Document:

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                                                                   EXHIBIT 10.17

                       THIRD AMENDMENT TO CREDIT AGREEMENT

         THIS THIRD AMENDMENT TO CREDIT AGREEMENT (this "Amendment") is dated as
of December 30, 2002 by and among LIFEPOINT HOSPITALS HOLDINGS, INC. (the
"Borrower"); the financial institutions which are now, or in accordance with
SECTION 10.6 of the Credit Agreement (hereinafter described) hereafter, parties
to the Credit Agreement hereto by execution of the signature pages to the Credit
Agreement or otherwise (collectively, the "Lenders" and each individually, a
"Lender"); FLEET NATIONAL BANK, as administrative agent ("Administrative
Agent"), for the Lenders (in such capacity as Administrative Agent, together
with its successors and assigns in such capacity, the "Agent"); CREDIT LYONNAIS
NEW YORK BRANCH and SUNTRUST BANK, as co-documentation agents (in such capacity,
together with their successors and assigns in such capacity, the "Documentation
Agents"); and DEUTSCHE BANK ALEX. BROWN INC. and BANK OF AMERICA, N.A., as
co-syndication agents (in such capacity, together with their successors and
assigns in such capacity, the "Syndication Agents").

                                    RECITALS

         A.       The Borrower, the Lenders, the Agent, the Syndication Agents
and the Documentation Agents are parties to an Amended and Restated Credit
Agreement dated as of June 19, 2001, as amended pursuant to the First Amendment
to Credit Agreement dated as of April 30, 2002 and the Second Amendment to
Credit Agreement dated as of October 1, 2002 (the "Credit Agreement").
Capitalized terms used herein without definition have the meanings assigned to
them in the Credit Agreement.

         B.       The Borrower has requested certain amendments to the Credit
Agreement.

         C.       The Lenders signing below are willing to consent to such
amendments on the terms and conditions hereinafter set forth.

         NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the parties hereto agree as
follows:

I.       AMENDMENTS TO CREDIT AGREEMENT. Subject to the satisfaction of each of
the conditions set forth herein, the Credit Agreement is hereby amended as
follows:

         A.       DEFINITIONS. Section 1.1 of the Credit Agreement is amended as
follows:

                  1.       By inserting the following new definitions in
         alphabetical order:

                           "Copy" or "copy": with respect to the submission of
                  any data, either requested by the Administrative Agent or any
                  Lender or required by this Agreement, (a) a hard copy thereof,
                  (b) an electronic transmission thereof or (c) written or
                  electronic notification referencing an SEC filing containing
                  such

<PAGE>

                  data and posted on the SEC's website (provided that the
                  Administrative Agent shall have received from the Loan Parties
                  hard copy or electronic transmission of such data)."

                           "Exempt Subsidiary": see Section 6.11.

                           "Greenfield": construction of a Medical Facility not
                  constituting an addition to, or extension or modification of,
                  a facility then owned or used by a Loan Party.

                           "Inactive Subsidiary": a direct or indirect
                  Subsidiary of Borrower which is not engaged in any business
                  operations and has no assets or liabilities and in which
                  neither Borrower nor any Subsidiary of Borrower has any
                  Investment (other than a de minimis initial capitalization
                  sufficient for the formation thereof).

                  2.       By inserting the words "or Greenfields" at the end of
         the definition of "Capital Expenditures", immediately prior to the
         period.

                  3.       By deleting the definition of "Consolidated EBITDA"
         and substituting therefor the following:

                           "Consolidated EBITDA": for any period, as to
                  LifePoint Parent and its Subsidiaries, Consolidated Net Income
                  for such period plus, without duplication and to the extent
                  reflected as a charge in the statement of such Consolidated
                  Net Income for such period, the sum of (a) income tax expense,
                  (b) Consolidated Interest Expense, (c) depreciation and
                  amortization expense (including deferred loan cost
                  amortization if a non-cash charge), (d) ESOP expense (if a
                  non-cash charge), (e) non-cash stock compensation expenses and
                  (f) other non-cash charges not to exceed five percent (5%) of
                  the book value Consolidated Total Assets as of the last day of
                  the most recent Reference Period for which the Administrative
                  Agent has received financial statements pursuant to Section
                  6.1(a) or (b), all determined on a consolidated basis in
                  accordance with GAAP.

                  4.       By deleting from the definition of "Consolidated
         Interest Expense" the proviso commencing :"; provided however" and
         ending immediately prior to the period.

                  5.       By deleting clause (b) of the definition of
         "Indebtedness" and substituting therefor the following:

                           "(b)     obligations of such Person for the deferred
                  purchase price of property or services (other than trade
                  payables, including without limitation equipment purchase
                  payables not constituting Capital Lease Obligations, payables
                  to construction contractors, operating lease obligations and
                  physician guarantee payments, all to the extent incurred in
                  the ordinary course of such Person's business)"

                                       -2-
<PAGE>

                  6.       By deleting the definition of "Permitted
         Acquisitions" and substituting therefor the following:

                           "Permitted Acquisition or Greenfield": an Acquisition
                  or Greenfield by Borrower or a Subsidiary Guarantor, subject
                  to the fulfillment of the following conditions:

                  (i)      Either (A) after giving effect to such Acquisition or
                           Greenfield or any series of related Acquisitions
                           and/or Greenfields, the ratio of the Consolidated
                           Total Debt of LifePoint Parent (calculated as of the
                           most recently ended Reference Period) plus the
                           aggregate principal amount of Indebtedness proposed
                           to be incurred or assumed by Borrower or any of its
                           Subsidiaries in connection with such Acquisition or
                           Greenfield, or such series of related Acquisitions
                           and/or Greenfields, to Consolidated EBITDA for the
                           most recently ended Reference Period does not exceed
                           3.00:1.00 or (B) Borrower shall have obtained the
                           prior written approval of the Required Lenders;

                  (ii)     With respect to each Acquisition, Target EBITDA of
                           the Target for its most recently ended fiscal year
                           shall not exceed a negative number greater than 5% of
                           the Consolidated EBITDA (expressed as a negative
                           number) for the most recently ended Reference Period;

                  (iii)    With respect to Acquisitions and Greenfields not
                           approved by the Required Lenders under clause (i)(A)
                           above, if such Acquisition or Greenfield or any
                           series of related Acquisitions and/or Greenfields
                           involves a Total Purchase Price of more than 10% of
                           the Consolidated Total Assets of LifePoint Parent and
                           its Subsidiaries (calculated as of the end of the
                           most recent Reference Period), Borrower shall have
                           provided written notice thereof to the Lenders at
                           least seven (7) days prior to the consummation or
                           commencement thereof, as the case may be;

                  (iv)     If such Acquisition or Greenfield or any series of
                           related Acquisitions and/or Greenfields involves a
                           Total Purchase Price of more than $75,000,000 in the
                           aggregate, then no later than (A) 10 days subsequent
                           to the consummation of each such Acquisition or the
                           commencement of each such Greenfield, as the case may
                           be, Borrower shall have delivered to the
                           Administrative Agent, with sufficient copies for all
                           of the Lenders, (1) if clause (i)(A) is applicable
                           thereto, a certificate of Borrower setting forth the
                           calculations referred to in such clause and
                           certifying compliance with such clause and (2) copies
                           of executed counterparts of the applicable Purchase
                           Agreements and construction agreements, together with
                           exhibits, schedules and, for each Greenfield, a
                           detailed breakdown of construction costs, (B)
                           promptly following a request therefor, copies of such

                                       -3-
<PAGE>

                           other information or documents relating to such
                           Acquisition or Greenfield as the Administrative Agent
                           shall have reasonably requested, and (C) if requested
                           by the Administrative Agent, promptly following the
                           consummation of such Acquisition or the commencement
                           of such Greenfield, certified copies of the
                           agreements, instruments and documents referred to
                           above, to the extent the same have been executed and
                           delivered at the closing under such Purchase
                           Agreement or construction agreement; and

                  (v)      No Default shall have occurred and be continuing or
                           reasonably be expected to result from such
                           Acquisition or Greenfield.

