WEBB HOSPITAL HOLDINGS, LLC
		
	TRIAD HEALTHCARE CORPORATION	  	WESLEY HEALTH SYSTEM, LLC
		
	TRIAD HOLDINGS III, LLC	  	WEST GROVE HOSPITAL COMPANY, LLC
		
	TRIAD HOLDINGS IV, LLC	  	WHMC, LLC
		
	TRIAD HOLDINGS V, LLC	  	WILKES-BARRE BEHAVIORAL HOSPITAL COMPANY, LLC
		
	TRIAD NEVADA HOLDINGS, LLC	  	WILKES-BARRE HOLDINGS, LLC
		
	TRIAD OF ALABAMA, LLC	  	WILKES-BARRE HOSPITAL COMPANY, LLC
		
	TRIAD OF OREGON, LLC	  	WILLIAMSTON HOSPITAL CORPORATION
		
	TRIAD-ARMC, LLC	  	WOMEN & CHILDREN’S HOSPITAL, LLC
		
	TRIAD-EL DORADO, INC.	  	WOODLAND HEIGHTS MEDICAL CENTER, LLC
		
	TRIAD-NAVARRO REGIONAL HOSPITAL SUBSIDIARY, LLC	  	WOODWARD HEALTH SYSTEM, LLC
		
	TUNKHANNOCK HOSPITAL COMPANY, LLC	  	YOUNGSTOWN OHIO 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	  	

  

					
	By: 	 	 /s/ Rachel A. Seifert

		 	Name:	 	RACHEL A. SEIFERT
		 	Title:	 	EXECUTIVE VICE PRESIDENT

 Acting on behalf of each of the Guarantors set forth above 

[Signature Page to Registration Rights Agreement] 

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

above written.

	
	 CREDIT SUISSE SECURITIES (USA) LLC
Acting on behalf of itself
and
as Representative of the Several Purchasers

		
	by:	 	CREDIT SUISSE SECURITIES (USA) LLC
			
		 	By: 	 	 /s/ Colin Bathgate

		 		 	Name:	 		 	Colin Bathgate
		 		 	Title:	 		 	Director

 SCHEDULE A 
 Initial Purchasers 
 Credit Suisse Securities (USA) LLC 

Merrill Lynch, Pierce, Fenner & Smith 

         Incorporated 
 Citigroup Global Markets Inc. 
 J. P. Morgan Securities Inc. 

Wells Fargo Securities, LLC 
 Credit Agricole
Securities (USA) Inc. 
 Goldman, Sachs & Co. 
 Morgan Stanley & Co. LLC 
 RBC Capital Markets, LLC 

Scotia Capital (USA) Inc. 
 SunTrust Robinson
Humphrey, Inc. 

  

					
		 	Schedule A	 	23

 ANNEX A 
 Each broker-dealer that receives Exchange Securities for its own account pursuant to the Exchange Offer must acknowledge that it will deliver a prospectus in connection with any resale of such Exchange
Securities. The Letter of Transmittal states that by so acknowledging and by delivering a prospectus, a broker-dealer will not be deemed to admit that it is an “underwriter” within the meaning of the Securities Act. This Prospectus, as it
may be amended or supplemented from time to time, may be used by a broker-dealer in connection with resales of Exchange Securities received in exchange for Initial Securities where such Initial Securities were acquired by such broker-dealer as a
result of market-making activities or other trading activities. The Company has agreed that, for a period of 180 days after the Expiration Date (as defined herein), it will make this Prospectus available to any broker-dealer for use in connection
with any such resale. See “Plan of Distribution.” 

 ANNEX B 
 Each broker-dealer that receives Exchange Securities for its own account in exchange for Securities, where such Initial Securities were acquired by such broker-dealer as a result of market-making
activities or other trading activities, must acknowledge that it will deliver a prospectus in connection with any resale of such Exchange Securities. See “Plan of Distribution.” 

