Contract

Exhibit 4.1

THIS FOURTH SUPPLEMENTAL INDENTURE (the “Fourth Supplemental Indenture”), dated as of August 23, 2013, is by and among LifePoint Hospitals, Inc. a Delaware corporation (the “Company”), the guarantors named herein (the “Guarantors”) and The Bank of New York Mellon Trust Company, N.A., as trustee (the “Trustee”) under the Indenture referred to below, as defined below.

W I T N E S S E T H

WHEREAS, the Company and the Guarantors have heretofore executed and delivered to the Trustee the Indenture, dated as of September 23, 2010, as supplemented by that First Supplemental Indenture, dated as of July 19, 2011, that Second Supplemental Indenture dated as of February 8, 2012 and that Third Supplemental Indenture dated as of September 28, 2012 (together, the “Indenture”), providing for the issuance of the Company’s 6.625% Senior Notes due 2020 (the “Notes”);

WHEREAS, Section 9.02 of the Indenture provides that the Company, the Guarantors and the Trustee may amend or supplement the Indenture with the consent of the Holders of at least a majority in principal amount of the Notes then outstanding, subject to certain conditions contained therein; and

WHEREAS, pursuant to a Consent Solicitation Statement dated July 30, 2013 (as amended on August 21, 2013, the “Consent Solicitation Statement”) and the related Consent Form (as such term is defined in the Consent Solicitation Statement and, together with the Consent Solicitation Statement, the “Consent Solicitation”), the Company solicited the Holders of the Notes for approval to amend and modify certain provisions contained in the Indenture (the “Proposed Amendments”); and

WHEREAS, the Holders of at least a majority in principal amount of the Notes outstanding as of the Record Date (as defined in the Consent Solicitation) have tendered Consents (as such term is defined in the Consent Solicitation) pursuant to the terms of the Consent Solicitation and have approved the Proposed Amendments as described in this Fourth Supplemental Indenture; and

WHEREAS, pursuant to Article 9.02 of the Indenture, the Trustee is authorized to execute and deliver this Fourth Supplemental Indenture.

NOW THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Company, the Guarantors and the Trustee agree as follows:

1. Capitalized Terms.  Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture.

2. Amendments to the Indenture.  The Indenture is hereby amended as follows:

(a) The definition of “Excluded Subsidiaries” in Section 1.01 of the Indenture shall be amended and restated in its entirety as follows:

“Excluded Subsidiaries” means those Domestic Subsidiaries that are designated by the Company as Domestic Subsidiaries that will not be Guarantors; provided, however, that in no event will the Excluded Subsidiaries, either individually or collectively, hold more than 45% of the consolidated assets of the Company and its Domestic Subsidiaries as of the end of any fiscal quarter (determined as of the most recent fiscal quarter for which the Company has internal financial statements available); provided, further, that any wholly owned Domestic Subsidiary that guarantees any Indebtedness incurred pursuant to clause (a) of the second paragraph of Section 4.07 hereof may not be designated as or continue to be an Excluded Subsidiary. In the event any Domestic Subsidiaries, individually or collectively, previously designated as Excluded Subsidiaries cease to meet the requirements of the previous sentence, the Company will, within 60 calendar days following such event, cause one or more of such Domestic Subsidiaries to become Guarantors so that the requirements of the previous sentence are complied with.  After the Issue Date, the Company may designate Domestic Subsidiaries as Excluded Subsidiaries by an Officers’ Certificate submitted to the Trustee. Notwithstanding the foregoing, no Existing Guarantor may be designated as an Excluded Subsidiary unless, after giving effect to such release, the Excluded Subsidiaries will not, either individually or collectively, hold more than 25% of the consolidated assets of the Company and its Domestic Subsidiaries as of the end of any fiscal quarter or account for more than 25% of the consolidated revenue of the Company and its Domestic Subsidiaries during the most recent four-quarter period (in each case determined as of the most recent fiscal quarter for which the Company has internal financial statements available).

(b) The definition of “Existing Guarantors” shall be added to Section 1.01 of the Indenture as follows:

“Existing Guarantors” means those Domestic Subsidiaries that are Guarantors immediately prior to the date of this Supplemental Indenture.

(c) The first paragraph of Section 4.07 of the Indenture shall be amended by adding the following as the final sentence of such paragraph:

Notwithstanding the foregoing, Indebtedness incurred by non wholly owned Excluded Subsidiaries pursuant to this first paragraph of Section 4.07 may not exceed $250.0 million at any time outstanding.