                  7.       By adding the words "or Greenfield" after the word
         "Acquisition" where used in the definition of "Total Purchase Price".

                  8.       By deleting the definition of "Restricted Payment"
         and substituting therefor the following:

                           "Restricted Payment": any distribution or payment of
                  cash or property, or both, directly or indirectly, (a) in
                  respect of any Subordinated Debt or (b) in respect of any
                  Equity Interests in any Loan Party or any direct or indirect
                  Subsidiary of any Loan Party, including without limitation the
                  acquisition, repurchase, retirement or redemption of any such
                  Equity Interests, any sinking fund or similar payments and any
                  dividends, distributions or other payments in respect of such
                  Equity Interests.

                  9.       By deleting the definition of "Subsidiary Guarantor"
         and substituting therefor the following:

                           "Subsidiary Guarantor": each direct and indirect
                  Subsidiary of Borrower, excluding any Exempt Subsidiary or
                  Inactive Subsidiary.

         B.       FINANCIAL REPORTING. Section 6.1 of the Credit Agreement is
amended by deleting the words "together with consolidating financial statements"
and "and other written reports for such Persons" from subparagraph (a) thereof.

         C.       INACTIVE AND EXEMPT SUBSIDIARIES. Section 6.11 of the Credit
Agreement is amended as follows:

                  1.       By adding "(other than an Inactive Subsidiary)" after
         the word "Subsidiary" where it first appears.

                  2.       By deleting clause (iii) thereof (preceding subclause
         (A)) and substituting therefor : "(iii) cause such new Subsidiary (with
         the exception of the Exempt Subsidiaries)".

                                       -4-
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                  3.       By adding the following sentences at the end thereof:

                  "Notwithstanding anything to the contrary set forth in this
                  Section 6.11, Borrower may, from time to time, designate any
                  Subsidiary which is intended to have health professionals as
                  minority shareholders and which is not already a Subsidiary
                  Guarantor (other than Subsidiary Guarantors primarily involved
                  in operating (but not owning) outpatient surgery centers and
                  medical office buildings or Subsidiary Guarantors who are no
                  longer involved in any business activities), as an "Exempt
                  Subsidiary" by written notice to the Administrative Agent, so
                  long as (i) no Default or Event of Default shall have occurred
                  and be continuing after giving effect to such designation,
                  (ii) after giving effect to such designation, as of the date
                  of any such designation, no more than 5% of the Consolidated
                  EBITDA of LifePoint Parent for the most recently ended
                  Reference Period was derived from the Exempt Subsidiaries,
                  (iii) after giving effect to such designation, as of the date
                  of any such designation, the aggregate amount of assets of all
                  Exempt Subsidiaries does not exceed 10% of the Consolidated
                  Total Assets of LifePoint Parent calculated as of the last day
                  of the most recently ended Reference Period, (iv) the Borrower
                  or a Subsidiary Guarantor owns no less than 51% on a fully
                  diluted basis of the Equity Interests of the Exempt
                  Subsidiaries at all times (unless the Disposition of such
                  Exempt Subsidiary is permitted under Section 7.5), and (v) no
                  Exempt Subsidiaries are primarily involved in the business of
                  owning and operating Hospitals. Pursuant to the foregoing, if
                  an existing Subsidiary Guarantor is designated as an Exempt
                  Subsidiary, it shall transfer its tangible personal property
                  (except inventory), real estate and fixtures constituting
                  Collateral, subject only to the Lien in favor of the
                  Administrative Agent on behalf of the Lenders and other
                  existing Permitted Liens hereunder, to a wholly-owned
                  Subsidiary which becomes a party to the Guarantee and Security
                  Agreement on or prior to such transfer and assumes all
                  obligations of such Exempt Subsidiary under any Mortgages, the
                  Guarantee and Security Agreement and other applicable Security
                  Documents with respect to such Collateral. Assuming the
                  designation of an Exempt Subsidiary complies with all of the
                  foregoing, the Administrative Agent agrees to release the
                  Exempt Subsidiary from the Guarantee and Security Agreement
                  and agrees to release the assets remaining in the Exempt
                  Subsidiary, after the aforementioned transfer, from the
                  security interest granted in favor of the Lenders pursuant to
                  the Guarantee and Security Agreement."

         D.       CONSOLIDATED NET WORTH. Section 7.1(c) of the Credit Agreement
is amended to read in its entirety as follows:

                           "(c) Consolidated Net Worth. At all times after the
                  end of the first fiscal quarter to occur after the Closing
                  Date, permit Consolidated Net Worth of LifePoint Parent to be
                  less than the sum of (i) $204,400,000 plus (ii) as of the end
                  of each fiscal quarter to occur after the Closing Date, an
                  amount equal to 50% of Consolidated Net Income (but not less
                  than zero) for such fiscal quarter, such

                                       -5-
<PAGE>

                  increases to be cumulative, plus (iii) an amount equal to 100%
                  of Net Cash Proceeds from any offering of Equity Interests of
                  Borrower or any direct or indirect Subsidiary of Borrower
                  consummated after the Closing Date."

         E.       INDEBTEDNESS. Section 7.2 of the Credit Agreement is amended
as follows:

                  1.       By adding at the end of clause (c) thereof the words:
         "or Borrower".

                  2.       By adding the following language at the end of clause
         (d) thereof: "provided, however, the aggregate amount of all
         Indebtedness owed by Exempt Subsidiaries to Persons other than Borrower
         or any Subsidiary Guarantor shall not exceed $10,000,000 at any time
         outstanding."

                  3.       By deleting subparagraph (g) thereof and substituting
         therefor the following:

                           "(g) Indebtedness of LifePoint Parent (and the
                  related Guarantee Obligations, if any) pursuant to any public
                  offering of Subordinated Debt (including without limitation,
                  any unsecured Subordinated Debt convertible into Equity
                  Interests) occurring after the Closing Date, provided that, on
                  the date such Indebtedness is incurred and after giving effect
                  thereto, (i) no Default or Event of Default shall have
                  occurred and be continuing and (ii) the ratio of Consolidated
                  Total Debt of LifePoint Parent (calculated as of the last day
                  of the most recently ended Reference Period) plus the
                  aggregate principal amount of such Indebtedness to
                  Consolidated EBITDA for such Reference Period does not exceed
                  3.00:1.00 (and Borrower promptly thereafter delivers to the
                  Administrative Agent a certificate of Borrower certifying as
                  to its compliance with the foregoing ratio requirement);"

                  4. By deleting the word "and" where it appears at the end of
         subparagraph (h), inserting the character and word "; and" at the end
         of subparagraph (i) in lieu of the period and adding immediately after
         such subparagraph (i) the following:

                           "(j) Indebtedness of Exempt Subsidiaries to Borrower,
                  any Subsidiary Guarantor and third parties, provided that: (A)
                  on the date of such incurrence of Indebtedness and after
                  giving effect thereto, no Default or Event of Default shall
                  have occurred and be continuing, (B) without limiting the
                  generality of clause (A) above, the incurrence of any such
                  Indebtedness payable to Borrower or any Subsidiary Guarantor
                  shall be in compliance with Section 7.8(v) and (C) the
                  aggregate amount of all such Indebtedness (whether under this
                  clause (j) or otherwise) owed by Exempt Subsidiaries to
                  Persons other than Borrower or a Subsidiary Guarantor shall
                  not exceed $10,000,000 at any time outstanding."