 ANNEX C 
 PLAN OF DISTRIBUTION 
 Each broker-dealer that receives Exchange Securities for
its own account pursuant to the Exchange Offer must acknowledge that it will deliver a prospectus in connection with any resale of such Exchange Securities. This Prospectus, as it may be amended or supplemented from time to time, may be used by a
broker-dealer in connection with resales of Exchange Securities received in exchange for Initial Securities where such Initial Securities were acquired as a result of market-making activities or other trading activities. The Company has agreed that,
for a period of 180 days after the Expiration Date, it will make this prospectus, as amended or supplemented, available to any broker-dealer for use in connection with any such resale. In addition, until
            , 201  , all dealers effecting transactions in the Exchange Securities may be required to deliver a prospectus. 

The Company will not receive any proceeds from any sale of Exchange Securities by broker-dealers. Exchange Securities received by
broker-dealers for their own account pursuant to the Exchange Offer may be sold from time to time in one or more transactions in the over-the-counter market, in negotiated transactions, through the writing of options on the Exchange Securities or a
combination of such methods of resale, at market prices prevailing at the time of resale, at prices related to such prevailing market prices or negotiated prices. Any such resale may be made directly to purchasers or to or through brokers or dealers
who may receive compensation in the form of commissions or concessions from any such broker-dealer or the purchasers of any such Exchange Securities. Any broker-dealer that resells Exchange Securities that were received by it for its own account
pursuant to the Exchange Offer and any broker or dealer that participates in a distribution of such Exchange Securities may be deemed to be an “underwriter” within the meaning of the Securities Act and any profit on any such resale of
Exchange Securities and any commission or concessions received by any such persons may be deemed to be underwriting compensation under the Securities Act. The Letter of Transmittal states that, by acknowledging that it will deliver and by delivering
a prospectus, a broker-dealer will not be deemed to admit that it is an “underwriter” within the meaning of the Securities Act. 
 For a period of 180 days after the Expiration Date the Company will promptly send additional copies of this Prospectus and any amendment or supplement to this Prospectus to any broker-dealer that requests
such documents in the Letter of Transmittal. The Company has agreed to pay all expenses incident to the Exchange Offer (including the expenses of one counsel for the Holders of the Securities) other than commissions or concessions of any brokers or
dealers and will indemnify the Holders of the Securities (including any broker-dealers) against certain liabilities, including liabilities under the Securities Act. 

 ANNEX D 
  ̈ CHECK HERE IF YOU ARE A BROKER-DEALER AND WISH TO RECEIVE 10 ADDITIONAL COPIES OF THE PROSPECTUS AND 10 COPIES OF ANY AMENDMENTS OR SUPPLEMENTS THERETO.

  

							
		 	Name:	 	  
	  	
		 	Address:	 	  
	  	
		 		 	  
	  	

 If the undersigned is not a broker-dealer, the undersigned represents that it is not engaged in, and does not intend to
engage in, a distribution of Exchange Securities. If the undersigned is a broker-dealer that will receive Exchange Securities for its own account in exchange for Initial Securities that were acquired as a result of market-making activities or other
trading activities, it acknowledges that it will deliver a prospectus in connection with any resale of such Exchange Securities; however, by so acknowledging and by delivering a prospectus, the undersigned will not be deemed to admit that it is an
“underwriter” within the meaning of the Securities Act. 

