Fourth Supplemental Indenture to 6.625% Senior Notes Due 2020—LifePoint Hospitals, Inc., Guarantors, and The Bank of New York Mellon Trust Company, N.A.

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.

[Guarantor Signature Pages Follow]

[Signature Page to Fourth Supplemental Indenture]