EX-10.1 FOURTH AMENDMENT TO CREDIT AGREEMENT

EX-10.1 2 g91878exv10w1.txt EX-10.1 FOURTH AMENDMENT TO CREDIT AGREEMENT EXHIBIT 10.1 FOURTH AMENDMENT TO CREDIT AGREEMENT THIS FOURTH AMENDMENT to Credit Agreement (this "Amendment") dated as of November 12, 2004 is by and among Ardent Health Services, Inc., a Delaware corporation (the "Borrower"), the Guarantors, the Lenders party hereto and Citicorp North America, Inc., as Administrative Agent (in such capacity, "CNAI" or the "Administrative Agent") on behalf of itself and the Lenders. All capitalized terms used herein but not otherwise defined herein shall have the meanings provided to such terms in the Credit Agreement (as defined below). W I T N E S S E T H WHEREAS, a credit facility was established in favor of the Borrower pursuant to the terms of that certain Credit Agreement dated as of August 19, 2003 among the Borrower, the Guarantors, the Lenders and CNAI (as successor to Bank One, NA), as Administrative Agent, as amended by that certain First Amendment to Credit Agreement dated as of December 31, 2003, that certain Second Amendment to Credit Agreement dated as of July 12, 2004 and that certain Third Amendment to Credit Agreement dated as of August 12, 2004 (as further amended, modified and supplemented from time to time, the "Credit Agreement"); WHEREAS, the Borrower has requested the Required Lenders to amend the Credit Agreement as set forth herein; and WHEREAS, the Required Lenders have agreed to amend the Credit Agreement on the terms and conditions set forth herein. NOW, THEREFORE, IN CONSIDERATION of the premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. Amendments. The Credit Agreement is amended in the following respects: (a) The following definition is hereby added to Section 1.01 in the appropriate alphabetical order and shall read as follows: "Fourth Amendment Effective Date" means November 12, 2004. (b) The last sentence in the definition of "Consolidated EBITDA" in Section 1.01 is hereby amended to read as follows: Notwithstanding anything to the contrary in this Agreement, for purposes of calculating the Consolidated Interest Coverage Ratio, the Consolidated Leverage Ratio and the Consolidated Senior Leverage Ratio as of the end of the fiscal quarters ending September 30, 2004, December 31, 2004 and March 31, 2005, Consolidated EBITDA for the twelve month period ending as of the applicable fiscal quarter shall be an amount for such period as agreed to by the Parent and the Required Lenders. (c) A new proviso is hereby added immediately prior to the period (".") now appearing at the end of Section 7.01(b)(i) to read as follows: ; provided that, notwithstanding the foregoing, with respect to the fiscal quarter ended September 30, 2004 only, the Loan Parties shall have until January 14, 2005 to deliver to the Administrative Agent and the Lenders all the financial statements required by Section 7.01(b)(i) as of the end of the fiscal quarter ended September 30, 2004 (d) A new proviso is hereby added immediately prior to the period (".") now appearing at the end of Section 7.01(b)(ii) to read as follows: ; provided that, notwithstanding the foregoing, with respect to the fiscal quarter ended September 30, 2004 only, the Loan Parties shall have until January 14, 2005 to deliver to the Administrative Agent and the Lenders all the financial statements required by Section 7.01(b)(ii) as of the end of the fiscal quarter ended September 30, 2004 (e) A new subsection (d) is hereby added to the end of Section 7.01 to read as follows: (d) Restated Financial Statements. In the event that the Loan Parties shall be required, or shall elect at the advice of their independent auditor, to restate any financial statements of the Parent and its Subsidiaries delivered prior to the Fourth Amendment Effective Date pursuant to this Agreement upon the completion of the Loan Parties' internal review of accounting practices at Lovelace conducted and concluded prior to January 14, 2005, no breach of this Agreement prior to the Fourth