Indenture, dated as of April 3, 2012



 Exhibit 4.1 
 EXECUTION 
  
  

USPI FINANCE CORP. 
 9.000% SENIOR NOTES DUE 2020 
 Dated as of April 3, 2012 

U.S. Bank National Association 
 Trustee 
  
  







 CROSS-REFERENCE TABLE* 

 

			
	   Trust Indenture

      Act Section    
	  	Indenture Section
	 310(a)(1)
	  	7.10
	 (a)(2)
	  	7.10
	 (a)(3)
	  	N.A.
	 (a)(4)
	  	N.A.
	 (a)(5)
	  	7.10
	 (b)
	  	7.10
	 (c)
	  	N.A.
	 311(a)
	  	7.11
	 (b)
	  	7.11
	 (c)
	  	N.A.
	 312(a)
	  	2.05
	 (b)
	  	12.03
	 (c)
	  	12.03
	 313(a)
	  	7.06
	 (b)(1)
	  	N.A.
	 (b)(2)
	  	7.06; 7.07
	 (c)
	  	7.06; 13.02
	 (d)
	  	7.06
	 314(a)
	  	4.03; 4.04; 12.02; 12.05
	 (b)
	  	N.A.
	 (c)(1)
	  	N.A.
	 (c)(2)
	  	N.A.
	 (c)(3)
	  	N.A.
	 (d)
	  	N.A.
	 (e)
	  	12.05
	 (f)
	  	N.A.
	 315(a)
	  	7.01
	 (b)
	  	7.05
	 (c)
	  	7.01
	 (d)
	  	7.01
	 (e)
	  	6.11
	 316(a)(last sentence)
	  	2.09
	 (a)(1)(A)
	  	6.05
	 (a)(1)(B)
	  	6.04
	 (a)(2)
	  	N.A.
	 (b)
	  	6.07
	 (c)
	  	N.A.
	 317(a)(1)
	  	6.08
	 (a)(2)
	  	6.09
	 (b)
	  	2.04
	 318(a)
	  	12.01
	 (b)
	  	N.A.
	 (c)
	  	12.01

 N.A. means not applicable. 
  

	*	This Cross Reference Table is not part of this Indenture. 








 TABLE OF CONTENTS 

 

					
	 	  	Page	 
	 ARTICLE 1.
	   

	
	 DEFINITIONS AND INCORPORATION BY REFERENCE
	   

		
	 SECTION 1.01 Definitions
	  	 	1	  
	 SECTION 1.02 Other Definitions
	  	 	35	  
	 SECTION 1.03 Incorporation by Reference of Trust Indenture Act
	  	 	36	  
	 SECTION 1.04 Rules of Construction and Calculation
	  	 	36	  
	
	 ARTICLE 2.
	   

	
	 THE NOTES
	   

		
	 SECTION 2.01 Form and Dating
	  	 	37	  
	 SECTION 2.02 Execution and Authentication
	  	 	38	  
	 SECTION 2.03 Registrar and Paying Agent
	  	 	38	  
	 SECTION 2.04 Paying Agent To Hold Money in Trust
	  	 	39	  
	 SECTION 2.05 Holder Lists
	  	 	39	  
	 SECTION 2.06 Transfer and Exchange
	  	 	39	  
	 SECTION 2.07 Replacement Notes
	  	 	52	  
	 SECTION 2.08 Outstanding Notes
	  	 	52	  
	 SECTION 2.09 Treasury Notes
	  	 	52	  
	 SECTION 2.10 Temporary Notes
	  	 	52	  
	 SECTION 2.11 Cancellation
	  	 	53	  
	 SECTION 2.12 Defaulted Interest
	  	 	53	  
	 SECTION 2.13 CUSIP Numbers
	  	 	53	  
	 SECTION 2.14 Issuance of Additional Notes
	  	 	53	  
	
	 ARTICLE 3.
	   

	
	 REDEMPTION AND PREPAYMENT
	   

		
	 SECTION 3.01 Notices to Trustee
	  	 	54	  
	 SECTION 3.02 Selection of Notes To Be Redeemed or Purchased
	  	 	54	  
	 SECTION 3.03 Notice of Redemption
	  	 	55	  
	 SECTION 3.04 Effect of Notice of Redemption
	  	 	56	  
	 SECTION 3.05 Deposit of Redemption or Purchase Price
	  	 	56	  
	 SECTION 3.06 Notes Redeemed or Purchased in Part
	  	 	56	  
	 SECTION 3.07 Optional Redemption
	  	 	56	  
	 SECTION 3.08 Mandatory Redemption
	  	 	57	  
	 SECTION 3.09 Offer To Purchase by Application of Excess Proceeds
	  	 	57	  


  
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	 	  	Page	 
	 ARTICLE 4.
	   

	
	 COVENANTS
	   

		
	 SECTION 4.01 Payment of Notes
	  	 	58	  
	 SECTION 4.02 Maintenance of Office or Agency
	  	 	59	  
	 SECTION 4.03 Reports
	  	 	59	  
	 SECTION 4.04 Compliance Certificate
	  	 	60	  
	 SECTION 4.05 Stay, Extension and Usury Laws
	  	 	60	  
	 SECTION 4.06 Restricted Payments
	  	 	61	  
	 SECTION 4.07 Dividend and Other Payment Restrictions Affecting Restricted Subsidiaries
	  	 	66	  
	 SECTION 4.08 Incurrence of Indebtedness and Issuance of Disqualified Stock and Preferred Stock
	  	 	68	  
	 SECTION 4.09 Asset Sales
	  	 	73	  
	 SECTION 4.10 Transactions with Affiliates
	  	 	75	  
	 SECTION 4.11 Liens
	  	 	77	  
	 SECTION 4.12 Corporate Existence
	  	 	78	  
	 SECTION 4.13 Offer To Repurchase Upon Change of Control
	  	 	78	  
	 SECTION 4.14 Designation of Restricted and Unrestricted Subsidiaries
	  	 	80	  
	 SECTION 4.15 Payments for Consent
	  	 	80	  
	 SECTION 4.16 Additional Subsidiary Guarantees
	  	 	80	  
	 SECTION 4.17 Distributions by Qualified Restricted Subsidiaries
	  	 	81	  
	 SECTION 4.18 Discharge and Suspension of Covenants
	  	 	81	  
	 SECTION 4.19 Activities Prior to the Merger
	  	 	82	  
	
	 ARTICLE 5.
	   

	
	 SUCCESSORS
	   

		
	 SECTION 5.01 Merger, Consolidation, or Sale of Assets
	  	 	82	  
	 SECTION 5.02 Successor Corporation Substituted
	  	 	84	  
	
	 ARTICLE 6.
	   

	
	 DEFAULTS AND REMEDIES
	   

		
	 SECTION 6.01 Events of Default
	  	 	85	  
	 SECTION 6.02 Acceleration
	  	 	87	  
	 SECTION 6.03 Other Remedies
	  	 	87	  
	 SECTION 6.04 Waiver of Past Defaults
	  	 	87	  
	 SECTION 6.05 Control by Majority
	  	 	87	  
	 SECTION 6.06 Limitation on Suits
	  	 	88	  
	 SECTION 6.07 Rights of Holders To Receive Payment
	  	 	88	  
	 SECTION 6.08 Collection Suit by Trustee
	  	 	88	  
	 SECTION 6.09 Trustee May File Proofs of Claim
	  	 	88	  
	 SECTION 6.10 Priorities
	  	 	89	  
	 SECTION 6.11 Undertaking for Costs
	  	 	89	  


  
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	 	  	Page	 
	 ARTICLE 7.
	   

	
	 TRUSTEE
	   

		
	 SECTION 7.01 Duties of Trustee
	  	 	89	  
	 SECTION 7.02 Rights of Trustee
	  	 	90	  
	 SECTION 7.03 Individual Rights of Trustee
	  	 	92	  
	 SECTION 7.04 Trustee’s Disclaimer
	  	 	92	  
	 SECTION 7.05 Notice of Defaults
	  	 	92	  
	 SECTION 7.06 Reports by Trustee to Holders of the Notes
	  	 	92	  
	 SECTION 7.07 Compensation and Indemnity
	  	 	92	  
	 SECTION 7.08 Replacement of Trustee
	  	 	93	  
	 SECTION 7.09 Successor Trustee by Merger, etc.
	  	 	94	  
	 SECTION 7.10 Eligibility; Disqualification
	  	 	94	  
	 SECTION 7.11 Preferential Collection of Claims Against Issuer
	  	 	94	  
	
	 ARTICLE 8.
	   

	
	 LEGAL DEFEASANCE AND COVENANT DEFEASANCE
	   

		
	 SECTION 8.01 Option To Effect Legal Defeasance or Covenant Defeasance
	  	 	95	  
	 SECTION 8.02 Legal Defeasance and Discharge
	  	 	95	  
	 SECTION 8.03 Covenant Defeasance
	  	 	95	  
	 SECTION 8.04 Conditions to Legal or Covenant Defeasance
	  	 	96	  
	 SECTION 8.05 Deposited Money and Government Securities To Be Held in Trust; Other Miscellaneous Provisions
	  	 	97	  
	 SECTION 8.06 Repayment to Issuer
	  	 	97	  
	 SECTION 8.07 Reinstatement
	  	 	98	  
	
	 ARTICLE 9.
	   

	
	 AMENDMENT, SUPPLEMENT AND WAIVER
	   

		
	 SECTION 9.01 Without Consent of Holders
	  	 	98	  
	 SECTION 9.02 With Consent of Holders
	  	 	99	  
	 SECTION 9.03 Amendments regarding Change of Control
	  	 	100	  
	 SECTION 9.04 Compliance with Trust Indenture Act
	  	 	100	  
	 SECTION 9.05 Revocation and Effect of Consents
	  	 	100	  
	 SECTION 9.06 Notation on or Exchange of Notes
	  	 	100	  
	 SECTION 9.07 Trustee To Sign Amendments, etc.
	  	 	101	  
	
	 ARTICLE 10.
	   

	
	 SUBSIDIARY GUARANTEES
	   

		
	 SECTION 10.01 Guarantee; Right of Payment
	  	 	101	  
	 SECTION 10.02 [Reserved]
	  	 	102	  
	 SECTION 10.03 Limitation on Guarantor Liability
	  	 	102	  
	 SECTION 10.04 Execution and Delivery of Subsidiary Guarantee
	  	 	102	  
	 SECTION 10.05 [Reserved]
	  	 	103	  
	 SECTION 10.06 Releases
	  	 	103	  


  
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	 	  	Page	 
	 ARTICLE 11.
	   

	
	 SATISFACTION AND DISCHARGE
	   

		
	 SECTION 11.01 Satisfaction and Discharge
	  	 	104	  
	 SECTION 11.02 Application of Trust Money
	  	 	105	  
	
	 ARTICLE 12.
	   

	
	 MISCELLANEOUS
	   

		
	 SECTION 12.01 Trust Indenture Act Controls
	  	 	105	  
	 SECTION 12.02 Notices
	  	 	105	  
	 SECTION 12.03 Communication by Holders with Other Holders
	  	 	106	  
	 SECTION 12.04 Certificate and Opinion as to Conditions Precedent
	  	 	106	  
	 SECTION 12.05 Statements Required in Certificate or Opinion
	  	 	107	  
	 SECTION 12.06 Rules by Trustee and Agents
	  	 	107	  
	 SECTION 12.07 No Personal Liability of Directors, Officers, Employees and Stockholders
	  	 	107	  
	 SECTION 12.08 Governing Law
	  	 	107	  
	 SECTION 12.09 No Adverse Interpretation of Other Agreements
	  	 	108	  
	 SECTION 12.10 Successors
	  	 	108	  
	 SECTION 12.11 Severability
	  	 	108	  
	 SECTION 12.12 Counterpart Originals
	  	 	108	  
	 SECTION 12.13 Table of Contents, Headings, etc.
	  	 	108	  

 EXHIBITS 
  

			
		
	Exhibit A1	  	FORM OF NOTE
		
	Exhibit A2	  	FORM OF REGULATION S TEMPORARY GLOBAL NOTE
		
	Exhibit B	  	FORM OF CERTIFICATE OF TRANSFER
		
	Exhibit C	  	FORM OF CERTIFICATE OF EXCHANGE
		
	Exhibit D	  	FORM OF NOTATION OF SUBSIDIARY GUARANTEE
		
	Exhibit E	  	FORM OF SUPPLEMENTAL INDENTURE TO BE DELIVERED BY SUBSEQUENT GUARANTORS
		
	Exhibit F	  	FORM OF SUPPLEMENTAL INDENTURE TO BE DELIVERED ON EFFECTIVE DATE


  
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 INDENTURE dated as of April 3, 2012 by and between USPI FINANCE CORP., a Delaware
corporation (“USPI Finance”), and U.S. BANK NATIONAL ASSOCIATION, a national banking association, as trustee (the “Trustee”). 
 The Issuer and the Trustee agree as follows for the benefit of each other and for the equal and ratable benefit of the Holders (as defined) of the 9.000% Senior Notes due 2020 (the “Initial
Notes”): 
 ARTICLE 1. 
 DEFINITIONS AND INCORPORATION BY REFERENCE 
 SECTION 1.01 Definitions. 

“144A Global Note” means a Global Note substantially in the form of Exhibit A1 hereto bearing the Global Note
Legend and the Private Placement Legend and deposited with or on behalf of, and registered in the name of, the Depositary or its nominee, issued in a denomination equal to the outstanding principal amount of the Notes sold in reliance on Rule 144A.

 “2012 Dividend” means a one-time cash dividend made on or about the Effective Date by the Issuer to
Holdings, the proceeds of which will be used to make a dividend or other payment to holders of Equity Interests of Holdings or any direct or indirect parent thereof. 
 “Acquired Debt” means, with respect to any specified Person: 
 (1) Indebtedness of any other Person existing at the time such other Person is merged with or into or became a Restricted Subsidiary of such specified Person, whether or not such Indebtedness is incurred
in connection with, or in contemplation of, such other Person merging with or into, or becoming a Restricted Subsidiary of, such specified Person; and 
 (2) Indebtedness secured by a Lien encumbering any asset acquired by such specified Person. 
 “Additional Assets” means any property or assets (other than Indebtedness and Capital Stock) to be used by the Issuer or a Restricted Subsidiary in a Permitted Business. 

“Additional Interest” means all additional interest then owing pursuant to the Registration Rights Agreement.

 “Additional Notes” means any Notes (other than the Initial Notes), if any, issued under this Indenture in
accordance with Sections 2.02, 2.14 and 4.09. 
 “Affiliate” of any specified Person means any other Person
directly or indirectly controlling or controlled by or under direct or indirect common control with such specified Person. For purposes of this definition, “control,” as used with respect to any Person, means the possession, directly or
indirectly, of the power to direct or cause the direction of the management or policies of such Person, whether through the ownership of voting securities, by agreement or otherwise. For purposes of this definition, the terms
“controlling,” “controlled by” and “under common control with” have correlative meanings. No Person in whom a Receivables Subsidiary makes an Investment in connection with a Qualified Receivables Transaction will be
deemed to be an Affiliate of the Issuer or any of its Subsidiaries solely by reason of such Investment. 







 “Agent” means any Registrar, co-registrar, Paying Agent or additional
paying agent. 
 “Applicable Premium” means, with respect to any Note on any Make-Whole Redemption Date, the
greater of (i) 1.0% of the principal amount of such Note and (ii) the excess of (A) the present value at such Make-Whole Redemption Date of (1) the redemption price of such Note on April 1, 2015 (exclusive of accrued
interest), plus (2) all scheduled interest payments due on such note from the Make-Whole Redemption Date through April 1, 2015 computed using a discount rate equal to the Treasury Rate at such Make-Whole Redemption Date, plus 50 basis
points over (B) the principal amount of such Note. 
 “Applicable Procedures” means, with respect to any
transfer or exchange of or for beneficial interests in any Global Note, the rules and procedures of the Depositary that apply to such transfer or exchange. 
 “Asset Sale” means: 
 (1) the sale, lease (other
than operating leases), conveyance or other disposition of any assets or rights outside of the ordinary course of business; provided that the sale, lease, conveyance or other disposition of all or substantially all of the assets of the Issuer
and its Restricted Subsidiaries taken as a whole shall be governed by Sections 4.13 and 5.01 of this Indenture and not by Section 4.09 of this Indenture; and 

(2) the issuance of Equity Interests in any of the Issuer’s Restricted Subsidiaries or the sale of Equity Interests
in any of its Restricted Subsidiaries (other than directors’ qualifying Equity Interests or Equity Interests required by applicable law to be held by a Person other than the Issuer or a Restricted Subsidiary). 

Notwithstanding the preceding, none of the following items shall be deemed to be an Asset Sale: 

(1) any single transaction or series of related transactions that involves assets having a Fair Market Value of less than
$5.0 million; 
 (2) a transfer of assets between or among the Issuer and its Restricted Subsidiaries;

 (3) an issuance of Equity Interests by a Restricted Subsidiary to the Issuer or to a Restricted Subsidiary;

 (4) the sale or lease of products, services or accounts receivable (including at a discount) in the ordinary
course of business and any sale or other disposition of damaged, worn-out, negligible, surplus or obsolete assets in the ordinary course of business; 
 (5) the sale or other disposition of Cash Equivalents; 
 (6) a
Restricted Payment that does not violate Section 4.06 of this Indenture or is a Permitted Investment; 
 (7)
any financing transaction with respect to property built or acquired by the Issuer or any Restricted Subsidiary after the Effective Date, including sale and leaseback transactions and asset securitizations not prohibited by this Indenture;


  
 -2-









 (8) any exchange of like-kind property of the type described in
Section 1031 of the Code for use in a Permitted Business; 
 (9) the sale or disposition of any assets or
property received as a result of a foreclosure by the Issuer or any of its Restricted Subsidiaries on any secured Investment or any other transfer of title with respect to any secured Investment in default; 

(10) the licensing of intellectual property in the ordinary course of business or in accordance with industry practice;

 (11) any issuance of or sale, lease, conveyance, disposition or other transfer of (a) the Capital Stock
of, or any Investment in, any Unrestricted Subsidiary or (b) Permitted Investments made pursuant to clause (15) of the definition thereof; 
 (12) surrender or waiver of contract rights or the settlement, release or surrender of contract, tort or other claims of any kind; 

(13) leases or subleases to third persons in the ordinary course of business that do not interfere in any material respect
with the business of the Issuer or any of its Restricted Subsidiaries; 
 (14) sales of accounts receivable and
related assets of the type specified in the definition of Qualified Receivables Transaction to a Receivables Subsidiary for the Fair Market Value thereof, less amounts required to be established as reserves and customary discounts pursuant to
contractual agreements with entities that are not Affiliates of the Issuer entered into as part of a Qualified Receivables Transaction; 
 (15) transfers of accounts receivable and related assets of the type specified in the definition of Qualified Receivables Transaction (or a fractional undivided interest therein) by a Receivables
Subsidiary in a Qualified Receivables Transaction; and 
 (16) for purposes of Section 4.09 only, the sale
of Capital Stock in a Qualified Restricted Subsidiary to a Strategic Investor in connection with the syndication or resyndication of such Capital Stock within eighteen (18) months of the commencement of syndication or the purchase thereof from
another Strategic Investor, as applicable, in the ordinary course of business. 
 “Bankruptcy Law” means Title
11, United States Bankruptcy Code of 1978, as amended, or any similar federal or state law for the relief of debtors. 

“Beneficial Owner” has the meaning assigned to such term in Rule 13d-3 and Rule 13d-5 under the Exchange Act, except
that in calculating the beneficial ownership of any particular “person” (as that term is used in Section 13(d)(3) of the Exchange Act), such “person” will be deemed to have beneficial ownership of all securities that such
“person” has the right to acquire by conversion or exercise of other securities, whether such right is currently exercisable or is exercisable only after the passage of time. 

“Board of Directors” means: 
 (1) with respect to a corporation, the board of directors of the corporation or any committee thereof duly authorized to act on behalf of such board; 

  
 -3-









 (2) with respect to a partnership, the board of directors or board of
managers of the general partner of the partnership; 
 (3) with respect to a limited liability company, the
managing member or members or any controlling committee of managing members thereof; and 
 (4) with respect to
any other Person, the board or committee of such Person serving a similar function. 
 “Broker-Dealer” means
any broker or dealer registered under the Exchange Act. 
 “Business Day” means any day other than a Legal
Holiday. 
 “Capital Lease Obligation” means, at the time any determination is to be made, the amount of the
liability in respect of a capital lease that would at that time be required to be capitalized on a balance sheet prepared in accordance with GAAP, and the Stated Maturity thereof shall be the date of the last payment of rent or any other amount due
under such lease prior to the first date upon which such lease may be prepaid by the lessee without payment of a penalty. 

“Capital Stock” means: 
 (1) in the case of a corporation, corporate stock; 
 (2) in the
case of an association or business entity, any and all shares, interests, participations, rights or other equivalents (however designated) of corporate stock; 
 (3) in the case of a partnership or limited liability company, partnership interests (whether general or limited) or membership interests; and 

(4) any other interest or participation that confers on a Person the right to receive a share of the profits and losses
of, or distributions of assets of, the issuing Person, but excluding from all of the foregoing any debt securities convertible into Capital Stock, whether or not such debt securities include any right of participation with Capital Stock. 

