Exhibit 10.3


 


MAGELLAN HEALTH SERVICES, INC.


 


2008 MANAGEMENT INCENTIVE PLAN


 


RESTRICTED STOCK UNIT AGREEMENT


 


REFERENCE NUMBER:  2008- MARCH 5,
2008 (Name)


 


As of  MARCH 5, 2008


 


SECTION 1.         GRANT OF RESTRICTED STOCK UNITS.


 


(a)           Restricted Stock Units. 
On the terms and conditions set forth in this Agreement and each Notice
of Restricted Stock Unit Award referencing this Agreement, Magellan Health
Services, Inc. (the “Company,” as further defined below) grants to
the Grantee referred to on the signature page hereof the right to receive
on the Settlement Date (as hereinafter defined) the number of shares of
Ordinary Common Stock, $0.01 par value per share, of the Company (“Shares,”
as further defined below) equal to the number of “Stock Units” awarded to the Grantee
as set forth in the Notice of Restricted Stock Unit Award, subject to
adjustment thereto on account of any change that may be made in the Shares as
provided by Section 4 below (the “Unit Shares”).  Each such Notice of Restricted Stock Unit
Award, together with this referenced Agreement, shall be a separate “Restricted
Stock Unit” governed by the terms of this Agreement and any such separate
Restricted Stock Unit may be referred to herein as the “Restricted Stock Unit,”
and, as pertinent, any of multiple Notices of Restricted Stock Unit Award
referencing this Agreement may be referred to herein as the “Restricted Stock
Unit Award Notice.”


 


(b)           2008 Management Incentive Plan and Defined Terms.  The Restricted Stock Unit Award is granted
under and subject to the terms of the 2008 Management Incentive Plan, as
amended and supplemented from time to time (the “Plan”), which is
incorporated herein by this reference. 
Unless otherwise defined herein, capitalized terms used herein shall
have the meanings ascribed to them in the Plan.


 


(c)           Scope of this Agreement. 
This Agreement shall apply both to the Restricted Stock Unit and to any
Unit Shares acquired upon the settlement of the Restricted Stock Units.


 


SECTION 2.         VESTING AND SETTLEMENT OF RESTRICTED
STOCK UNITS.


 


(a)           Vesting.  The
Restricted Stock Unit shall vest in whole or in part on the date or dates
provided by the Notice of Restricted Stock Unit Award, provided that Grantee
remains in the Service of the Company, a Subsidiary or a Parent company at such
date; it being understood that the Notice of Restricted Stock Unit Award may
provide that the Restricted Stock Unit shall vest upon termination of Grantee’s
Service in such circumstances as are provided in the Notice of Restricted Stock
Unit Award.


 


(b)           Settlement in Shares. 
Subject to following provisions of this Section 2, the Company
shall settle the Restricted Stock Unit, to the extent it has vested, on the
date on which the 


 

















 


Restricted Stock Unit has vested (or, if such date
is not a Business Day, the next Business Day) by the delivery to Grantee of the
number of Unit Shares equal to the number of Restricted Stock Units so
vested.  The date on which a Restricted
Stock Unit is to be settled is herein referred to as the “Settlement Date.”  Subject to subsection 2(b) below, in
settlement of the Restricted Stock Unit, the Company shall cause to be issued
on the Settlement Date or as soon as practicable thereafter (but not more than
five business days) an appropriate certificate or certificates for the Unit
Shares, registered in the name of the Grantee (or, at the direction of the
Grantee, in the names of such person and his or her spouse as community
property or as joint tenants with right of survivorship or as tenants in the
entirety); provided, however, that such Unit Shares shall be subject to
such restrictions on transfer or other restrictions as are provided by the
Restricted Stock Unit Award Notice and the certificates so issued may bear a
legend reflecting such restrictions and any restrictions applicable in
accordance with subsections 2(g) and 3(c) below.