Amendment Effective Date due to the failure to timely deliver the financial statements that are subject to such restatement under this Section 7.01(d) or due to the inaccuracy of any representation delivered or deemed delivered pursuant to Section 6.05(a), (b), (d) or (e) or Section 6.15 due to the inaccuracy of previously delivered financial statements shall be deemed to have occurred or resulted therefrom unless and until the Loan Parties shall fail to deliver any such restated financial statements in accordance with the terms hereof (together with restated and duly completed Compliance Certificate(s) in respect thereof in accordance with the terms hereof reflecting compliance for all applicable periods with all financial covenants set forth in Section 8.11) to the Administrative Agent and the Lenders on or prior to January 14, 2005. (f) A new proviso is hereby added immediately prior to the period (".") now appearing at the end of the first sentence of Section 7.08 to read as follows: ; provided that, notwithstanding the foregoing, the Loan Parties' failure to file within the time periods specified in the SEC's rules and regulations the financial statements of the Parent and its Subsidiaries for the fiscal quarter ended September 30, 2004 shall not constitute a breach of this Section 7.08 unless and until the Loan Parties shall fail to file such financial statements with the SEC on or before January 14, 2005. 2. Acknowledgement. The parties hereto acknowledge and agree that no new Loans will be made, nor will new Letters of Credit be issued, under and pursuant to the terms of the Credit Agreement on or before January 14, 2005. 3. Conditions Precedent. This Amendment shall be effective as of the date hereof upon receipt by the Administrative Agent of this Amendment executed by the Borrower, the Guarantors, the Required Lenders and the Administrative Agent. 4. Miscellaneous. (a) The Credit Agreement, as amended hereby, and the obligations of the Loan Parties thereunder and under the other Loan Documents shall remain in full force and effect according to their terms. (b) Each Guarantor (i) acknowledges and consents to all of the terms and conditions of this Amendment, (ii) affirms all of its obligations under the Loan Documents, (iii) agrees that this Amendment and all documents executed in connection herewith do not operate to reduce or discharge its obligations under the Credit Agreement or the other Loan Documents and (iv) hereby confirms and agrees that its Guaranty shall continue and remain in full force and effect after giving effect to this Amendment and that, notwithstanding any contrary terms in such Guaranty, such Guaranty now applies to the Credit Agreement as amended by this Amendment. (c) The Borrower and the Guarantors hereby represent and warrant as follows: (i) Each Loan Party has taken all necessary action to authorize the execution, delivery and performance of this Amendment. (ii) This Amendment has been duly executed and delivered by the Loan Parties and constitutes each of the Loan Parties' legal, valid and binding obligations, enforceable in accordance with its terms, except as such enforceability may be subject to (A) bankruptcy, insolvency, reorganization, fraudulent conveyance or transfer, moratorium or similar laws affecting creditors' rights generally and (B) general principles of equity (regardless of whether such enforceability is considered in a proceeding at law or in equity). (iii) No consent, approval, authorization or order of, or filing, registration or qualification with, any court or governmental authority or third party is required in connection with the execution, delivery or performance by any Loan Party of this Amendment, other than those that have already been obtained and are in full force and effect as of the date hereof. (d) The Loan Parties represent and warrant to the Lenders that no event has occurred and is continuing which constitutes a Default or an Event of Default. (e) The Borrower agrees to pay all reasonable costs and expenses