Exhibit 4.3
AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT
AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT (this “Agreement”), dated as of February 6, 2026, is by and among HCA Healthcare, Inc., a Delaware corporation (the “Company”), Hercules Holding II, a Delaware general partnership (“Hercules”) and Frisco Holding II, a Delaware general partnership (“Frisco” and Hercules, Frisco and any Person who becomes a party hereto pursuant to Section 11(c), each an “Investor”).
WHEREAS, Hercules and the Company, together with other Persons, previously entered into a Registration Rights Agreement (the “Old Agreement”), dated as of November 22, 2010, providing for certain registration rights in respect of Hercules’ and such Persons’ holdings of common stock, par value $0.01 per share (the “Common Stock”), of the Company;
WHEREAS, Hercules has distributed to Frisco all shares of Common Stock attributable to, and in redemption of, Frisco’s interest in Hercules (the “Old Shares”);
WHEREAS, concurrently with the execution and delivery of this Agreement, (a) the Company and Frisco have entered into that certain Exchange Agreement, dated as of the date of this Agreement, pursuant to which Frisco transferred to the Company the Old Shares, and, in consideration therefor, the Company issued to Frisco 36,557,141 shares of Common Stock and (b) the Company, Hercules and Frisco have entered into that certain Amended and Restated Stockholders’ Agreement (the “Amended and Restated Stockholders’ Agreement”), dated as of the date of this Agreement, as amended, modified or supplemented from time to time, providing for certain corporate governance matters in respect of Hercules’ and Frisco’s holdings of the Common Stock;
WHEREAS, in connection with Hercules’ and Frisco’s ownership of the Common Stock, certain members of the Frist Group have entered into the Amended and Restated Partnership Agreement of Hercules (the “Hercules Partnership Agreement”) and the Partnership Agreement of Frisco (the “Frisco Partnership Agreement” and, together with the Hercules Partnership Agreement, the “Partnership Agreements”), in each case, dated as of February 6, 2026, as amended, modified or supplemented from time to time, setting forth certain rights of the Frist Group related to corporate governance and other matters of Hercules and Frisco in respect of the Company; and
WHEREAS, the parties hereto now wish to amend and restate the Old Agreement in the form of this Agreement to correspond to the Amended and Restated Stockholders’ Agreement and to provide certain registration rights in respect of the holdings of the Frist Group, both indirectly through Hercules and Frisco, and directly, and of any other Investors, in each case, of the Common Stock.
NOW, THEREFORE, for and in consideration of the mutual agreements contained herein and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto, intending to be legally bound hereby, agree as follows:
“Amended and Restated Stockholders’ Agreement” shall have the meaning set forth in the Recitals.
“Common Stock” shall have the meaning set forth in the Recitals.
“Demand Notice” shall have the meaning set forth in Section 2(a) hereof.
“Demand Registration” shall have the meaning set forth in Section 2(a) hereof.
“Exchange Act” shall mean the Securities Exchange Act of 1934, as amended, and any successor statute thereto and the rules and regulations of the SEC promulgated thereunder.
“Family Member” shall mean, with respect to any natural Person, (i) any family member (including any child, stepchild, grandchild or more remote issue, parent, stepparent, grandparent, spouse, former spouse, domestic partner, sibling, child of sibling, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, cousin and adoptive relationships) or heir, legatee, beneficiary, devisee or estate of such Person or (ii) any foundation, trust, family limited partnership, family limited liability company or other entity created and used for estate planning, charitable or educational purposes, so long as any such foundation, trust, family limited partnership, family limited liability company or other entity is controlled by, for the benefit of, or owned by one or more Persons described in clause (i) and/or clause (ii).
“Family Representative” means Frisco (or such other Person who is a member of the Frist Group following Frisco’s notice to the Company in writing to that effect from time to time).
“Frisco” shall have the meaning set forth in the Preamble.
“Frisco Partnership Agreement” shall have the meaning set forth in the Recitals.
“Frist Group” shall mean the following Persons, collectively: Hercules, Frisco, partners of Hercules and/or Frisco and each of their respective successors, permitted assigns and Permitted Transferees, as applicable, that from time to time directly or indirectly hold any interest in the Company.
“Hercules Partnership Agreement” shall have the meaning set forth in the Recitals.
“Losses” shall have the meaning set forth in Section 7(a) hereof.
“Management Stockholder’s Agreement” shall mean the Management Stockholder’s Agreement dated as of November 17, 2006, among the Company and certain members of senior management of the Company and any other substantially similar Management Stockholder’s Agreement subsequently entered into among the Company and any employee of the Company, in each case as amended from time to time.
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“Old Agreement” shall have the meaning set forth in the Recitals.