         F.       FUNDAMENTAL CHANGES. Section 7.4 of the Credit Agreement is
amended by deleting the word "and" after clause (a) of the first sentence
thereof and adding at the end of such

                                       -6-
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sentence the following: "and (c) any Exempt Subsidiary may be merged or
consolidated with or into, or may Dispose of any and all of its assets to,
another Exempt Subsidiary.

         G.       DISPOSITION OF PROPERTY; EXEMPT SUBSIDIARIES. Section 7.5 of
the Credit Agreement is amended as follows:

                  1.       By deleting subparagraph (e) thereof and relettering
         the following subparagraphs accordingly.

                  2.       By deleting the last subparagraph thereof and
         substituting therefor the following:

                           "(f) Asset Sales (other than sales and issuances of
                  Equity Interests in Exempt Subsidiaries and sale leasebacks
                  prohibited by Section 7.10) and the sale or issuance of Equity
                  Interests of any Exempt Subsidiary; provided that (i) the same
                  shall be for at least fair market value and for cash, cash
                  equivalents and Investments (to the extent permitted under
                  Section 7.8(r)), except for any sale or issuance of up to 49%
                  of the issued and outstanding Equity Interests in an Exempt
                  Subsidiary, (ii) the aggregate amount of all Asset Sales and
                  sales or issuances of such Equity Interests during any fiscal
                  year shall not exceed an amount equal to 10% of the book value
                  of Consolidated Total Assets of LifePoint Parent (calculated
                  as of the end of the most recent fiscal year for which the
                  Administrative Agent has received audited financial
                  statements), and (iii) no Default or Event of Default shall
                  exist immediately before or after giving effect to such sale."

         H.       RESTRICTED PAYMENTS. Section 7.6 of the Credit Agreement is
amended as follows:

                  1.       By deleting subparagraph (g) and substituting
         therefor the following:

                           (g) Borrower may make distributions to LifePoint
                  Parent in order to permit, and LifePoint Parent may make,
                  regularly scheduled payments (but not prepayments) of interest
                  on Subordinated Debt unless, on the date of any such proposed
                  distribution or payment or after giving effect thereto, a
                  Default or Event of Default shall have occurred and be
                  continuing."

                  2.       By deleting the period at the end of subparagraph (h)
         thereof, adding the character and word "; and" after such subparagraph
         (h) and adding the following subparagraphs (i) and (j) thereafter:

                  "(i)     Any Exempt Subsidiary may (i) declare and pay
         dividends and make distributions in respect of its Equity Interests to
         the Borrower or any Subsidiary Guarantor, (ii) repay Indebtedness owed
         to Borrower or any Subsidiary and (iii) make subordinated intercompany
         loans to Borrower or any Subsidiary; and

                                       -7-
<PAGE>

                  (j) In addition to dividends declared and paid and
         distributions made as permitted under subparagraph (i) above, any
         Exempt Subsidiary may declare or pay pro rata dividends and make pro
         rata distributions to minority holders of its Equity Interests,
         provided that, on the date of any such Restricted Payment and after
         giving effect thereto, (i) the majority shareholder of the Exempt
         Subsidiary shall have received its pro rata share of such dividend and
         distribution, and (ii) the aggregate amount of all such dividends
         declared and paid and distributions made by any Exempt Subsidiary in
         any fiscal year shall not exceed the amount which such Exempt
         Subsidiary is legally required by contract to pay (which amount shall
         not be greater than such minority holders pro rata share of such Exempt
         Subsidiary's net income, cash flow or allocable share of Consolidated
         EBITDA, as applicable, for such fiscal year)."

         I.       CAPITAL EXPENDITURES. Section 7.7 of the Credit Agreement is
amended to read in its entirety as follows:

         "7.7 Capital Expenditures. Make Capital Expenditures in any consecutive
         four quarters, except Capital Expenditures in an amount not to exceed
         15% of consolidated net revenues of LifePoint Parent for the
         immediately preceding consecutive four quarters, determined on a
         consolidated basis in accordance with GAAP."

         J.       PERMITTED INVESTMENTS. Section 7.8 of the Credit Agreement is
amended as follows:

                  1.       By substituting the words "its Subsidiaries" for the
         words "the Subsidiary Guarantors" in the first line of subparagraph (d)
         thereof.

                  2.       By adding the words "and Greenfields" after the words
         "Permitted Acquisitions" in subparagraph (i) thereof.

                  3.       By deleting subparagraph (s) thereof and adding the
         following after subparagraph (r):

                           "(s) Investments directly or indirectly constituting
                  guaranties of physician income, provided that any cash payment
                  by Borrower or any Subsidiary with respect to such Investment
                  is treated as an expense for accounting purposes;

                           (t)      Investments by Exempt Subsidiaries in other
                  Exempt Subsidiaries;

                           (u)      Investments consisting of the purchase of
                  any of the minority Equity Interests of any third party
                  investor in a Subsidiary of Borrower, unless, on the date of
                  any such proposed Investment or after giving effect thereto, a
                  Default or Event of Default shall have occurred and be
                  continuing.;

                                       -8-
<PAGE>

                           (v)      Investments by Borrower or any Subsidiary of
                  Borrower (other than an Exempt Subsidiary) in any Exempt
                  Subsidiary made (A) on the date such Exempt Subsidiary is
                  designated as such in accordance with the provisions of
                  Section 6.11 (and any renewal or replacement of such
                  Investment in an amount no greater than that being renewed or
                  replaced) and (B) after the date of such designation; provided
                  that, on the date such Investment is made and after giving
                  effect thereto, (i) no Default or Event of Default shall have
                  occurred and be continuing, (ii) the aggregate assets of all
                  Exempt Subsidiaries do not exceed 10% of the Consolidated
                  Total Assets of LifePoint Parent (calculated as of the end of
                  the most recent Reference Period for which the Administrative
                  Agent has received financial statements), and (iii) no more
                  than 5% of the Consolidated EBITDA of LifePoint Parent for the
                  most recently ended Reference Period shall have been derived
                  from the Exempt Subsidiaries (calculated as of the end of the
                  most recent Reference Period for which the Administrative
                  Agent has received financial statements);

                           (w)      deposits made by Borrower or any Subsidiary
                  in connection with self-retention or self-insurance of general
                  liability, medical malpractice, professional liability,
                  property or workers' compensation liability which are required
                  by providers of general liability, medical malpractice,
                  professional liability, property or workers' compensation
                  insurance to Borrower or any Subsidiary; and

                           (x)      Investments of a nature not contemplated in
                  the foregoing subsections in an amount not to exceed at any
                  time three percent (3%) of the Consolidated Total Assets of
                  LifePoint Parent at such time, provided that, on the date of
                  any such proposed Investment and after giving effect thereto,
                  no Event of Default shall have occurred and be continuing."

         K.       CERTAIN AGREEMENTS. Section 7.15 of the Credit Agreement is
amended to read in its entirety as follows:

         "7.15 Certain Agreements. Amend or modify the Transition Agreements or
         any documents, if any, evidencing any Subordinated Debt hereafter
         permitted. Amend or modify the Organizational Documents of the Existing
         Joint Venture in a manner adverse to Borrower's direct or indirect
         partnership interest therein. Amend or modify any agreements relating
         to any Exempt Subsidiary to increase the amount of dividends and
         distributions or other Restricted Payments payable to the minority
         shareholders at any time after and during the continuance of a Default
         or an Event of Default."

         L.       NO FURTHER AMENDMENTS. Except as specifically amended hereby,
the text of the Credit Agreement and all other Loan Documents shall remain
unchanged and in full force and effect.