“Captive Insurance Subsidiary” means a Subsidiary established by the Issuer or any of its Subsidiaries for the sole
purpose of insuring the business, facilities and/or employees of the Issuer and its Subsidiaries. 
 “Cash
Equivalents” means: 
 (1) United States dollars or, in the case of any Restricted Subsidiary which is
not a Domestic Subsidiary, any other currencies held from time to time in the ordinary course of business; 
 (2)
securities issued or directly and fully guaranteed or insured by the United States government or any agency or instrumentality of the United States government (provided that the full faith and credit of the United States is pledged in support
of those securities) having maturities of not more than 12 months from the date of acquisition; 

  
 -4-









 (3) direct obligations issued by any state of the United States of America
or any political subdivision of any such state, or any public instrumentality thereof, in each case having maturities of not more than 12 months from the date of acquisition; 

(4) certificates of deposit and eurodollar time deposits with maturities of 12 months or less from the date of
acquisition, bankers’ acceptances with maturities not exceeding 12 months and overnight bank deposits, in each case, with any lender party to the Credit Agreement or with any domestic commercial bank that has capital and surplus of not less
than $500.0 million; 
 (5) repurchase obligations with a term of not more than one year for underlying
securities of the types described in clauses (2) and (4) above entered into with any financial institution meeting the qualifications specified in clause (4) above; 

(6) commercial paper having one of the two highest ratings obtainable from Moody’s Investors Service, Inc. or
Standard & Poor’s Rating Services and, in each case, maturing within 12 months after the date of acquisition; 
 (7) Indebtedness or preferred stock issued by Persons with a rating of “A” or higher from Standard & Poor’s Rating Services or “A2” or higher from Moody’s Investors
Service, Inc. with maturities of 12 months or less from the date of acquisition; and 
 (8) money market funds at
least 95% of the assets of which constitute Cash Equivalents of the kinds described in clauses (1) through (6) of this definition or money market funds that comply with the criteria set forth in SEC Rule 2a-7 under the Investment Company
Act of 1940, as amended, substantially all of whose assets are invested in investments of the type described in clauses (1) through (6) above. 
 “Change of Control” means the occurrence of any of the following: 
 (1) the direct or indirect sale, lease, transfer, conveyance or other disposition (other than by way of merger or consolidation), in one or a series of related transactions, of all or substantially all of
the properties or assets of the Issuer and its Subsidiaries, taken as a whole, to any Person other than Permitted Holders; 
 (2) the adoption of a plan relating to the liquidation or dissolution of the Issuer; or 
 (3) the Issuer becomes aware of (by way of a report or any other filing pursuant to Section 13(d) of the Exchange Act, proxy, vote, written notice or otherwise) the acquisition by any Person or group
(within the meaning of Section 13(d)(3) or Section 14(d)(2) of the Exchange Act, or any successor provision), including any such group acting for the purpose of acquiring, holding or disposing of securities (within the meaning of Rule
13d-5(b)(1) under the Exchange Act), other than one or more Permitted Holders, in a single transaction or in a related series of transactions, by way of merger, consolidation or other business combination or purchase of beneficial ownership (within
the meaning of Rule 13d-3 under the Exchange Act, or any successor provision) of more than 50.0% of the total voting power of the Voting Stock of the Issuer or any direct or indirect parent company of the Issuer. 

“Code” means the Internal Revenue Code of 1986, as amended from time to time and the rules and regulations promulgated
thereunder from time to time. 

  
 -5-









 “Consolidated Adjusted EBITDA” means, with respect to any specified Person
for any period (the “Measurement Period”), the Consolidated Net Income of such Person for such period 
 (1) increased,
without duplication and to the extent deducted in determining such Consolidated Net Income (other than with respect to clause (10)), by: 
 (a) the consolidated interest expense of such Person and its Restricted Subsidiaries for the Measurement Period; plus 
 (b) the consolidated income tax expense of such Person and its Restricted Subsidiaries for the Measurement Period; plus 
 (c) the consolidated depreciation expense of such Person and its Restricted Subsidiaries for the Measurement Period; plus 
 (d) the consolidated amortization expense of such Person and its Restricted Subsidiaries for the Measurement Period; plus 
 (e) fees, costs and expenses paid or payable in cash by the Issuer or any of its Subsidiaries during the Measurement Period in connection with the Transactions; plus 

(f) other non-cash expenses and charges for the Measurement Period reducing Consolidated Net Income (including any impairment charges or
the impact of purchase accounting), excluding any such charge that represents an accrual or reserve for a cash expenditure for a future period; plus 
 (g) any non-recurring out-of-pocket fees, expenses or charges for the Measurement Period relating to any offering of Equity Interests by the Issuer, Holdings or any other direct or indirect parent of the
Issuer or merger, recapitalization or acquisition transactions made by the Issuer or any of its Restricted Subsidiaries, or any Indebtedness incurred by the Issuer or any of its Restricted Subsidiaries (in each case, whether or not successful); plus

 (h) all fees paid by the Issuer pursuant to clauses (8) and (15) of Section 4.10; plus 

(i) the amount of any restructuring charges or reserves, integration and facilities opening costs or other business optimization expenses
(which, for the avoidance of doubt, shall include business optimization programs, new systems design and implementation costs, retention, severance, systems establishment cost, contract termination costs, including future lease commitments, costs to
close and/or consolidate facilities and relocate employees, project start-up costs and one-time costs incurred in connection with acquisitions after the Effective Date); plus 
 (j) the amount of “run-rate” net cost savings and synergies (other than any of the foregoing related to Specified Transactions) projected by the Issuer in good faith to be realized as a result
of specified actions taken or expected to be taken no later than 12 months after the end of such period (calculated on a pro forma basis as though such cost savings and synergies had been realized on the first day of the period for which
Consolidated Adjusted EBITDA is being determined), net of the amount of actual benefits realized during such period from such actions; provided that such benefit is expected to be 

  
 -6-









 
realized within 12 months of taking such action; provided, further that (A) such cost savings and synergies are reasonably identifiable, factually supportable and reasonably
attributable to the actions specified and reasonably anticipated to result from such actions, (B) no cost savings or synergies shall be added pursuant to this clause (j) to the extent duplicative of any expenses or charges relating to such
cost savings or synergies that are included elsewhere in this definition with respect to such period or duplicative of any pro forma adjustments made pursuant to the definition of “Fixed Charge Coverage Ratio” and (C) the
aggregate amount of cost savings and synergies added pursuant to this clause (j) shall not exceed 5% of Consolidated Adjusted EBITDA for any period of four consecutive fiscal quarters; plus 

(k) the amount of loss on sale of receivables, transfers of accounts receivable and related assets of the type specified in the definition
of Qualified Receivables Transaction (or a fractional undivided interest therein) to any Receivables Subsidiary in connection with a Qualified Receivables Transaction; plus 
 (l) any fees, expenses or charges incurred during such period, or any amortization thereof for such period, in connection with any acquisition, Investment, recapitalization, Asset Sale, incurrence or
repayment of Indebtedness, issuance of Equity Interests, refinancing transaction or amendment or modification of any debt instrument (including, in each case, any such transaction consummated prior to the Effective Date and any such transaction
undertaken but not completed), and any charges or non-recurring merger costs incurred during such period as a result of any such transaction, shall be excluded; and 
 (2) decreased, without duplication, by other non-cash items increasing Consolidated Net Income of such Person for the Measurement Period, excluding any such non-cash item to the extent it represents the
reversal of an accrual or reserve for potential cash item that reduced Consolidated Adjusted EBITDA in any prior period and any non-cash items with respect to cash actually received in a prior period so long as such cash did not increase
Consolidated Adjusted EBITDA in such prior period; and 
 (3) increased or decreased by, without duplication: 

(a) any net gain or loss resulting in such period from currency gains or losses related to Indebtedness, intercompany balances and other
balance sheet items, plus or minus, as the case may be, and 
 (b) any net gain or loss resulting in such period
from Hedging Obligations, and the application of Financial Accounting Standards Codification No. 815—Derivatives and Hedging. 
 “Consolidated Leverage Ratio” means, on any date, the ratio of (a) Consolidated Total Indebtedness of the Issuer and its Restricted Subsidiaries on such date to (b) Consolidated
Adjusted EBITDA of the Issuer and its Restricted Subsidiaries for the most recently ended four fiscal quarters ending immediately prior to such date for which internal financial statements are available, in each case with such pro forma
adjustments as are appropriate and consistent with the pro forma adjustment provisions set forth in the definition of “Fixed Charge Coverage Ratio”. 
 “Consolidated Net Income” means, with respect to any specified Person for any period, the aggregate of the Net Income of such specified Person and its Restricted Subsidiaries for such
period, on a consolidated basis, and otherwise determined in accordance with GAAP; provided that, without duplication: 

  
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 (1) solely for the purpose of determining the amount available for Restricted Payments under
clause (3)(A) of Section 4.06(a), the Net Income (but not loss) of any other Person that is not a Restricted Subsidiary of such specified Person, or is an Unrestricted Subsidiary, or that is accounted for by the equity method of accounting
will be excluded; provided that, notwithstanding the foregoing, Consolidated Net Income of the Issuer will be increased by the amount of dividends or other distributions or other payments actually paid in cash (or to the extent converted into
cash) or Cash Equivalents to the referent Person or a Restricted Subsidiary thereof in respect of such period; 
 (2) solely for
the purpose of determining the amount available for Restricted Payments under clause (3)(A) of Section 4.06(a), the Net Income for such period of any Restricted Subsidiary (other than any Guarantor) shall be excluded to the extent that the
declaration or payment of dividends or similar distributions by that Restricted Subsidiary of its Net Income is not at the date of determination wholly permitted without any prior governmental approval (which has not been obtained) or, directly or
indirectly, by the operation of the terms of its charter or any agreement, instrument, judgment, decree, order, statute, rule, or governmental regulation applicable to that Restricted Subsidiary or its stockholders, unless such restriction with
respect to the payment of dividends or similar distributions has been legally waived; provided that, notwithstanding the foregoing, Consolidated Net Income of the Issuer will be increased by the amount of dividends or other distributions or
other payments actually paid in cash (or to the extent converted into cash) or Cash Equivalents to the Issuer or a Restricted Subsidiary thereof in respect of such period, to the extent not already included therein; 

(3) the cumulative effect of a change in accounting principles will be excluded; 

(4) the amortization of any premiums, fees or expenses incurred in connection with the Transactions or any amounts required or permitted
by ASC 805 (including non-cash write-ups and non-cash charges relating to inventory and fixed assets, in each case arising in connection with the Transactions) and ASC 350 (including non-cash charges relating to intangibles and goodwill), in each
case in connection with the Transactions, will be excluded; 
 (5) any gain or loss, together with any related provision for
taxes on such gain or loss, realized in connection with: (a) any sale of assets outside the ordinary course of business; or (b) the disposition of any securities by such Person or any of its Restricted Subsidiaries or the extinguishment of
any (i) Indebtedness, (ii) obligations under any Hedging Obligations or (iii) other derivative instruments of such Person or any of its Restricted Subsidiaries will be excluded; 

(6) any extraordinary gain or loss, together with any related provision for taxes on such extraordinary gain or loss will be excluded;

 (7) income or losses attributable to discontinued operations (including, without limitation, operations disposed during such
period whether or not such operations were classified as discontinued) will be excluded; 
 (8) effects of adjustments (including
the effects of such adjustments pushed down to the Issuer and its Restricted Subsidiaries) in any line item in such Person’s consolidated financial statements required or permitted by ASC 805 and ASC 350 (formerly Financial Accounting


  
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Standards Board Statement Nos. 141 and 142, respectively) resulting from the application of purchase accounting in relation to the Transactions and any acquisition that is consummated after the
Effective Date or the amortization or write-off of any amounts thereof, net of taxes, will be excluded; 
 (9) any impairment
charge, asset write-off or write-down pursuant to ASC 350 and ASC 360 (formerly Financial Accounting Standards Board Statement Nos. 142 and 144, respectively) and the amortization of intangibles arising pursuant to ASC 805 (formerly Financial
Accounting Standards Board Statement No. 141), will be excluded; 
 (10) all non-cash charges relating to employee benefit
or other management or stock compensation plans of the Issuer or a Restricted Subsidiary (excluding any such non-cash charge to the extent that it represents an accrual of or reserve for cash expenses in any future period or amortization of a
prepaid cash expense incurred in a prior period) will be excluded to the extent that such non-cash charges are deducted in computing such Consolidated Net Income; provided, further, that if the Issuer or any Restricted Subsidiary makes a cash
payment in respect of such non-cash charge in any period, such cash payment will (without duplication) be deducted from the Consolidated Net Income of the Issuer for such period; 

(11) (i) any after-tax effect of income (loss) from the early extinguishment of Indebtedness or Hedging Obligations or other derivative
instruments (including deferred financing costs written off and premiums paid), (ii) any non-cash income (or loss) related to currency gains or losses related to Indebtedness, intercompany balances and other balance sheet items and to Hedging
Obligations pursuant to Financial Accounting Standards Codification No. 815—Derivatives and Hedging (or such successor provision) and (iii) any non-cash expense, income or loss attributable to the movement in mark to market valuation
of Indebtedness or derivative instruments pursuant to GAAP, will be excluded; 
 (12) to the extent covered by insurance
(including, without limitation, business interruption insurance) and actually reimbursed, or, so long as the Issuer has made a determination that there exists reasonable evidence that such amount will in fact be reimbursed by the insurer and only to
the extent that such amount is (a) not denied by the applicable carrier in writing within 180 days and (b) in fact reimbursed within 365 days of the date of the insurable event (with a deduction for any amount so added back to the extent
not so reimbursed within such 365 day period), expenses with respect to liability or casualty events or business interruption shall be excluded; provided, that any proceeds of such reimbursement when received shall be excluded to the extent
the expense reimbursed was previously excluded pursuant to this clause (12); 
 (13) any (i) non-cash compensation expense
recorded from grants of stock appreciation or similar rights, phantom equity, stock options, restricted stock or other rights to officers, directors, managers or employees and (ii) income (loss) attributable to deferred compensation plans or
trusts, shall be excluded; and 
 (14) cash expenses incurred during such period in connection with an acquisition to the extent
that such expenses are reimbursed in cash during such period pursuant to indemnification provisions of any agreement relating to such transaction shall be excluded. 
 Notwithstanding the foregoing, for the purpose of Section 4.06 only (other than clause (a)(3)(C) thereof), there shall be excluded from Consolidated Net Income any income arising from any sale or
other disposition of Restricted Investments made by the Issuer and the Restricted Subsidiaries, any repurchases 

  
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and redemptions of Restricted Investments from the Issuer and the Restricted Subsidiaries, any repayments of loans and advances which constitute Restricted Investments by the Issuer or any
Restricted Subsidiary, in each case only to the extent such amounts increase the amount of Restricted Payments permitted under such covenant pursuant to clause (a)(3)(C) thereof. 

“Consolidated Secured Leverage Ratio” means, on any date, the ratio of (a) Consolidated Total Indebtedness of the
Issuer and its Restricted Subsidiaries that is secured by Liens on such date to (b) Consolidated Adjusted EBITDA of the Issuer and its Restricted Subsidiaries for the most recently ended four fiscal quarters ending immediately prior to such
date for which internal financial statements are available, in each case with such pro forma adjustments as are appropriate and consistent with the pro forma adjustment provisions set forth in the definition of “Fixed Charge
Coverage Ratio” ; provided, however, that solely for purposes of the calculation of the Consolidated Secured Leverage Ratio, in connection with the incurrence of any Lien pursuant to clause (28) of the definition of
“Permitted Liens,” the Issuer or its Restricted Subsidiaries may elect, pursuant to an Officer’s Certificate delivered to the Trustee, to treat all or any portion of the commitment under any Indebtedness which is to be secured by such
Lien as being incurred at such time and any subsequent incurrence of Indebtedness under such commitment shall not be deemed, for purposes of this calculation to be an incurrence at such subsequent time.

“Consolidated Total Indebtedness” means, as at any date of determination, an amount equal to (a) (1) the
aggregate amount of all outstanding Indebtedness of the Issuer and its Restricted Subsidiaries on a consolidated basis consisting of Indebtedness for borrowed money, Obligations in respect of Capital Lease Obligations and debt obligations evidenced
by promissory notes and similar instruments (and, excluding for the avoidance of doubt, Hedging Obligations), as determined in accordance with GAAP and (2) the aggregate amount of all outstanding Disqualified Stock of the Issuer and all
preferred stock of its Restricted Subsidiaries on a consolidated basis, with the amount of such Disqualified Stock and preferred stock equal to the greater of their respective voluntary or involuntary liquidation preferences and Maximum Fixed
Repurchase Prices, in each case determined on a consolidated basis in accordance with GAAP, minus (b) the aggregate amount of cash and Cash Equivalents included in the consolidated balance sheet of the Issuer and its Restricted
Subsidiaries as of such date, provided that the aggregate amount of cash and Cash Equivalents of any Non-Guarantor Subsidiaries counted for purposes of this clause (b) may not exceed the aggregate principal amount at maturity of all
outstanding Indebtedness or preferred stock of any Non-Guarantor Subsidiaries included in clause (a) above. 
 For purposes
hereof, the “Maximum Fixed Repurchase Price” of any Disqualified Stock or preferred stock means the price at which such Disqualified Stock or preferred stock could be redeemed or repurchased by the issuer thereof in accordance with its
terms or, if such Disqualified Stock or preferred stock cannot be so redeemed or repurchased, the fair market value of such Disqualified Stock or preferred stock, in each case, determined on any date on which Consolidated Total Indebtedness shall be
required to be determined. 
 “Continuing Directors” means, as of any date of determination, any member of the
Board of Directors of the Issuer who: 
 (1) was a member of such Board of Directors on the Effective Date; 

(2) was nominated for election or elected to such Board of Directors with the approval of a majority of the Continuing Directors who were
members of such Board of Directors at the time of such nomination or election; or 

  
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 (3) was designated or appointed with the approval of Permitted Holders holding a majority of
the Voting Stock of all of the Permitted Holders. 
 “Corporate Trust Office of the Trustee” shall be at the
address of the Trustee specified in Section 12.02 or such other address as to which the Trustee may give notice to the Issuer. 
 “Credit Agreement” means that certain Credit Agreement, dated as of April 19. 2007, as amended through and on the Effective Date, by and among the Issuer, as borrower, Holdings,
certain subsidiaries of the Issuer, J.P. Morgan Chase Bank, N.A., as administrative agent and collateral agent, the other agents named therein and the various lenders from time to time party thereto, including any related notes, Guarantees,
collateral documents, instruments and agreements executed in connection therewith, and, in each case, as amended, restated, modified, renewed, refunded, replaced (whether upon or after termination or otherwise) or refinanced by any other
Indebtedness (including by means of sales of debt securities and including any amendment, restatement, modification, renewal, refunding, replacement or refinancing that increases the amount borrowed thereunder or extends the maturity thereof) in
whole or in part from time to time. 
 “Credit Facilities” means, one or more debt facilities (including,
without limitation, the Credit Agreement) or other financing arrangements (including, without limitation, commercial paper facilities with banks or other institutional lenders or indentures) providing for revolving credit loans, term loans, notes,
receivables financing (including through the sale of receivables to such lenders or to special purpose entities formed to borrow from such lenders against such receivables), letters of credit or other Indebtedness, in each case, as amended,
restated, modified, renewed, refunded, replaced (whether upon or after termination or otherwise) or refinanced (including by means of sales of debt securities and including any amendment, restatement, modification, renewal, refunding, replacement or
refinancing that increases the amount borrowed thereunder or extends the maturity thereof) in whole or in part from time to time. 
 “Custodian” means the Trustee, as custodian with respect to the Notes in global form, or any successor entity thereto. 

“Default” means any event that is, or with the passage of time or the giving of notice or both would be, an Event of
Default. 
 “Definitive Note” means a certificated Note registered in the name of the Holder thereof and issued
in accordance with Section 2.06, substantially in the form of Exhibit A1 hereto except that such Note shall not bear the Global Note Legend and shall not have the “Schedule of Exchanges of Global Note” attached thereto.

 “Depositary” means, with respect to the Notes issuable or issued in whole or in part in global form, the
Person specified in Section 2.03 as the Depositary with respect to the Notes, and any and all successors thereto appointed as depositary hereunder and having become such pursuant to the applicable provision of this Indenture. 

“Designated Noncash Consideration” means any non-cash consideration received by the Issuer or a Restricted Subsidiary in
connection with an Asset Sale that is designated as Designated Noncash Consideration pursuant to an Officer’s Certificate. 

