0001045829-12-000109 Sample Contracts

SUPPLEMENTAL INDENTURE
Supplemental Indenture • November 1st, 2012 • Vanguard Health Systems Inc • Hospital & medical service plans • New York

THIRD SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of July 23, 2012, among Advantage Health Care Management Company LLC, a Delaware limited liability company (“AHCM”), Arizona Health Partners, LLC, an Arizona limited liability company (“AHP”), BHS Accountable Care, LLC, a Delaware limited liability company (“BHS-AC”), BHS Integrated Physician Partners, LLC, a Delaware limited liability company (“BHS-IPP”), C7 Technologies, LLC, a Delaware limited liability company (“C7”), DMC Shared Savings ACO, LLC, a Delaware limited liability company (“DMC-ACO”), New Dimensions, LLC, an Illinois limited liability company (“ND”), Resolute Health Family Urgent Care, Inc., a Delaware corporation (“RESOLUTE”), Total Accountable Care Organization, LLC, a Delaware limited liability company (“TACO”), Vanguard IT Services, LLC, a Delaware limited liability company (“VITS”), Vanguard Medical Specialists, LLC, a Delaware limited liability company (“VMS”), VHS of Michigan Staffing, Inc., a

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MEMORANDUM OF UNDERSTANDING
Memorandum of Understanding • November 1st, 2012 • Vanguard Health Systems Inc • Hospital & medical service plans

THIS MEMORANDUM OF UNDERSTANDING (“Agreement”) is dated as of the 16th day of October, 2012, by and between Michael E. Duggan (“Mr. Duggan”) and Vanguard Health Management, Inc. (“Employer”).

AMENDMENT NO. 4 TO EMPLOYMENT AGREEMENT
Employment Agreement • November 1st, 2012 • Vanguard Health Systems Inc • Hospital & medical service plans

This Amendment No. 4 (this “Amendment’) dated as of October 1, 2012, is made by and between Vanguard Health Systems, Inc., a Delaware corporation (the “Company”), and Kent H. Wallace (the “Executive”).

AMENDMENT NO. 4 TO EMPLOYMENT AGREEMENT
Employment Agreement • November 1st, 2012 • Vanguard Health Systems Inc • Hospital & medical service plans

This Amendment No. 4 (this “Amendment’) dated as of October 1, 2012, is made by and between Vanguard Health Systems, Inc., a Delaware corporation (the “Company”), and Phillip W. Roe (the “Executive”).

SUPPLEMENTAL INDENTURE
Supplemental Indenture • November 1st, 2012 • Vanguard Health Systems Inc • Hospital & medical service plans • New York

EIGHTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of July 23, 2012, among Advantage Health Care Management Company LLC, a Delaware limited liability company (“AHCM”), Arizona Health Partners, LLC, an Arizona limited liability company (“AHP”), BHS Accountable Care, LLC, a Delaware limited liability company (“BHS-AC”), BHS Integrated Physician Partners, LLC, a Delaware limited liability company (“BHS-IPP”), C7 Technologies, LLC, a Delaware limited liability company (“C7”), DMC Shared Savings ACO, LLC, a Delaware limited liability company (“DMC-ACO”), New Dimensions, LLC, an Illinois limited liability company (“ND”), Resolute Health Family Urgent Care, Inc., a Delaware corporation (“RESOLUTE”), Total Accountable Care Organization, LLC, a Delaware limited liability company (“TACO”), Vanguard IT Services, LLC, a Delaware limited liability company (“VITS”), Vanguard Medical Specialists, LLC, a Delaware limited liability company (“VMS”), VHS of Michigan Staffing, Inc., a

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