                                       -9-
<PAGE>

II.      REFERENCES IN SECURITY DOCUMENTS; CONFIRMATION OF SECURITY. All
references to the "Credit Agreement" in all Security Documents, and in any other
Loan Documents shall, from and after the date hereof, refer to the Credit
Agreement, as amended by this Amendment, and all obligations of the Loan Parties
under the Loan Documents shall be secured by and be entitled to the benefits of
said Security Documents and such other Loan Documents. All Security Documents
heretofore executed by any of the Loan Parties shall remain in full force and
effect and, by the Borrower's signature hereto and each other Loan Party's
consent hereto, such Security Documents are hereby ratified and affirmed.

III.     REPRESENTATIONS, WARRANTIES AND COVENANTS OF THE BORROWER. The Borrower
hereby represents and warrants to, and covenants and agrees with, the Lenders
that:

         A.       The execution and delivery of this Amendment have been duly
authorized by all requisite company action on the part of the Borrower.

         B.       The representations and warranties of each of the Loan Parties
contained in the Credit Agreement and the other Loan Documents are true and
correct in all material respects on and as of the date of this Amendment as
though made at and as of such date. Since the Closing Date, no event or
circumstance has occurred or existed which could reasonably be expected to have
a Material Adverse Effect. As of the date hereof and after giving effect to this
Amendment, no Default has occurred and is continuing.

         C.       No Loan Party is required to obtain any consent, approval or
authorization from, or to file any declaration or statement with, any
governmental instrumentality or other agency or any other person or entity in
connection with or as a condition to the execution, delivery or performance of
this Amendment.

         D.       This Amendment constitutes the legal, valid and binding
obligation of each Loan Party signatory hereto, enforceable against it in
accordance with their respective terms, subject to bankruptcy, insolvency,
reorganization, moratorium and similar laws affecting the rights and remedies of
creditors generally or the application of principles of equity, whether in any
action at law or proceeding in equity, and subject to the availability of the
remedy of specific performance or of any other equitable remedy or relief to
enforce any right thereunder.

         E.       The Borrower will satisfy all of the conditions set forth in
SECTION IV.

IV.      CONDITIONS. The willingness of the Agent and the Lenders to amend the
Credit Agreement as provided above is subject to the following conditions
precedent and subsequent:

         A.       The Borrower shall have executed and delivered to the Agent
(or shall have caused to be executed and delivered to the Agent by the
appropriate persons) the following:

                  1.       On or before the date hereof:

                                      -10-
<PAGE>

                           (a)      This Amendment;

                           (b)      The Consent and Confirmation of Security of
                  Parent and the Consent and Confirmation of Security of
                  Subsidiaries attached hereto; and

                           (c)      True and complete copies of any required
                  stockholders' and/or directors' consents and/or resolutions,
                  authorizing the execution and delivery of this Amendment,
                  certified by the Secretary of the Borrower.

                  2.       Such other supporting documents and certificates as
         the Agent or its counsel may reasonably request within the time
         period(s) reasonably designated by the Agent or its counsel.

         B.       All legal matters incident to the transactions hereby
contemplated shall be reasonably satisfactory to the Agent's counsel.

V.       MISCELLANEOUS.

         A.       As provided in the Credit Agreement, the Borrower agrees to
reimburse the Agent upon demand for all reasonable fees and disbursements of
counsel to the Agent incurred in connection with the preparation of this
Amendment.

         B.       This Amendment shall be governed by and construed in
accordance with the laws of the State of New York.

         C.       This Amendment may be executed by the parties hereto in
several counterparts hereof and by the different parties hereto on separate
counterparts hereof, all of which counterparts shall together constitute one and
the same agreement. Delivery of an executed signature page of this Amendment by
facsimile transmission shall be effective as an in-hand delivery of an original
executed counterpart hereof.

                    [The next pages are the signature pages.]

                                      -11-
<PAGE>

         IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
duly executed as a sealed instrument by their duly authorized representatives,
all as of the day and year first above written.

                                    LIFEPOINT HOSPITALS HOLDINGS, INC.

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

                                    FLEET NATIONAL BANK,
                                    as Administrative Agent and a Lender

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

                                    BANK OF AMERICA, N.A.,
                                    as Co-Syndication Agent and a Lender

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

                                    DEUTSCHE BANK SECURITIES INC.,
                                    as Co-Syndication Agent

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

                                    CREDIT LYONNAIS NEW YORK BRANCH,
                                    as Co-Documentation Agent and a Lender

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

                             (signatures continued)

                                               Signature Page to Third Amendment

<PAGE>

                                    SUNTRUST BANK,
                                    as Co-Documentation Agent and a Lender

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

                                    DEUTSCHE BANK TRUST COMPANY
                                    AMERICAS,
                                    as a Lender

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

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

                                    CREDIT SUISSE FIRST BOSTON,
                                    as a Lender

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

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

                                    FIRSTAR BANK, N.A.,
                                    as a Lender

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

                             (signatures continued)

                                               Signature Page to Third Amendment

<PAGE>

                                    NATIONAL CITY BANK OF KENTUCKY,
                                    as a Lender

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

                                    MERRILL LYNCH CAPITAL CORPORATION,
                                    as a Lender

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

                                    GENERAL ELECTRIC CAPITAL CORPORATION,
                                    as a Lender

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

                                               Signature Page to Third Amendment

<PAGE>

                 CONSENT AND CONFIRMATION OF SECURITY OF PARENT

         The undersigned, LIFEPOINT HOSPITALS, INC., which owns all of the
issued and outstanding equity interests in the Borrower, hereby joins in the
execution of the foregoing Third Amendment to Credit Agreement dated as of
December 30, 2002 (the "Amendment") to which this Consent is attached (1) to
confirm its consent to all of the transactions contemplated by the Amendment,
and (2) to confirm and ratify its Amended and Restated Guarantee Agreement and
Security Agreement entered into as required under such Credit Agreement and
dated as of June 19, 2001 in favor of the Agent and the Lenders which remains in
full force and effect.

                                    LIFEPOINT HOSPITALS, INC.

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

<PAGE>

              CONSENT AND CONFIRMATION OF SECURITY OF SUBSIDIARIES

         Each of the undersigned Subsidiaries of the Borrower hereby joins in
the execution of the foregoing Third Amendment to Credit Agreement dated as of
December 30, 2002 (the "Amendment") to which this Consent and Confirmation of
Security of Subsidiaries is attached (1) to confirm its consent, to the extent
required, to all of the transactions contemplated by the Amendment, and (2) to
confirm and ratify, as applicable, its Amended and Restated Guarantee and
Security Agreement entered into as required under such Credit Agreement and
dated as of June 19, 2001 with the Agent, on behalf of the Lenders, or its
Guarantee and Pledge Agreement entered into under such Credit Agreement and
dated as of July 30, 2001, each of which remain in full force and effect with
respect to all of the Borrower Obligations and Grantor Obligations (as defined
therein).