“Disqualified Stock” means any Capital Stock that, by its terms (or by the terms of any security into which it is
convertible, or for which it is exchangeable, in each case, at the option of the holder of the Capital Stock), or upon the happening of any event, matures or is mandatorily redeemable, pursuant to a


  
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sinking fund obligation or otherwise, or redeemable at the option of the holder of the Capital Stock, in whole or in part, on or prior to the date that is 90 days after the date on which the
Notes mature. Notwithstanding the preceding sentence, (x) any Capital Stock that would constitute Disqualified Stock solely because the holders of the Capital Stock have the right to require the Issuer or the Subsidiary that issued such Capital
Stock to repurchase such Capital Stock upon the occurrence of a change of control or an asset sale will not constitute Disqualified Stock if the terms of such Capital Stock provide that the Issuer may not repurchase such Capital Stock unless the
Issuer would be permitted to do so in compliance with Section 4.06 (including as a result of a waiver thereunder), (y) any Capital Stock that would constitute Disqualified Stock solely as a result of any redemption feature that is
conditioned upon, and subject to, compliance with Section 4.06 (including as a result of a waiver thereunder) will not constitute Disqualified Stock and (z) any Capital Stock issued to any plan for the benefit of employees will not
constitute Disqualified Stock solely because it may be required to be repurchased by the Issuer or the Subsidiary that issued such Capital Stock in order to satisfy applicable statutory or regulatory obligations. The amount of Disqualified Stock
deemed to be outstanding at any time will be the maximum amount that the Issuer and its Restricted Subsidiaries may become obligated to pay upon the maturity of, or pursuant to any mandatory redemption provisions of, such Disqualified Stock,
exclusive of accrued dividends. 
 “Domestic Subsidiary” means any Restricted Subsidiary that was formed under
the laws of the United States or any state of the United States. 
 “Effective Date” means, the Issue Date.

 “Equity Interests” means Capital Stock and all warrants, options or other rights to acquire Capital Stock
(but excluding any debt security that is convertible into, or exchangeable for, Capital Stock). 
 “Equity
Offering” means a public or private offering of Qualified Capital Stock of the Issuer, Holdings or any other direct or indirect parent of the Issuer. 
 “Exchange Act” means the Securities Exchange Act of 1934, as amended. 
 “Exchange Notes” means the Notes issued in the Exchange Offer pursuant to the Registration Rights Agreement. 
 “Exchange Offer” means the “Registered Exchange Offer” as defined in the Registration Rights Agreement. 
 “Exchange Offer Registration Statement” has the meaning set forth in the Registration Rights Agreement. 
 “Excluded Contributions” means net cash proceeds, marketable securities or Qualified Proceeds received by the Issuer from (i) contributions to its equity capital (other than
Disqualified Stock) or (ii) the sale (other than to a Subsidiary of the Issuer or to any management equity plan or stock option plan or any other management or employee benefit plan or agreement of the Issuer) of Equity Interests (other than
Disqualified Stock) of the Issuer, in each case designated as Excluded Contributions pursuant to an Officer’s Certificate on the date such capital contributions are made or the date such Equity Interests are sold, as the case may be, that are
excluded from the calculation set forth in clause (3) of Section 4.06(a) hereof. 
 “Existing
Indebtedness” means Indebtedness, other than the Notes and Indebtedness under the Credit Agreement, existing on the Effective Date after giving effect to the Transactions. 

  
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 “Facility-Level EBITDA” means, for any period, the sum of
(a) Consolidated Adjusted EBITDA of the Issuer and its Restricted Subsidiaries plus (b) minority interest in income of consolidated Subsidiaries, plus (c) corporate level general and administrative expenses, minus
(d) equity in unconsolidated Affiliates, in each case for such period on a consolidated basis determined in accordance with GAAP. 
 “Fair Market Value” means the value that would be paid by a willing buyer to an unaffiliated willing seller in a transaction not involving distress or necessity of either party,
determined in good faith by the Board of Directors, chief executive officer or chief financial officer of the Issuer (unless otherwise provided in this Indenture). 
 “Fixed Charge Coverage Ratio” means with respect to any specified Person for any period, the ratio of (1) the Consolidated Adjusted EBITDA of such Person for such period to
(2) the Fixed Charges of such Person for such period. In the event that the specified Person or any of its Restricted Subsidiaries incurs, assumes, guarantees, repays, repurchases, redeems, defeases or otherwise discharges any Indebtedness
(other than Indebtedness incurred under any revolving credit facility unless such Indebtedness has been permanently repaid and has not been replaced) or issues, repurchases or redeems preferred stock or Disqualified Stock subsequent to the
commencement of the period for which the Fixed Charge Coverage Ratio is being calculated and on or prior to the date on which the event for which the calculation of the Fixed Charge Coverage Ratio is made (the “Calculation Date”), then the
Fixed Charge Coverage Ratio will be calculated giving pro forma effect to such incurrence, assumption, Guarantee, repayment, repurchase, redemption, defeasance or other discharge of Indebtedness, or such issuance, repurchase or redemption of
preferred stock or Disqualified Stock, and the pro forma application of the net proceeds therefrom, as if the same had occurred at the beginning of the applicable four-quarter reference period. 

In addition, for purposes of calculating the Fixed Charge Coverage Ratio: 

(1) Investments, acquisitions, mergers, consolidations and dispositions that have been made by the specified Person or any of its
Restricted Subsidiaries, or any Person or any of its Restricted Subsidiaries acquired by, merged or consolidated with the specified Person or any of its Restricted Subsidiaries, and including any related financing transactions and including
increases in ownership of Restricted Subsidiaries, during the four-quarter reference period or subsequent to such reference period and on or prior to the Calculation Date will be given pro forma effect, as if they had occurred on the first
day of the four-quarter reference period; 
 (2) the Consolidated Adjusted EBITDA attributable to discontinued operations, as
determined in accordance with GAAP, and operations or businesses (and ownership interests therein) disposed of prior to the Calculation Date, will be excluded; 
 (3) the Fixed Charges attributable to discontinued operations, as determined in accordance with GAAP, and operations or businesses (and ownership interests therein) disposed of prior to the Calculation
Date, will be excluded, but only to the extent that the obligations giving rise to such Fixed Charges will not be obligations of the specified Person or any of its Restricted Subsidiaries following the Calculation Date; 

(4) any Person that is a Restricted Subsidiary on the Calculation Date will be deemed to have been a Restricted Subsidiary at all times
during such four-quarter period; 
 (5) any Person that is not a Restricted Subsidiary on the Calculation Date will be deemed not
to have been a Restricted Subsidiary at any time during such four-quarter period; and 

  
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 (6) if any Indebtedness bears a floating rate of interest, the interest expense on such
Indebtedness will be calculated as if the rate in effect on the Calculation Date had been the applicable rate for the entire period (taking into account any Hedging Obligation applicable to such Indebtedness). 

For purposes of this definition, whenever pro forma effect is given to a transaction, the pro forma calculations shall be made in good
faith by a responsible financial or accounting officer of the Issuer and include, for the avoidance of doubt, the amount of “run-rate” cost savings, operating expense reductions and synergies projected by the Issuer in good faith to be
realized as a result of specified actions taken, committed to be taken or expected to be taken (calculated as though such cost savings, operating expense reductions and synergies had been realized on the first day of such period and as if such cost
savings, operating expense reductions and synergies were realized during the entirety of such period) and “run-rate” means the full recurring benefit for a period that is associated with any action taken, committed to be taken or expected
to be taken (including any savings expected to result from the elimination of a public target’s compliance costs with public company requirements) net of the amount of actual benefits realized during such period from such actions, and any such
adjustments shall be included in the initial pro forma calculations of such financial ratios or tests and during any subsequent Measurement Period in which the effects thereof are expected to be realized relating to such transaction; provided
that at the election of the Issuer, such pro forma calculations shall not be required to be determined for any transaction to the extent the aggregate consideration paid in connection with such transaction was less than $5.0 million and
provided, further, that (A) the chief financial officer of the Issuer shall have certified that such amounts are reasonably identifiable and factually supportable in the good faith judgment of the Issuer, (B) such actions are
taken, committed to be taken or expected to be taken no later than 12 months after the date of such transaction, and (C) such pro forma adjustments may be in addition to (but not duplicative of) any amounts that are otherwise added back
in computing Consolidated Adjusted EBITDA, whether through a pro forma adjustment or otherwise, with respect to such period. For purposes of determining whether any Indebtedness constituting a Guarantee may be incurred, the interest on the
Indebtedness to be guaranteed shall be included in calculating the Fixed Charge Coverage Ratio on a pro forma basis. Interest on a Capital Lease Obligation shall be deemed to accrue at an interest rate reasonably determined by a responsible
financial or accounting officer of the Issuer to be the rate of interest implicit in such Capital Lease Obligation in accordance with GAAP. For purposes of making the computation referred to above, interest on any Indebtedness under a revolving
credit facility computed on a pro forma basis shall be computed based upon the average daily balance of such Indebtedness during the applicable period. Interest on Indebtedness that may optionally be determined at an interest rate based upon a
factor of a prime or similar rate, a eurocurrency interbank offered rate, or other rate, shall be deemed to have been based upon the rate actually chosen, or, if none, then based upon such optional rate chosen as the Issuer may designate.

 “Fixed Charges” means, with respect to any specified Person for any period, the sum, without duplication,
of: 
 (1) the consolidated interest expense of such Person and its Restricted Subsidiaries for such period, to the extent such
expense was deducted (and not added back) in computing Consolidated Net Income (including, without limitation, (a) amortization of original issue discount or premium resulting from the issuance of Indebtedness at less than or greater than par,
as applicable, other than with respect to Indebtedness issued in connection with the Transactions, (b) non-cash interest payments (but excluding any non-cash interest expense attributable to the movement in the mark to market valuation of
Hedging Obligations or other derivative instruments pursuant to GAAP), (c) the interest component of any deferred payment obligations and the interest component of all payments associated with Capital Lease Obligations, (d) all
commissions, discounts and other fees and charges incurred in respect of letter of credit or bankers’ acceptance financings, 

  
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and (e) net of the effect of all cash payments, if any, made or received pursuant to Hedging Obligations with respect to Indebtedness, and excluding (v) amortization of deferred
financing fees, debt issuance costs, commissions, fees and expenses, (w) accretion or accrual of discounted liabilities not constituting Indebtedness, (x) any expense resulting from the discounting of any Indebtedness in connection with
the application of recapitalization or purchase accounting, (y) any expensing of bridge, commitment and other financing fees and (z) commissions, discounts, yield and other fees and charges (including any interest expense) related to any
Qualified Receivables Transaction); plus 
 (2) any interest on Indebtedness of another Person that is guaranteed by such Person
or one of its Restricted Subsidiaries or secured by a Lien on assets of such Person or one of its Restricted Subsidiaries, but only to the extent that such Guarantee or Lien is called upon; plus 

(3) consolidated capitalized interest of such Person and its Restricted Subsidiaries for such period, whether paid or accrued, plus

 (4) all cash dividends or other distributions paid on any series of preferred stock of such Person or any of its Restricted
Subsidiaries (other than to the Issuer or a Restricted Subsidiary), in each case, determined on a consolidated basis in accordance with GAAP; plus 
 (5) all cash dividends or other distributions paid on any series of Disqualified Stock of such Person or any of its Restricted Subsidiaries (other than to the Issuer or a Restricted Subsidiary), in each
case, determined on a consolidated basis in accordance with GAAP; less 
 (6) interest income for such period. 

For purposes of this definition, interest on a Capital Lease Obligation shall be deemed to accrue at an interest rate reasonably
determined by such Person to be the rate of interest implicit in such Capital Lease Obligation in accordance with GAAP. 

“Foreign Subsidiary” means any Subsidiary that is not formed under the laws of the United States of America, any State
thereof or the District of Columbia. 
 “GAAP” means generally accepted accounting principles set forth in the
opinions and pronouncements of the Accounting Principles Board of the American Institute of Certified Public Accountants and statements and pronouncements of the Financial Accounting Standards Board or in such other statements by such other entity
as have been approved by a significant segment of the accounting profession, which are in effect on the Effective Date. 

“Global Note Legend” means the legend set forth in Section 2.06(g)(2), which is required to be placed on all Global
Notes issued under this Indenture. 
 “Global Notes” means, individually and collectively, each of the
Restricted Global Notes and the Unrestricted Global Notes deposited with or on behalf of and registered in the name of the Depository or its nominee, substantially in the form of Exhibits A1 and A2 hereto and that bears the Global Note
Legend and that has the “Schedule of Exchanges of Global Note” attached thereto, issued in accordance with Section 2.01, 2.06(b)(3), 2.06(b)(4), 2.06(d)(2) or 2.06(f) hereof. 

  
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 “Government Securities” means direct obligations of, or obligations
guaranteed by, the United States of America (including any agency or instrumentality thereof) and the payment for which the United States pledges its full faith and credit. 
 “Guarantee” means a guarantee other than by endorsement of negotiable instruments for collection in the ordinary course of business, direct or indirect, in any manner including, without
limitation, by way of a pledge of assets or through letters of credit or reimbursement agreements in respect thereof, of all or any part of any Indebtedness (whether arising by virtue of partnership arrangements, or by agreements to keep-well, to
purchase assets, goods, securities or services, to take or pay or to maintain financial statement conditions or otherwise). 

“Guarantors” means each Restricted Subsidiary that executes a Subsidiary Guarantee in accordance with the provisions of
this Indenture, and their respective successors and assigns, in each case, until the Subsidiary Guarantee of such Person has been released in accordance with the provisions herein. 

“Hedging Obligations” means, with respect to any specified Person, the obligations of such Person under: 

(1) interest rate swap agreements (whether from fixed to floating or from floating to fixed), interest rate cap agreements and interest
rate collar agreements; 
 (2) other agreements or arrangements designed to manage interest rates or interest rate risk; and

 (3) other agreements or arrangements designed to protect such Person against fluctuations in currency exchange rates or
commodity prices. 
 “Holder” means a Person in whose name a Note is registered. 

“Holdings” means USPI Holdings, Inc., a Delaware corporation. 

“Indebtedness” means, with respect to any specified Person, the principal and premium (if any) of any indebtedness of
such Person (excluding accrued expenses and trade payables), whether or not contingent: 
 (1) in respect of borrowed money;

 (2) evidenced by bonds, notes, debentures or similar instruments or letters of credit (or reimbursement agreements in respect
thereof) (other than letters of credit issued in respect of trade payables); 
 (3) in respect of banker’s acceptances;

 (4) representing Capital Lease Obligations; 
 (5) representing the balance deferred and unpaid of the purchase price of any property or services due more than twelve months after such property is acquired or such services are completed (other than
(i) trade accounts and accrued expenses payable in the ordinary course of business, (ii) any earn-out obligation until such obligation is not paid after becoming due and payable and (iii) accruals for payroll and other liabilities
accrued in the ordinary course of business); or 

  
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 (6) representing the net obligations under any Hedging Obligations, 

if and to the extent any of the preceding items (other than letters of credit, and Hedging Obligations) would appear as a liability upon a balance sheet
of the specified Person prepared in accordance with GAAP. In addition, the term “Indebtedness” includes all Indebtedness of others secured by a Lien on any asset of the specified Person (whether or not such Indebtedness is assumed by the
specified Person) and, to the extent not otherwise included, the Guarantee by the specified Person of any Indebtedness of any other Person. 
 Notwithstanding the foregoing, Indebtedness shall be deemed not to include (1) contingent obligations incurred in the ordinary course of business; (2) obligations under or in respect of a
Qualified Receivables Transaction and (3) current liabilities due to affiliates in connection with cash management arrangements in the ordinary course of business. 
 “Indenture” means this Indenture, as amended or supplemented from time to time. 
 “Indirect Participant” means a Person who holds a beneficial interest in a Global Note through a Participant. 
 “Initial Issue Price” has the meaning set forth on the cover page of the Offering Memorandum. 
 “Initial Notes” means the first $440.0 million aggregate principal amount of Notes issued under this Indenture. 
 “Initial Purchasers” means Barclays Capital Inc., J.P. Morgan Securities LLC, Morgan Stanley & Co. LLC, Goldman, Sachs & Co., Nomura Securities International, Inc.,
SunTrust Robinson Humphrey, Inc. and Natixis Securities Americas LLC. 
 “Investment Grade Rating” means a
rating equal to or higher than Baa3 (or the equivalent) by Moody’s and BBB- (or the equivalent) by S&P, or an equivalent rating by any other Rating Agency. 
 “Investments” means, with respect to any Person, all direct or indirect investments by such Person in other Persons (including Affiliates) in the forms of loans (including Guarantees or
other obligations), advances or capital contributions (excluding accounts receivable, trade credit, advances to customers and commission, travel, relocation and similar advances to officers and employees made in the ordinary course of business),
purchases or other acquisitions for consideration of Indebtedness, Equity Interests or other securities, together with all items that are or would be classified as investments on a balance sheet prepared in accordance with GAAP. If the Issuer or any
Restricted Subsidiary sells or otherwise disposes of any Equity Interests of any direct or indirect Restricted Subsidiary such that, after giving effect to any such sale or disposition, such Person is no longer a Subsidiary of the Issuer, the Issuer
will be deemed to have made an Investment on the date of any such sale or disposition equal to the Fair Market Value of the Issuer’s Investments in such Subsidiary that were not sold or disposed of in an amount determined as provided in
Section 4.06(c). The acquisition by the Issuer or any Restricted Subsidiary of a Person that holds an Investment in a third Person will be deemed to be an Investment by the Issuer or such Restricted Subsidiary in such third Person in an amount
equal to the Fair Market Value of the Investments held by the acquired Person in such third Person in an amount determined as provided in Section 4.06(c). The outstanding amount of any Investment shall be the original cost thereof, reduced by
all returns on such Investment (including dividends, interest, distributions, returns of principal and profits on sale). 

“Issue Date” means April 3, 2012 

  
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 “Issuer” means (a) prior to the consummation of the Merger, USPI
Finance and not to any of its subsidiaries and (b) from and after the consummation of the Merger, USPI and not any of its subsidiaries. 
 “Legal Holiday” means a Saturday, a Sunday or a day on which banking institutions in the City of New York or at a place of payment are authorized by law, regulation or executive order to
remain closed. If a payment date is a Legal Holiday at a place of payment, payment may be made at that place on the next succeeding day that is not a Legal Holiday, and no interest shall accrue on such payment for the intervening period. 

“Letter of Transmittal” means the letter of transmittal to be prepared by the Issuer and sent to all Holders of the
Notes for use by such Holders in connection with the Exchange Offer. 
 “Lien” means, with respect to any
asset, any mortgage, lien, pledge, charge, security interest or encumbrance of any kind in respect of such asset, whether or not filed, recorded or otherwise perfected under applicable law, including any conditional sale or other title retention
agreement, any lease in the nature thereof, any option or other agreement to sell or give a security interest in and any filing of or agreement to give any financing statement under the Uniform Commercial Code (or equivalent statutes) of any
jurisdiction; provided that in no event shall an operating lease be deemed a Lien. 
 “Make-Whole Redemption
Date” means the date on which any Note is redeemed pursuant to Section 5(c) of the Notes. 
 “Management
Agreements” means the management, service or similar agreements pursuant to which Parent or any of its Qualified Restricted Subsidiaries manages the assets and businesses of any of its Restricted Subsidiaries. 

“Management Stockholders” means (i) the members of management of Holdings, the Issuer or any of its Subsidiaries
who are investors in the Issuer or Holdings (or any other direct or indirect parent company of the Issuer), (ii) the spouses, ancestors, siblings, descendants (including children or grandchildren by adoption) and the descendants of any of the
siblings of the Persons referred to in clause (i), (iii) in the event of the incompetence or death of any of the Persons described in any of clauses (i) through (ii), such Person’s estate, executor, administrator, committee or other
personal representative, in each case who at any particular date shall be the owner, beneficially or of record, or have the right to acquire, directly or indirectly, Equity Interests of the Issuer or Holdings (or any other direct or indirect parent
company of the Issuer); (iv) any trust created for the benefit of the Persons described in any of clauses (i) through (iii) or any trust for the benefit of any such trust; or (v) any Person controlled by any of the Persons
described in any of the clauses (i) through (iv). 
 “Merger” means a merger of USPI Finance with or into
USPI. 
 “Net Income” means, with respect to any specified Person, the net income (loss) of such Person,
determined in accordance with GAAP and before any reduction in respect of preferred stock dividends and after reduction for any net income attributable to noncontrolling interests. 

“Net Proceeds” means the aggregate cash proceeds received by the Issuer or any of its Restricted Subsidiaries in respect
of any Asset Sale (including, without limitation, any cash received upon the sale or other disposition of any non-cash consideration received in any Asset Sale), net of the direct costs relating to such Asset Sale, including, without limitation,
legal, accounting and investment banking fees, payments made in order to obtain a necessary consent or required by applicable law, and sales commissions, and any relocation expenses incurred as a result of the Asset Sale, taxes paid or payable as a
result of the Asset Sale, including taxes resulting from the transfer of the proceeds of such Asset Sale to the Issuer, in each case, after taking into account: 

  
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 (1) any available tax credits or deductions and any tax sharing arrangements; 

(2) amounts required to be applied to the repayment of Indebtedness secured by a Lien on the asset or assets that were the subject of such
Asset Sale; 
 (3) any reserve for adjustment in respect of the sale price of such asset or assets established in accordance with
GAAP; 
 (4) any reserve for adjustment in respect of any liabilities associated with the asset disposed of in such transaction
and retained by the Issuer or any Restricted Subsidiary after such sale or other disposition thereof; 
 (5) any distributions
and other payments required to be made to minority interest holders in Subsidiaries or joint ventures as a result of such Asset Sale; and 
 (6) in the event that a Restricted Subsidiary consummates an Asset Sale and makes a pro rata payment of dividends to all of its stockholders from any cash proceeds of such Asset Sale, the amount of
dividends paid to any stockholder other than the Issuer or any other Restricted Subsidiary, provided that any net proceeds of an Asset Sale by a Non-Guarantor Subsidiary that are subject to legal or contractual restrictions on repatriation to
the Issuer will not be considered Net Proceeds for so long as such proceeds are subject to such restrictions, provided, however, that any such contractual restrictions on repatriation were not entered into in contemplation of such Asset Sale.