 


(c)           Alternative Settlement in Cash.  In lieu of settlement of the Restricted Stock
Unit in Unit Shares, the Committee may in its sole discretion elect to settle
all or a portion of the Restricted Stock Unit by a cash payment equal to the
Fair Market Value as of the Settlement Date of the Unit Shares that would
otherwise have been issued under this Agreement.  Such payment may be made by good check of the
Company issued in accordance with its normal payroll practices or such other
means as are acceptable to the Company


 


(d)           Withholding Requirements. 
The Company may withhold any tax (or other governmental obligation) the
Company is required to withhold as a result of the grant of the Restricted Stock
Unit and/or the issuance of Unit Shares (or cash in lieu of Unit Shares) in
settlement of a Restricted Stock Unit and, as a condition to the grant of the
Restricted Stock Unit or issuance of the Unit Shares in settlement thereof, the
Grantee shall make arrangements satisfactory to the Company to enable it to
satisfy all such withholding requirements.


 


(e)           Injurious Conduct. 
Except as otherwise explicitly provided by the Restricted Stock Unit
Award Notice or other Award document or by an agreement executed by the Company
with the approval of the Committee, in the event the Grantee has engaged in
Injurious Conduct as defined in, and as determined to have occurred in
accordance with, Section 12 of the Plan during Grantee’s Service or during
the year following termination of Grantee’s Service, then (i) no Unit
Shares shall be issued to Grantee in connection with the settlement of a
Restricted Stock Unit Award under the Plan after such determination (even if
such Award is fully vested) nor shall any other benefit of any Award thereafter
accrue to the Grantee under this Agreement or the Plan (including by reason of
the lapse of any restriction on transfer or other restriction then applicable
to Unit Shares that have been issued), and the Company shall not complete the
settlement of any other Award, and (ii) any such unsettled Restricted
Stock Unit Award shall be forfeited and shall terminate and any Unit Shares
subject to any such restrictions shall be forfeited (provided, however,
that the foregoing shall not excuse the Company from settling, completing
delivery of or removing any legend restricting the transfer of (A) any
Restricted Stock Award or (B) Restricted Stock Unit Awards and any related
Dividend Equivalent Rights the settlement of which have been deferred at the
election of the Grantee, if such Restricted Stock Award or Restricted Stock
Unit Awards were fully vested before the date such Injurious Conduct occurred
(as so determined)).  In addition, except
as otherwise specifically provided by a Restricted Stock Unit Award Notice or
other Award document or by an agreement executed by the Company with the
approval of the Committee, in the event the Grantee has engaged in Injurious
Conduct as 


 


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defined in, and as determined to have occurred in
accordance with, Section 12 of the Plan during Grantee’s Service or during
the year following termination of Grantee’s Service, any benefits realized by
Grantee as a result of any Award under the Plan at any time after such
Injurious Conduct occurred (as so determined), whether upon vesting or exercise
of an Option, lapse of restrictions on Option Shares, vesting of Restricted
Stock Awards or Stock Units or related Dividend Equivalent Rights, or the lapse
of any restrictions on Shares issued as a result thereof, or as a result of any
other settlement of an Award, shall be forfeited by Grantee and Grantee shall
pay over to the Company in cash the amount of any benefits so received by
Grantee or deliver to the Company any Shares so received by Grantee and still
owned by Grantee (provided, however, that the foregoing shall not
require the forfeiture of or excuse the Company from settling, completing
delivery of or removing any legend restricting the transfer of (i) any
Restricted Stock Award or (ii) Stock Units and any related Dividend
Equivalent Rights the settlement of which have been deferred at the election of
the Grantee, if such Restricted Stock Award or Stock Units were fully vested
before the date such Injurious Conduct occurred (as so determined)).  A forfeiture of benefits as provided hereby
upon the Committee determining that Grantee has engaged in Injurious Conduct
during Grantee’s Service or during the year following termination of Grantee’s
Service shall not relieve Grantee of any other liability he or she may have to
the Company, any Subsidiary or any Parent as a result of engaging in the
Injurious Conduct.


 


(f)            Transfer Restrictions On Unit Shares.  Subject to subsection 2(d) above and
subsections 2(g) and 3(c) below, unless otherwise provided by the
Restricted Stock Unit Award Notice or another agreement between Grantee and the
Company, upon the acquisition of Unit Shares pursuant to the settlement of a
Restricted Stock Unit Award, Grantee shall be free to dispose of the Unit
Shares so acquired in any manner and at any time.