                                    AMERICA GROUP OFFICES, LLC
                                    AMERICA MANAGEMENT COMPANIES, LLC
                                    AMG-CROCKETT, LLC
                                    AMG-HILCREST, LLC
                                    AMG-HILLSIDE, LLC
                                    AMG-LIVINGSTON, LLC
                                    AMG-LOGAN, LLC
                                    AMG-SOUTHERN TENNESSEE, LLC
                                    AMG-TRINITY, LLC
                                    ASHLEY VALLEY MEDICAL CENTER, LLC
                                    ASHLEY VALLEY PHYSICIAN PRACTICE, LLC
                                    ATHENS PHYSICIAN PRACTICE, LLC
                                    ATHENS REGIONAL MEDICAL CENTER, LLC
                                    BARROW MEDICAL CENTER, LLC
                                    BARTOW HEALTHCARE PARTNER, INC.
                                    BARTOW HEALTHCARE SYSTEM LTD
                                    BARTOW MEMORIAL LIMITED PARTNER, LLC
                                    BOURBON COMMUNITY HOSPITAL, LLC
                                    BOURBON PHYSICIAN PRACTICE, LLC
                                    BUFFALO TRACE RADIATION ONCOLOGY
                                      ASSOCIATES, LLC
                                    CASTLEVIEW HOSPITAL, LLC
                                    CASTLEVIEW MEDICAL, LLC
                                    CASTLEVIEW PHYSICIAN PRACTICE, LLC
                                    COMMUNITY HOSPITAL OF ANDALUSIA, INC.
                                    COMMUNITY MEDICAL, LLC
                                    CROCKETT HOSPITAL, LLC
                                    CROCKETT PHO, LLC
                                    DODGE CITY HEALTHCARE GROUP, L.P.
                                    DODGE CITY HEALTHCARE PARTNER, INC.

                             (signatures continued)

<PAGE>

                                    GEORGETOWN COMMUNITY HOSPITAL, LLC
                                    GEORGETOWN REHABILITATION, LLC
                                    HALSTEAD HOSPITAL, LLC
                                    HCK LOGAN MEMORIAL, LLC
                                    HDP ANDALUSIA, LLC
                                    HDP GEORGETOWN, LLC
                                    HILLSIDE HOSPITAL, LLC
                                    HST PHYSICIAN PRACTICE, LLC
                                    HTI GEORGETOWN, LLC
                                    HTI PINELAKE, LLC
                                    INTEGRATED PHYSICIAN SERVICES, LLC
                                    KANSAS HEALTHCARE MANAGEMENT
                                      COMPANY, INC.
                                    KANSAS HEALTHCARE MANAGEMENT
                                      SERVICES, LLC
                                    KENTUCKY HOSPITAL, LLC
                                    KENTUCKY MEDSERV, LLC
                                    KENTUCKY MSO, LLC
                                    KENTUCKY PHYSICIANS SERVICES, INC.
                                    LAKE CUMBERLAND REGIONAL HOSPITAL,
                                       LLC
                                    LAKE CUMBERLAND REGIONAL PHYSICIAN
                                      HOSPITAL ORGANIZATION, LLC
                                    LANDER VALLEY MEDICAL CENTER, LLC
                                    LHSC, LLC
                                    LIFEPOINT ASSET MANAGEMENT COMPANY,
                                      INC.
                                    LIFEPOINT CORPORATE SERVICES, GENERAL
                                      PARTNERSHIP
                                    LIFEPOINT CSGP, LLC
                                    LIFEPOINT CSLP, LLC
                                    LIFEPOINT HOLDINGS 2, LLC
                                    LIFEPOINT HOLDINGS 3, INC.
                                    LIFEPOINT OF GAGP, LLC
                                    LIFEPOINT OF GEORGIA, LIMITED
                                      PARTNERSHIP
                                    LIFEPOINT OF KENTUCKY, LLC
                                    LIFEPOINT OF LAKE CUMBERLAND, LLC
                                    LIFEPOINT MEDICAL GROUP-HILLSIDE, INC.
                                    LIFEPOINT RC, INC.
                                    LIVINGSTON REGIONAL HOSPITAL, LLC
                                    LOGAN MEDICAL, LLC

                             (signatures continued)

<PAGE>

                                    LOGAN MEMORIAL HOSPITAL, LLC
                                    LOGAN PHYSICIAN PRACTICE, LLC
                                    MEADOWVIEW PHYSICIAN PRACTICE, LLC
                                    MEADOWVIEW REGIONAL MEDICAL CENTER,
                                      LLC
                                    MEADOWVIEW RIGHTS, LLC
                                    PINELAKE PHYSICIAN PRACTICE, LLC
                                    PINELAKE REGIONAL HOSPITAL, LLC
                                    POITRAS PRACTICE, LLC
                                    PUTNAM COMMUNITY MEDICAL CENTER, LLC
                                    PUTNAM DIAGNOSTIC IMAGING CENTER, LLC
                                    R. KENDALL BROWN PRACTICE, LLC
                                    RIVERTON MEMORIAL HOSPITAL, LLC
                                    RIVERTON PHYSICIAN PRACTICES, LLC
                                    RIVERVIEW MEDICAL CENTER, LLC
                                    SELECT HEALTHCARE, LLC
                                    SILETCHNIK PRACTICE, LLC
                                    SMITH COUNTY MEMORIAL HOSPITAL, LLC
                                    SOMERSET SURGERY PARTNER, LLC
                                    SOUTHERN TENNESSEE EMS, LLC
                                    SOUTHERN TENNESSEE MEDICAL CENTER, LLC
                                    SOUTHERN TENNESSEE PHO, LLC
                                    SPRINGHILL MEDICAL CENTER, LLC
                                    SPRINGHILL MOB, LLC
                                    SPRINGHILL PHYSICIAN PRACTICE LLC
                                    THM PHYSICIAN PRACTICE, LLC
                                    VILLE PLATTE MEDICAL CENTER, LLC
                                    WESTERN PLAINS REGIONAL HOSPITAL, LLC
                                    WOODFORD HOSPITAL, LLC

                                    By:
                                       -----------------------------
                                       Name:
                                            ------------------------
                                       Title:
                                             -----------------------
                                       (duly authorized signatory as to all)<PAGE>
                                                                   EXHIBIT 10.19

           AMENDMENT TO THE CORPORATE INTEGRITY AGREEMENT BETWEEN THE
                       OFFICE OF INSPECTOR GENERAL OF THE
                     DEPARTMENT OF HEALTH AND HUMAN SERVICES
                                       AND
                            LIFEPOINT HOSPITALS, INC.

The Office of Inspector General ("OIG") of the Department of Health and Human
Services and LifePoint Hospitals, Inc. ("LifePoint") entered into a Corporate
Integrity Agreement ("CIA") on December 21, 2000.

A.       Pursuant to section XI.C. of LifePoint's CIA, modifications to the CIA
         may be made with the prior written consent of both the OIG and
         LifePoint. Therefore, the OIG and LifePoint hereby agree that
         LifePoint's CIA will be amended as follows:

         Section III.D., Review Procedures, of the CIA is hereby superseded by
         the attached new section III.D., Review Procedures.

         Appendix A of LifePoint's CIA is hereby superseded by the attached new
         Appendix A.

B.       The OIG and LifePoint agree that all other sections of LifePoint's CIA
         will remain unchanged and in effect, unless specifically amended upon
         the prior written consent of the OIG and LifePoint.

C.       The undersigned LifePoint signatories represent and warrant that they
         are authorized to execute this Amendment. The undersigned OIG signatory
         represents that he is signing the Amendment in his official capacity
         and that he is authorized to execute this Amendment.

D.       This effective date of this Amendment will be the date on which the
         final signatory of this Amendment signs this Amendment.

<PAGE>

                             ON BEHALF OF LIFEPOINT

       /s/ Kenneth C. Donahey                                    04/25/2002
---------------------------------------------               --------------------
Kenneth C. Donahey                                          DATE
Chairman and Chief Executive Officer
LifePoint Hospitals, Inc.

       /s/ Todd Kerr                                             04/25/2002
---------------------------------------------               --------------------
Todd Kerr                                                   DATE
Senior Vice President of Audit and Compliance
LifePoint Hospitals, Inc.