 “Non-Guarantor Subsidiaries” means (1) any Unrestricted Subsidiary, (2) any Receivables
Subsidiary, (3) any Captive Insurance Subsidiary, (4) any Foreign Subsidiary, (5) any Subsidiary that is treated as a disregarded entity for federal income tax purposes and substantially all of the assets of which include the Equity
Interests and/or Indebtedness of one or more Foreign Subsidiaries and any other assets incidental thereto, and (6) any other Subsidiary of the Issuer that does not guarantee the Issuer’s Obligations under the Credit Agreement. 

“Non-Recourse Debt” means Indebtedness: 

(1) as to which neither the Issuer nor any of its Restricted Subsidiaries (a) provides credit support of any kind
(including any undertaking, agreement or instrument that would constitute Indebtedness) or (b) is directly or indirectly liable as a guarantor or otherwise; and 

(2) as to which the lenders have been notified in writing or have agreed in writing (in the agreement relating thereto or
otherwise) that they will not have any recourse to the stock or assets of the Issuer or any of its Restricted Subsidiaries, except as permitted by the definition of “Unrestricted Subsidiary.” 

“Non-U.S. Person” means a Person who is not a U.S. Person. 

“Notes” means the Initial Notes and more particularly means any Notes authenticated and delivered under this Indenture.
For all purposes of this Indenture, the term “Notes” shall also include the Exchange Notes and any Additional Notes that may be issued under a supplemental indenture. 

  
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 “Obligations” means any principal, interest, penalties, fees,
indemnifications, reimbursements, damages and other liabilities payable under the documentation governing any Indebtedness. 

“Offering Memorandum” means the Issuer’s offering memorandum, dated March 20, 2012, related to the issuance
and sale of the Initial Notes. 
 “Officer” means, with respect to any Person, the Chairman of the Board, the
Chief Executive Officer, the President, the Chief Operating Officer, the Chief Financial Officer, the Treasurer, any Assistant Treasurer, the Controller, the Secretary or any Vice President of such Person. 

“Officer’s Certificate” means a certificate signed on behalf of the Issuer by one Officer of the Issuer, who must
be the principal executive officer, the principal financial officer, the treasurer or the principal accounting officer of the Issuer, that meets the requirements of Section 12.05 hereof. 

“Opinion of Counsel” means an opinion from legal counsel that meets the requirements of Section 12.05. The counsel
may be an employee of or counsel to the Issuer or any Subsidiary of the Issuer. 
 “Pari Passu Indebtedness”
means: 
 (1) all Indebtedness of the Issuer or any Guarantor outstanding under the Credit Agreement or under any other Credit
Facilities (including interest accruing on or after the filing of any petition in bankruptcy or similar proceeding or for reorganization of the Issuer or any Guarantor (at the rate provided for in the documentation with respect thereto, regardless
of whether or not a claim for post-filing interest is allowed in such proceedings)), and any and all other fees, expense reimbursement obligations, indemnification amounts, penalties, and other amounts (whether existing on the Effective Date or
thereafter created or incurred) and all obligations of the Issuer or any Guarantor to reimburse any bank or other Person in respect of amounts paid under letters of credit, acceptances or other similar instruments; 

(2) all Hedging Obligations and Treasury Management Obligations (and guarantees thereof) owing to a Lender (as defined in the Credit
Agreement) or any Affiliate of such Lender (or any Person that was a Lender or an Affiliate of such Lender at the time the applicable agreement giving rise to such Hedging Obligation or Treasury Management Obligation was entered into),
provided that such Hedging Obligations and Treasury Management Obligations are permitted to be incurred under the terms of this Indenture; 
 (3) any other Indebtedness of the Issuer or any Guarantor permitted to be incurred under the terms of this Indenture, unless the instrument under which such Indebtedness is incurred expressly provides
that it is subordinated in right of payment to the Notes or any Subsidiary Guarantee; and 
 (4) all Obligations with respect to
the items listed in the preceding clauses (1), (2) and (3). 

  
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 Notwithstanding anything to the contrary in the preceding, Pari Passu Indebtedness will not
include: 
 (1) any liability for federal, state, local or other taxes owed or owing by the Issuer or the Guarantors; 

(2) any intercompany Indebtedness of the Issuer or any of its Subsidiaries to the Issuer or any of its Affiliates; 

(3) any trade payables; 
 (4) the portion of any Indebtedness that is incurred in violation of this Indenture (but only to the extent so incurred); provided that Indebtedness outstanding under Credit Facilities will not
cease to be Pari Passu Indebtedness as a result of this clause (4) if the lenders or agents thereunder obtained a representation from the Issuer or any of its Subsidiaries on the date such Indebtedness was incurred to the effect that such
Indebtedness was not prohibited by this Indenture; 
 (5) Indebtedness which is classified as non-recourse in accordance with
GAAP or any unsecured claim arising in respect thereof by reason of the application of Section 1111(b)(1) of the Bankruptcy Code; or 
 (6) Disqualified Stock. 
 “Participant” means, with respect to
the Depositary, a Person who has an account with the Depositary. 
 “Permitted Business” means (i) any
business engaged in by the Issuer or any of its Restricted Subsidiaries on the Effective Date, and (ii) any business or other activities that are reasonably similar, ancillary, complementary or related to, or a reasonable extension, development
or expansion of, the businesses in which the Issuer and its Restricted Subsidiaries are engaged on the Effective Date. 

“Permitted Holder” means each of (i) the Sponsor and the Management Stockholders of the Issuer (or any direct or
indirect parent company) who are holders of Equity Interests of the Issuer (or any direct or indirect parent company) on the Effective Date and any group (within the meaning of Section 13(d)(3) or Section 14(d)(2) of the Exchange Act or
any successor provision) of which any of the foregoing are members; provided, that, in the case of such group and without giving effect to the existence of such group or any other group, the Sponsor beneficially owns (within the meaning of
Rule 13d-3 under the Exchange Act, or any successor provision) at least 50.0% of the total voting power of the Voting Stock of the Issuer held by such group and (ii) any Permitted Parent. 

“Permitted Investments” means: 
 (1) any Investment in the Issuer or in a Qualified Restricted Subsidiary of the Issuer; 
 (2) any Investment in Cash Equivalents; 
 (3) any Investment by the Issuer or any
Qualified Restricted Subsidiary of the Issuer in a Person, if as a result of such Investment: 
 (a) such Person becomes a
Qualified Restricted Subsidiary of the Issuer; 

  
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 (b) such Person, in one transaction or a series of transactions, is merged, consolidated or
amalgamated with or into, or transfers or conveys substantially all of its assets to, or is liquidated into, the Issuer or a Qualified Restricted Subsidiary of the Issuer; or 
 (c) such Person becomes a Guarantor, provided, however, that such Person’s primary business is a Permitted Business; 
 (4) any Investment made as a result of the receipt of non-cash consideration from an Asset Sale that was made pursuant to and in compliance with Section 4.09 hereof or in connection with a
disposition of assets not constituting an Asset Sale; 
 (5) any Investment solely in exchange for the issuance of Equity
Interests (other than Disqualified Stock) of the Issuer; 
 (6) any Investments received in compromise, settlement or resolution
of (A) obligations of trade debtors or customers that were incurred in the ordinary course of business of the Issuer or any of its Restricted Subsidiaries, including pursuant to any plan of reorganization or similar arrangement upon the
bankruptcy or insolvency of any trade debtor or customer, (B) litigation, arbitration or other disputes with Persons who are not Affiliates or (C) as a result of a foreclosure by the Issuer or any Restricted Subsidiary with respect to any
secured Investment or other transfer of title with respect to any secured Investment in default; 
 (7) Investments represented
by Hedging Obligations entered into to protect against fluctuations in interest rates, exchange rates and commodity prices; 

(8) any Investment in payroll, travel and similar advances to cover business-related travel expenses, moving expenses or other similar
expenses, in each case incurred in the ordinary course of business; 
 (9) Investments in receivables owing to the Issuer or any
Restricted Subsidiary if created or acquired in the ordinary course of business and payable or dischargeable in accordance with customary trade terms; provided, however, that such trade terms may include such concessionary trade terms
as the Issuer or any such Restricted Subsidiary deems reasonable under the circumstances; 
 (10) Investments in prepaid
expenses, negotiable instruments held for collection and lease, utility and workers compensation, performance and similar deposits entered into as a result of the operations of the business in the ordinary course of business; 

(11) obligations of one or more officers or other employees of the Issuer or any of its Restricted Subsidiaries in connection with such
officer’s or employee’s acquisition of shares of Capital Stock of the Issuer or Capital Stock of Holdings (or any other direct or indirect parent company of the Issuer) so long as no cash or other assets are paid by the Issuer or any of
its Restricted Subsidiaries to such officers or employees in connection with the acquisition of any such obligations; 
 (12)
loans or advances to and guarantees provided for the benefit of employees made in the ordinary course of business of the Issuer or the Restricted Subsidiary in an aggregate principal amount not to exceed $5.0 million at any one time outstanding;


  
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 (13) Investments existing on the Effective Date or an Investment consisting of any
extension, modification or renewal of any Investment existing as of the Effective Date (excluding any such extension, modification or renewal involving additional advances, contributions or other investments of cash or property or other increases
thereof unless it is a result of the accrual or accretion of interest or original issue discount or payment-in-kind pursuant to the terms, as of the Issue Date, of the original Investment so extended, modified or renewed); 

(14) repurchases of the Notes; 
 (15) Investments in any Person having an aggregate Fair Market Value (measured on the date each such Investment was made and without giving effect to subsequent changes in value), when taken together with
all other Investments made pursuant to this clause (15) that are at the time outstanding not to exceed $50.0 million; provided, however, that if any Investment pursuant to this clause (15) is made in any Person that is not a
Qualified Restricted Subsidiary of the Issuer at the date of the making of such Investment and such Person becomes a Qualified Restricted Subsidiary of the Issuer or is merged or consolidated into, or transfers all or substantially all of its assets
to, or is liquidated into, the Issuer or a Qualified Restricted Subsidiary after such date, such Investment shall thereafter be deemed to have been made pursuant to clause (1) above and shall cease to have been made pursuant to this clause
(15) for so long as such Person continues to be a Qualified Restricted Subsidiary of the Issuer (it being understood that if such Person thereafter ceases to be a Qualified Restricted Subsidiary of the Issuer, such Investment will again be
deemed to have been made pursuant to this clause (15)); 
 (16) the acquisition by a Receivables Subsidiary in connection with a
Qualified Receivables Transaction of Equity Interests of a trust or other Person established by such Receivables Subsidiary to effect such Qualified Receivables Transaction; and any other Investment by the Issuer or a Subsidiary of the Issuer in a
Receivables Subsidiary or any Investment by a Receivables Subsidiary in any other Person in connection with a Qualified Receivables Transaction customary for such transactions; 
 (17) payments to any Captive Insurance Subsidiary in an amount equal to (i) the capital required under the applicable laws or regulations of the jurisdiction in which such Captive Insurance
Subsidiary is formed or determined by independent actuaries as prudent and necessary capital to operate such Captive Insurance Subsidiary plus (ii) any reasonable general corporate and overhead expenses of such Captive Insurance Subsidiary;

 (18) Investments in joint ventures or Unrestricted Subsidiaries in an amount, taken together with all other Restricted
Payments made pursuant to this clause (18) not to exceed 20% of Total Assets outstanding at any time; provided that (i) substantially all of the business activities of any such joint venture consists of owning or operating surgical
facilities and (ii) a majority of the Voting Stock of such Person is owned by the Issuer, its Restricted Subsidiaries and/or other Persons that are not Affiliates of the Issuer; provided, further, that if any Investment pursuant
to this clause (18) is made in any Person that is not a Qualified Restricted Subsidiary of the Issuer at the date of the making of such Investment and such Person becomes a Qualified Restricted Subsidiary of the Issuer or is merged or
consolidated into, or transfers all or substantially all of its assets to, or is liquidated into, the Issuer or a Qualified Restricted Subsidiary after such date, such Investment shall thereafter be deemed to have been made pursuant to clause
(1) above and shall cease to have been made pursuant to this clause (18) (it being understood that if such Person thereafter ceases to be a Qualified Restricted Subsidiary of the Issuer, such Investment will again be deemed to have been
made pursuant to this clause (18)); 

  
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 (19) Guarantees of Indebtedness of the Issuer or a Restricted Subsidiary permitted under
Section 4.08, performance guarantees in the ordinary course of business and guarantees of operating leases in the ordinary course of business; and 
 (20) Investments consisting of amounts due from a seller of property in an acquisition that (i) relate to customary post-closing adjustments with respect to accounts receivable, accounts payable and
similar items typically subject to post-closing adjustments in similar transactions and (ii) are outstanding for a period of one hundred twenty (120) days or less following the closing of such acquisition. 

“Permitted Liens” means: 
 (1) Liens in favor of the Issuer or the Guarantors; 
 (2) Liens on property or
assets of a Person, plus renewals and extensions of such Liens, existing at the time such Person is merged with or into, consolidated with or acquired by the Issuer or any Restricted Subsidiary; provided that such Liens were in existence
prior to the contemplation of such merger, consolidation or acquisition and do not extend to any assets other than those of the Person merged into, consolidated with or acquired by the Issuer or such Subsidiary; 

(3) Liens on property (including Capital Stock) existing at the time of acquisition of the property by the Issuer or any Restricted
Subsidiary; provided that such Liens were in existence prior to, such acquisition, and not incurred in contemplation of, such acquisition; 
 (4) Liens (including deposits and pledges) to secure the performance of public or statutory obligations, progress payments, surety or appeal bonds, performance bonds or other obligations of a like nature
incurred in the ordinary course of business; 
 (5) Liens to secure Indebtedness (including Capital Lease Obligations) permitted
under Section 4.08(b)(4) covering only the assets acquired, constructed or improved with or financed by such Indebtedness; 

(6) Liens existing on the Effective Date, plus renewals and extensions of such Liens; 

(7) Liens for taxes, assessments or governmental charges or claims that are not yet delinquent or that are being contested in good faith
by appropriate proceedings promptly instituted and diligently concluded; provided that any reserve or other appropriate provision as is required in conformity with GAAP has been made therefor; 

(8) Liens imposed by law, such as carriers’, warehousemen’s, landlord’s, materialmen’s, laborers’,
employees’, suppliers’ and mechanics’ Liens, in each case, incurred in the ordinary course of business; 
 (9)
survey exceptions, title defects, encumbrances, easements or reservations of, or rights of others for, licenses, rights-of-way, sewers, electric lines, telegraph and telephone lines and other similar purposes, or zoning or other restrictions as to
the use of real property that do not materially interfere with the ordinary conduct of the business of the Issuer and its Subsidiaries, taken as a whole; 
 (10) Liens created for the benefit of (or to secure) the Notes (or the Subsidiary Guarantees); 

  
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 (11) Liens to secure any Permitted Refinancing Indebtedness permitted to be incurred under
this Indenture; provided, however, that: 
 (a) the new Lien shall be limited to all or part of the same property and
assets that secured or, under the written agreements pursuant to which the original Lien arose, could secure the original Indebtedness (plus improvements and accessions to, such property or proceeds or distributions thereof); and 

(b) the Indebtedness secured by the new Lien is not increased to any amount greater than the sum of (x) the outstanding principal
amount, or, if greater, committed amount, of the Permitted Refinancing Indebtedness and (y) an amount necessary to pay any fees and expenses, including premiums, related to such renewal, refunding, refinancing, replacement, defeasance or
discharge; 
 (12) Liens incurred in the ordinary course of business of the Issuer or any Subsidiary of the Issuer with respect
to obligations that do not exceed $10.0 million at any one time outstanding; 
 (13) Liens incurred in connection with a
Qualified Receivables Transaction (which, in the case of the Issuer and its Restricted Subsidiaries (other than Receivables Subsidiaries) shall be limited to receivables and related assets referred to in the definition of Qualified Receivables
Transaction); 
 (14) security for the payment of workers’ compensation, unemployment insurance, other social security
benefits or other insurance-related obligations (including, but not limited to, in respect of deductibles, self-insured retention amounts and premiums and adjustments thereto) entered into in the ordinary course of business; 

(15) deposits or pledges in connection with bids, tenders, leases and contracts (other than contracts for the payment of money), and Liens
arising from conditional sale, title retention, consignment and similar arrangements, in each case entered into in the ordinary course of business; 
 (16) zoning restrictions, easements, licenses, reservations, provisions, encroachments, encumbrances, protrusion permits, servitudes, covenants, conditions, waivers, restrictions on the use of property or
minor irregularities of title (and with respect to leasehold interests, mortgages, obligations, liens and other encumbrances incurred, created, assumed or permitted to exist and arising by, through or under a landlord or owner of the leased
property, with or without consent of the lessee), in each case, not materially interfering with the ordinary conduct of the business of the Issuer and its Subsidiaries, taken as a whole; 

(17) leases, subleases, licenses or sublicenses to third parties entered into in the ordinary course of business; 

(18) Liens securing Hedging Obligations entered into to protect against fluctuations in interest rates, exchange rates and commodity
prices; 
 (19) Liens arising out of judgments, decrees, orders or awards in respect of which the Issuer shall in good faith be
prosecuting an appeal or proceedings for review which appeal or proceedings shall not have been finally terminated, or if the period within which such appeal or proceedings may be initiated shall not have expired; 

  
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 (20) Liens on Capital Stock of an Unrestricted Subsidiary that secure Indebtedness or other
obligation of such Unrestricted Subsidiary; 
 (21) Liens on the assets of Non-Guarantor Subsidiaries securing Indebtedness of
the Issuer or the Restricted Subsidiaries that were permitted by the terms of this Indenture to be incurred; 
 (22) Liens
arising from filing Uniform Commercial Code financing statements regarding leases; 
 (23) [Reserved]; 

(24) Liens (i) of a collection bank arising under Section 4-210 of the Uniform Commercial Code on items in the course of
collection and (ii) in favor of banking institution encumbering deposits (including the right of set-off) and which are within the general parameters customary in the banking industry; 

(25) Liens encumbering reasonable customary initial deposits and margin deposits and similar Liens attaching to brokerage accounts
incurred in the ordinary course of business and not for speculative purposes; 
 (26) Liens created or deemed to exist by the
establishment of trusts for the purpose of satisfying government reimbursement program costs and other actions or claims pertaining to the same or related matters or other medical reimbursement programs; 

(27) Liens solely on any cash earned money deposits made by the Issuer or any Restricted Subsidiary with any letter of intent or purchase
agreement permitted under this Indenture; and 
 (28) (i) Liens securing Indebtedness under one or more Credit Facilities
permitted to be incurred pursuant to Section 4.08(b)(1), (ii) Liens securing Indebtedness permitted to be incurred pursuant to Section 4.08(a)(y) and (iii) Liens securing Indebtedness permitted to be incurred pursuant to Sections
4.08(a)(x) or 4.08(b), so long as, in the case of clause (iii), after giving effect to such incurrence and such Liens, the Consolidated Secured Leverage Ratio of the Issuer and its Restricted Subsidiaries shall be equal to or less than 4.0 to 1.0
for the Issuer’s most recently ended four full fiscal quarters for which internal financial statements are available immediately preceding the date on which such Lien is incurred. The Issuer may elect, pursuant to an Officer’s Certificate
delivered to the Trustee, to treat all or any portion of the commitment under any Indebtedness which is to be secured by a Lien permitted by this clause (28) as being incurred at the time the Lien is incurred and any subsequent issuance of
Indebtedness under such Indebtedness shall not be deemed to be an incurrence at such subsequent time. 
 “Permitted
Parent” means any direct or indirect parent of the Issuer that at the time it became a parent of the Issuer was a Permitted Holder pursuant to clause (i) of the definition thereof and such parent was not formed in connection with, or
in contemplation of, a transaction (other than the Transactions) that would otherwise constitute a Change of Control. 