 


(g)           Securities Law Restrictions On Issuance of Unit Shares.  Unless a registration statement under the
Securities Act permitting the sale and delivery of Unit Shares upon settlement
of the Restricted Stock Unit Award is in effect on the Settlement Date, the
Company shall not be required to issue Unit Shares upon such settlement, except
as otherwise provided in this subsection. 
The Company shall use its commercially reasonable efforts to register
under the Securities Act sufficient Unit Shares to permit delivery to Grantee
of all Unit Shares that may be acquired by Grantee upon the settlement of the
Restricted Stock Unit Award; provided, however, that the Company
shall only be so required to register the Unit Shares on Form S-8 under
the Securities Act (or any successor form). 
Notwithstanding the foregoing, the Company shall, if Grantee has given
the Company at least 90 days’ notice requesting the Company to register in
accordance with the foregoing provisions of this subsection the Unit Shares
that may then be acquired by Grantee upon settlement of the Restricted Stock
Unit Award and the Company has failed to do so, issue Unit Shares to Grantee
upon settlement of the Restricted Stock Unit Award without registration thereof
under the Securities Act if (i) Grantee represents, effective on the date
of such issuance, in writing in a form acceptable to the Company (A) that
such Unit Shares are being acquired for investment and not with a present view
to distribution, (B) Grantee understands that the Unit Shares have not
been registered under the Securities Act and cannot be sold or otherwise
Transferred unless a registration statement under the Securities Act is in
effect with respect thereto or the Company has received an opinion of counsel,
satisfactory to it, to the effect that such registration is not required, (C) that
Grantee has, alone or together with any qualified advisor, such knowledge and
experience in financial and business matters as is necessary to evaluate the
risks of an investment in the Unit Shares, is acquiring the Unit Shares 


 


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based on an independent evaluation of the long-term
prospects of an investment in the Unit Shares and has been furnished with such
financial and other information regarding the Company as the Grantee has
requested for purposes of making such evaluation, and (D) Grantee is able
to bear the economic risk of an investment in the Unit Shares subject to such
restrictions on Transfer and (ii) if the Company determines that under the
circumstances issuing the Unit Shares pursuant to such settlement of the
Restricted Stock Unit Award is lawful; provided, however, that
the Company may require, as a condition of such issuance of Unit Shares, that
Grantee execute and deliver to it such other certificates, agreements and other
instruments as in the judgment of the Company, upon advice of counsel, are
necessary or appropriate to assure that the 
Unit Shares are issued to Grantee in accordance with the Securities Act
and any other applicable securities law and may require that any certificates
representing Unit Shares so issued bear any restrictive legend appropriate for
such purpose.  In addition, even if a
registration statement under the Securities Act permitting the delivery of Unit
Shares upon settlement of the Restricted Stock Unit Award is in effect at the
Settlement Date, the Company may suspend the issuance of Unit Shares pursuant
to the settlement of all Restricted Stock Unit Awards issued under the Plan for
such period of time as in the judgment of the Company, upon advice of counsel,
is necessary in order for the Company to come into compliance with all the
reporting requirements applicable to the Company pursuant to Section 13(a) of
the Exchange Act or to otherwise avoid in connection with the issuance of
the  Unit Shares under such registration
statement a violation of Sections 10, 11 or 12 of the Securities Act.  If the Company suspends the issuance of Unit
Shares pursuant to the settlement of Restricted Stock Unit Awards issued under
the Plan, the Company shall give prompt written notice thereof to the Grantee
(but the failure of the Company to give such notice shall not prevent the
Company from suspending the issuance of Unit Shares as permitted hereby) and,
at such time as such period of suspension ends, shall give prompt written
notice thereof to Grantee. 
Notwithstanding that the Company in accordance with this subsection may
not be able to issue Unit Shares in settlement of a Restricted Stock Unit, the
Company shall not be required to settle a Restricted Stock Unit in cash, but
may do so if it elects in its discretion to do so, as provided by subsection 2(c) above.


 


(h)           Special Distribution Rules to
Comply with Code Section 409A.  In the event that any Restricted Stock Units
constitute a “deferral of compensation” under Section 409A of the Internal
Revenue Code (the “Code”),(1) the timing of settlement of such Restricted
Stock Units will be subject to applicable limitations under Code Section 409A
and Section 19(a) of the Plan, including the following restrictions
on settlement:


 


(i)            Settlement of the Restricted Stock Units upon
Grantee’s termination by the Company not for Cause or termination by Grantee
for Good Reason during the specified period following a Change in Control will
be subject to the requirement that the termination constitute a “separation
from service” under Treasury Regulation § 1.409A-1(h), and subject to the
six-month delay rule under Plan Section 19(a)(iii)(B).