              ON BEHALF OF THE OFFICE OF INSPECTOR GENERAL OF THE
                    DEPARTMENT OF HEALTH AND HUMAN SERVICES

      /s/ Lewis Morris                                           04/29/2002
---------------------------------------------               --------------------
Lewis Morris                                                DATE
Assistant Inspector General for Legal Affairs
Office of Inspector General
U.S. Department of Health and Human Services

<PAGE>

D.       Review Procedures.

          1.      General Description.

                  a.       Retention of Independent Review Organization. Within
         90 days of the effective date of this CIA, LifePoint shall retain an
         entity (or entities), such as an accounting, auditing or consulting
         firm (hereinafter "Independent Review Organization" or "IRO"), to
         perform a review engagement to assist LifePoint in evaluating its
         billing and coding practices. The Independent Review Organization
         retained by LifePoint shall have expertise in the billing, coding,
         reporting and other requirements of the particular sector of the health
         care industry pertaining to matters that the IRO is reviewing and in
         the general requirements of the Federal health care program(s) from
         which LifePoint seeks reimbursement. The IRO shall assess, along with
         LifePoint, whether it can perform the IRO review in a professionally
         independent fashion taking into account any other business
         relationships or other engagements that may exist.

                  b.       Types of Engagement. LifePoint's Internal Audit and
         Compliance Department (references to "LifePoint" in the review
         procedures described in this CIA and the incorporated appendices refer
         to this department) and the Independent Review Organization(s) shall
         conduct an engagement that shall address LifePoint's billing and coding
         to the Federal health care programs ("Billing Engagement") and shall
         include a review of DRG and laboratory claims.

                  c.       Frequency of Billing Engagement. The Billing
         Engagement shall be performed annually and shall cover each of the
         calendar years 2001 through 2005.

                  d.       Retention of records. The IRO and LifePoint shall
         retain and make available to the OIG upon request all work papers
         related to the engagement (including, but not limited to, all
         substantive correspondence exchanged regarding the reports) and all
         draft and final reports delivered to LifePoint.

         2.       Billing Engagement. The Billing Engagement shall be composed
of the following types of reviews: a "DRG Claims Review," a "Laboratory Claims
Review," a "Systems Review," and an Operations DRG Review." The Claims Reviews
and corresponding Reports are discussed in detail in Appendices A, B, and C to
this CIA, which are incorporated by reference.

                  a.       DRG Claims Review.

                           i.       DRG Claims Review. LifePoint shall perform a
                  Claims Review to identify any overpayments through an
                  appraisal of inpatient discharges paid by Medicare DRG to
                  LifePoint. The Claims Reviews shall be performed in accordance
                  with the procedures set forth in Appendix A to this CIA. The
                  Claims Reviews shall cover the two six-month periods during
                  each year covered by the Billing Engagement. LifePoint will
                  perform Claims Reviews at a minimum of two hospitals during
                  each six-month period (for a minimum of four hospitals each
                  year.) The hospitals, and the DRGs to be reviewed at each
                  hospital, will be chosen as set forth in section III.D.2.c.

<PAGE>

                           ii.      DRG Claims Review Report. LifePoint shall
                  prepare a report based upon each Claims Review performed
                  ("Claims Review Report"). The Claims Review Report shall be
                  created in accordance with the procedures set forth in
                  Appendix A to this CIA.

                           iii.     IRO Review. With respect to LifePoint's
                  Claims Reviews, the IRO will prepare a report documenting the
                  IRO's findings with respect to the following procedures:

                                    A.       The IRO will obtain LifePoint's
                           workpapers and perform procedures to test concurrence
                           with the criteria included in section III.D.2.c.

                                    B.       The IRO will select a random sample
                           of a minimum of 10% of the Items reviewed by
                           LifePoint pursuant to the DRG Claims Review and
                           reperform LifePoint's workplan steps.

          b.      Laboratory Claims Review.

                           i.       Claims Review. LifePoint shall perform a
                  Claims Review to identify any overpayments through an
                  appraisal of outpatient laboratory claims submitted by
                  LifePoint to the Medicare program and paid by Medicare. The
                  Claims Reviews shall be performed in accordance with the
                  procedures set forth in Appendix A to this CIA. The Claims
                  Reviews shall cover the two six-month periods during each year
                  covered by the Billing Engagement. LifePoint will perform
                  Claims Reviews at a minimum of two hospitals during each
                  six-month period (for a minimum of four hospitals each year.)
                  The hospitals, and the tests to be reviewed at each hospital,
                  will be chosen as set forth in section III.D.2.c.

                           ii.      Laboratory Claims Review Report. LifePoint
                  shall prepare a report based upon each Laboratory Claims
                  Review performed ("Claims Review Report"). The Claims Review
                  Report shall be created in accordance with the procedures set
                  forth in Appendix A to this CIA.

                           iii.     IRO Review. With respect to LifePoint's
                  Laboratory Claims Review, the IRO will prepare a report
                  documenting the IRO's findings with respect to the following
                  procedures:

                                    A.       The IRO will obtain LifePoint's
                           workpapers and perform procedures to test concurrence
                           with the criteria set forth in section III.D.2.c.

                                    B.       The IRO will select a random sample
                           of a minimum of 10% of the Items reviewed pursuant to
                           the Laboratory Review and re-perform LifePoint's
                           workplan steps.

                                       2
<PAGE>

          c.      Selection of Hospitals for Claims Reviews.

                           i.       DRG Claims Review Hospital Selection.
                  LifePoint shall select the two hospitals subject to review
                  during each six-month period as follows:

                                    A.       The hospital that has the highest
                           percentage of Medicare focused DRGs, as compared to
                           total Medicare DRGs, during the relevant six month
                           period under review, will be chosen. (However, if a
                           hospital has already been selected under this process
                           during any of the immediately preceding two reviews
                           then the hospital with the next highest percentage
                           shall be chosen instead).

                                    B.       One hospital will be randomly
                           selected using RAT-STATS. A replacement hospitals
                           should be generated in case the hospital randomly
                           selected has already been identified under section
                           III.D.2.c.i.A.

                           ii.      Laboratory Claims Review Hospital Selection.
                  LifePoint shall select the two hospitals subject to review
                  during each six-month period as follows:

                                    A.       The hospital that has the highest
                           percentage of Medicare outpatient laboratory services
                           revenue, as compared to total Medicare outpatient
                           services revenue, during the relevant six month
                           period, will be chosen. (However, if a hospital has
                           already been selected under this process during any
                           of the immediately preceding two reviews then the
                           hospital with the next highest percentage shall be
                           chosen instead).

                                    B.       One hospital will be randomly
                           selected using RAT-STATS. A replacement hospital
                           should be generated in case the hospital randomly
                           selected has already been identified under section
                           III.D.2.c.ii.A.

                  d.       Systems Review. LifePoint shall review LifePoint's
         billing and coding systems and/or operations (the "Systems Review").
         The Systems Review shall include the reviews described in Appendix B
         for at least four hospitals. The Systems Review shall consist of a
         thorough review of the following as more specifically described in
         Appendix B:

                           i.       LifePoint's billing systems and/or
                  operations relating to claims submitted to all Federal health
                  care programs (including, but not limited to, the operation of
                  the billing system, safeguards to ensure proper claim
                  submission and billing, and procedures to correct inaccurate
                  billing); and

                           ii.      LifePoint's coding systems and/or operations
                  relating to claims submitted to all Federal health care
                  programs (including, but not limited to, the process by which
                  claims are coded, safeguards to ensure proper coding, and
                  procedures to correct inaccurate coding).