“Old Shares” shall have the meaning set forth in the Recitals.
“Permitted Transferee” shall mean: (i) a partner of Hercules or Frisco; (ii) a Family Member with respect to a Person described in clause (i); or (iii) a Person who is a Family Member with respect to the same natural Person as a person described in clause (i) and/or clause (ii).
“Person” shall mean any natural person, corporation, limited partnership, general partnership, limited liability company, joint stock company, joint venture, association, company, estate, trust, bank trust company, land trust, business trust, or other organization, whether or not a legal entity, custodian, trustee-executor, administrator, nominee or entity in a representative capacity and any government or agency or political subdivision thereof.
“Piggyback Notice” shall have the meaning set forth in Section 3(a) hereof.
“Piggyback Registration” shall have the meaning set forth in Section 3(a) hereof.
“Proceeding” shall mean an action, claim, suit, arbitration or proceeding (including, without limitation, an investigation or partial proceeding, such as a deposition), whether commenced or threatened.
“Prospectus” shall mean the prospectus included in any Registration Statement (including, without limitation, a prospectus that discloses information previously omitted from a prospectus filed as part of an effective Registration Statement in reliance upon Rule 430A promulgated under the Securities Act), as amended or supplemented by any prospectus supplement, with respect to the terms of the offering of any portion of the Registrable Securities covered by such Registration Statement, and all other amendments and supplements to the Prospectus, including post-effective amendments, and all material incorporated by reference or deemed to be incorporated by reference in such prospectus.
“Public Offering” shall mean the sale of Common Stock to the public pursuant to an effective registration statement (other than a registration statement on Form S‑4 or Form S‑8 or any similar or successor form) filed under the Securities Act or any comparable law or regulatory scheme of any foreign jurisdiction.
“Registrable Securities” shall mean all shares of Common Stock held directly or indirectly by a Registration Rights Holder (including (i) any shares of Common Stock held indirectly by a Registration Rights Holder through Hercules or Frisco and (ii) any shares of Common Stock issuable upon exercise of an Option (as defined in the Management Stockholder’s Agreement) held by a Registration Rights Holder to the extent then exercisable). As to any particular Registrable Securities, once issued such securities shall cease to be Registrable Securities when (i) they are sold pursuant to an effective Registration Statement under the Securities Act, (ii) they are sold pursuant to Rule 144, (iii) they shall have ceased to be outstanding or (iv) they have been sold in a private transaction in which the transferor’s rights under this Agreement are not assigned to the transferee of the securities. No Registrable Securities may be registered under more than one Registration Statement at any one time.
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“Registration Rights Holder” shall mean, each of the Investors, any member of the Frist Group holding Common Stock directly rather than indirectly through Hercules or Frisco, any employee party to a Management Stockholder’s Agreement (but only to the extent that such employee is entitled to registration rights thereunder), and any other person entitled to incidental or piggyback registration rights pursuant to an agreement with the Company.
“Registration Statement” shall mean any registration statement of the Company under the Securities Act which permits the public offering of any of the Registrable Securities pursuant to the provisions of this Agreement, including the Prospectus, amendments and supplements to such registration statement, including post-effective amendments, all exhibits and all material incorporated by reference or deemed to be incorporated by reference in such registration statement.
“Requisite Investors” shall mean, except as specifically provided herein, one or more Investors holding in the aggregate more than 5% of the shares of Common Stock (including indirect holdings through Hercules or Frisco).
“Rule 144” shall mean Rule 144 under the Securities Act, as such Rule may be amended from time to time, or any similar rule or regulation hereafter adopted by the SEC.
“SEC” shall mean the Securities and Exchange Commission or any successor agency having jurisdiction under the Securities Act.
“Securities Act” shall mean the Securities Act of 1933, as amended, and any successor statute thereto and the rules and regulations of the SEC promulgated thereunder.
“Senior Manager” shall have the meaning given thereto in the Management Stockholder’s Agreement.
“underwritten registration or underwritten offering” shall mean a registration in which securities of the Company are sold to an underwriter for reoffering to the public.
Where this Agreement provides for the vote, consent or approval of the Frist Group, the Frist Group’s vote, consent or approval shall be deemed to be given if approved by the Family Representative. Each Registration Rights Holder shall be deemed, for purposes hereunder, to be a holder of (i) a percentage of the number of shares of Common Stock directly but not indirectly held by Hercules equal to the percentage of the total “Units” issued by Hercules held by such Registration Rights Holder, (ii) a percentage of the number of shares of Common Stock directly but not indirectly held by Frisco equal to the percentage of the total “Units” issued by Frisco held by such Registration Rights Holder and (iii) any shares of Common Stock of the Company directly but not indirectly held by such Registration Rights Holder.