 


(ii)           Other applicable provisions of Plan Section 19(a) will
apply to such Restricted Stock Units.


 


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SECTION 3.                            TRANSFER OF RESTRICTED STOCK UNIT AWARD OR UNIT SHARES


 


(a)           Transfers Generally Prohibited.  Except as otherwise provided by the
Restricted Stock Unit Award Notice or otherwise permitted by the Plan or in the
case of a transfer permitted by subsection 3(b) below, the Restricted
Stock Unit Award may be settled only during the Grantee’s lifetime and only by
the issuance of Unit Shares (or a cash payment in lieu thereof where permitted
by the Restricted Stock Unit Award Notice) to Grantee.  Except as otherwise provided in subsection 3(b) below,
the Restricted Stock Unit Award and the rights and privileges conferred by the
Restricted Stock Unit Award shall not be sold or otherwise Transferred.


 


(b)           Certain Transfers Permitted. 
Notwithstanding the foregoing provisions of this Section 3, the
Restricted Stock Unit Award may be Transferred (i) in the event of the
Grantee’s death, by will or the laws of descent and distribution or by a
written beneficiary designation accepted by the Company, (ii) by operation
of law in connection with a merger, consolidation, recapitalization,
reclassification or exchange of Shares, reorganization or similar transaction
involving the Company and affecting the Shares generally or (iii) with the
approval of the Committee, to a member of Grantee’s family, or a trust
primarily for the benefit of Grantee and/or one or more members of Grantee’s
family, or to a corporation, partnership or other entity primarily for the
benefit of Grantee and/or one or more such family members and/or trusts or (iv) with
the approval of the Committee, in another estate or personal financial planning
transaction; provided, however, that in any such case the
Restricted Stock Unit Award so Transferred and, upon issuance of Unit Shares in
settlement thereof, the Unit Shares issued to the Transferee shall remain
subject in the hands of the Transferee to the restrictions on Transfer provided
hereby and all other terms hereof, including the terms of subsection 2(c) above.  The foregoing notwithstanding, if RSUs
constitute deferrals of compensation for purposes of Code Section 409A,
RSUs and any related right of Grantee shall not be subject to anticipation,
alienation, sale, transfer, assignment, pledge, encumbrance, attachment, or
garnishment by creditors of the Grantee or his or her beneficiary, except as
permitted under Code Section 409A and regulations and guidance thereunder.


 


(c)           Fiduciary And Securities Law Restrictions.  As a employee, officer and/or director of the
Company, Grantee may be subject to restrictions on his or her ability to sell
or otherwise Transfer Unit Shares by reason of being a fiduciary for the
Company or by reason of federal or state securities laws and/or the policies
regarding transactions in securities of the Company from time to time adopted
by the Company and applicable to Grantee in connection therewith.  Nothing contained herein shall relieve
Grantee of any restriction on sale or other Transfer of Unit Shares provided
thereby and any other restrictions of sale or other Transfer of Unit Shares
provided herein (including in a Restricted Stock Unit Award Notice or in the
Plan) shall be in addition to and not in lieu of any other restrictions
provided thereby.


 


SECTION 4.         ADJUSTMENT OF SHARES.


 


(a)           Adjustment Generally. 
If while the Restricted Stock Unit remains in effect there shall be any
change in the outstanding Shares of the class which are to be issued upon
settlement of the Restricted Stock Unit, through merger, consolidation,
reorganization, recapitalization, stock dividend, stock split, reverse stock
split, combination of shares, exchange of shares for other 


 


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securities or other like change in the outstanding
Shares, or any spin-off, split-off, dividend in kind or other extraordinary
dividend or other distribution in respect of such outstanding Shares or other
extraordinary change in the capital structure of the Company, an adjustment
shall be made to the terms of the Restricted Stock Unit so that the Restricted
Stock Unit shall thereafter be ultimately settled, otherwise on the same terms
and conditions as provided by the Restricted Stock Unit Award Notice, this
Agreement and the Plan, for such securities, cash and/or other property as
would have been received in respect of the Shares that would have been issued
upon settlement of the Restricted Stock Unit had the Restricted Stock Unit been
settled in full immediately prior to such change or distribution (whether or
not the Restricted Stock Unit was then fully vested) or, if and to the extent
the Committee determines that so adjusting the consideration to be received
upon settlement of the Restricted Stock Unit, in whole or in part, is not
practicable, the Committee shall equitably modify the consideration to be
received in respect of the settlement of the Restricted Stock Unit or other
pertinent terms and conditions of the Restricted Stock Unit as provided by
subsection 4(b) below.  Such an
adjustment shall be made successively each time any such change in the
outstanding Shares of the class which may be received upon settlement of the
Restricted Stock Unit or extraordinary distribution in respect of such
outstanding Shares or extraordinary change in the capital structure of the
Company shall occur.