 SCHEDULE I 
 Guarantors 
  

			
	 Guarantor
	  	 Jurisdiction of Organization

	 Community Health Systems, Inc.
	  	DE
		
	 Abilene Hospital, LLC
	  	DE
		
	 Abilene Merger, LLC
	  	DE
		
	 Anna Hospital Corporation
	  	IL
		
	 Berwick Hospital Company, LLC
	  	DE
		
	 Big Bend Hospital Corporation
	  	TX
		
	 Big Spring Hospital Corporation
	  	TX
		
	 Birmingham Holdings II, LLC
	  	DE
		
	 Birmingham Holdings, LLC
	  	DE
		
	 Bluefield Holdings, LLC
	  	DE
		
	 Bluefield Hospital Company, LLC
	  	DE
		
	 Bluffton Health System, LLC
	  	DE
		
	 Brownsville Hospital Corporation
	  	TN
		
	 Brownwood Hospital, L.P.
	  	DE
		
	 Brownwood Medical Center, LLC
	  	DE
		
	 Bullhead City Hospital Corporation
	  	AZ
		
	 Bullhead City Hospital Investment Corporation
	  	DE
		
	 Carlsbad Medical Center, LLC
	  	DE
		
	 Centre Hospital Corporation
	  	AL
		
	 CHHS Holdings, LLC
	  	DE
		
	 CHS Kentucky Holdings, LLC
	  	DE
		
	 CHS Pennsylvania Holdings, LLC
	  	DE
		
	 CHS Virginia Holdings, LLC
	  	DE
		
	 CHS Washington Holdings, LLC
	  	DE
		
	 Clarksville Holdings, LLC
	  	DE
		
	 Cleveland Hospital Corporation
	  	TN
		
	 Cleveland Tennessee Hospital Company, LLC
	  	DE
		
	 Clinton Hospital Corporation
	  	PA
		
	 Coatesville Hospital Corporation
	  	PA
		
	 College Station Hospital, L.P.
	  	DE
		
	 College Station Medical Center, LLC
	  	DE
		
	 College Station Merger, LLC
	  	DE

  
 Schedule I - 1

			
	 Guarantor
	  	 Jurisdiction of Organization

	 Community GP Corp.
	  	DE
		
	 Community Health Investment Company, LLC
	  	DE
		
	 Community LP Corp.
	  	DE
		
	 CP Hospital GP, LLC
	  	DE
		
	 CPLP, LLC
	  	DE
		
	 Crestwood Hospital, LLC
	  	DE
		
	 Crestwood Hospital, LP, LLC
	  	DE
		
	 CSMC, LLC
	  	DE
		
	 CSRA Holdings, LLC
	  	DE
		
	 Deaconess Holdings, LLC
	  	DE
		
	 Deaconess Hospital Holdings, LLC
	  	DE
		
	 Deming Hospital Corporation
	  	NM
		
	 Desert Hospital Holdings, LLC
	  	DE
		
	 Detar Hospital, LLC
	  	DE
		
	 DHFW Holdings, LLC
	  	DE
		
	 DHSC, LLC
	  	DE
		
	 Dukes Health System, LLC
	  	DE
		
	 Dyersburg Hospital Corporation
	  	TN
		
	 Emporia Hospital Corporation
	  	VA
		
	 Evanston Hospital Corporation
	  	WY
		
	 Fallbrook Hospital Corporation
	  	DE
		
	 Foley Hospital Corporation
	  	AL
		
	 Forrest City Arkansas Hospital Company, LLC
	  	AR
		
	 Forrest City Hospital Corporation
	  	AR
		
	 Fort Payne Hospital Corporation
	  	AL
		
	 Frankfort Health Partner, Inc.
	  	IN
		
	 Franklin Hospital Corporation
	  	VA
		
	 Gadsden Regional Medical Center, LLC
	  	DE
		
	 Galesburg Hospital Corporation
	  	IL
		
	 Granbury Hospital Corporation
	  	TX
		
	 Granite City Hospital Corporation
	  	IL
		
	 Granite City Illinois Hospital Company, LLC
	  	IL
		
	 Greenville Hospital Corporation
	  	AL
		
	 GRMC Holdings, LLC
	  	DE
		
	 Hallmark Healthcare Company, LLC
	  	DE

  
 Schedule I - 2

			
	 Guarantor
	  	 Jurisdiction of Organization

	 Hobbs Medco, LLC
	  	DE
		
	 Hospital of Barstow, Inc.
	  	DE
		
	 Hospital of Fulton, Inc.
	  	KY
		