“Permitted Payment Restriction” means any consensual encumbrance or restriction (each, a “restriction”)
on the ability of any Restricted Subsidiary to (a) pay dividends or make any other distributions on its Equity Interests to the Issuer or a Restricted Subsidiary or pay any Indebtedness owed to the Issuer or a Restricted Subsidiary or
(b) make any loans or advances to the Issuer or a Restricted Subsidiary, which restriction satisfies all of the following conditions: (i) such restriction becomes effective 

  
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only upon the occurrence of (x) specified events under its charter or (y) a default by such Restricted Subsidiary in the payment of principal of or interest, a bankruptcy default, a
default on any financial covenant or any other material default, in each case, on Indebtedness that was incurred by such Restricted Subsidiary under Section 4.08, and (ii) such restriction would not materially impair the Issuer’s
ability to make scheduled payments of cash interest and to make required principal payments on the Notes, as determined in good faith by the chief executive officer or chief financial officer of the Issuer whose determination shall be conclusive.

 “Permitted Payments to Parent” means 

(1) payments, directly or indirectly, to Holdings or any other direct or indirect parent company of the Issuer to be used by Holdings (or
any other direct or indirect parent company of the Issuer) to pay (x) consolidated, combined or similar Federal, state and local taxes payable by Holdings (or such parent company) and directly attributable to (or arising as a result of) the
operations of the Issuer and its Subsidiaries and (y) franchise or similar taxes and fees of Holdings (or such parent company) required to maintain Holdings’ (or such parent company’s) corporate or other existence and other taxes;
provided that: 
 (a) the amount of such dividends, distributions or advances paid shall not exceed (x) the amount
that the Issuer and its Subsidiaries would be required to pay in respect of Federal, state, and local taxes were the Issuer and its Subsidiaries to pay such taxes separately from Holdings (or such parent company) plus (y) the actual amount of
such franchise or similar taxes and fees of Holdings (or such parent company) required to maintain Holdings’ (or such parent company’s) corporate or other existence and other taxes, each as applicable; provided, that notwithstanding
anything to the contrary, the Issuer may make payments to Holdings in an amount necessary to enable Holdings to pay (or make payments to allow a parent company to pay) any taxes incurred as a result of the U.K. Spin-Out and the 2012 Dividend; and

 (b) such payments are used by Holdings (or such parent company) for such purposes within 90 days of the receipt of such
payments; and 
 (2) payments, directly or indirectly, to Holdings or any other direct or indirect parent company of the Issuer
if the proceeds thereof are (i) used to pay general corporate and overhead expenses (including salaries and other compensation of employees) incurred in the ordinary course of its business or of the business of Holdings or such other parent
company of the Issuer as a direct or indirect holding company for the Issuer, including such amounts relating to Holdings or such other parent company of the Issuer being a public company or (ii) used to pay fees and expenses (other than to
Affiliates) relating to any unsuccessful debt or equity financing. 
 “Permitted Refinancing Indebtedness”
means any Indebtedness of the Issuer or any of its Restricted Subsidiaries issued in exchange for, or the net proceeds of which are used to extend, renew, refund, refinance, replace, defease or discharge other Indebtedness of the Issuer or any of
its Restricted Subsidiaries (other than intercompany Indebtedness); provided, that: 
 (1) the principal amount (or if
issued with original issue discount, issue price) of such Permitted Refinancing Indebtedness does not exceed the principal amount (or if issued with original issue discount, accreted value) of the Indebtedness extended, renewed, refunded,
refinanced, replaced, defeased or discharged (plus all accrued interest (including capitalized interest) on the Indebtedness and the amount of all fees, commissions, discounts and expenses, including premiums, incurred in connection therewith);


  
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 (2) either (a) such Permitted Refinancing Indebtedness has a final maturity date later
than the final maturity date of, and has a Weighted Average Life to Maturity equal to or greater than the Weighted Average Life to Maturity of, the Indebtedness being extended, renewed, refunded, refinanced, replaced, defeased or discharged or
(b) all scheduled payments on or in respect of such Permitted Refinancing Indebtedness (other than interest payments) shall be at least 91 days following the final scheduled maturity of the Notes; 

(3) if the Indebtedness being extended, renewed, refunded, refinanced, replaced, defeased or discharged is subordinated in right of
payment to the Notes, such Permitted Refinancing Indebtedness is subordinated in right of payment to the Notes on terms at least as favorable to the Holders as those contained in the documentation governing the Indebtedness being extended, renewed,
refunded, refinanced, replaced, defeased or discharged; and 
 (4) such Indebtedness is incurred 

(a) by the Issuer or by the Restricted Subsidiary who is the obligor on the Indebtedness being renewed, refunded, refinanced, replaced,
defeased or discharged; 
 (b) by any Guarantor if the obligor on the Indebtedness being renewed, refunded, refinanced, replaced,
defeased or discharged is a Guarantor; or 
 (c) by any Non-Guarantor Subsidiary if the obligor on the Indebtedness being
renewed, refunded, refinanced, replaced, defeased or discharged is a Non-Guarantor Subsidiary. 
 “Person”
means any individual, corporation, partnership, joint venture, association, joint-stock company, trust, unincorporated organization, limited liability company or government or other entity. 

“Private Placement Legend” means the legend set forth in Section 2.06(g)(1) to be placed on all Notes issued under
this Indenture except where otherwise permitted by the provisions of this Indenture. 
 “QIB” means a
“qualified institutional buyer” as defined in Rule 144A. 
 “Qualified Capital Stock” means any
Capital Stock that is not Disqualified Stock. 
 “Qualified Proceeds” means any of the following or any
combination of the following: 
 (1) Cash Equivalents; 
 (2) the Fair Market Value of assets that are used or useful in the Permitted Business; and 
 (3) the Fair Market Value of the Capital Stock of any Person engaged primarily in a Permitted Business if, in connection with the receipt by the Issuer or any of its Restricted Subsidiaries of such
Capital Stock, such Person becomes a Restricted Subsidiary or such Person is merged or consolidated into the Issuer or any Restricted Subsidiary; 

  
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 provided that (i) for purposes of clause (3) of Section 4.06(a),
Qualified Proceeds shall not include Excluded Contributions and (ii) the amount of Qualified Proceeds shall be reduced by the amount of payments made in respect of the applicable transaction which are permitted under clause (8) of Section
4.10(b). 
 “Qualified Receivables Transaction” means any transaction or series of transactions entered
into by the Issuer or any of its Subsidiaries pursuant to which the Issuer or any of its Subsidiaries sells, conveys or otherwise transfers, or grants a security interest, to: 
 (1) a Receivables Subsidiary (in the case of a transfer by the Issuer or any of its Subsidiaries, which transfer may be effected through the Issuer or one or more of its Subsidiaries); and 

(2) if applicable, any other Person (in the case of a transfer by a Receivables Subsidiary), 

in each case, in any accounts receivable (including health care insurance receivables), instruments, chattel paper, general intangibles and similar
assets (whether now existing or arising in the future, the “Receivables”) of the Issuer or any of its Subsidiaries, and any assets related thereto, including, without limitation, all collateral securing such Receivables, all
contracts, contract rights and all guarantees or other obligations in respect of such Receivables, proceeds of such Receivables and any other assets, which are customarily transferred or in respect of which security interests are customarily granted
in connection with receivables financings and asset securitization transactions of such type, together with any related transactions customarily entered into in receivables financings and asset securitizations, including servicing arrangements. All
determinations as to whether a particular provision in respect of a receivables transaction is customary shall be made by the Issuer in good faith (which determination shall be conclusive). 

“Qualified Restricted Subsidiary” means any other Restricted Subsidiary that satisfies all of the following
requirements: 
 (1) except for Permitted Payment Restrictions, there are no restrictions, directly or indirectly, on the ability
of such Restricted Subsidiary to pay dividends or make distributions to the holders of its Capital Stock; 
 (2) the Capital
Stock of such Restricted Subsidiary consists solely of (A) Capital Stock owned by the Issuer and its Qualified Restricted Subsidiaries, (B) Capital Stock owned by Strategic Investors and (C) directors’ qualifying shares; and

 (3) the primary business of such Restricted Subsidiary is a Permitted Business. 

“Rating Agencies” mean Moody’s and S&P or if Moody’s or S&P or both shall not make a rating on the
Notes publicly available, a nationally recognized statistical rating agency or agencies, as the case may be, selected by the Issuer (as certified by a Board Resolution) which shall be substituted for Moody’s or S&P or both, as the case may
be. 
 “Recapitalization Transaction” means a transaction that results in a Person or group (within the meaning
of Section 13(d)(3) or Section 14(d)(2) of the Exchange Act, or any successor provision), including any such group acting for the purpose of acquiring, holding or disposing of securities (within the meaning of Rule 13d-5(b)(1) under the
Exchange Act), other than a Sponsor, becoming the beneficial owner (within the meaning of Rule 13d-3 under the Exchange Act, or any successor provision), including by acquiring, directly or indirectly, through any contract, arrangement,
understanding, relationship or otherwise, the power to vote or to direct the vote, of 20% or more of the total voting power of the Voting Stock of the Issuer or any direct or indirect parent company. 

  
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 “Receivables Fees” means distributions or payments made directly or by
means of discounts with respect to any participation interest issued or sold in connection with, and other fees paid to a Person that is not a Restricted Subsidiary in connection with, any Qualified Receivables Transaction. 

“Receivables Subsidiary” means a Subsidiary of the Issuer which engages in no activities other than in connection with
the financing of accounts receivable and in businesses related or ancillary thereto and that is designated by the Board of Directors of the Issuer (as provided below) as a Receivables Subsidiary 

(A) no portion of the Indebtedness or any other Obligations (contingent or otherwise) of which: 

(1) is guaranteed by the Issuer or any Subsidiary of the Issuer (excluding guarantees of Obligations (other than the principal of, and
interest on, Indebtedness) pursuant to representations, warranties, covenants and indemnities customarily entered into in connection with a Qualified Receivables Transaction); 
 (2) is recourse to or obligates the Issuer or any Subsidiary of the Issuer in any way other than pursuant to representations, warranties, covenants and indemnities customarily entered into in connection
with a Qualified Receivables Transaction; or 
 (3) subjects any property or asset of the Issuer or any Subsidiary of the Issuer
(other than accounts receivable and related assets as provided in the definition of Qualified Receivables Transaction), directly or indirectly, contingently or otherwise, to the satisfaction thereof, other than pursuant to representations,
warranties, covenants and indemnities customarily entered into in connection with a Qualified Receivables Transaction; and 
 (B) with which
neither the Issuer nor any Subsidiary of the Issuer has any material contract, agreement, arrangement or understanding other than on terms no less favorable to the Issuer or such Subsidiary than those that might be obtained at the time from Persons
who are not Affiliates of the Issuer, other than as may be customary in a Qualified Receivables Transaction including for fees payable in the ordinary course of business in connection with servicing accounts receivable; and (C) with which
neither the Issuer nor any Subsidiary of the Issuer has any obligation to maintain or preserve such Subsidiary’s financial condition or cause such Subsidiary to achieve certain levels of operating results other than pursuant to representations,
warranties, covenants and indemnities entered into in connection with a Qualified Receivables Transaction. Any such designation by the Board of Directors of the Issuer will be evidenced to the Trustee by filing with the Trustee a certified copy of
the resolution of the Board of Directors of the Issuer giving effect to such designation and an Officer’s Certificate certifying that such designation complied with the foregoing conditions. 

“Refinance” means, in respect of any Indebtedness, Disqualified Stock or preferred stock, to refinance, extend, renew,
refund, repay, prepay, purchase, redeem, defease or retire, or to issue other Indebtedness, Disqualified Stock or preferred stock in exchange or replacement for, such Indebtedness, Disqualified Stock or preferred stock, in whole or in part.
“Refinanced” and “Refinancing” shall have correlative meanings. 

  
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 “Registration Rights Agreement” means (i) the Registration Rights
Agreement, dated as of April 3, 2012 among USPI Finance and the Initial Purchasers, as such agreement may be amended, modified or supplemented from time to time and (ii) with respect to any Additional Notes, one or more registration rights
agreements among the Issuer and the other parties thereto, as such agreement(s) may be amended, modified or supplemented from time to time, relating to rights given by the Issuer to the purchasers of Additional Notes to register such Additional
Notes under the Securities Act. 
 “Regulation S” means Regulation S promulgated under the Securities
Act. 
 “Regulation S Global Note” means a Regulation S Temporary Global Note or Regulation S
Permanent Global Note, as appropriate. 
 “Regulation S Permanent Global Note” means a permanent Global
Note in the form of Exhibit A1 hereto bearing the Global Note Legend and the Private Placement Legend and deposited with or on behalf of and registered in the name of the Depositary or its nominee, issued in a denomination equal to the
outstanding principal amount of the Regulation S Temporary Global Note upon expiration of the Restricted Period. 

“Regulation S Temporary Global Note” means a temporary Global Note in the form of Exhibit A2 hereto bearing
the legend set forth in Section 2.06(g)(3) deposited with or on behalf of and registered in the name of the Depositary or its nominee, issued in a denomination equal to the outstanding principal amount of the Notes initially sold in reliance on
Rule 903 of Regulation S. 
 “Replacement Preferred Stock” means any Disqualified Stock of the Issuer or
any of its Restricted Subsidiaries issued in exchange for, or the net proceeds of which are used to renew, refund, refinance, replace or discharge any Disqualified Stock of the Issuer or any of its Restricted Subsidiaries (other than intercompany
Disqualified Stock); provided that such Replacement Preferred Stock (i) is issued by the Issuer or by the Restricted Subsidiary who is the issuer of the Disqualified Stock being redeemed, refunded, refinanced, replaced or discharged, and
(ii) does not have an initial liquidation preference in excess of the liquidation preference plus accrued and unpaid dividends on the Disqualified Stock being redeemed, refunded, refinanced, replaced or discharged. 

“Representative” means any trustee, agent or representative for any Senior Debt. 

“Responsible Officer,” when used with respect to the Trustee, means any officer within the Corporate Trust Office of the
Trustee (or any successor group of the Trustee) or any other officer of the Trustee customarily performing functions similar to those performed by any of the above designated officers and also means, with respect to a particular corporate trust
matter, any other officer to whom such matter is referred because of his knowledge of and familiarity with the particular subject and who shall have responsibility for the administration of this Indenture. 

“Restricted Definitive Note” means a Definitive Note bearing the Private Placement Legend. 

“Restricted Global Note” means a Global Note bearing the Private Placement Legend. 

“Restricted Investment” means an Investment other than a Permitted Investment. 

“Restricted Period” means the 40-day distribution compliance period as defined in Regulation S. 

“Restricted Subsidiary” of a Person means any Subsidiary of the referent Person that is not an Unrestricted Subsidiary.
Unless otherwise specified, all references to “Restricted Subsidiaries” or “Restricted Subsidiary” are to Restricted Subsidiaries of the Issuer. 

  
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 “Rule 144” means Rule 144 promulgated under the Securities Act. 

“Rule 144A” means Rule 144A promulgated under the Securities Act. 

“Rule 903” means Rule 903 promulgated under the Securities Act. 

“Rule 904” means Rule 904 promulgated under the Securities Act. 

“SEC” means the Securities and Exchange Commission. 

“Secured Indebtedness” means any Indebtedness of the Issuer or any of its Restricted Subsidiaries secured by a Lien.

 “Securities Act” means the Securities Act of 1933, as amended. 

“Shelf Registration Statement” means the Shelf Registration Statement as defined in the Registration Rights Agreement.

 “Significant Subsidiary” means any Subsidiary that would be a “significant subsidiary” as defined
in Article 1, Rule 1-02 of Regulation S-X, promulgated pursuant to the Securities Act, as such Regulation is in effect on the Effective Date. For purposes of determining whether an Event of Default has occurred, if any group of Restricted
Subsidiaries as to which a particular event has occurred and is continuing at any time would be, taken as a whole, a “Significant Subsidiary” then such event shall be deemed to have occurred with respect to a Significant Subsidiary.

 “Specified Transaction” means any Investment that results in a Person becoming a Restricted Subsidiary, any
designation of a Subsidiary as a Restricted Subsidiary or an Unrestricted Subsidiary, any acquisition or disposition that results in a Restricted Subsidiary ceasing to be a Subsidiary of the Issuer, any Investment constituting an acquisition of
assets constituting a business unit, line of business or division of, or all or substantially all of the Equity Interests of, another Person or any disposition of a business unit, line of business or division of the Issuer or a Restricted
Subsidiary, in each case whether by merger, consolidation, amalgamation or otherwise, or any incurrence or repayment of Indebtedness (other than Indebtedness incurred or repaid under any revolving credit facility or line of credit) or Restricted
Payment. 
 “Sponsor” means (i) any of WCAS Management Corporation and its Affiliates, and investment
funds and partnerships managed or advised by any of them or any of their respective Affiliates but not including, however, any operating company or a company controlled by an operating company of any of the foregoing, (ii) any officer,
director, employee, member, partner or stockholder of the manager or general partner (or the general partner of the general partner) of any of the Persons referred to in clause (i), (iii) the spouses, ancestors, siblings, descendants (including
children or grandchildren by adoption) and the descendants of any of the siblings of the Persons referred to in clause (ii), (iv) in the event of the incompetence or death of any of the Persons described in any of clauses (ii) through
(iii), such Person’s estate, executor, administrator, committee or other personal representative, in each case who at any particular date shall be the owner, beneficially or of record, or have the right to acquire, directly or indirectly,
Equity Interests of the Issuer or Holdings (or any other direct or indirect parent company of the Issuer), (v) any trust created for the benefit of the Persons described in any of clauses (ii) through (iv) or any trust for the benefit
of any such trust; or (vi) any Person controlled by any of the Persons described in any of the clauses (ii) through (v). The provisions set forth in clauses (ii) through (v) above shall only be applicable to the determination of
Permitted Holders and for no other purpose. 

  
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 “Stated Maturity” means, with respect to any installment of interest or
principal on any series of Indebtedness, the date on which the payment of interest or principal was scheduled to be paid in the documentation governing such Indebtedness as of the Effective Date, and will not include any contingent obligations to
repay, redeem or repurchase any such interest or principal prior to the date originally scheduled for the payment thereof. 

“Strategic Investors” means physicians, hospitals, health systems, other healthcare providers, other healthcare
companies and other similar strategic joint venture partners which joint venture partners are actively involved in the day-to-day operations of providing surgical care and surgery-related services, or, in the case of physicians, that have retired
therefrom, individuals who are former owners or employees of surgical care facilities purchased by the Issuer, any of its Restricted Subsidiaries, and consulting firms that receive common stock solely as consideration for consulting services
performed. 
 “Subordinated Indebtedness” means, with respect to the Notes, 

(1) any Indebtedness of the Issuer which is expressly subordinated in right of payment to the Notes by its terms or pursuant to a written
agreement, and 
 (2) any Indebtedness of any Guarantor which expressly subordinated in right of payment to the Subsidiary
Guarantee of such Guarantor by its term or pursuant to a written agreement. 
 “Subsidiary” means, with respect
to any specified Person (the “parent”) at any date, any corporation, limited liability company, partnership, association or other entity the accounts of which would be consolidated with those of the parent in the parent’s
consolidated financial statements if such financial statements were prepared in accordance with GAAP as of such date. 

“Subsidiary Guarantee” means the Guarantee by each Guarantor of the Issuer’s Obligations under this Indenture and
the Notes, executed pursuant to the provisions of this Indenture. 
 “TIA” means the Trust Indenture Act of
1939 (15 U.S.C. Sections 77aaa-77bbbb) as in effect on the date on which this Indenture is qualified thereunder. 

“Total Assets” means the total consolidated assets of the Issuer and its Restricted Subsidiaries as set forth on the
most recent consolidated balance sheet of the Issuer and its Restricted Subsidiaries. 
 “Transactions” means,
collectively, any or all of the following: (i) the offer and issuance of the Notes and the entry into this Indenture and related agreements, (ii) the entry into the Credit Agreement and the incurrence of Indebtedness thereunder,
(iii) the repayment of certain existing Indebtedness of the Issuer and its Subsidiaries, (iv) the 2012 Dividend, (v) the U.K. Spin-Out and (vi) all other transactions relating to any of the foregoing (including payment of fees
and expenses related to any of the foregoing). 
 “Treasury Management Obligations” means obligations under any
agreement governing the provision of treasury or cash management services, including deposit accounts, funds transfer, automated clearinghouse, zero balance accounts, returned check concentration, controlled disbursement, lockbox, account
reconciliation and reporting and trade finance services. Treasury Management Obligations shall not constitute Indebtedness. 

“Treasury Rate” means, with respect to any Make-Whole Redemption Date, the yield to maturity at the time of computation
of United States Treasury securities with a constant maturity (as compiled and published in the most recent Federal Reserve Statistical Release H.15(519) that has become publicly 

  
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available at least two business days prior to such Make-Whole Redemption Date (or, if such Statistical Release is no longer published, any publicly available source of similar market data)) most
nearly equal to the period from such Make-Whole Redemption Date to April 1, 2015; provided, however, that if the period from such Make-Whole Redemption Date to April 1, 2015 is not equal to the constant maturity of a United
States Treasury security for which a weekly average yield is given, the Treasury Rate shall be obtained by linear interpolation (calculated to the nearest one-twelfth of a year) from the weekly average yields of United States Treasury securities for
which such yields are given, except that if the period from such Make-Whole Redemption Date to April 1, 2015 is less than one year, the weekly average yield on actually traded United States Treasury securities adjusted to a constant maturity of
one year shall be used. 
 “Trustee” means the party named as such in the preamble to this Indenture until a
successor replaces it in accordance with the applicable provisions of this Indenture and thereafter means the successor serving hereunder. 
 “U.K. Spin-Out” means, collectively, (a) the distribution by the Issuer of all of the outstanding Equity Interests of USPE Holdings, Ltd. to Holdings, (b) the distribution by
Holdings of all of such Equity Interests to its parent company and (c) each subsequent distribution of all of such Equity Interests by a direct or indirect parent of Holdings and ultimately to the shareholders of USPI Group Holdings, Inc.