                                       3
<PAGE>

                  e.       Systems Review Report. LifePoint shall prepare a
         report based upon each Systems Review performed ("Systems Review
         Report"). The Systems Review Report shall include LifePoint's findings
         and supporting rationale regarding:

                           i.       all findings and recommendations regarding
                  LifePoint's billing systems and/or operations;

                           ii.      all findings and recommendations regarding
                  LifePoint's coding systems and/or operations; and

                           iii.     any recommendations LifePoint may have to
                  improve any of these systems, operations, and processes.

                  f.       Operational DRG Review. LifePoint shall review
         LifePoint's DRG coding for hospital inpatients (the "Operational DRG
         Review"). The Operational DRG Review shall include the reviews
         described in Appendix C for at least eight hospitals. The Operational
         DRG Review shall consist of a thorough review of the DRG coding
         operations (including a review of at least 50 DRG claims at each
         hospital) as more specifically described in Appendix C. Except for the
         fact that the review of claims need not meet the statistical confidence
         and precision parameters set forth in Appendix A, the Operational DRG
         Review shall be conducted in a manner consistent with Appendix A, e.g.,
         paid claims without supporting documentation shall be considered an
         error and the total reimbursement received by LifePoint for such Paid
         Claim shall be deemed an Overpayment.

                  g.       Operational DRG Review Report. LifePoint shall
         provide to the OIG in its Annual Reports the Executive Summaries
         related to the Operational DRG Reviews. The Executive Summaries shall
         include a summary of the Medicare and other Federal health care program
         overpayments (including number of overpayments, dollar amount of
         overpayments, and percentage of paid dollars attributable to
         overpayments) identified in each Operational DRG Review. All other
         documents related to the Operational DRG Reviews shall be available to
         the OIG upon request.

         3.       Validation Review. In the event the OIG has reason to believe
that: (a) LifePoint's Billing Engagement fails to conform to the requirements of
this CIA; or (b) LifePoint's or the IRO's findings or Billing Engagement results
are inaccurate, the OIG may, at its sole discretion, conduct its own review to
determine whether the Billing Engagement complied with the requirements of the
CIA and/or the findings or Billing Engagement results are inaccurate
("Validation Review"). LifePoint agrees to pay for the reasonable cost of any
such review performed by the OIG or any of its designated agents so long as it
is initiated before one year after LifePoint's final Annual Report and any
additional information requested by the OIG is received by the OIG.

         Prior to initiating a Validation Review, the OIG shall notify LifePoint
of its intent to do so and provide a written explanation of why the OIG believes
such a review is necessary. To resolve any concerns raised by the OIG, LifePoint
may request a meeting with the OIG to discuss the results of any Billing
Engagement submissions or findings; present any additional or relevant
information to clarify the results of the Billing Engagement or to

                                       4
<PAGE>

correct the inaccuracy of the Billing Engagement; and/or propose alternatives to
the Validation Review. LifePoint agrees to provide any additional information as
may be requested by the OIG under this section in an expedited manner. The OIG
will attempt in good faith to resolve any Billing Engagement issues with
LifePoint prior to conducting a Validation Review. However, the final
determination as to whether or not to proceed with a Validation Review shall be
made at the sole discretion of the OIG.

         4.       Independence Certification. The IRO shall include in its
report(s) to LifePoint a certification or sworn affidavit that it has evaluated
its professional independence with regard to the Billing Engagement and that it
has concluded that it is, in fact, independent.

                                       5
<PAGE>

                                   APPENDIX A

A.       CLAIMS REVIEW.

         1.       DEFINITIONS. For the purposes of the DRG and Laboratory Claims
Reviews, the following definitions shall be used:

                  a.       Claims Review Sample: A statistically valid, randomly
         selected, sample of items selected for appraisal in the DRG or
         Laboratory Claims Review.

                  b.       Item: (i) for the purposes of a DRG review, an "Item"
         is a hospital inpatient discharge for which LifePoint has been
         reimbursed by Medicare on the basis of one of the focused DRGs set
         forth in Appendix D; and (ii) for the purposes of a Laboratory Review,
         an "Item" is an outpatient laboratory test. The OIG shall have the
         right to change the DRGs included in Appendix D at any time during the
         term of the CIA.

                  c.       Overpayment: The amount of money LifePoint has
         received in excess of the amount due and payable under any Federal
         health care program requirements.

                  d.       Paid Claim: A code or line item submitted by
         LifePoint and for which LifePoint has received reimbursement from the
         Medicare program.

                  e.       Population: All Items for which LifePoint has
         submitted a code or line item and for which LifePoint has received
         reimbursement from the Medicare program (i.e., a Paid Claim) during the
         six-month period covered by the DRG or Laboratory Claims Review. To be
         included in the Population, an Item must have resulted in at least one
         Paid Claim.

                  f.       Error Rate: The Error Rate shall be the percentage of
         net Overpayments identified in the sample. The net Overpayments shall
         be calculated by subtracting all underpayments identified in the sample
         from all gross Overpayments identified in the sample. (Note: Any
         potential cost settlements or other supplemental payments should not be
         included in the net Overpayment calculation. Rather, only underpayments
         identified as part of the Discovery Sample or Full Sample (as
         applicable) shall be included as part of the net Overpayment
         calculation.) The Error Rate is calculated by dividing the net
         Overpayment identified in the sample by the total dollar amount
         associated with the Items in the sample.

                  g.       RAT-STATS: OIG's Office of Audit Services Statistical
         Sampling Software. RAT-STATS is publicly available to download through
         the Internet at "www.hhs.gov/oig/oas/ratstat.html."

         2.       DESCRIPTION OF CLAIMS REVIEW. Each DRG and Laboratory Claims
Review shall consist of an appraisal of a statistically valid sample of Items
(the Claims Review Sample) that can be projected to the total Population.

                                       6
<PAGE>

                  a.       DRG Claims Review. The DRG Claims Review shall
         include a Discovery Sample and, if necessary, a Full Sample. The
         applicable definitions, procedures, and reporting requirements are
         outlined in this Appendix A.

                  b.       Discovery Sample. LifePoint shall randomly select and
         review a sample of 50 Medicare Paid Claims submitted by or on behalf of
         LifePoint. The Paid Claims shall be reviewed based on the supporting
         documentation available at LifePoint or under LifePoint's control and
         applicable billing and coding regulations and guidance to determine
         whether the claim submitted was correctly coded, submitted, and
         reimbursed.

                           i.       If the Error Rate for the Discovery Sample
                  is less than 5%, no additional sampling is required, nor is
                  the Systems Review required. (Note: The threshold listed above
                  does not imply that this is an acceptable error rate.
                  Accordingly, LifePoint should, as appropriate, further analyze
                  any errors identified in the Discovery Sample. LifePoint
                  recognizes that the OIG or other HHS component, in its
                  discretion and as authorized by statute, regulation, or other
                  appropriate authority may also analyze or review Paid Claims
                  included, or errors identified, in the Discovery Sample.)

