AMENDMENT NO. 1 TO EMPLOYMENT AGREEMENT

EXHIBIT 10.67

AMENDMENT NO. 1
TO
EMPLOYMENT AGREEMENT

            This Amendment No. 1 (this “Amendment’) dated as of May 5, 2009, is made by and between Vanguard Health Systems, Inc., a Delaware corporation (the “Company”), and Mark R. Montoney, MD (the “Executive”).

            WHEREAS , the Company and the Executive executed a certain Employment Agreement  dated as of December 31, 2008 ( the “EA”),  to secure the services of the Executive as Executive Vice President &  Chief Medical Officer; and

            WHEREAS , the Company and the Executive wish the Executive’s base salary set forth in Section 6(a) of the EA to be increased to $522,750, effective as of April 1, 2009.

            NOW, THEREFORE , in consideration of the premises and the mutual covenants herein contained, the Company and the Executive hereby agree that t