 “Unrestricted Definitive Note” means a Definitive Note that does not bear and is not required to bear the
Private Placement Legend. 
 “Unrestricted Global Note” means a Global Note that does not bear and is not
required to bear the Private Placement Legend. 
 “Unrestricted Subsidiary” means any Subsidiary of the Issuer
that is designated by the Board of Directors of the Issuer as an Unrestricted Subsidiary pursuant to a resolution of the Board of Directors and any Subsidiary of an Unrestricted Subsidiary, but only to the extent that such Subsidiary: 

(1) has no Indebtedness other than Non-Recourse Debt; provided that this clause (1) shall be deemed to be
satisfied for so long as the total amount of Indebtedness of all Unrestricted Subsidiaries that is not Non-Recourse Debt does not exceed, measured as of the date of incurrence thereof, 1% of Total Assets; 

(2) except with respect to any Indebtedness permitted by clause (1), is not party to any agreement, contract, arrangement
or understanding with the Issuer or any Restricted Subsidiary unless the terms of any such agreement, contract, arrangement or understanding are no less favorable to the Issuer or such Restricted Subsidiary than those permitted under
Section 4.10 hereof; 
 (3) is a Person with respect to which neither the Issuer nor any of its Restricted
Subsidiaries has any direct or indirect obligation to maintain or preserve such Person’s financial condition or to cause such Person to achieve any specified levels of operating results; and 

(4) has not guaranteed or otherwise directly or indirectly provided credit support for any Indebtedness of the Issuer or
any of its Restricted Subsidiaries. 
 “U.S. Person” means a U.S. Person as defined in Rule 902(k) promulgated
under the Securities Act. 

  
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 “USPI” means United Surgical Partners International, Inc., a Delaware
corporation. 
 “Voting Stock” of any specified Person as of any date means the Capital Stock of such Person
that is at the time entitled to vote in the election of the Board of Directors of such Person. 
 “Weighted Average Life
to Maturity” means, when applied to any Indebtedness at any date, the number of years obtained by dividing: 
 (1) the sum of the products obtained by multiplying (a) the amount of each then remaining installment, sinking fund, serial maturity or other required payments of principal, including payment at
final maturity, in respect of the Indebtedness, by (b) the number of years (calculated to the nearest one-twelfth) that will elapse between such date and the making of such payment; by 

(2) the then outstanding principal amount of such Indebtedness. 

“Wholly Owned Subsidiary” of any specified Person means a Subsidiary of such Person all of the outstanding Capital Stock
or other ownership interest of which (other than directors’ qualifying shares) will at that time be owned by such Person or by one or more Wholly Owned Subsidiaries of such person. 
 SECTION 1.02 Other Definitions. 
  

			
	 Term
	  	 Defined in Section

	 “Affiliate Transaction”
	  	4.10
	 “Asset Sale Offer”
	  	3.09
	 “Authentication Order”
	  	2.02
	 “Calculation Date”
	  	1.01 (Definition of “Fixed Charge Coverage Ratio”)
	 “Change of Control Offer”
	  	4.13
	 “Change of Control Payment”
	  	4.13
	 “Change of Control Payment Date”
	  	4.13
	 “Covenant Defeasance”
	  	8.03
	 “DTC”
	  	2.03
	 “Event of Default”
	  	6.01
	 “Excess Proceeds”
	  	4.09
	 “incur”
	  	4.08
	 “Legal Defeasance”
	  	8.02
	 “Offer Amount”
	  	3.09
	 “Offer Period”
	  	3.09
	 “Paying Agent”
	  	2.03
	 “Permitted Debt”
	  	4.08
	 “Payment Default”
	  	6.01
	 “Purchase Date”
	  	3.09
	 “Registrar”
	  	2.03
	 “Restricted Payments”
	  	4.06
	 “Temporary Notes”
	  	2.10


  
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 SECTION 1.03 Incorporation by Reference of Trust Indenture Act. 

At all times after the effectiveness of a registration statement under the Registration Rights Agreement, this Indenture will be subject
to the mandatory provisions of the TIA, which are incorporated by reference in and made a part of this Indenture effective upon the effectiveness of any such registration statement. Whenever this Indenture refers to a provision of the TIA, the
provision is incorporated by reference in and made a part of this Indenture. 
 The following TIA terms used in this Indenture
have the following meanings: 
 “indenture securities” means the Notes; 

“indenture security holder” means a Holder of a Note; 
 “indenture to be qualified” means this Indenture; 
 “indenture
trustee” or “institutional trustee” means the Trustee; and 
 “obligor” on the Notes and the Subsidiary
Guarantees means the Issuer and the Guarantors, respectively, and any successor obligor upon the Notes and the Subsidiary Guarantees, respectively. 
 All other terms used in this Indenture that are defined by the TIA, defined by TIA reference to another statute or defined by SEC rule under the TIA have the meanings so assigned to them. 

SECTION 1.04 Rules of Construction and Calculation. 
 Unless the context otherwise requires: 
 (1) a term has the meaning
assigned to it; 
 (2) an accounting term not otherwise defined has the meaning assigned to it in accordance with
GAAP; 
 (3) “or” is not exclusive; 

(4) words in the singular include the plural, and in the plural include the singular; 

(5) “will” shall be interpreted to express a command; 

(6) provisions apply to successive events and transactions; 

(7) references to sections of or rules under the Securities Act will be deemed to include substitute, replacement or
successor sections or rules adopted by the SEC from time to time; 
 (8) “including” shall be
interpreted to mean “including without limitation”; 
 (9) references to Sections, Articles and
Exhibits shall refer to Sections, Articles and Exhibits of this Indenture; and 

  
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 (10) the principal amount of any non-interest bearing or other discount security at any date
shall be the principal amount thereof that would be shown on a balance sheet of the Issuer dated such date prepared in accordance with GAAP. 
 ARTICLE 2. 
 THE NOTES 
 SECTION 2.01 Form and Dating. 
 (a) General. The Notes and the
Trustee’s certificate of authentication shall be substantially in the form of Exhibits A1 or A2 attached hereto. The Notes may have notations, legends or endorsements required by law, stock exchange rule or usage (provided
that any such notation, legend or endorsement required by usage is in a form reasonably acceptable to the Issuer). Each Note shall be dated the date of its authentication. The Notes shall be in denominations of $2,000 and integral multiples of
$1,000 in excess thereof. 
 The terms and provisions contained in the Notes shall constitute, and are hereby expressly made, a
part of this Indenture and the Issuer, the Guarantors and the Trustee, by their execution and delivery of this Indenture, expressly agree to such terms and provisions and to be bound thereby. However, to the extent any provision of any Note
conflicts with the express provisions of this Indenture, the provisions of this Indenture shall govern and be controlling. 

(b) Global Notes. Notes issued in global form shall be substantially in the form of Exhibits A1 or A2 attached
hereto (including the Global Note Legend thereon and the “Schedule of Exchanges of Global Note” attached thereto). Notes issued in definitive form shall be substantially in the form of Exhibit A1 attached hereto (but without the
Global Note Legend thereon and without the “Schedule of Exchanges of Global Note” attached thereto). Each Global Note shall represent such of the outstanding Notes as shall be specified therein and each shall provide that it represents the
aggregate principal amount of outstanding Notes from time to time endorsed thereon and that the aggregate principal amount of outstanding Notes represented thereby may from time to time be reduced or increased, as appropriate, to reflect exchanges,
repurchases, and redemptions. Any endorsement of a Global Note to reflect the amount of any increase or decrease in the aggregate principal amount of outstanding Notes represented thereby shall be made by the Trustee or the Custodian, at the
direction of the Trustee, in accordance with instructions given by the Holder thereof as required by Section 2.06 and shall be made on the records of the Trustee and the Depositary. 

(c) Temporary Global Notes. Notes offered and sold in reliance on Regulation S shall be issued initially in the form of the
Regulation S Temporary Global Note, which shall be deposited on behalf of the purchasers of the Notes represented thereby with the Trustee, as custodian for the Depositary, and registered in the name of the Depositary or the nominee of the
Depositary, duly executed by the Issuer and authenticated by the Trustee as hereinafter provided. The Restricted Period shall be terminated upon the receipt by the Trustee of: 

(1) a written certificate from the Depositary certifying that it has received certification of non-United States
beneficial ownership of 100% of the aggregate principal amount of the Regulation S Temporary Global Note (except to the extent of any beneficial owners thereof who acquired an interest therein during the Restricted Period pursuant to another
exemption from registration under the Securities Act and who shall take delivery of a beneficial ownership interest in a 144A Global Note bearing a Private Placement Legend, all as contemplated by Section 2.06(b)); and 

  
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 (2) an Officer’s Certificate from the Issuer. 

Following the termination of the Restricted Period, beneficial interests in the Regulation S Temporary Global Note shall be
exchanged for beneficial interests in the Regulation S Permanent Global Note pursuant to the Applicable Procedures. Simultaneously with the authentication of the Regulation S Permanent Global Note, the Trustee shall cancel the
Regulation S Temporary Global Note. The aggregate principal amount of the Regulation S Temporary Global Note and the Regulation S Permanent Global Note may from time to time be increased or decreased by adjustments made on the records
of the Trustee and the Depositary or its nominee, as the case may be, in connection with transfers of interest as hereinafter provided. 

SECTION 2.02 Execution and Authentication. 
 At least one Officer must sign the Notes for the Issuer by manual or facsimile signature. 
 If an Officer whose signature is on a Note no longer holds that office at the time a Note is authenticated, the Note shall nevertheless be valid. 

A Note shall not be valid until authenticated by the manual signature of the Trustee. The signature of the Trustee shall be conclusive
evidence that the Note has been duly authenticated under this Indenture. 
 The Trustee shall authenticate and deliver:
(i) on the Issue Date, an aggregate principal amount of $440.0 million 9.000% Senior Notes due 2020, (ii) Additional Notes for an original issue in an aggregate principal amount specified in an Authentication Order pursuant to this
Section 2.02, and (iii) Exchange Notes for issue only in an Exchange Offer pursuant to the Registration Rights Agreement, for a like principal amount of Initial Notes or Additional Notes, in each case upon a written order of the Issuer
signed by one Officer (an “Authentication Order”). Such Authentication Order shall specify the amount of the Notes to be authenticated and the date on which the original issue of the Notes is to be authenticated. 

The Trustee may appoint an authenticating agent acceptable to the Issuer to authenticate Notes. An authenticating agent may authenticate
Notes whenever the Trustee may do so. Each reference in this Indenture to authentication by the Trustee includes authentication by such agent. An authenticating agent has the same rights as an Agent to deal with Holders or an Affiliate of the
Issuer. 
 SECTION 2.03 Registrar and Paying Agent. 
 The Issuer shall maintain an office or agency where Notes may be presented for registration of transfer or for exchange (“Registrar”) and an office or agency where Notes may be presented for
payment (“Paying Agent”). The Registrar shall keep a register of the Notes and of their transfer and exchange. The Issuer may appoint one or more co-registrars and one or more additional paying agents. The term “Registrar”
includes any co-registrar and the term “Paying Agent” includes any additional paying agent. The Issuer may change any Paying Agent or Registrar without notice to any Holder. The Issuer shall notify the Trustee in writing of the name and
address of any Agent not a party to this Indenture. If the Issuer fails to appoint or maintain another entity as Registrar or Paying Agent, the Trustee shall act as such. The Issuer or any of its Subsidiaries may act as Paying Agent or Registrar.


  
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 The Issuer initially appoints The Depository Trust Company (“DTC”) to act as
Depositary with respect to the Global Notes. 
 The Issuer initially appoints the Trustee to act as the Registrar and Paying
Agent and to act as Custodian with respect to the Global Notes. 
 SECTION 2.04 Paying Agent To Hold Money in Trust. 

The Issuer shall require each Paying Agent other than the Trustee to agree in writing that the Paying Agent shall hold in trust for the
benefit of Holders or the Trustee all money held by the Paying Agent for the payment of principal, premium or Additional Interest, if any, or interest on the Notes, and shall notify the Trustee of any default by the Issuer in making any such
payment. While any such default continues, the Trustee may require in writing a Paying Agent to pay all money held by it in trust to the Trustee. The Issuer at any time may require in writing a Paying Agent to pay all money held by it in trust to
the Trustee. Upon payment over to the Trustee, the Paying Agent (if other than the Issuer or a Subsidiary) shall have no further liability for the money. If the Issuer or a Subsidiary acts as Paying Agent, it shall segregate and hold in a separate
trust fund for the benefit of the Holders all money held by it as Paying Agent. Upon any bankruptcy or reorganization proceedings relating to the Issuer, the Trustee shall serve as Paying Agent for the Notes. 

SECTION 2.05 Holder Lists. 
 The Trustee shall preserve in as current a form as is reasonably practicable the most recent list available to it of the names and addresses of all Holders and shall otherwise comply with TIA
Section 312(a). If the Trustee is not the Registrar, the Issuer shall furnish to the Trustee at least seven Business Days before each interest payment date and at such other times as the Trustee may request in writing, a list in such form and
as of such date as the Trustee may reasonably require of the names and addresses of the Holders and the Issuer shall otherwise comply with TIA Section 312(a). 
 SECTION 2.06 Transfer and Exchange. 
 (a) Transfer and Exchange of
Global Notes. A Global Note may not be transferred except in whole (but not in part) by the Depositary to a nominee of the Depositary, by a nominee of the Depositary to the Depositary or to another nominee of the Depositary, or by the Depositary
or any such nominee to a successor Depositary or a nominee of such successor Depositary. All Global Notes shall be exchanged by the Issuer for Definitive Notes if: 

(1) the Depository (a) notifies the Issuer that it is unwilling or unable to continue as Depositary for the Global
Notes or (b) has ceased to be a clearing agency registered under the Exchange Act and, in either case, a successor Depositary is not appointed by the Issuer within 120 days after the date of such notice from the Depositary; or 

(2) there has occurred and is continuing a Default or an Event of Default with respect to the Notes. 

Upon the occurrence of any of the preceding events in (1) or (2) above, Definitive Notes shall be issued in such names as the
Depositary shall instruct the Trustee. Global Notes also may be exchanged or replaced, in whole or in part, as provided in Sections 2.07 and 2.10. A Global Note may not be exchanged for another Note other than as provided in this
Section 2.06(a); however, beneficial interests in a Global Note may be transferred and exchanged as provided in Section 2.06(b), (c) or (f). 

  
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 (b) Transfer and Exchange of Beneficial Interests in the Global Notes. The transfer
and exchange of beneficial interests in the Global Notes shall be effected through the Depositary, in accordance with the provisions of this Indenture and the Applicable Procedures. Beneficial interests in the Restricted Global Notes shall be
subject to restrictions on transfer comparable to those set forth herein to the extent required by the Securities Act. Transfers of beneficial interests in the Global Notes also shall require compliance with either subparagraph (1) or
(2) below, as applicable, as well as one or more of the other following subparagraphs, as applicable: 
 (1)
Transfer of Beneficial Interests in the Same Global Note. Beneficial interests in any Restricted Global Note may be transferred to Persons who take delivery thereof in the form of a beneficial interest in the same Restricted Global Note in
accordance with the transfer restrictions set forth in the Private Placement Legend; provided, however, that prior to the expiration of the Restricted Period, transfers of beneficial interests in the Regulation S Temporary Global
Note may not be made to a U.S. Person or for the account or benefit of a U.S. Person (other than an Initial Purchaser). Beneficial interests in any Unrestricted Global Note may be transferred to Persons who take delivery thereof in the form of a
beneficial interest in an Unrestricted Global Note. No written orders or instructions shall be required to be delivered to the Registrar to effect the transfers described in this Section 2.06(b)(1). 

(2) All Other Transfers and Exchanges of Beneficial Interests in Global Notes. In connection with all transfers and
exchanges of beneficial interests that are not subject to Section 2.06(b)(1) above, the transferor of such beneficial interest must deliver to the Registrar either: 

(A) both: 
 (i) a written order from a Participant or an Indirect Participant given to the Depositary in accordance with the Applicable Procedures directing the Depositary to credit or cause to be credited a
beneficial interest in another Global Note in an amount equal to the beneficial interest to be transferred or exchanged; and 
 (ii) instructions given in accordance with the Applicable Procedures containing information regarding the Participant account to be credited with such increase; or 

(B) both: 
 (i) a written order from a Participant or an Indirect Participant given to the Depositary in accordance with the Applicable Procedures directing the Depositary to cause to be issued a Definitive Note in
an amount equal to the beneficial interest to be transferred or exchanged; and 
 (ii) instructions given by the
Depositary to the Registrar containing information regarding the Person in whose name such Definitive Note shall be registered to effect the transfer or exchange referred to in clause (i) above; provided that in no event shall Definitive
Notes be issued upon the transfer or exchange of beneficial interests in the Regulation S Temporary Global Note prior to (A) the expiration of the Restricted Period and (B) the receipt by the Registrar of any certificates required
pursuant to Rule 903 under the Securities Act. 

  
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 Upon consummation of an Exchange Offer by the Issuer in accordance with
Section 2.06(f), the requirements of this Section 2.06(b)(2) shall be deemed to have been satisfied upon receipt by the Registrar of the instructions contained in the Letter of Transmittal delivered by the holder of such beneficial
interests in the Restricted Global Notes. 
 Upon satisfaction of all of the requirements for transfer or
exchange of beneficial interests in Global Notes contained in this Indenture and the Notes or otherwise applicable under the Securities Act, the Trustee shall adjust the principal amount of the relevant Global Note(s) pursuant to
Section 2.06(h). 
 (3) Transfer of Beneficial Interests to Another Restricted Global Note. A beneficial interest in
any Restricted Global Note may be transferred to a Person who takes delivery thereof in the form of a beneficial interest in another Restricted Global Note if the transfer complies with the requirements of Section 2.06(b)(2) above and the
Registrar receives the following: 
 (A) if the transferee shall take delivery in the form of a beneficial
interest in the 144A Global Note, a certificate in the form of Exhibit B hereto, including the certifications in item (1) thereof; and 
 (B) if the transferee shall take delivery in the form of a beneficial interest in the Regulation S Global Note, a certificate in the form of Exhibit B hereto, including the certifications
in item (2) thereof. 
 (4) Transfer and Exchange of Beneficial Interests in a Restricted Global Note for Beneficial
Interests in an Unrestricted Global Note. A beneficial interest in any Restricted Global Note may be exchanged by any holder thereof for a beneficial interest in an Unrestricted Global Note or transferred to a Person who takes delivery thereof
in the form of a beneficial interest in an Unrestricted Global Note if the exchange or transfer complies with the requirements of Section 2.06(b)(2) above and: 

(A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance with the Registration Rights
Agreement and the holder of the beneficial interest to be transferred, in the case of an exchange, or the transferee, in the case of a transfer, certifies in the applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a
Person participating in the distribution of the Exchange Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer; 
 (B) such transfer is effected pursuant to the Shelf Registration Statement in accordance with the Registration Rights Agreement; 

(C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer Registration Statement in accordance with
the Registration Rights Agreement; or 
 (D) the Registrar receives the following: 

(i) if the holder of such beneficial interest in a Restricted Global Note proposes to exchange such beneficial interest
for a beneficial interest in an Unrestricted Global Note, a certificate from such holder in the form of Exhibit C hereto, including the certifications in item (1)(a) thereof; or 

  
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 (ii) if the holder of such beneficial interest in a Restricted Global Note
proposes to transfer such beneficial interest to a Person who shall take delivery thereof in the form of a beneficial interest in an Unrestricted Global Note, a certificate from such holder in the form of Exhibit B hereto, including the
certifications in item (4) thereof; 
 and, in each such case set forth in this subparagraph (D), if the Registrar so
requests or if the Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and that the restrictions on transfer
contained herein and in the Private Placement Legend are no longer required in order to maintain compliance with the Securities Act. 
 If any such transfer is effected pursuant to subparagraph (B) or (D) above at a time when an Unrestricted Global Note has not yet been issued, the Issuer shall issue and, upon receipt of an
Authentication Order in accordance with Section 2.02, the Trustee shall authenticate one or more Unrestricted Global Notes in an aggregate principal amount equal to the aggregate principal amount of beneficial interests transferred pursuant to
subparagraph (B) or (D) above. 
 Beneficial interests in an Unrestricted Global Note cannot be exchanged for, or
transferred to Persons who take delivery thereof in the form of, a beneficial interest in a Restricted Global Note. 
 (c)
Transfer or Exchange of Beneficial Interests for Definitive Notes. 
 (1) Beneficial Interests in Restricted Global
Notes to Restricted Definitive Notes. If any holder of a beneficial interest in a Restricted Global Note proposes to exchange such beneficial interest for a Restricted Definitive Note or to transfer such beneficial interest to a Person who takes
delivery thereof in the form of a Restricted Definitive Note, then, upon receipt by the Registrar of the following documentation: 
 (A) if the holder of such beneficial interest in a Restricted Global Note proposes to exchange such beneficial interest for a Restricted Definitive Note, a certificate from such holder in the form of
Exhibit C hereto, including the certifications in item (2)(a) thereof; 
 (B) if such beneficial
interest is being transferred to a QIB in accordance with Rule 144A, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (1) thereof; 

(C) if such beneficial interest is being transferred to a Non-U.S. Person in an offshore transaction in accordance with
Rule 903 or Rule 904, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (2) thereof; 
 (D) if such beneficial interest is being transferred pursuant to an exemption from the registration requirements of the Securities Act in accordance with Rule 144, a certificate to the effect set forth in
Exhibit B hereto, including the certifications in item (3)(a) thereof; 
 (E) if such beneficial
interest is being transferred to the Issuer or any of its Subsidiaries, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (3)(b) thereof; or 

  
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 (F) if such beneficial interest is being transferred pursuant to an
effective registration statement under the Securities Act, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (3)(c) thereof, 
 the Trustee shall cause the aggregate principal amount of the applicable Global Note to be reduced accordingly pursuant to Section 2.06(h), and the Issuer shall execute and the Trustee shall
authenticate and deliver to the Person designated in the instructions a Definitive Note in the appropriate principal amount. Any Definitive Note issued in exchange for a beneficial interest in a Restricted Global Note pursuant to this
Section 2.06(c) shall be registered in such name or names and in such authorized denomination or denominations as the holder of such beneficial interest shall instruct the Registrar through instructions from the Depositary and the Participant
or Indirect Participant. The Trustee shall deliver such Definitive Notes to the Persons in whose names such Notes are so registered. Any Definitive Note issued in exchange for a beneficial interest in a Restricted Global Note pursuant to this
Section 2.06(c)(1) shall bear the Private Placement Legend and shall be subject to all restrictions on transfer contained therein. 
 (2) Beneficial Interests in Regulation S Temporary Global Note to Definitive Notes. Notwithstanding Sections 2.06(c)(1)(A) and (C), a beneficial interest in the Regulation S Temporary
Global Note may not be exchanged for a Definitive Note or transferred to a Person who takes delivery thereof in the form of a Definitive Note prior to (A) the expiration of the Restricted Period and (B) the receipt by the Registrar of any
certificates required pursuant to Rule 903(b)(3)(ii)(B) under the Securities Act, except in the case of a transfer pursuant to an exemption from the registration requirements of the Securities Act other than Rule 903 or Rule 904. 