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No Demand Registration shall be deemed to have occurred for purposes of this Section 2 if the Registration Statement relating thereto (i) does not become effective (ii) is not maintained effective for the period required pursuant to this Section 2, or (iii) the offering of the Registrable Securities pursuant to such Registration Statement is subject to a stop order, injunction or similar order or requirement of the SEC during such period in which case such requesting holder of Registrable Securities shall be entitled to an additional Demand Registration, as the case may be, in lieu thereof.
Within 10 days after receipt by the Company of a Demand Notice, the Company shall give written notice (the “Notice”) of such Demand Notice to all other holders of Registrable Securities and shall, subject to the provisions of Section 2(b) hereof, include in such registration all Registrable Securities with respect to which the Company received written requests for inclusion therein within 15 days after such Notice is given by the Company to such holders.
All requests made pursuant to this Section 2 will specify the number of Registrable Securities to be registered and the intended methods of disposition thereof.
The Company shall be required to maintain the effectiveness of the Registration Statement with respect to any Demand Registration for a period of at least 270 days after the effective date thereof or such shorter period in which all Registrable Securities included in such Registration Statement have actually been sold.
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For purposes of any underwriter cutback, all Registrable Securities held by any member of the Frist Group shall also include any Registrable Securities held by the estates and Family Members of any such member of the Frist Group, any trusts for the benefit of any of the foregoing persons and, at the election of such member of the Frist Group, any charitable organization, in each case to which any of the foregoing shall have distributed, transferred or contributed Common Stock prior to the execution of the underwriting agreement in connection with such underwritten offering; provided, that such distribution, transfer or contribution occurred not more than 90 days prior to such execution, and such holder and other persons shall be deemed to be a single selling holder, and any pro rata reduction with respect to such selling holder shall be based upon the aggregate amount of Common Stock owned by all entities and individuals included in such selling holder, as defined in this sentence. No securities excluded from the underwriting by reason of the underwriter’s marketing limitation shall be included in such registration.
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If any registration pursuant to Section 2 of this Agreement shall be in connection with any underwritten Public Offering, the Company will not effect any public sale or distribution of any common equity (or securities convertible into or exchangeable or exercisable for common equity) (other than a registration statement (i) on Form S‑4, Form S‑8 or any successor forms thereto or (ii) filed solely in connection with an exchange offer or any employee benefit or dividend reinvestment plan) for its own account, within 90 days (or such shorter periods as the managing underwriters may agree to with the Family Representative) after the effective date of such registration.
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The Company may require each seller of Registrable Securities as to which any registration is being effected to furnish to the Company in writing such information required in connection with such registration regarding such seller and the distribution of such Registrable Securities as the Company may, from time to time, reasonably request in writing and the Company may exclude from such registration the Registrable Securities of any seller who unreasonably fails to furnish such information within a reasonable time after receiving such request.
Each holder of Registrable Securities agrees if such holder has Registrable Securities covered by such Registration Statement that, upon receipt of any notice from the Company of the happening of any event of the kind described in Section 5(c)(ii), 5(c)(iii), 5(c) (iv), 5(c)(v) or 5(c)(vi) hereof, such holder will forthwith discontinue disposition of such Registrable Securities covered by such Registration Statement or Prospectus until such holder’s receipt of the copies of the supplemented or amended Prospectus contemplated by Section 5(k) hereof, or until it is advised in writing by the Company that the use of the applicable Prospectus may be resumed, and has received copies of any additional or supplemental filings that are incorporated or deemed to be incorporated by reference in such Prospectus; provided, however, that the Company shall extend the time periods under Section 2 with respect to the length of time that the effectiveness of a Registration Statement must be maintained by the amount of time the holder is required to discontinue disposition of such securities.
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The Company shall not be required to pay (i) except as noted above, fees and disbursements of any counsel retained by any holder of Registrable Securities or by any underwriter (except as set forth in clauses 6(i)(B) and 6(vii)) (including, for the avoidance of doubt, any counsel retained by any holder of Registrable Securities to provide an opinion that a transfer of Registrable Securities complies with the requirements of Rule 144), (ii) any underwriter’s fees (including discounts, commissions or fees of underwriters, selling brokers, dealer managers or similar securities industry professionals) relating to the distribution of the Registrable Securities (other than with respect to Registrable Securities sold by the Company), or (iii) any other expenses of the holders of Registrable Securities not specifically required to be paid by the Company pursuant to the first paragraph of this Section 6.