 


(b)           Modification Of Restricted Stock Unit.  In the event any change in the outstanding
Shares of the class which may be received upon settlement of the Restricted
Stock Unit or extraordinary distribution in respect of such outstanding Shares
or extraordinary change in the capital structure of the Company described in
subsection 4(a) above occurs, or in the event of any change in applicable
laws or any change in circumstances which results in or would result in any
substantial dilution or enlargement of the rights granted to, or available for,
Grantee in respect of a Restricted Stock Unit or otherwise as a participant in
the Plan or which otherwise warrants equitable adjustment to the terms and
conditions of the Restricted Stock Unit because such event or circumstances
interferes with the intended operation of the Plan (including the intended tax
consequences of Awards) occurs, then the Committee may, and shall where
required by subsection 7(a) above, adjust the number and kind of Unit
Shares and/or other securities and/or cash or other property that may be issued
or delivered upon the settlement of the Restricted Stock Unit and/or adjust the
other terms and conditions of the Restricted Stock Unit as the Committee in its
discretion determines to be equitable in order to prevent dilution or
enlargement of the Grantee’s rights in respect of the Restricted Stock Unit as
such existed before such event. 
Appropriate adjustments may likewise be made by the Committee in other
terms and conditions of the Restricted Stock Unit to reflect equitably such
changes in circumstances, including modifications of performance targets and
changes in the length of performance periods relating to the vesting of the
Restricted Stock Unit or any restrictions on Unit Shares.  Notwithstanding the foregoing, no adjustment
shall be made which is prohibited by Section 13 of the Plan.


 


(c)           Modifications To Comply With Section 409A.  To the extent applicable, this Agreement
(including any related Notice of Restricted Stock Award) shall be interpreted
in accordance with Code Section 409A and Department of Treasury
regulations and other interpretive guidance issued thereunder, including
without limitation any such regulations or guidance that may be issued after
the date on which a Restricted Stock Unit was awarded.  Without limiting the authority of the
Committee under subsection 4(b) above to make 


 


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modifications to the Restricted Stock Unit by reason
of changes in law or circumstances that would result in any substantial
dilution or enlargement of the rights granted to, or available for, Grantee in
respect of a Restricted Stock Unit or otherwise as a participant in the Plan or
which otherwise warrants equitable adjustment to the terms and conditions of
the Restricted Stock Unit because such event interferes with the operation of
the Plan, and notwithstanding any provision of this Agreement to the contrary,
in the event that the Committee or an authorized officer of the Company
determines that any amounts will be immediately taxable to the Participant
under Section 409A of the Code and related Department of Treasury guidance
(or subject the Grantee to a penalty tax) in connection with the grant or
vesting of the Restricted Stock Unit or any other provision of the Restricted
Stock Unit Award Notice or this Agreement or the Plan, the Company may (a) adopt
such amendments to the Restricted Stock Unit, including amendments to this
Agreement (having prospective or retroactive effect), that the Committee or
authorized officer determines to be necessary or appropriate to preserve the
intended tax treatment of the Restricted Stock Unit and/or (b) take such
other actions as the Committee or authorized officer determines to be necessary
or appropriate to comply with the requirements of Section 409A of the Code
and related Department of Treasury guidance, including such Department of
Treasury guidance and other interpretive materials as may be issued after the
date on which such Restricted Stock Unit was awarded, but only to the extent
permitted under Code Section 409A and regulations and guidance thereunder.                           .


 


SECTION 5.         MISCELLANEOUS PROVISIONS.