of the Administrative Agent in connection with the preparation, execution and delivery of this Amendment, including without limitation the reasonable fees and expenses of Moore & Van Allen, PLLC. (f) This Amendment may be executed in any number of counterparts, each of which when so executed and delivered shall be an original, but all of which shall constitute one and the same instrument. Delivery of an executed counterpart of this Amendment by telecopy shall be effective as an original and shall constitute a representation that an executed original shall be delivered. (g) THIS AMENDMENT AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES HEREUNDER SHALL BE GOVERNED BY AND CONSTRUED AND INTERPRETED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. [Signature Pages Follow] IN WITNESS WHEREOF, each of the parties hereto has caused a counterpart of this Amendment to be duly executed and delivered as of the date and year first above written. BORROWER: ARDENT HEALTH SERVICES, INC., a Delaware corporation By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Executive Vice President GUARANTORS: ARDENT HEALTH SERVICES LLC, a Delaware limited liability company By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Executive Vice President and Chief Financial Officer AHS ALBUQUERQUE HOLDINGS, LLC, a New Mexico limited liability company AHS CUMBERLAND HOSPITAL, LLC, a Virginia limited liability company AHS KENTUCKY HOLDINGS, INC., a Delaware corporation AHS KENTUCKY HOSPITALS, INC., a Delaware corporation AHS LOUISIANA HOLDINGS, INC., a Delaware corporation AHS LOUISIANA HOSPITALS, INC., a Delaware corporation AHS MANAGEMENT COMPANY, INC., a Tennessee corporation AHS NEW MEXICO HOLDINGS, INC., a New Mexico corporation AHS SAMARITAN HOSPITAL, LLC, a Kentucky limited liability company AHS S.E.D. MEDICAL LABORATORIES, INC., a New Mexico corporation AHS SUMMIT HOSPITAL, LLC, a Delaware limited liability company ARDENT MEDICAL SERVICES, INC., a Delaware corporation BEHAVIORAL HEALTHCARE CORPORATION, a Delaware corporation By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Senior Vice President of each of the foregoing Guarantors ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT BHC MANAGEMENT SERVICES OF NEW MEXICO, LLC, a Delaware limited liability company BHC MANAGEMENT SERVICES OF STREAMWOOD, LLC, a Delaware limited liability company BHC MEADOWS PARTNER, INC., a Delaware corporation BHC MONTEVISTA HOSPITAL, INC., a Nevada corporation BHC OF INDIANA, GENERAL PARTNERSHIP, a Tennessee general partnership BHC ALHAMBRA HOSPITAL, INC., a Tennessee corporation BHC BELMONT PINES HOSPITAL, INC., a Tennessee corporation BHC CEDAR VISTA HOSPITAL, INC., a California corporation BHC COLUMBUS HOSPITAL, INC., a Tennessee corporation BHC FAIRFAX HOSPITAL, INC., a Tennessee corporation BHC FOX RUN HOSPITAL, INC., a Tennessee corporation BHC FREMONT HOSPITAL, INC., a Tennessee corporation BHC GULF COAST MANAGEMENT GROUP, INC., a Tennessee corporation BHC HEALTH SERVICES OF NEVADA, INC., a Nevada corporation BHC HERITAGE OAKS HOSPITAL, INC., a Tennessee corporation BHC HOSPITAL HOLDINGS, INC., a Delaware corporation BHC INTERMOUNTAIN HOSPITAL, INC., a Tennessee corporation BHC LEBANON HOSPITAL, INC., a Tennessee corporation BHC MANAGEMENT HOLDINGS, INC., a Delaware corporation BHC MANAGEMENT SERVICES, LLC, a Delaware limited liability company BHC MANAGEMENT SERVICES OF INDIANA, LLC, a Delaware limited liability company BHC MANAGEMENT SERVICES OF KENTUCKY, LLC, a Delaware limited liability company By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Senior Vice President of each of the foregoing Guarantors ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT BHC OF NORTHERN INDIANA, INC., a Tennessee corporation BHC PHYSICIAN SERVICES OF KENTUCKY, LLC, a Delaware limited liability company BHC PINNACLE POINTE HOSPITAL, INC., a Tennessee corporation BHC PROPERTIES, INC., a Tennessee corporation BHC SIERRA VISTA HOSPITAL, INC., a Tennessee corporation BHC SPIRIT OF ST. LOUIS HOSPITAL, INC., a