	 Hospital of Louisa, Inc.
	  	KY
		
	 Hospital of Morristown, Inc.
	  	TN
		
	 Jackson Hospital Corporation (KY)
	  	KY
		
	 Jackson Hospital Corporation (TN)
	  	TN
		
	 Jourdanton Hospital Corporation
	  	TX
		
	 Kay County Hospital Corporation
	  	OK
		
	 Kay County Oklahoma Hospital Company, LLC
	  	OK
		
	 Kirksville Hospital Company, LLC
	  	DE
		
	 Lakeway Hospital Corporation
	  	TN
		
	 Lancaster Hospital Corporation
	  	DE
		
	 Las Cruces Medical Center, LLC
	  	DE
		
	 Lea Regional Hospital, LLC
	  	DE
		
	 Lexington Hospital Corporation
	  	TN
		
	 Longview Merger, LLC
	  	DE
		
	 LRH, LLC
	  	DE
		
	 Lutheran Health Network of Indiana, LLC
	  	DE
		
	 Marion Hospital Corporation
	  	IL
		
	 Martin Hospital Corporation
	  	TN
		
	 Massillon Community Health System LLC
	  	DE
		
	 Massillon Health System LLC
	  	DE
		
	 Massillon Holdings, LLC
	  	DE
		
	 McKenzie Tennessee Hospital Company, LLC
	  	DE
		
	 McNairy Hospital Corporation
	  	TN
		
	 MCSA, L.L.C.
	  	AR
		
	 Medical Center of Brownwood, LLC
	  	DE
		
	 Merger Legacy Holdings, LLC
	  	DE
		
	 MMC of Nevada, LLC
	  	DE
		
	 Moberly Hospital Company, LLC
	  	DE
		
	 MWMC Holdings, LLC
	  	DE
		
	 Nanticoke Hospital Company, LLC
	  	DE
		
	 National Healthcare of Leesville, Inc.
	  	DE
		
	 National Healthcare of Mt. Vernon, Inc.
	  	DE

  
 Schedule I - 3

			
	 Guarantor
	  	 Jurisdiction of Organization

	 National Healthcare of Newport, Inc.
	  	DE
		
	 Navarro Hospital, L.P.
	  	DE
		
	 Navarro Regional, LLC
	  	DE
		
	 NC-DSH, LLC
	  	NV
		
	 Northampton Hospital Company, LLC
	  	DE
		
	 Northwest Hospital, LLC
	  	DE
		
	 NOV Holdings, LLC
	  	DE
		
	 NRH, LLC
	  	DE
		
	 Oak Hill Hospital Corporation
	  	WV
		
	 Oro Valley Hospital, LLC
	  	DE
		
	 Palmer-Wasilla Health System, LLC
	  	DE
		
	 Payson Hospital Corporation
	  	AZ
		
	 Pennsylvania Hospital Company, LLC
	  	DE
		
	 Phillips Hospital Corporation
	  	AR
		
	 Phoenixville Hospital Company, LLC
	  	DE
		
	 Pottstown Hospital Company, LLC
	  	DE
		
	 QHG Georgia Holdings II, LLC
	  	DE
		
	 QHG Georgia Holdings, Inc.
	  	GA
		
	 QHG Georgia, LP
	  	GA
		
	 QHG of Bluffton Company, LLC
	  	DE
		
	 QHG of Clinton County, Inc.
	  	IN
		
	 QHG of Enterprise, Inc.
	  	AL
		
	 QHG of Forrest County, Inc.
	  	MS
		
	 QHG of Fort Wayne Company, LLC
	  	DE
		
	 QHG of Hattiesburg, Inc.
	  	MS
		
	 QHG of Massillon, Inc.
	  	OH
		
	 QHG of South Carolina, Inc.
	  	SC
		
	 QHG of Spartanburg, Inc.
	  	SC
		
	 QHG of Springdale, Inc.
	  	AR
		
	 QHG of Warsaw Company, LLC
	  	DE
		
	 Quorum Health Resources, LLC
	  	DE
		
	 Red Bud Hospital Corporation
	  	IL
		
	 Red Bud Illinois Hospital Company, LLC
	  	IL
		
	 Regional Hospital of Longview, LLC
	  	DE
		
	 River Region Medical Corporation
	  	MS

  
 Schedule I - 4

			
	 Guarantor
	  	 Jurisdiction of Organization

	 Roswell Hospital Corporation
	  	NM
		
	 Ruston Hospital Corporation
	  	DE
		
	 Ruston Louisiana Hospital Company, LLC
	  	DE
		
	 SACMC, LLC
	  	DE
		
	 Salem Hospital Corporation
	  	NJ
		