3. Receipt by Trustee.  In accordance with Section 9.02 of the Indenture, the Trustee acknowledges that it has received a copy of the Board Resolution authorizing the execution of this Fourth Supplemental Indenture and the Act of the Holders of the Notes consenting to the Proposed Amendment evidenced by this Fourth Supplemental Indenture.  In addition, in accordance with Section 9.06, Section 12.04, and Section 12.05 of the Indenture, the Trustee acknowledges that it has received an Officers’ Certificate and Opinion of Counsel stating

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that the execution of this Fourth Supplement Indenture is authorized or permitted by the Indenture, and that all conditions precedent have been complied with.

4. New York Law to Govern.  The Internal Law of the State of New York shall govern and be used to construe this Supplemental Indenture but without giving effect to applicable principles of conflicts of law to the extent that the application of the laws of another jurisdiction would be required thereby.

5. Severability.  In case any provision in this Fourth Supplemental Indenture shall be invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

6. Counterparts.  The parties may sign any number of copies of this Fourth Supplemental Indenture.  Each signed copy shall be original, but all of them together represent the same agreement.

7. Effect of Headings.  The Section headings herein are for convenience only and shall not affect the construction hereof.

8. The Trustee.  The Trustee shall not be responsible in any manner whatsoever for or in respect of the validity or sufficiency of this Fourth Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Company.

9. Ratification of Indenture; Fourth Supplemental Indenture Part of Indenture.  Except as expressly supplemented 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 Fourth Supplemental Indenture shall form a part of the Indenture for all purposes, and every Holder of Notes heretofore or hereafter authenticated and delivered shall be bound hereby.

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

	LIFEPOINT HOSPITALS, INC.
	By:	/s/ Xxxxxxx X. Xxxxx
		Name:	Xxxxxxx X. Xxxxx
		Title:	Vice President and Corporate Secretary
	THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A., as Trustee
	By:	/s/ Xxxxxxxx X. Xxxxx
		Name: Xxxxxxxx X. Xxxxx
		Title:   Vice President

[Guarantor Signature Pages Follow]

[Signature Page to Fourth Supplemental Indenture]

AMERICA MANAGEMENT COMPANIES, LLC

AMG-XXXXXXXX, LLC

AMG-HILCREST, LLC

AMG-HILLSIDE, LLC

AMG-XXXXXXXXXX, LLC

AMG-XXXXX, LLC

AMG-SOUTHERN TENNESSEE, LLC

AMG-TRINITY, LLC

ANDALUSIA PHYSICIAN PRACTICES, LLC

ASHLAND PHYSICIAN SERVICES, LLC

ASHLEY VALLEY MEDICAL CENTER, LLC

ASHLEY VALLEY PHYSICIAN PRACTICE, LLC

ATHENS PHYSICIANS PRACTICE, LLC

ATHENS REGIONAL MEDICAL CENTER, LLC

ATHENS SURGERY CENTER PARTNER, LLC

XXXXXX MEDICAL CENTER, LLC

BARTOW GENERAL PARTNER, LLC

BARTOW HEALTHCARE SYSTEM, LTD.

BARTOW MEMORIAL LIMITED PARTNER, LLC

BOLIVAR PHYSICIAN PRACTICES, LLC

BOURBON COMMUNITY HOSPITAL, LLC

BOURBON PHYSICIAN PRACTICE, LLC

BRIM HOSPITALS, INC.

BUFFALO TRACE RADIATION ONCOLOGY ASSOCIATES, LLC

CARE HEALTH COMPANY, INC.

CASTLEVIEW HOSPITAL, LLC

CASTLEVIEW MEDICAL, LLC

CASTLEVIEW PHYSICIAN PRACTICE, LLC

XXXXX REGIONAL PHYSICIAN PRACTICES, LLC

CLINCH PROFESSIONAL PHYSICIAN SERVICES, LLC

CLINCH VALLEY MEDICAL CENTER, INC.

CLINCH VALLEY PHYSICIANS ASSOCIATES, LLC

CLINCH VALLEY PULMONOLOGY, LLC

CLINCH VALLEY UROLOGY, LLC

COLORADO PLAINS PHYSICIAN PRACTICES, LLC

COMMUNITY HOSPITAL OF ANDALUSIA, INC.

COMMUNITY MEDICAL, LLC

COMMUNITY-BASED SERVICES, LLC

XXXXXXXX HOSPITAL, LLC

XXXXXXXX PHO, LLC

DANVILLE DIAGNOSTIC IMAGING CENTER, LLC

DANVILLE PHYSICIAN PRACTICES, LLC

DANVILLE REGIONAL MEDICAL CENTER SCHOOL OF HEALTH PROFESSIONS, LLC

DANVILLE REGIONAL MEDICAL CENTER, LLC

DLP PARTNER MARQUETTE, LLC

DLP PARTNER TWIN COUNTY, LLC

DLP PARTNER, LLC

DODGE CITY HEALTHCARE GROUP, LLC

DODGE CITY HEALTHCARE PARTNER, INC.

