Floyd E. Allen General Counsel The Detroit Medical Center Corporate Administrative Offices 3990 John R — 1 Brush South Detroit, MI 48201 (313) 966-2080 (313) 966-2040 FAXVanguard Health Systems Inc • November 9th, 2010 • Hospital & medical service plans
RE: Extension of Time under Paragraph 5.2(b), Purchase and Sale Agreement Dated June 10, 2010 (“Agreement”) by and among The Detroit Medical Center and its subsidiary organizations (“Seller”), VHS of Michigan, Inc. and its subsidiary organizations (“Buyer”) and Vanguard Health Systems, Inc.
SUPPLEMENTAL INDENTURESupplemental Indenture • November 9th, 2010 • Vanguard Health Systems Inc • Hospital & medical service plans • New York
THIRD SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of August 18, 2010, among VHS Westlake Hospital, Inc., a Delaware corporation (“VHS-WL”); VHS West Suburban Medical Center, Inc., a Delaware corporation (“VHS-WS”); VHS Acquisition Subsidiary Number 4, Inc., a Delaware corporation (“VHS-4”); Midwest Pharmacies, Inc., an Illinois corporation (“MPI”; VHS-WL, WHS-WS; VHS-4 and MPI, collectively, referred to herein as the “New Guarantors”), each of the New Guarantors being a subsidiary of Vanguard Health Holding Company II, LLC, a Delaware limited liability company (“VHS Holdco II”); Vanguard Holding Company II, Inc., a Delaware corporation and a wholly owned subsidiary of VHS Holdco II (together with VHS Holdco II, the “Issuers”); Vanguard Health Holding Company I, LLC; Vanguard Health Systems, Inc.; and U.S. Bank National Association, as trustee under the Indenture referred to below (the “Trustee”).