(3) Beneficial Interests in Restricted Global Notes to Unrestricted Definitive Notes. A holder of a beneficial interest in a
Restricted Global Note may exchange such beneficial interest for an Unrestricted Definitive Note or may transfer such beneficial interest to a Person who takes delivery thereof in the form of an Unrestricted Definitive Note only if: 

(A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance with the Registration Rights
Agreement and the holder of such beneficial interest, in the case of an exchange, or the transferee, in the case of a transfer, certifies in the applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a Person
participating in the distribution of the Exchange Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer; 
 (B) such transfer is effected pursuant to the Shelf Registration Statement in accordance with the Registration Rights Agreement; 

(C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer Registration Statement in accordance with
the Registration Rights Agreement; or 
 (D) the Registrar receives the following: 

(i) if the holder of such beneficial interest in a Restricted Global Note proposes to exchange such beneficial interest
for an Unrestricted Definitive Note, a certificate from such holder in the form of Exhibit C hereto, including the certifications in item (1)(b) thereof; or 

(ii) if the holder of such beneficial interest in a Restricted Global Note proposes to transfer such beneficial interest
to a Person who shall take delivery thereof in the form of an Unrestricted Definitive Note, a certificate from such holder in the form of Exhibit B hereto, including the certifications in item (4) thereof; 

  
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 and, in each such case set forth in this subparagraph (D), if the Registrar so requests or
if the Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and that the restrictions on transfer contained
herein and in the Private Placement Legend are no longer required in order to maintain compliance with the Securities Act. 

(4) Beneficial Interests in Unrestricted Global Notes to Unrestricted Definitive Notes. If any holder of a beneficial interest in
an Unrestricted Global Note proposes to exchange such beneficial interest for a Definitive Note or to transfer such beneficial interest to a Person who takes delivery thereof in the form of a Definitive Note, then, upon satisfaction of the
conditions set forth in Section 2.06(b)(2), the Trustee shall cause the aggregate principal amount of the applicable Global Note to be reduced accordingly pursuant to Section 2.06(h), and the Issuer shall execute and the Trustee shall
authenticate and deliver to the Person designated in the instructions a Definitive Note in the appropriate principal amount. Any Definitive Note issued in exchange for a beneficial interest pursuant to this Section 2.06(c)(4) shall be
registered in such name or names and in such authorized denomination or denominations as the holder of such beneficial interest requests through instructions to the Registrar from or through the Depositary and the Participant or Indirect
Participant. The Trustee shall deliver such Definitive Notes to the Persons in whose names such Notes are so registered. Any Definitive Note issued in exchange for a beneficial interest pursuant to this Section 2.06(c)(4) shall not bear the
Private Placement Legend. 
 (d) Transfer and Exchange of Definitive Notes for Beneficial Interests. 

(1) Restricted Definitive Notes to Beneficial Interests in Restricted Global Notes. If any Holder of a Restricted Definitive Note
proposes to exchange such Note for a beneficial interest in a Restricted Global Note or to transfer such Restricted Definitive Notes to a Person who takes delivery thereof in the form of a beneficial interest in a Restricted Global Note, then, upon
receipt by the Registrar of the following documentation: 
 (A) if the Holder of such Restricted Definitive Note
proposes to exchange such Note for a beneficial interest in a Restricted Global Note, a certificate from such Holder in the form of Exhibit C hereto, including the certifications in item (2)(b) thereof; 

(B) if such Restricted Definitive Note is being transferred to a QIB in accordance with Rule 144A, a certificate to the
effect set forth in Exhibit B hereto, including the certifications in item (1) thereof; 
 (C) if
such Restricted Definitive Note is being transferred to a Non-U.S. Person in an offshore transaction in accordance with Rule 903 or Rule 904, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item
(2) thereof; 
 (D) if such Restricted Definitive Note is being transferred pursuant to an exemption from
the registration requirements of the Securities Act in accordance with Rule 144, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (3)(a) thereof; 

(E) if such Restricted Definitive Note is being transferred to the Issuer or any of its Subsidiaries, a certificate to the
effect set forth in Exhibit B hereto, including the certifications in item (3)(b) thereof; or 

  
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 (F) if such Restricted Definitive Note is being transferred pursuant to an
effective registration statement under the Securities Act, a certificate to the effect set forth in Exhibit B hereto, including the certifications in item (3)(c) thereof, 
 the Trustee shall cancel the Restricted Definitive Note and increase or cause to be increased the aggregate principal amount of the applicable Global Note. 

(2) Restricted Definitive Notes to Beneficial Interests in Unrestricted Global Notes. A Holder of a Restricted Definitive Note may
exchange such Note for a beneficial interest in an Unrestricted Global Note or transfer such Restricted Definitive Note to a Person who takes delivery thereof in the form of a beneficial interest in an Unrestricted Global Note only if: 

(A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance with the Registration Rights
Agreement and the Holder, in the case of an exchange, or the transferee, in the case of a transfer, certifies in the applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a Person participating in the distribution of
the Exchange Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer; 
 (B) such
transfer is effected pursuant to the Shelf Registration Statement in accordance with the Registration Rights Agreement; 
 (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer Registration Statement in accordance with the Registration Rights Agreement; or 

(D) the Registrar receives the following: 

(i) if the Holder of such Definitive Notes proposes to exchange such Notes for a beneficial interest in the Unrestricted
Global Note, a certificate from such Holder in the form of Exhibit C hereto, including the certifications in item (1)(c) thereof; or 
 (ii) if the Holder of such Definitive Notes proposes to transfer such Notes to a Person who shall take delivery thereof in the form of a beneficial interest in the Unrestricted Global Note, a certificate
from such Holder in the form of Exhibit B hereto, including the certifications in item (4) thereof; 
 and, in each
such case set forth in this subparagraph (D), if the Registrar so requests or if the Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable to the Registrar to the effect that such exchange or transfer is in compliance
with the Securities Act and that the restrictions on transfer contained herein and in the Private Placement Legend are no longer required in order to maintain compliance with the Securities Act. 

Upon satisfaction of the conditions of any of the subparagraphs in this Section 2.06(d)(2), the Trustee shall cancel the Definitive
Notes and increase or cause to be increased the aggregate principal amount of the Unrestricted Global Note. 
 (3)
Unrestricted Definitive Notes to Beneficial Interests in Unrestricted Global Notes. A Holder of an Unrestricted Definitive Note may exchange such Note for a beneficial interest in an Unrestricted Global Note or transfer such Definitive Notes
to a Person who takes delivery thereof in the form of a beneficial interest in an Unrestricted Global Note at any time. Upon receipt of a request for such an exchange or transfer, the Trustee shall cancel the applicable Unrestricted Definitive Note
and increase or cause to be increased the aggregate principal amount of one of the Unrestricted Global Notes. 

  
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 If any such exchange or transfer from a Definitive Note to a beneficial interest is effected
pursuant to subparagraphs (2)(B), (2)(D) or (3) above at a time when an Unrestricted Global Note has not yet been issued, the Issuer shall issue and, upon receipt of an Authentication Order in accordance with Section 2.02, the Trustee
shall authenticate one or more Unrestricted Global Notes in an aggregate principal amount equal to the principal amount of Definitive Notes transferred or exchanged pursuant to subparagraph (2)(B), (2)(D) or (3) above. 

(e) Transfer and Exchange of Definitive Notes for Definitive Notes. Upon request by a Holder of Definitive Notes and such
Holder’s compliance with the provisions of this Section 2.06(e), the Registrar shall register the transfer or exchange of Definitive Notes. Prior to such registration of transfer or exchange, the requesting Holder must present or surrender
to the Registrar the Definitive Notes duly endorsed or accompanied by a written instruction of transfer in form satisfactory to the Registrar duly executed by such Holder or by its attorney, duly authorized in writing. In addition, the requesting
Holder must provide any additional certifications, documents and information, as applicable, required pursuant to the following provisions of this Section 2.06(e). 

(1) Restricted Definitive Notes to Restricted Definitive Notes. Any Restricted Definitive Note may be transferred
to and registered in the name of Persons who take delivery thereof in the form of a Restricted Definitive Note if the Registrar receives the following: 
 (A) if the transfer shall be made pursuant to Rule 144A, then the transferor must deliver a certificate in the form of Exhibit B hereto, including the certifications in item (1) thereof;

 (B) if the transfer shall be made pursuant to Rule 903 or Rule 904, then the transferor must deliver a
certificate in the form of Exhibit B hereto, including the certifications in item (2) thereof; and 

(C) if the transfer shall be made pursuant to any other exemption from the registration requirements of the Securities
Act, then the transferor must deliver a certificate in the form of Exhibit B hereto, including the certifications required by item (3) thereof, if applicable. 

(2) Restricted Definitive Notes to Unrestricted Definitive Notes. Any Restricted Definitive Note may be exchanged
by the Holder thereof for an Unrestricted Definitive Note or transferred to a Person or Persons who take delivery thereof in the form of an Unrestricted Definitive Note if: 

(A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance with the Registration Rights
Agreement and the Holder, in the case of an exchange, or the transferee, in the case of a transfer, certifies in the applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a Person participating in the distribution of
the Exchange Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer; 
 (B) any
such transfer is effected pursuant to the Shelf Registration Statement in accordance with the Registration Rights Agreement; 

  
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 (C) any such transfer is effected by a Broker-Dealer pursuant to the
Exchange Offer Registration Statement in accordance with the Registration Rights Agreement; or 
 (D) the
Registrar receives the following: 
 (i) if the Holder of such Restricted Definitive Notes proposes to transfer
such Notes to a Person who shall take delivery thereof in the form of an Unrestricted Definitive Note, a certificate from such Holder in the form of Exhibit B hereto, including the certifications in item (4) thereof; 

(ii) if the Holder of such Restricted Definitive Notes proposes to transfer such Notes to a Person who shall take
delivery thereof in the form of an Unrestricted Definitive Note, a certificate from such Holder in the form of Exhibit B hereto, including the certifications in item (4) thereof; 

and, in each such case set forth in this subparagraph (D), if the Registrar so requests, an Opinion of Counsel in form reasonably
acceptable to the Registrar to the effect that such exchange or transfer is in compliance with the Securities Act and that the restrictions on transfer contained herein and in the Private Placement Legend are no longer required in order to maintain
compliance with the Securities Act. 
 (3) Unrestricted Definitive Notes to Unrestricted Definitive Notes.
A Holder of Unrestricted Definitive Notes may transfer such Notes to a Person who takes delivery thereof in the form of an Unrestricted Definitive Note. Upon receipt of a request to register such a transfer, the Registrar shall register the
Unrestricted Definitive Notes pursuant to the instructions from the Holder thereof. 
 (f) Exchange Offer. Upon the
occurrence of the Exchange Offer in accordance with the Registration Rights Agreement, the Issuer shall issue and, upon receipt of an Authentication Order in accordance with Section 2.02, the Trustee shall authenticate: 

(1) one or more Unrestricted Global Notes in an aggregate principal amount equal to the principal amount of the beneficial
interests in the Restricted Global Notes accepted for exchange in the Exchange Offer by Persons that certify in the applicable Letters of Transmittal that (A) they are not Broker-Dealers, (B) they are not participating in a distribution of
the Exchange Notes and (C) they are not affiliates (as defined in Rule 144) of the Issuer; and 
 (2)
Unrestricted Definitive Notes in an aggregate principal amount equal to the principal amount of the Restricted Definitive Notes accepted for exchange in the Exchange Offer. 
 Concurrently with the issuance of such Notes, the Trustee shall cause the aggregate principal amount of the applicable Restricted Global Notes to be reduced accordingly, and the Issuer shall execute and
the Trustee shall authenticate and deliver to the Persons designated by the Holders of Restricted Definitive Notes so accepted Unrestricted Definitive Notes in the appropriate principal amount. Any Notes that remain outstanding after the
consummation of the Exchange Offer, and Exchange Notes issued in connection with the Exchange Offer, shall be treated as a single class of securities under this Indenture. 

  
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 (g) Legends. The following legends shall appear on the face of all Global Notes and
Definitive Notes issued under this Indenture unless specifically stated otherwise in the applicable provisions of this Indenture. 
 (1) Private Placement Legend. 
 (A) Except as permitted by
subparagraph (B) below, each Global Note and each Definitive Note (and all Notes issued in exchange therefor or substitution thereof) shall bear the legend in substantially the following form. 

“THIS NOTE HAS NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), OR UNDER THE
SECURITIES LAWS OF ANY STATE OR OTHER JURISDICTION, AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS EXCEPT AS SET FORTH BELOW. EACH PURCHASER OF THIS NOTE IS HEREBY NOTIFIED
THAT THE SELLER OF THIS NOTE MAY BE RELYING ON THE EXEMPTION FROM THE PROVISIONS OF SECTION 5 OF THE SECURITIES ACT PROVIDED BY RULE 144A THEREUNDER OR ANOTHER EXEMPTION UNDER THE SECURITIES ACT. 

“BY ITS ACCEPTANCE HEREOF, THE HOLDER OF THIS NOTE (1) REPRESENTS THAT (A) IT IS A “QUALIFIED INSTITUTIONAL
BUYER” (AS DEFINED IN RULE 144A UNDER THE SECURITIES ACT), (B) IT IS NOT A U.S. PERSON AND IS ACQUIRING THIS NOTE IN AN OFFSHORE TRANSACTION IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT OR (C) IT IS AN
“INSTITUTIONAL” ACCREDITED INVESTOR (AS DEFINED IN RULE 501(a)(1), (2), (3) OR, (7) UNDER REGULATION D PROMULGATED UNDER THE SECURITIES ACT (AN “ACCREDITED INVESTOR”) AND (2) AGREES THAT IT WILL NOT, WITHIN ONE
YEAR FOR” NOTES ISSUED PURSUANT TO RULE 144A OR WITHIN 40 DAYS FOR NOTES ISSUED IN OFFSHORE TRANSACTIONS PURSUANT TO REGULATION S, AFTER THE LATER OF THE DATE OF THE ORIGINAL ISSUANCE OF THIS NOTE AND THE DATE ON WHICH THE COMPANY OR ANY OF ITS
RESPECTIVE AFFILIATES OWNED THIS NOTE, OFFER, RESELL OR OTHERWISE TRANSFER THIS NOTE EXCEPT (A) (I) TO THE COMPANY OR ANY SUBSIDIARY THEREOF, (II) FOR SO LONG AS THIS NOTE IS ELIGIBLE FOR RESALE PURSUANT TO RULE 144A UNDER THE SECURITIES
ACT INSIDE THE UNITED STATES TO A PERSON WHOM THE SELLER REASONABLY BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER IN COMPLIANCE WITH RULE 144A UNDER THE SECURITIES ACT, (III) INSIDE THE UNITED STATES TO AN ACCREDITED INVESTOR THAT IS ACQUIRING THE
NOTES FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF SUCH AN ACCREDITED INVESTOR, IN EACH CASE IN A MINIMUM PRINCIPAL AMOUNT OF THE NOTES OF $250,000, FOR INVESTMENT PURPOSES AND NOT WITH A VIEW TO OR FOR THE OFFER OR SALE IN CONNECTION WITH ANY
DISTRIBUTION IN VIOLATION OF THE SECURITIES ACT, AND THAT PRIOR TO SUCH TRANSFER, FURNISHES (OR HAS FURNISHED ON ITS BEHALF BY A U.S. BROKER-DEALER) TO THE TRUSTEE A SIGNED LETTER CONTAINING CERTAIN REPRESENTATIONS AND AGREEMENTS RELATING TO THE
RESTRICTIONS ON TRANSFER OF THIS NOTE (THE 

  
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FORM OF WHICH LETTER CAN BE OBTAINED FROM THE TRUSTEE FOR THIS NOTE), (IV) OUTSIDE THE UNITED STATES IN AN OFFSHORE TRANSACTION IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT (IF
AVAILABLE), (V) PURSUANT TO THE EXEMPTION FROM REGISTRATION PROVIDED BY RULE 144 UNDER THE SECURITIES ACT (IF AVAILABLE), (VI) IN ACCORDANCE WITH ANOTHER EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT (AND BASED UPON AN
OPINION OF COUNSEL IF THE COMPANY SO REQUESTS), OR (VII) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND (B) IN ACCORDANCE WITH ALL APPLICABLE SECURITIES LAWS OF THE STATES OF THE UNITED STATES AND OTHER
JURISDICTIONS. BY ITS ACCEPTANCE HEREOF, THE HOLDER OF THIS NOTE FURTHER AGREES THAT IT WILL GIVE TO EACH PERSON TO WHOM THIS NOTE IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF THIS LEGEND. IN CONNECTION WITH ANY TRANSFER OF THIS NOTE
PURSUANT TO SUBCLAUSES (III) TO (VI) OF CLAUSE (A) ABOVE, AND THAT, THE HOLDER MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE TRUSTEE AND THE COMPANY SUCH CERTIFICATIONS, LEGAL OPINIONS OR OTHER INFORMATION AS EITHER OF THEM MAY REASONABLY
REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT. AS USED HEREIN, THE TERMS “OFFSHORE TRANSACTION,” “UNITED
STATES” AND “U.S. PERSON” HAVE THE MEANINGS GIVEN TO THEM BY REGULATION S UNDER THE SECURITIES ACT.” 
 (B) Notwithstanding the foregoing, any Global Note or Definitive Note issued pursuant to subparagraphs (b)(4), (c)(3), (c)(4), (d)(2), (d)(3), (e)(2), (e)(3) or (f) of this Section 2.06 (and all
Notes issued in exchange therefor or substitution thereof) shall not bear the Private Placement Legend. 
 (2)
Global Note Legend. Each Global Note shall bear a legend in substantially the following form: 
 “THIS GLOBAL NOTE IS
HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING THIS NOTE) OR ITS NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS HEREOF, AND IS NOT TRANSFERABLE TO ANY PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT (1) THE TRUSTEE MAY
MAKE SUCH NOTATIONS HEREON AS MAY BE REQUIRED PURSUANT TO SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3) THIS GLOBAL NOTE MAY
BE DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 2.11 OF THE INDENTURE AND (4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF THE ISSUERS. 

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM, THIS NOTE MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY
THE DEPOSITARY TO A NOMINEE OF THE DEPOSITARY OR BY A 

  
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NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.
UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY (55 WATER STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY
CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS MAY BE REQUESTED BY AN
AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN.” 