GEORGETOWN COMMUNITY HOSPITAL, LLC

GEORGETOWN REHABILITATION, LLC

XXXXX VALLEY HOSPITAL, LLC

XXXXXXXX HOSPITAL, LLC

HCK XXXXX MEMORIAL, LLC

HDP ANDALUSIA, LLC

HDP GEORGETOWN, LLC

HILLSIDE HOSPITAL, LLC

HISTORIC LIFEPOINT HOSPITALS, INC.

HRMC, LLC

HSC MANAGER, LLC

HSCGP, 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 PHYSICIAN SERVICES, INC.

LAKE CUMBERLAND CARDIOLOGY ASSOCIATES, LLC

LAKE CUMBERLAND PHYSICIAN PRACTICES, LLC

LAKE CUMBERLAND REGIONAL HOSPITAL, LLC

LAKE CUMBERLAND REGIONAL PHYSICIAN HOSPITAL ORGANIZATION, LLC

LAKELAND COMMUNITY HOSPITAL, LLC

LAKELAND PHYSICIAN PRACTICES, LLC

XXXXX SURGERY CENTER, X.X.

XXXXXX VALLEY AMBULATORY SURGERY CENTER, LLC

LANDER VALLEY MEDICAL CENTER, LLC

LANDER VALLEY PHYSICIAN PRACTICES, LLC

LAS CRUCES ENDOSCOPY PARTNER, LLC

LAS CRUCES PHYSICIAN PRACTICES, LLC

LCMC MRI, LLC

LCMC PET, LLC

LHSC, LLC

LIFEPOINT ACQUISITION CORP.

LIFEPOINT BILLING SERVICES, LLC

LIFEPOINT CORPORATE SERVICES, GENERAL PARTNERSHIP

LIFEPOINT CSLP, LLC

LIFEPOINT HOLDINGS 2, LLC

LIFEPOINT HOLDINGS 3, INC.

LIFEPOINT HOSPITALS HOLDINGS, INC.

LIFEPOINT MEDICAL GROUP - HILLSIDE, INC

LIFEPOINT OF GAGP, LLC

LIFEPOINT OF GEORGIA, LIMITED PARTNERSHIP

LIFEPOINT OF KENTUCKY, LLC

LIFEPOINT OF LAKE CUMBERLAND, LLC

LIFEPOINT RC, INC.

LIFEPOINT VA HOLDINGS, INC.

LIFEPOINT WV HOLDINGS, INC.

XXXXXXXXXX REGIONAL HOSPITAL, LLC

XXXXX GENERAL HOSPITAL, LLC

XXXXX HEALTHCARE PARTNER, LLC

XXXXX MEDICAL, LLC

XXXXX MEMORIAL HOSPITAL, LLC

XXXXX PHYSICIAN PRACTICE, LLC

LOS ALAMOS PHYSICIAN PRACTICES, LLC

MARTINSVILLE PHYSICIAN PRACTICES, LLC

MEADOWVIEW PHYSICIAN PRACTICE, LLC

MEADOWVIEW REGIONAL MEDICAL CENTER, LLC

MEADOWVIEW RIGHTS, LLC

MEMORIAL HOSPITAL OF MARTINSVILLE & XXXXX COUNTY AMBULATORY SURGERY CENTER, LLC

MEMORIAL PROMPT CARE, LLC

MERCY PHYSICIAN PRACTICES, LLC

MEXIA PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP

MEXIA-PRINCIPAL, INC.

MINDEN PHYSICIAN PRACTICES, LLC

NORTHEASTERN NEVADA PHYSICIAN PRACTICES, LLC

NORTHWEST MEDICAL CENTER-WINFIELD, LLC

NORTON PARTNER, LLC

NWMC — WINFIELD ANESTHESIA PHYSICIANS, LLC

NWMC — WINFIELD HOSPITALIST PHYSICIANS, LLC

NWMC-WINFIELD PHYSICIAN PRACTICES, LLC

OPELOUSAS IMAGING CENTER PARTNER, LLC

OPELOUSAS PET/CT IMAGING CENTER, LLC

ORTHOPEDICS OF SOUTHWEST VIRGINIA, LLC

PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP

PALESTINE-PRINCIPAL G.P., INC.

PHC HOSPITALS, LLC

PHC-ASHLAND, L.P.

PHC-AVIATION, INC.

PHC-BELLE GLADE, INC.

PHC-CHARLESTOWN, L.P.

PHC-CLEVELAND, INC.

PHC-DOCTORS’ HOSPITAL, INC.

PHC-ELKO, INC.

PHC-FORT MOHAVE, INC.

PHC-FORT XXXXXX, INC.

PHC-INDIANA, INC.

PHC-XXXX, INC.

PHC-LAKE HAVASU, INC.

PHC-LAKEWOOD, INC.

PHC-LAS CRUCES, INC.

PHC-LOS ALAMOS, INC.