 


(a)           Rights
as a Shareholder.  Neither the
Grantee nor the Grantee’s personal representative or permitted Transferee shall
have any rights as a shareholder with respect to any Unit Shares until the
Grantee or his or her personal representative or permitted Transferee becomes
entitled to receive such Unit Shares pursuant to this Agreement, the Plan and
the applicable Restricted Stock Unit Award Notice, and any such right shall
also be subject to subsections 2(g) and 3(c) above.


 


(b)           Tenure.  Nothing in
the Restricted Stock Unit Award Notice, this Agreement or in the Plan shall
confer upon the Grantee any right to continue in the Company’s Service for any
period of specific duration or interfere with or otherwise restrict in any way
the rights of the Company (or any Parent or Subsidiary employing or retaining
the Grantee) or of the Grantee, which rights are hereby expressly reserved by
each, to terminate his or her Service at any time and for any reason, with or
without cause.


 


(c)           Notification.  Any
notification required by the terms of this Agreement shall be given in writing
and shall be deemed effective upon personal delivery to the President,
Treasurer, General Counsel, Secretary or any Assistant Secretary of the Company
or five Business Days upon deposit with the United States Postal Service, by
registered or certified mail, with postage and fees prepaid addressed to the
Company.  A notice shall be addressed to
the Company at its principal executive office, marked to the attention of the
Corporate Secretary, and to the Grantee at the address that he or she most
recently provided to the Company.


 


(d)           Entire Agreement. 
This Agreement, any related Restricted Stock Unit Award Notice and the Plan
constitute the entire contract between the parties hereto with regard to the
subject matter hereof and supersede any other agreements, representations or
understandings (whether oral or written and whether express or implied) which
relate to the subject matter hereof.


 


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(e)           Waiver.  No waiver of
any breach or condition of this Agreement shall be deemed to be a waiver of any
other or subsequent breach or condition whether of like or different nature.


 


(f)            Successors and Assigns. 
The provisions of this Agreement shall inure to the benefit of, and be
binding upon, the Company and its successors and assigns and upon the Grantee,
the Grantee’s personal representatives, heirs, legatees and other permitted
Transferees, assigns and the legal representatives, heirs and legatees of the
Grantee’s estate, whether or not any such person shall have become a party to
this Agreement and have agreed in writing to be joined herein and be bound by
the terms hereof.


 


(g)           Choice of Law.  This
Agreement shall be governed by, and construed in accordance with, the laws of
the State of Delaware, as such laws are applied to contracts entered into and
performed in such State.


 


SECTION 6.         DEFINITIONS.


 


(a)           “Code” shall mean the Internal Revenue Code of 1986, as
amended and as the same may be amended from time to time, and the
regulations promulgated thereunder.


 


(b)           “Company” shall mean Magellan Health Services, Inc., a
Delaware corporation, and any successor thereto.


 


(c)           “Exchange
Act” shall mean the Securities Exchange Act of 1934, as amended and as the
same may be amended from time to time, and any successor statute, and the rules and
regulations promulgated thereunder.


 


(d)           “Securities Act” shall mean the Securities Act of 1933, as
amended and as the same may be amended from time to time, and any successor
statute, and the rules and regulations promulgated thereunder.


 


(e)           “Share”  shall mean a share of Ordinary Common Stock,
$0.01 par value per share, of the Company, as the same may generally be
exchanged for or changed into any other share of capital stock or other
security of the Company or any other company in connection with a transaction
referred to in Section 4 above (and in the event of any such successive
exchange or change, any security resulting from any such successive exchange or
change).


 


(f)            “Transfer” shall mean, with respect to any Restricted Stock
Unit or any Unit Share, any sale, assignment, transfer, alienation, conveyance,
gift, bequest by will or under intestacy laws, pledge, lien encumbrance or
other disposition, with or without consideration, of all or part of such
Restricted Stock Unit or any Unit Share, or of any beneficial interest therein,
now or hereafter owned by the Grantee, including by execution, attachments,
levy or similar process


 


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In consideration of the
foregoing and intending to be legally bound hereby, the Company and the Grantee
named below have executed this Agreement as of the date first above written.


 


	
   

  	
   

  	
  MAGELLAN HEALTH SERVICES,
  INC.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name: Rene Lerer

  
	
   

  	
   

  	
  Title: President and Chief
  Executive Officer

  
	
   

  	
   

  	
   

  
	
  GRANTEE:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Name:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Address for Notice:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Social Security Number:

  	
   

  	
   

  	
   

  
				



 


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