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UNITED SURGICAL PARTNERS HOLDINGS, INC.
  THE GUARANTORS FROM TIME TO TIME PARTY HERETO,
  THE BANK OF NEW YORK TRUST COMPANY, N.A.,
  
 SECOND SUPPLEMENTAL INDENTURE




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THIS SECOND SUPPLEMENTAL INDENTURE Supplemental Indenture Company Guarantors Trustee
 Indenture Notes
    Tender Offer
   ARTICLE I
 DEFINITIONS
 Deletion of Definitions and Related References




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ARTICLE II
 AMENDMENTS TO INDENTURE AND NOTES
 Amendments to the Indenture




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Amendments to Notes
 ARTICLE III
 MISCELLANEOUS PROVISIONS
 Defined Terms
 Indenture
 Governing Law
 Successors
 Duplicate Originals
 Severability
 Trustee Disclaimer




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Effectiveness
 Endorsement and Change of Form of Notes
  Effect of Headings




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UNITED SURGICAL PARTNERSHOLDINGS, INC.By:
    
    /s/ William H. WilcoxName:
    
    William H. WilcoxTitle:
    
    President




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UNITED SURGICAL PARTNERSINTERNATIONAL, INC.By:
    
    /s/ William H. WilcoxName:
    
    William H. WilcoxTitle:
    
    President & CEO




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American Endoscopy Services, Inc.
    
    USP Chesterfield, Inc.Georgia Musculoskeletal Network, Inc.
    
    USP Chicago, Inc.Health Horizons of Kansas City, Inc.
    
    USP Cleveland, Inc.Health Horizons of Murfreesboro, Inc.
    
    USP Coast, Inc.Health Horizons of Nashville, Inc.
    
    USP Columbia, Inc.Medcenter Management Services, Inc.
    
    USP Corpus Christi, Inc.Ortho Excel, Inc.
    
    USP Cottonwood, Inc.OrthoLink ASC Corporation
    
    USP Creve Coeur, Inc.OrthoLink/Georgia ASC, Inc.
    
    USP Decatur, Inc., f.k.a. Health Horizons of Decatur, Inc.OrthoLink/New Mexico ASC, Inc.
    
    USP Destin, Inc.OrthoLink Physicians Corporation
    
    USP Domestic Holdings, Inc.OrthoLink Radiology Services Corporation
    
    USP Florissant, Inc.OrthoLink/TN ASC, Inc.
    
    USP Fontana, Inc.Physicians Data Professionals, Inc.
    
    USP Fredericksburg, Inc.Specialty Surgicenters, Inc.
    
    USP Glendale, Inc.SSI Holdings, Inc.
    
    USP Houston, Inc.Surgicoe of Texas, Inc.
    
    USP Huntsville, Inc.Surginet, Inc.
    
    USP Indiana, Inc.Surginet of Northwest Houston, Inc.
    
    USP International Holdings, Inc.Surginet of Rivergate, Inc.
    
    USP Kansas City, Inc.Surgis, Inc.
    
    USP Las Cruces, Inc.Surgis of Chico, Inc.
    
    USP Long Island, Inc.Surgis of St. Clairsville, Inc.
    
    USP Lyndhurst, Inc.Surgis of Pearland, Inc.
    
    USP Michigan, Inc.Surgis of Phoenix, Inc.
    
    USP Midwest, Inc.Surgis of Redding, Inc.
    
    USP Mission Hills, Inc.Surgis of Sand Lake, Inc.
    
    USP Nevada, Inc.Surgis of Sonoma, Inc.
    
    USP Newport News, Inc.Surgis of Victoria, Inc.
    
    USP New Jersey, Inc.Surgis of Willowbrook Inc.
    
    USP North Kansas City, Inc.Surgis of Woolbright, Inc.
    
    USP North Texas, Inc.Surgis Management Services, Inc.
    
    USP Oklahoma, Inc.United Surgical of Atlanta, Inc.
    
    USP Olive, Inc.USP Alexandria, Inc.
    
    USP Oxnard, Inc.USP Austin, Inc.
    
    USP Philadelphia, Inc.USP Austintown, Inc.
    
    USP Phoenix, Inc.USP Baton Rouge, Inc.
    
    USP Pittsburgh, Inc.USP Baltimore, Inc.
    
    USP Reading, Inc.USP Belleville, Inc.
    
    USP Richmond, Inc.USP Bridgeton, Inc.
    
    USP Richmond II, Inc.USP Cedar Park, Inc.
    
    USP Rockwall, Inc.USP Central New Jersey, Inc.
    
    USP Sacramento, Inc.




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USP San Antonio, Inc.
    
    USP Tennessee, Inc.USP San Gabriel, Inc.
    
    USP Torrance, Inc.USP Sarasota, Inc.
    
    USP Virginia Beach, Inc.USP Securities Corporation
    
    USP West Covina, Inc.USP St. Peters, Inc.
    
    USP Westwood, Inc.USP Sunset Hills, Inc.
    
    USP Winter Park, Inc.




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By:
    
    /s/ John J. WellikName:
    
    John J. WellikTitle:
    
    VP




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Endoscopy & Surgical Center of Orlando, LLCBy:
    
    Surginet, Inc.,its sole memberCorpus Christi Holdings, LLCBy:
    
    USP Corpus Christi, Inc.,its sole memberDay-Op Surgery Consulting Company, LLCBy:
    
    USP Long Island, Inc.,its sole memberISS-Orlando, LLCBy:
    
    Surginet, Inc.its sole memberPasadena Holdings, LLCBy:
    
    USP Houston, Inc.,its sole memberSame Day Surgery, LLCBy:
    
    USP Chicago, Inc.its sole memberSame Day Management, L.L.C.By:
    
    Same Day Surgery, LLC,its sole memberBy:
    
    USP Chicago, Inc.,its sole memberSurgery Centers of America II, LLCBy:
    
    Surgis, Inc.,its sole memberUSP Nevada Holdings, LLCBy:
    
    USP North Texas, Inc.,its sole memberWHASA, L.L.C.By:
    
    Surginet, Inc.,its sole member




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By:
    
    /s/ John J. WellikName:
    
    John J. WellikTitle:
    
    VPUSP Texas Air, L.L.C.By:
    
    /s/ John J. WellikName:
    
    John J. WellikTitle:
    
    VP




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USP Texas, L.P.By: USP North Texas, Inc., its general partner




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By:
    
    /s/ John J. WellikName:
    
    John J. WellikTitle:
    
    VP




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THE BANK OF NEW YORKTRUST COMPANY, N.A.,as TrusteeBy:
    
    /s/ Tamara K. EllisName:
    
    Tamara K. EllisTitle:
    
    Vice President