Tennessee corporation BHC STREAMWOOD HOSPITAL, INC., a Tennessee corporation BHC WINDSOR HOSPITAL, INC., an Ohio corporation COLUMBUS HOSPITAL, LLC, a Delaware limited liability company INDIANA PSYCHIATRIC INSTITUTES, INC., a Delaware corporation LEBANON HOSPITAL, LLC, a Delaware limited liability company MESILLA VALLEY GENERAL PARTNERSHIP, a New Mexico general partnership MESILLA VALLEY MENTAL HEALTH ASSOCIATES, INC., a New Mexico corporation NORTHERN INDIANA HOSPITAL, LLC, a Delaware limited liability company VALLE VISTA, LLC, a Delaware limited liability company WILLOW SPRINGS, LLC, a Delaware limited liability company AHS RESEARCH AND REVIEW, LLC, a New Mexico limited liability company BHC NORTHWEST PSYCHIATRIC HOSPITAL, LLC, a Delaware limited liability company By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Senior Vice President of each of the foregoing Guarantors ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT AHS ACADEMIC HEALTH CENTER, LLC., a Delaware limited liability company AHS BRISTOW HOSPITAL, LLC, a Delaware limited liability company AHS CLEVELAND HOSPITAL, LLC, a Delaware limited liability company AHS CUSHING HOSPITAL, LLC, a Delaware limited liability company AHS EASTERN OKLAHOMA MEDICAL CENTER, LLC, a Delaware limited liability company AHS HENRYETTA HOSPITAL, LLC, a Delaware limited liability company AHS HILLCREST MEDICAL CENTER, LLC, a Delaware limited liability company AHS HILLCREST SPECIALTY HOSPITAL, LLC, a Delaware limited liability company AHS MANAGEMENT SERVICES OF OKLAHOMA, LLC, a Delaware limited liability company AHS OKLAHOMA HEALTH SYSTEM, LLP, a Delaware limited liability partnership AHS OKLAHOMA HOLDINGS, INC., a Delaware corporation AHS OKLAHOMA HOSPITALS, INC., a Delaware corporation AHS OKLAHOMA PHYSICIAN GROUP, LLC, a Delaware limited liability company AHS PAWNEE HOSPITAL, LLC, a Delaware limited liability company AHS RIVERSIDE PHO, LLC, a Delaware limited liability company AHS TULSA HOLDINGS, LLC, a Delaware limited liability company AHS TULSA REGIONAL MEDICAL CENTER, LLC, a Delaware limited liability company AHS WAGONER HOSPITAL, LLC, a Delaware limited liability company BHC MANAGEMENT SERVICES OF LOUISIANA, LLC, a Delaware limited liability company BHC MANAGEMENT SERVICES OF TULSA, LLC, a Delaware limited liability company By: /s/ R. Dirk Allison ----------------------------------------- Name: R. Dirk Allison Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT BLOOMINGTON MEADOWS, G.P., a Delaware general partnership By: BHC of Indiana, General Partnership, its partner By: BHC Valle Vista Hospital, Inc., as a partner By: /s/ R. Dirk Allison --------------------------------------- Name: R. Dirk Allison ------------------------------------- Title: Senior Vice President ------------------------------------ By: Indiana Psychiatric Institutes, Inc., its partner By: /s/ R. Dirk Allison --------------------------------------- Name: R. Dirk Allison ------------------------------------- Title: Senior Vice President ------------------------------------ ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT ADMINISTRATIVE AGENT: CITICORP NORTH AMERICA, INC., as Administrative Agent and Swing Line Lender By: /s/ Allen Fisher ----------------------------------------- Name: Allen Fisher Title: Vice President L/C ISSUERS: BANK ONE, NA, as an L/C Issuer By: /s/ Timothy K. Boyle FVP ----------------------------------------- Name: Timothy K. Boyle Title: First Vice President CITIBANK N.A., as an L/C Issuer By: /s/ Allen Fisher ----------------------------------------- Name: Allen Fisher Title: Vice President BANK OF OKLAHOMA, N.A., as an L/C Issuer By: /s/ Brad A. Vincent ----------------------------------------- Name: Brad A. Vincent Title: SVP ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT LENDERS: CITICORP NORTH AMERICA, INC. By: /s/ Allen Fisher ----------------------------------------- Name: Allen Fisher Title: Vice President BANK ONE, NA By: /s/ Timothy K. Boyle FVP ----------------------------------------- Name: Timothy K. Boyle