PHC-LOUISIANA, INC.

PHC-MARTINSVILLE, INC.

PHC-MINDEN G.P., INC.

PHC-MINDEN, L.P.

PHC-XXXXXX CITY, L.P.

PHC-MORGAN LAKE, INC.

PHC-OPELOUSAS, L.P.

PHC-PALESTINE, INC.

PHC-SELMA, LLC

PHC-TENNESSEE, INC.

PINELAKE PHYSICIAN PRACTICE, LLC

XXXXXXX PRACTICE, LLC

PRHC-ALABAMA, LLC

PRHC-XXXXX X.X., INC.

PRHC-XXXXX, X.X.

PRINCIPAL HOSPITAL COMPANY OF NEVADA, INC.

PRINCIPAL XXXX, L.L.C.

PRINCIPAL XXXX, X.X.

PRINCIPAL-NEEDLES, INC.

PROVINCE HEALTHCARE COMPANY

XXXXXX AMBULATORY SURGERY CENTER, LLC

XXXXXX COMMUNITY MEDICAL CENTER, LLC

XXXXXX PHYSICIAN PRACTICES, LLC

R. XXXXXXX XXXXX PRACTICE, LLC

RALEIGH GENERAL HOSPITAL, LLC

RIVER PARISHES HOLDINGS, LLC

RIVER PARISHES HOSPITAL, LLC

RIVER PARISHES PARTNER, LLC

RIVER PARISHES PHYSICIAN PRACTICES, LLC

RIVERTON MEMORIAL HOSPITAL, LLC

RIVERTON ONCOLOGY PRACTICE, LLC

RIVERTON PHYSICIAN PRACTICES, LLC

RIVERVIEW MEDICAL CENTER, LLC

RIVERVIEW PHYSICIAN PRACTICES, LLC

ROCKDALE CLINICALLY INTEGRATED MEDICAL CARE ORGANIZATION, LLC

ROCKDALE HOSPITAL, LLC

ROCKDALE PHYSICIAN PRACTICES, LLC

RUSSELLVILLE HOSPITAL, LLC

RUSSELLVILLE PHYSICIAN PRACTICES, LLC

SELECT HEALTHCARE, LLC

SELMA DIAGNOSTIC IMAGING, LLC

SILETCHNIK PRACTICE, LLC

XXXXX COUNTY MEMORIAL HOSPITAL, LLC

SOMERSET SURGERY PARTNER, LLC

SOUTHERN TENNESSEE EMS, LLC

SOUTHERN TENNESSEE MEDICAL CENTER, LLC

SOUTHERN TENNESSEE PHO, LLC

SPRING VIEW HOSPITAL, LLC

SPRING VIEW PHYSICIAN PRACTICES, LLC

SPRINGHILL MEDICAL CENTER, LLC

SST COMMUNITY HEALTH, L.L.C.

XXXXXX PHYSICIAN PRACTICES, LLC

XXXXXX PHYSICIAN PRACTICES, LLC

XXXXXX REAL ESTATE HOLDINGS, LLC

XXXXXX REGIONAL MEDICAL CENTER, LLC

TEXAS SPECIALTY PHYSICIANS

THE MRI CENTER OF NORTHWEST ALABAMA, LLC

THM PHYSICIAN PRACTICE, LLC

XXXXXXXXX MEDICAL CENTER, LLC

XXXXXXXXX PHYSICIAN PRACTICES, LLC

VALLEY VIEW PHYSICIAN PRACTICES, LLC

XXXXXXX PHYSICIAN PRACTICES, LLC

VILLE PLATTE MEDICAL CENTER, LLC

WEST VIRGINIA MANAGEMENT SERVICES ORGANIZATION, INC.

WESTERN PLAINS PHYSICIAN PRACTICES, LLC

WESTERN PLAINS REGIONAL HOSPITAL, LLC

WOODFORD HOSPITAL, LLC

XXXXX MEMORIAL HOSPITAL

WYOMING HOLDINGS, LLC

WYTHE COUNTY COMMUNITY HOSPITAL, LLC

WYTHE COUNTY PHYSICIAN PRACTICES, LLC

ZONE, INCORPORATED

	By:	/s/ Xxxxxxx X. Xxxxx
	Name:	Xxxxxxx X. Xxxxx
	Title:	Vice President and Secretary

	LIFEPOINT ASSET MANAGEMENT COMPANY, INC.
	By:	/s/ Xxxxxxx X. Xxxxx
	Name:	Xxxxxxx X. Xxxxx
	Title:	Assistant Secretary

	PINELAKE REGIONAL HOSPITAL, LLC
	By:	/s/ Xxxxxxx X. Xxxxxx
	Name:	Xxxxxxx X. Xxxxxx
	Title:	Senior Vice President, Secretary and Treasurer