                           ii.      If the Discovery Sample indicates that the
                  Error Rate is 5% or greater, LifePoint shall perform a Full
                  Sample and a Systems Review, as described below.

                  c.       Full Sample. If necessary, as determined by
         procedures set forth above, LifePoint shall perform an additional
         sample of Paid Claims using commonly accepted sampling methods and in
         accordance with this Appendix A. The Full Sample should be designed to
         (1) estimate the actual Overpayment in the population with a 90%
         confidence level and with a maximum relative precision of 25% of the
         point estimate and (2) conform with the Centers for Medicare and
         Medicaid Services' statistical sampling for overpayment estimation
         guidelines. The Paid Claims shall be reviewed based on supporting
         documentation available at LifePoint or under LifePoint's control and
         applicable billing and coding regulations and guidance to determine
         whether the claim submitted was correctly coded, submitted, and
         reimbursed. For purposes of calculating the size of the Full Sample,
         the Discovery Sample may serve as the probe sample, if statistically
         appropriate. Additionally, LifePoint may use the Items sampled as part
         of the Discovery Sample, and the corresponding findings for those 50
         Items, as part of its Full Sample. The OIG, in its full discretion, may
         refer the findings of the Full Sample (and any related workpapers)
         received from LifePoint to the appropriate Federal health care program
         payor, including the Medicare contractor (e.g., carrier, fiscal
         intermediary, or DMERC), for appropriate follow-up by that payor.

                  d.       Claims Systems Review. If LifePoint's Discovery
         Sample identifies an Error Rate of 5% or greater, LifePoint shall also
         conduct a Systems Review. Specifically, for each claim in the Discovery
         Sample and Full Sample that resulted in an Overpayment, LifePoint
         should perform a "walk through" of the system(s) and process(es) that
         generated the claim to identify any problems or weaknesses that may
         have resulted in the identified Overpayments. LifePoint shall prepare a
         report

                                       7
<PAGE>

         containing the observations and recommendations on suggested
         improvements to the system(s) and the process(es) that generated the
         claim.

                  e.       Repayment of Identified Overpayments. In accordance
         with section III.H.1 of the CIA, LifePoint agrees to repay within 30
         days any Overpayment(s) identified in the Discovery Sample or the Full
         Sample (if applicable), regardless of the Error Rate, to the
         appropriate payor and in accordance with payor refund policies.
         LifePoint agrees to make available to the OIG any and all documentation
         that reflects the refund of the Overpayment(s) to the payor.

                  f.       Laboratory Claims Review Sample. Each Laboratory
         Claims Review Sample shall consist of an appraisal of a random sample
         of 200 Items for each hospital for each period under review.

                  g.       Item Appraisal. For each Item appraised (either as
         part of the Claims Review Sample or of the Probe Sample), only Paid
         Claims shall be evaluated. Every Paid Claim in the Claims Review Sample
         shall be evaluated by LifePoint. Ten percent of all Paid Claims in the
         DRG or Laboratory Probe Sample Review or the DRG or Laboratory Claims
         Review shall be evaluated by the IRO to determine whether the claim
         submitted was correctly coded, submitted, and reimbursed. Each
         appraisal must be sufficient to provide all information required under
         the Claims Review Report.

                  h.       Paid Claims without Supporting Documentation. For the
         purpose of appraising Items included in the Claims Review and/or the
         Probe Sample, any Paid Claim for which LifePoint cannot produce
         documentation sufficient to support the Paid Claim shall be considered
         an error and the total reimbursement received by LifePoint for such
         Paid Claim shall be deemed an Overpayment. Replacement sampling for
         Paid Claims with missing documentation is not permitted.

                  i.       Use of First Samples Drawn. For the purposes of all
         samples (Probe Sample(s) and Claims Review Sample(s)) discussed in this
         Appendix, the Paid Claims associated with the Items selected in the
         first sample (or first sample for each strata, if applicable) shall be
         used. In other words, it is not permissible to generate a number of
         random samples and then select one for use as the Probe Sample or
         Claims Review Sample.

B.       CLAIMS REVIEW REPORT. The following information shall be included in
each Claims Review Report:

         1.       CLAIMS REVIEW METHODOLOGY

                  a.       Claims Review Objective: A clear statement of the
         objective intended to be achieved by the DRG or Laboratory Claims
         Review.

                  b.       Sampling Unit: A description of the Item as that term
         is utilized for the DRG or Laboratory Claims Review. As noted in
         section A.1.b above, (i) for the purposes of a DRG review, an "Item" is
         a hospital inpatient discharge for which LifePoint has been reimbursed
         by Medicare on the basis of one of the "high-risk"

                                       8
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         DRGs set forth in Appendix D; and (ii) for the purposes of a Laboratory
         Review, an "Item" is an outpatient laboratory test.

                  c.       Claims Review Population: A description of the
         Population subject to the DRG or Laboratory Claims Review.

                  d.       Sampling Frame: A description of the sampling frame,
         which is the totality of Items from which the Probe Sample and Claims
         Review Sample have been selected and an explanation of the methodology
         used to identify the sampling frame. In most circumstances, the
         sampling frame will be identical to the Population.

                  e.       Sources of Data: A description of the documentation
         relied upon by the IRO when performing the DRG or Laboratory Claims
         Review (e.g., medical records, physician orders, certificates of
         medical necessity, requisition forms, local medical review policies,
         HCFA program memoranda, Medicare carrier or intermediary manual or
         bulletins, other policies, regulations, or directives).

                  f.       Review Protocol: A narrative description of how the
         Claims Review was conducted and what was evaluated. This shall include
         a description of the analysis used to determine which hospitals were
         chosen for review under the Billing Engagement and the statistics
         relevant to the selection of the hospitals.

         2.       STATISTICAL SAMPLING DOCUMENTATION

                  a.       The number of Items appraised in the Probe Sample and
         in the Claims Review Sample.

                  b.       A copy of the RAT-STATS printout of the random
         numbers generated by the "Random Numbers" function.

                  c.       A copy of the RAT-STATS printout of the "Sample Size
         Estimators" results used to calculate the minimum number of Items for
         inclusion in the Claims Review Sample.

                  d.       A copy of the RAT-STATS printout of the "Variable
         Appraisals" function results for the Probe Sample.

                  e.       The Sampling Frame used in the Probe Sample(s) and
         the Claims Review Sample will be available to the OIG upon request.

         3.       CLAIMS REVIEW RESULTS

                  a.       Narrative Results.

                           i.       A narrative description of how the Claims
                  Review was conducted and what was evaluated. This shall
                  include a description of the analysis used to determine which
                  hospitals were chosen for review under the Billing Engagement
                  and the statistics relevant to the selection of the hospitals.

                                       9
<PAGE>

                           ii.      A narrative explanation of LifePoint's
                  findings and supporting rationale (including reasons for
                  errors, patterns noted, etc.) regarding the Claims Review,
                  including the results of the Discovery Sample, and the results
                  of the Full Sample (if any) with the gross Overpayment amount,
                  the net Overpayment amount, and the corresponding Error
                  Rate(s) related to the net Overpayment.

                  b.       Quantitative Results

                           i.       Total number and percentage of instances in
                  which LifePoint determined that the Paid Claim submitted by
                  the LifePoint hospital ("Claim Submitted") differed from what
                  should have been the correct claim ("Correct Claim"),
                  regardless of the effect on the payment.

                           ii.      Total number and percentage of instances in
                  which the Claim Submitted differed from the Correct Claim and
                  in which such difference resulted in an Overpayment to
                  LifePoint.

                           iii. The total dollar amount of all Paid Claims in
                  the Claims Review Sample and the total dollar amount of
                  Overpayments associated with the Paid Claims identified by the
                  DRG or Laboratory Claims Review. (This is the total dollar
                  amount of the Overpayments identified in section B.3.b above.)

                           iv.      Error Rate in the sample.

                           v.       A spreadsheet of the DRG or Laboratory
                  Claims Review results that includes the following information
                  for each Paid Claim appraised: Federal health care program
                  billed, beneficiary health insurance claim number, date of
                  service, procedure code submitted, procedure code reimbursed,
                  allowed amount reimbursed by payor, correct procedure code (as
                  determined by LifePoint), correct allowed amount (as
                  determined by LifePoint), dollar difference between allowed
                  amount reimbursed by payor and the correct allowed amount.
                  (See Attachment 1 to this Appendix.)

         4.       CLAIMS SYSTEMS REVIEW. Observations, findings and
recommendations on possible improvements to the system(s) and process(es) that
generated the Overpayment(s).

         5.       CREDENTIALS. The names and credentials of the individuals who:
(1) designed the statistical sampling procedures and the review methodology
utilized for the DRG or Laboratory Claims Review; and (2) performed the DRG or
Laboratory Claims Review.

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