Title: First Vice President BANK OF AMERICA, N.A. By: /s/ Gabriela Millhorn ----------------------------------------- Name: Gabriela Millhorn Title: Principal BANK OF OKLAHOMA, N.A. By: /s/ Brad A. Vincent ----------------------------------------- Name: Brad A. Vincent Title: SVP FIFTH THIRD BANK By: /s/ Sandy Hamrick ----------------------------------------- Name: Sandy Hamrick Title: Vice President GENERAL ELECTRIC CAPITAL CORPORATION By: /s/ Jeffrey P. Hoffman ----------------------------------------- Name: Jeffrey P. Hoffman Title: Its Duly Authorized Signatory OLD NATIONAL BANK By: /s/ Darrin McCauley ----------------------------------------- Name: Darrin McCauley Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT WELLS FARGO BANK N.A. By: /s/ Michael Rogholt ----------------------------------------- Name: Michael Rogholt Title: Vice President UBS AG, CAYMAN ISLANDS BRANCH By: /s/ Wilfred V. Saint ----------------------------------------- Name: Wilfred V. Saint Title: Director Banking Products Services, US By: /s/ Joselin Fernandes ----------------------------------------- Name: Joselin Fernandes Title: Associate Director Banking Products Services, US UBS AG, Stamford Branch By: /s/ Wilfred V. Saint ----------------------------------------- Name: Wilfred V. Saint Title: Director Banking Products Services, US By: /s/ Joselin Fernandes ----------------------------------------- Name: Joselin Fernandes Title: Associate Director Banking Products Services, US ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FORTRESS PORTFOLIO TRUST, as Lender By: Four Corners Capital Management LLC As Collateral Manager By: /s/ Adam Brown --------------------------------- Name: ADAM BROWN Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT MACQUARIE/FIRST TRUST GLOBAL INFRASTRUCTURE/UTILITIES DIVIDEND & INCOME FUND, as Lender By: Four Corners Capital Management LLC As Collateral Manager By: /s/ Adam Brown --------------------------------- Name: ADAM BROWN Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FIRST TRUST/FOUR CORNERS SENIOR FLOATING RATE INCOME FUND II, as Lender By: Four Corners Capital Management LLC As Collateral Manager By: /s/ Adam Brown ----------------------------------- Name: ADAM BROWN Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT LCM I LIMITED PARTNERSHIP By: Lyon Capital Management LLC, As Collateral Manager By: /s/ Alexander B. Kenna ----------------------------------------- Name: Alexander B. Kenna Title: Portfolio Manager ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT LCM II LIMITED PARTNERSHIP By: Lyon Capital Management LLC, As Attorney-In-Fact By: /s/ Alexander B. Kenna ----------------------------------------- Name: Alexander B. Kenna Title: Portfolio Manager ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT STANFIELD ARBITRAGE CDO, LTD. By: Stanfield Capital Partners LLC as its Collateral Manager By: /s/ Christopher E. Jansen ----------------------------------- Name: Christopher E. Jansen Title: Managing Partner ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT STANFIELD MODENA CLO, LTD. By: Stanfield Capital Partners LLC as its Asset Manager By: /s/ Christopher E. Jansen ----------------------------------- Name: Christopher E. Jansen Title: Managing Partner ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT EAGLE LOAN TRUST By: Stanfield Capital Partners LLC as its Collateral Manager By: /s/ Christopher E. Jansen ----------------------------------- Name: Christopher E. Jansen Title: Managing Partner ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT STANFIELD/RMF TRANSATLANTIC CDO LTD. By: Stanfield Capital Partners LLC as its Collateral Manager By: /s/ Christopher E. Jansen ----------------------------------- Name: Christopher E. Jansen Title: Managing Partner ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Centurion CDO II, Ltd. By: American Express Asset Management Group, Inc. as Collateral Manager By: /s/ Vincent P. Pham ------------------------ Name: Vincent P. Pham Title: Director - Operations ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Centurion CDO VI, Ltd. By: American Express Asset Management Group as Collateral Manager By: /s/ Vincent P. Pham ------------------------ Name: Vincent P. Pham Title: Director - Operations ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Centurion CDO VII, Ltd. By: American Express Asset Management Group, Inc. as Collateral Manager By: /s/ Vincent P. Pham ------------------------ Name: Vincent P. Pham Title: Director - Operations ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Western Asset Floating Rate High Income Fund By: /s/ [Illegible] ------------------------- Name: Title: ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT PPM MONARCH BAY FUNDING LLC By: /s/ Diana M. Himes --------------------------- Name: Diana M. Himes Title: Assistant Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT RIVIERA FUNDING LLC By: /s/ Diana M. Himes --------------------------- Name: Diana M. Himes Title: Assistant Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT SEMINOLE FUNDING LLC By: /s/ Diana M. Himes --------------------------- Name: Diana M. Himes Title: Assistant Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT ACCESS INSTITUTIONAL LOAN FUND By: Deerfield Capital Management LLC as its Portfolio Manager By: /s/ Dale Burrow ----------------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT BRYN MAWR CLO, Ltd. By: Deerfield Capital Management LLC as its Collateral Manager By: /s/ Dale Burrow ----------------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FOREST CREEK CLO, Ltd. By: Deerfield Capital Management LLC as its Collateral Manager By: /s/ Dale Burrow ----------------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT LONG GROVE CLO, LIMITED By: Deerfield Capital Management LLC as its Collateral Manager By: /s/ Dale Burrow ----------------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT ROSEMONT CLO, Ltd. By: Deerfield Capital Management LLC as its Collateral Manager By: /s/ Dale Burrow ----------------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT MARKET SQUARE CLO, Ltd. By: Deerfield Capital Management LLC as its Collateral Manager By: /s/ Dale Burrow ----------------------------------- Name: Dale Burrow Title: Senior Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT BIRCHWOOD FUNDING LLC By: /s/ Diana M. Himes ----------------------------------- Name: Diana M. Himes Title: Assistant Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT MUIRFIELD TRADING LLC By: /s/ Diana M. Himes ----------------------------------- Name: Diana M. Himes Title: Assistant Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FOOTHILL INCOME TRUST, L.P. By FIT GP, LLC, its General Partner By: /s/ M.E. Stevens ----------------------------------- Name: M.E. Stevens Title: Managing Member ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Franklin Floating Rate Trust By: /s/ Richard Hsu -------------------------------- Name: Richard Hsu Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FRANKLIN FLOATING RATE MASTER SERIES By: /s/ Richard Hsu ----------------------------------- Name: Richard Hsu Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FRANKLIN FLOATING RATE DAILY ACCESS FUND By: /s/ Richard Hsu ----------------------------------- Name: Richard Hsu Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FRANKLIN CLO I, LIMITED By: /s/ David Ardini ----------------------------------- Name: David Ardini Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FRANKLIN CLO III, LIMITED By: /s/ David Ardini ----------------------------------- Name: David Ardini Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT FRANKLIN CLO IV, LIMITED By: /s/ David Ardini ----------------------------------- Name: David Ardini Title: Vice President ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT Venture IV CDO, Limited By its investment advisor MJX Asset Management LLC /s/ Kenneth Ostmann ----------------------------------- Name: Kenneth Ostmann Title: Director ARDENT HEALTH SERVICES, INC. FOURTH AMENDMENT TO CREDIT AGREEMENT