	 San Angelo Community Medical Center, LLC
	  	DE
		
	 San Angelo Medical, LLC
	  	DE
		
	 San Miguel Hospital Corporation
	  	NM
		
	 Scranton Holdings, LLC
	  	DE
		
	 Scranton Hospital Company, LLC
	  	DE
		
	 Shelbyville Hospital Corporation
	  	TN
		
	 Siloam Springs Arkansas Hospital Company, LLC
	  	DE
		
	 Siloam Springs Holdings, LLC
	  	DE
		
	 Southern Texas Medical Center, LLC
	  	DE
		
	 Spokane Valley Washington Hospital Company, LLC
	  	DE
		
	 Spokane Washington Hospital Company, LLC
	  	DE
		
	 Tennyson Holdings, LLC
	  	DE
		
	 Tooele Hospital Corporation
	  	UT
		
	 Tomball Texas Holdings, LLC
	  	DE
		
	 Tomball Texas Hospital Company, LLC
	  	DE
		
	 Triad Healthcare Corporation
	  	DE
		
	 Triad Holdings III, LLC
	  	DE
		
	 Triad Holdings IV, LLC
	  	DE
		
	 Triad Holdings V, LLC
	  	DE
		
	 Triad Nevada Holdings, LLC
	  	DE
		
	 Triad of Alabama, LLC
	  	DE
		
	 Triad of Oregon, LLC
	  	DE
		
	 Triad-ARMC, LLC
	  	DE
		
	 Triad-El Dorado, Inc.
	  	AR
		
	 Triad-Navarro Regional Hospital Subsidiary, LLC
	  	DE
		
	 Tunkhannock Hospital Company, LLC
	  	DE
		
	 VHC Medical, LLC
	  	DE
		
	 Vicksburg Healthcare, LLC
	  	DE
		
	 Victoria Hospital, LLC
	  	DE
		
	 Victoria of Texas, L.P.
	  	DE

  
 Schedule I - 5

			
	 Guarantor
	  	 Jurisdiction of Organization

	 Virginia Hospital Company, LLC
	  	VA
		
	 Warren Ohio Hospital Company, LLC
	  	DE
		
	 Warren Ohio Rehab Hospital Company, LLC
	  	DE
		
	 Watsonville Hospital Corporation
	  	DE
		
	 Waukegan Hospital Corporation
	  	IL
		
	 Waukegan Illinois Hospital Company, LLC
	  	IL
		
	 Weatherford Hospital Corporation
	  	TX
		
	 Weatherford Texas Hospital Company, LLC
	  	TX
		
	 Webb Hospital Corporation
	  	DE
		
	 Webb Hospital Holdings, LLC
	  	DE
		
	 Wesley Health System, LLC
	  	DE
		
	 West Grove Hospital Company, LLC
	  	DE
		
	 WHMC, LLC
	  	DE
		
	 Wilkes-Barre Behavioral Hospital Company, LLC
	  	DE
		
	 Wilkes-Barre Holdings, LLC
	  	DE
		
	 Wilkes-Barre Hospital Company, LLC
	  	DE
		
	 Williamston Hospital Corporation
	  	NC
		
	 Women & Children’s Hospital, LLC
	  	DE
		
	 Woodland Heights Medical Center, LLC
	  	DE
		
	 Woodward Health System, LLC
	  	DE
		
	 Youngstown Ohio Hospital Company, LLC
	  	DE

  
 Schedule I - 6EX-4.31

 Exhibit 4.31 
 ELEVENTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of October 1, 2011, 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 7/8% 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 1st day of October, 2011.
		
		 	 CHS/Community Health Systems, Inc.
 a Delaware corporation

			
		 	By:	 	 /s/ Rachel A. Seifert

		 		 	Rachel A. Seifert
		 		 	Executive Vice President, Secretary & General Counsel
		
		 	 Tomball Texas Holdings, LLC,
 a Delaware limited liability company

			
		 	By:	 	 /s/ Rachel A. Seifert

		 		 	Rachel A. Seifert
		 		 	Executive Vice President and Secretary
		
		 	 Tomball Texas Hospital Company, 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 President

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