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The parties hereto agree that it would not be just and equitable if contribution pursuant to this Section 7(d) were determined by pro rata allocation or by any other method of allocation that does not take account of the equitable considerations referred to in the immediately preceding paragraph. Notwithstanding the provisions of this Section 7(d), an indemnifying party that is a selling holder of Registrable Securities shall not be required to contribute any amount in excess of the amount by which the net proceeds from the sale of the Registrable Securities sold by such indemnifying party exceeds the amount of any damages that such indemnifying party has otherwise been required to pay by reason of such untrue or alleged untrue statement or omission or alleged omission. No person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any Person who was not guilty of such fraudulent misrepresentation.
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No Person may participate in any underwritten registration hereunder unless such Person (i) agrees to sell the Registrable Securities it desires to have covered by the registration on the basis provided in any underwriting arrangements in customary form and (ii) completes and executes all questionnaires, powers of attorney, indemnities, underwriting agreements and other documents required under the terms of such underwriting arrangements; provided that such Person shall not be required to make any representations or warranties other than those related to title and ownership of shares and as to the accuracy and completeness of statements made in a Registration Statement, Prospectus, offering circular, or other document in reliance upon and in conformity with written information furnished to the Company or the managing underwriter by such Person; and provided, further, that such Person’s liability in respect of such representations and warranties shall not exceed such Person’s gross proceeds from the offering.
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if to the Company, to its principal executive officers;
if to Hercules or Frisco:
c/o:
Frisco, Inc.
1100 N. Market Street
Suite 4050
Wilmington, DE 19890
Attn: President
Telephone: (302) 651-8321
with a copy (which shall not constitute notice) to:
Thomas F. Frist III
3100 West End Avenue
Suite 1225
Nashville, TN 37203
Telephone: (615) 269-7979
and (which shall not constitute notice) to:
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Sullivan & Cromwell LLP
125 Broad Street
New York, NY 10004
Attn: Joseph Hearn; Stephen Kotran; Charles Dowling
Email: hearnj@sullcrom.com; kotrans@sullcrom.com; dowlingc@sullcrom.com
Telephone: (212) 558-4000;
and, if to any Investor, at such Investor’s address as set forth on the records of Hercules, Frisco or the Company, as applicable.
Any such notice shall be deemed given and effective upon actual receipt (or refusal of receipt).
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Each of the parties hereto hereby consents to process being served by any party to this Agreement in any suit, action, or proceeding of the nature specified in the paragraph above by the mailing of a copy thereof in the manner specified by the provisions of subsection (b) of this Section 11.
EACH OF THE PARTIES HERETO HEREBY IRREVOCABLY WAIVES ALL RIGHT TO TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTERCLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT.
[Remainder of Page Intentionally Left Blank]
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date set forth in the first paragraph hereof.
FRISCO HOLDING II
By: /s/ J. William B. Morrow_____________
Name: J. William B. Morrow
Title: President
[Signature Page to the Amended and Restated Registration Rights Agreement]
HERCULES HOLDING II
By: /s/ J. William B. Morrow_____________
Name: J. William B. Morrow
Title: President
[Signature Page to the Amended and Restated Registration Rights Agreement]
HCA HEALTHCARE, INC.
By: /s/ John M. Franck II________________
Name: John M. Franck II
Title: Vice President – Legal and Corporate
Secretary
[Signature Page to the Amended and Restated Registration Rights Agreement]
EXHIBIT A
ADDENDUM AGREEMENT
This Addendum Agreement is made this ___ day of __________, 20____, by and between ____________________ (the “New Investor”) and HCA Healthcare, Inc. (the “Company”), pursuant to a Registration Rights Agreement dated as of ___, 2026 (as the same may be amended from time to time, the “Agreement”), between and among the Company and the Investors. Capitalized terms used herein but not otherwise defined herein shall have the meanings ascribed to them in the Agreement.
WITNESSETH:
WHEREAS, the Company has agreed to provide registration rights with respect to the Registrable Securities as set forth in the Agreement; and WHEREAS, the New Investor has acquired Registrable Securities directly or indirectly from an Investor; and
WHEREAS, the Company and the Investors have required in the Agreement that all persons desiring registration rights must enter into an Addendum Agreement binding the New Investor to the Agreement to the same extent as if it were an original party thereto;
NOW, THEREFORE, in consideration of the mutual promises of the parties, the New Investor acknowledges that it has received and read the Agreement and that the New Investor shall be bound by, and shall have the benefit of, all of the terms and conditions set out in the Agreement to the same extent as if it were an original party to the Agreement and shall be deemed to be an Investor thereunder.
New Investor
Address (for notices pursuant to Section 11(b) of the Agreement):
AGREED TO on behalf of HCA HEALTHCARE, INC. pursuant to Section 11(c) of the Agreement.
HCA HEALTHCARE, INC.
By:
Name: [●]
Title: [●]
[Signature Page to the Addendum Agreement]