(3) Regulation S Temporary Global Note Legend. Each Regulation S Temporary Global Note shall bear a legend in substantially
the following form. 
 “THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES
GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED HEREIN).” 
 (h)
Cancellation and/or Adjustment of Global Notes. At such time as all beneficial interests in a particular Global Note have been exchanged for Definitive Notes or a particular Global Note has been redeemed, repurchased or canceled in whole and
not in part, each such Global Note shall be returned to or retained and canceled by the Trustee in accordance with Section 2.11. At any time prior to such cancellation, if any beneficial interest in a Global Note is exchanged for or transferred
to a Person who shall take delivery thereof in the form of a beneficial interest in another Global Note or for Definitive Notes, the principal amount of Notes represented by such Global Note shall be reduced accordingly and an endorsement shall be
made on such Global Note by the Trustee or by the Depositary at the direction of the Trustee to reflect such reduction; and if the beneficial interest is being exchanged for or transferred to a Person who shall take delivery thereof in the form of a
beneficial interest in another Global Note, such other Global Note shall be increased accordingly and an endorsement shall be made on such Global Note by the Trustee or by the Depositary at the direction of the Trustee to reflect such increase.

 (i) General Provisions Relating to Transfers and Exchanges. 

(1) To permit registrations of transfers and exchanges, the Issuer shall execute and the Trustee shall authenticate Global Notes and
Definitive Notes upon receipt of an Authentication Order in accordance with Section 2.02 or at the Registrar’s request. 
 (2) No service charge shall be made to a Holder of a beneficial interest in a Global Note or to a Holder of a Definitive Note for any registration of transfer or exchange, but the Issuer may require
payment of a sum sufficient to cover any transfer tax or similar governmental charge payable in connection therewith (other than any such transfer taxes or similar governmental charge payable upon exchange or transfer pursuant to Sections 2.10,
3.06, 3.09, 4.09, 4.13 and 9.06). 

  
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 (3) The Registrar shall not be required to register the transfer of or exchange of any Note
selected for redemption in whole or in part, except the unredeemed portion of any Note being redeemed in part. 
 (4) All Global
Notes and Definitive Notes issued upon any registration of transfer or exchange of Global Notes or Definitive Notes shall be the valid obligations of the Issuer, evidencing the same debt, and entitled to the same benefits under this Indenture, as
the Global Notes or Definitive Notes surrendered upon such registration of transfer or exchange. 
 (5) The Issuer shall not be
required: 
 (A) to issue, to register the transfer of or to exchange any Notes during a period beginning at the
opening of business 15 days before the day of any selection of Notes for redemption under Section 3.02 and ending at the close of business on the day of selection; 

(B) to register the transfer of or to exchange any Note selected for redemption in whole or in part, except the unredeemed
portion of any Note being redeemed in part; or 
 (C) to register the transfer of or to exchange a Note between a
record date and the next succeeding interest payment date. 
 (6) Prior to due presentment for the registration of a transfer of
any Note, the Trustee, any Agent and the Issuer may deem and treat the Person in whose name any Note is registered as the absolute owner of such Note for the purpose of receiving payment of principal of and interest on such Notes and for all other
purposes, and none of the Trustee, any Agent or the Issuer shall be affected by notice to the contrary. 
 (7) The Trustee shall
authenticate Global Notes and Definitive Notes in accordance with the provisions of Section 2.02. 
 (8) All
certifications, certificates and Opinions of Counsel required to be submitted to the Registrar pursuant to this Section 2.06 to effect a registration of transfer or exchange may be submitted by facsimile. 

(9) Neither the Trustee nor the Registrar shall be under any obligation or duty to determine or inquire as to compliance with the
Securities Act (including any rules or regulations promulgated thereunder) or any state securities laws that may be applicable in connection with or with respect to any transfer of any interest in any Note (including any transfers between or among
beneficial owners of interests in any Global Note) or to monitor, determine or inquire as to compliance with any restriction on transfer imposed under this Indenture with respect to transfers of interests in any security (including any transfers
between or among beneficial owners of interests in any Global Notes); except that the Trustee shall be under a duty to require delivery of such certificates and other documentation, if any, as are expressly required in the applicable circumstance,
and to do so if and when expressly required by, the terms of this Indenture, and to examine the same to determine substantial compliance on their face with the express requirements hereof. The Trustee shall have no responsibility for (i) the
actions or omissions of the Depositary, or for the accuracy of the books or records of the Depositary and (ii) transfers, of which it has no knowledge, between or among beneficial owners of interests in the same Global Note. 

  
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 SECTION 2.07 Replacement Notes. 

If any mutilated Note is surrendered to the Trustee or the Registrar and the Trustee receives evidence to its satisfaction of the
destruction, loss or theft of any Note, the Issuer shall issue and the Trustee, upon receipt of an Authentication Order, shall authenticate a replacement Note if the Trustee’s requirements are met. If required by the Trustee or the Issuer, an
indemnity bond must be supplied by the Holder that is sufficient in the judgment of the Trustee and the Issuer to protect the Issuer, the Trustee, any Agent and any authenticating agent from any loss that any of them may suffer if a Note is
replaced. The Issuer may charge for its expenses in replacing a Note. 
 Every replacement Note is an additional obligation of
the Issuer and shall be entitled to all of the benefits of this Indenture equally and proportionately with all other Notes duly issued hereunder. 
 SECTION 2.08 Outstanding Notes. 
 The Notes outstanding at any time are all
the Notes authenticated by the Trustee except for those canceled by it, those delivered to it for cancellation, those reductions in the interest in a Global Note effected by the Trustee in accordance with the provisions hereof, and those described
in this Section 2.08 as not outstanding. Subject to Section 2.09, a Note does not cease to be outstanding because the Issuer or an Affiliate of the Issuer holds the Note. 

If a Note is replaced pursuant to Section 2.07, it ceases to be outstanding unless the Trustee receives proof satisfactory to it
that the replaced Note is held by a protected purchaser. 
 If the principal amount of any Note is considered paid under
Section 4.01, it ceases to be outstanding and interest on it ceases to accrue. 
 If the Paying Agent (other than the
Issuer, a Subsidiary or an Affiliate of any thereof) holds, on a redemption date or maturity date, money sufficient to pay Notes payable on that date, then on and after that date such Notes shall be deemed to be no longer outstanding and shall cease
to accrue interest. 
 SECTION 2.09 Treasury Notes. 
 In determining whether the Holders of the required principal amount of Notes have concurred in any direction, waiver or consent, Notes owned by the Issuer or any of its Subsidiaries, shall be considered
as though not outstanding, except that for the purposes of determining whether the Trustee shall be protected in relying on any such direction, waiver or consent, only Notes that a Responsible Officer of the Trustee actually knows are so owned shall
be so disregarded. 
 SECTION 2.10 Temporary Notes. 
 Until certificates representing Notes are ready for delivery, the Issuer may prepare and the Trustee, upon receipt of an Authentication Order, shall authenticate temporary Notes (“Temporary
Notes”). Temporary Notes shall be substantially in the form of certificated Notes but may have variations that the Issuer considers appropriate for Temporary Notes and as may be reasonably acceptable to the Trustee. Without unreasonable delay,
the Issuer shall prepare and the Trustee shall authenticate Definitive Notes in exchange for Temporary Notes. 
 Holders of
Temporary Notes shall be entitled to all of the benefits of this Indenture. 

  
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 SECTION 2.11 Cancellation. 
 The Issuer at any time may deliver Notes to the Trustee for cancellation. The Registrar and Paying Agent shall forward to the Trustee any Notes surrendered to them for registration of transfer, exchange
or payment. The Trustee and no one else shall cancel all Notes surrendered for registration of transfer, exchange, payment, replacement or cancellation and shall dispose of such canceled Notes (subject to the record retention requirement of the
Exchange Act). Certification of the disposal of all canceled Notes shall be delivered to the Issuer upon its request therefor. The Issuer may not issue new Notes to replace Notes that it has paid or that have been delivered to the Trustee for
cancellation. If the Issuer shall acquire any of the Notes, such acquisition shall not operate as a redemption or satisfaction of the Indebtedness represented by such Notes unless and until the same are surrendered to the Trustee for cancellation
pursuant to this Section 2.11. 
 SECTION 2.12 Defaulted Interest. 

If the Issuer defaults in a payment of interest on the Notes, it shall pay the defaulted interest in any lawful manner plus, to the extent
lawful, interest payable on the defaulted interest, to the Persons who are Holders on a subsequent special record date, in each case at the rate provided in the Notes and in Section 4.01. The Issuer shall notify the Trustee in writing of the
amount of defaulted interest proposed to be paid on each Note and the date of the proposed payment. The Issuer shall fix or cause to be fixed each such special record date and payment date; provided that no such special record date may be
less than 10 days prior to the related payment date for such defaulted interest. At least 15 days before the special record date, the Issuer (or, upon the written request of the Issuer, the Trustee in the name and at the expense of the Issuer) shall
mail or cause to be mailed to Holders a notice that states the special record date, the related payment date and the amount of such interest to be paid. 
 SECTION 2.13 CUSIP Numbers. 
 The Issuer in issuing the Notes may use CUSIP
numbers and corresponding ISIN numbers (if then generally in use), and, if so, the Trustee will use CUSIP numbers in notices of redemption or repurchase and other notices to Holders as a convenience to Holders; provided that any such notice
may state that no representation is made as to the correctness of such numbers either as printed on the Notes or as contained in any notice of a redemption and that reliance may be placed only on the other identification numbers printed on the
Notes, and any such redemption will not be affected by any defect in or omission of such numbers. The Issuer will promptly notify the Trustee of any change in the CUSIP numbers. 
 SECTION 2.14 Issuance of Additional Notes. 
 The Issuer will be entitled,
from time to time, subject to its compliance with Section 4.08, without consent of the Holders, to issue Additional Notes under this Indenture with identical terms as the Initial Notes issued on the Issue Date other than with respect to
(i) the date of issuance, (ii) the issue price, (iii) the amount of interest payable on the first interest payment date and (iv) any adjustments in order to conform to and ensure compliance with the Securities Act (or other
applicable securities laws). The Initial Notes issued on the Issue Date, any Additional Notes and all Exchange Notes issued in exchange therefor will be treated as a single class for all purposes under this Indenture; provided that, if any
Additional Notes subsequently issued are not fungible for U.S. federal income tax purposes or securities law purposes with any Notes previously issued, such Additional Notes shall trade separately from such previously issued Notes under a separate
CUSIP number but shall otherwise be treated as a single class with all other Notes issued under this Indenture. 

  
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 With respect to any Additional Notes, the Issuer will set forth in an Officer’s
Certificate pursuant to a resolution of the Board of Directors of the Issuer, copies of which will be delivered to the Trustee, the following information: 
 (1) the aggregate principal amount of such Additional Notes to be authenticated and delivered pursuant to this Indenture; 

(2) the issue price, the issue date and the CUSIP number of such Additional Notes; and 

(3) whether such Additional Notes will be subject to transfer restrictions or will be issued in the form of Exchange
Notes. 
 ARTICLE 3. 
 REDEMPTION AND PREPAYMENT 
 SECTION 3.01 Notices to Trustee. 

If the Issuer elects to redeem Notes pursuant to the optional redemption provisions of Section 5 of the Notes, the Issuer shall
furnish to the Trustee, at least 30 days but not more than 60 days before the redemption date, an Officer’s Certificate setting forth: 
 (1) the clause of this Indenture pursuant to which the redemption shall occur; 
 (2) the redemption date; 
 (3) the principal amount of the Notes to
be redeemed; and 
 (4) the redemption price. 
 SECTION 3.02 Selection of Notes To Be Redeemed or Purchased. 

(a) If less than all of the Notes are to be redeemed pursuant to Sections 3.07 or 3.08 hereof or purchased in an offer to
purchase in an Asset Sale Offer pursuant to Section 4.09 hereof or a Change of Control Offer pursuant to Section 4.13 hereof, the Trustee shall select Notes for redemption or purchase on a pro rata basis except: 

(1) (a) if the Notes are listed on any national securities exchange, in compliance with the requirements of the principal
national securities exchange on which the Notes are listed or (b) to the extent that selection on a pro rata basis is not practicable, by lot or by such other method the Trustee considers fair and appropriate or as required by the rules of the
Depositary; or 
 (2) if otherwise required by law. 

(b) In the event of partial redemption or purchase by lot, the particular Notes to be redeemed or purchased shall be
selected, unless otherwise provided herein, not less than 30 nor more than 60 days prior to the redemption or purchase date by the Trustee from the outstanding Notes not previously called for redemption or purchase. 

  
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 (c) The Trustee shall promptly notify the Issuer in writing of the Notes selected for
redemption or purchase and, in the case of any Note selected for partial redemption or purchase, the principal amount thereof to be redeemed or purchased. Notes and portions of Notes selected shall be in amounts of $2,000 or integral multiples of
$1,000 in excess thereof; except that if all of the Notes of a Holder are to be redeemed or purchased, the entire outstanding amount of Notes held by such Holder, even if not a multiple of $1,000, shall be redeemed or purchased. Except as provided
in the preceding sentence, provisions of this Indenture that apply to Notes called for redemption or purchase also apply to portions of Notes called for redemption or purchase. 
 SECTION 3.03 Notice of Redemption. 
 Subject to the provisions of
Section 3.09, at least 30 days but not more than 60 days before a redemption date, the Issuer shall mail or cause to be mailed, by first class mail, a notice of redemption to each Holder whose Notes are to be redeemed at its registered address,
except that redemption notices may be mailed more than 60 days prior to a redemption date if the notice is issued in connection with a defeasance of the Notes or a satisfaction and discharge of this Indenture pursuant to Articles 8 or 11 of this
Indenture. 
 The notice shall identify the Notes to be redeemed (including CUSIP Number(s)) and shall state: 

(1) the redemption date; 
 (2) the redemption price; 
 (3) if any Note is being redeemed in
part, the portion of the principal amount of such Note to be redeemed and that, after the redemption date upon surrender of such Note, a new Note or Notes in principal amount equal to the unredeemed portion shall be issued upon cancellation of the
original Note; 
 (4) the name and address of the Paying Agent; 

(5) that Notes called for redemption must be surrendered to the Paying Agent to collect the redemption price; 

(6) that, unless the Issuer defaults in making such redemption payment, interest and Additional Interest, if any, on Notes
called for redemption ceases to accrue on and after the redemption date; 
 (7) the paragraph of the Notes and/or
Section of this Indenture pursuant to which the Notes called for redemption are being redeemed; 
 (8) that no
representation is made as to the correctness or accuracy of the CUSIP number, if any, listed in such notice or printed on the Notes; and 
 (9) if the redemption is made upon an Equity Offering or in connection with a transaction (or series of related transactions ) that constitute a Change of Control or other corporate transaction, one or
more conditions precedent to the redemption, including, but not limited to, completion of an Equity Offering or Change of Control, other offering or other transaction or event. 

  
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 At the Issuer’s request, the Trustee shall give the notice of redemption in the
Issuer’s name and at its expense; provided, however, that the Issuer has delivered to the Trustee, at least five Business Days before notice of redemption is required to be mailed or caused to be mailed to Holders pursuant to this
Section 3.03 (unless a shorter notice shall be agreed to by the Trustee), an Officer’s Certificate requesting that the Trustee give such notice and setting forth the information to be stated in such notice as provided in the preceding
paragraph. 
 SECTION 3.04 Effect of Notice of Redemption. 
 Once notice of redemption is mailed in accordance with Section 3.03, Notes called for redemption become irrevocably due and payable on the redemption date at the redemption price, except as otherwise
provided in Section 3.03 hereof. 
 SECTION 3.05 Deposit of Redemption or Purchase Price. 

On the relevant redemption or purchase date, the Issuer shall deposit with the Trustee or with the Paying Agent money sufficient to pay
the redemption or purchase price of and accrued interest and Additional Interest, if any, on all Notes to be redeemed or purchased on that date. The Trustee or the Paying Agent shall promptly return to the Issuer any money deposited with the Trustee
or the Paying Agent by the Issuer in excess of the amounts necessary to pay the redemption or purchase price of, and accrued interest and Additional Interest, if any, on, all Notes to be redeemed or purchased. 

If the Issuer complies with the provisions of the preceding paragraph, on and after the redemption or purchase date, interest and
Additional Interest, if any, shall cease to accrue on the Notes or the portions of Notes called for redemption or purchase. If a Note is redeemed or purchased on or after an interest record date but on or prior to the related interest payment date,
then any accrued and unpaid interest shall be paid to the Person in whose name such Note was registered at the close of business on such record date. If any Note called for redemption or purchase is not so paid upon surrender for redemption or
purchase because of the failure of the Issuer to comply with the preceding paragraph, interest shall be paid on the unpaid principal, from the redemption or purchase date until such principal is paid, and to the extent lawful on any interest not
paid on such unpaid principal, in each case at the rate provided in the Notes and in Section 4.01. 
 SECTION 3.06 Notes Redeemed or
Purchased in Part. 
 Upon surrender of a Note that is redeemed or purchased in part, the Issuer shall issue and, upon
receipt of an Authentication Order, the Trustee shall authenticate for the Holder at the expense of the Issuer a new Note equal in principal amount to the unredeemed or unpurchased portion of the Note surrendered; provided that each new Note
will be in denominations of $2,000 or an integral multiple of $1,000 in excess thereof. 
 SECTION 3.07 Optional Redemption. 

The Notes are subject to optional redemption as provided in Section 5 of each of the Notes. Any redemption of the Notes pursuant to
such Section shall be made pursuant to the provisions of Sections 3.01 through 3.06. 

  
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 SECTION 3.08 Mandatory Redemption 

The Issuer is not required to make mandatory redemption or sinking fund payments with respect to the Notes. 

SECTION 3.09 Offer To Purchase by Application of Excess Proceeds. 
 In the event that, pursuant to Section 4.09, the Issuer is required to commence an offer to all Holders to purchase Notes (an “Asset Sale Offer”), it shall follow the procedures specified
below. 
 The Asset Sale Offer shall be made to all Holders and if the Issuer elects (or is required by the terms of other Pari
Passu Indebtedness), all holders of other Indebtedness that is Pari Passu Indebtedness. The Asset Sale Offer shall remain open for a period of at least 20 Business Days following its commencement and not more than 30 Business Days, except to the
extent that a longer period is required by applicable law (the “Offer Period”). No later than five Business Days after the termination of the Offer Period (the “Purchase Date”), the Issuer shall apply all Excess Proceeds (the
“Offer Amount”) to the purchase of Notes and such other Pari Passu Indebtedness, if any, (on a pro rata basis, if applicable) or, if less than the Offer Amount has been tendered, all Notes and other Indebtedness tendered in response to the
Asset Sale Offer. Payment for any Notes so purchased shall be made pursuant to Section 4.01. 
 If the Purchase Date is on
or after an interest record date and on or before the related interest payment date, any accrued and unpaid interest and Additional Interest, if any, shall be paid to the Person in whose name a Note is registered at the close of business on such
record date, and no additional interest shall be payable to Holders who tender Notes pursuant to the Asset Sale Offer. 
 Upon
the commencement of an Asset Sale Offer, the Issuer shall send, by first class mail, a notice to the Trustee and each of the Holders, with a copy to the Trustee. The notice shall contain all instructions and materials necessary to enable such
Holders to tender Notes pursuant to the Asset Sale Offer. The notice, which shall govern the terms of the Asset Sale Offer, shall state: 
 (1) that the Asset Sale Offer is being made pursuant to this Section 3.09 and Section 4.09 and the length of time the Asset Sale Offer shall remain open; 

(2) the Offer Amount, the purchase price and the Purchase Date; 

(3) that any Note not tendered or accepted for payment shall continue to accrue interest; 

(4) that, unless the Issuer defaults in making such payment, any Note accepted for payment pursuant to the Asset Sale
Offer shall cease to accrue interest after the Purchase Date; 
 (5) that Holders electing to have a Note
purchased pursuant to an Asset Sale Offer may elect to have Notes purchased in a minimum amount of $2,000 or an integral multiple of $1,000 in excess thereof only; 

(6) that Holders electing to have Notes purchased pursuant to any Asset Sale Offer shall be required to surrender the
Note, with the form entitled “Option of Holder to Elect Purchase” attached to the Notes completed, or transfer by book-entry transfer, to the Issuer, a Depositary, if appointed by the Issuer, or a Paying Agent at the address specified in
the notice at least three days before the Purchase Date; 

  
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 (7) that Holders shall be entitled to withdraw their election if the Issuer,
the Depositary or the Paying Agent, as the case may be, receives, not later than on the expiration of the Offer Period, a facsimile transmission or letter setting forth the name of the Holder, the principal amount of the Note the Holder delivered
for purchase and a statement that such Holder is withdrawing his election to have such Note purchased; 
 (8)
that, if the aggregate principal amount of Notes and other Pari Passu Indebtedness surrendered by holders thereof exceeds the Offer Amount, the Issuer shall select the Notes and other Pari Passu Indebtedness to be purchased on a pro rata basis based
on the principal amount of Notes and such other Pari Passu Indebtedness surrendered (with such adjustments as may be deemed appropriate by the Issuer so that only Notes in denominations of $2,000, or integral multiples of $1,000 in excess thereof,
shall be purchased); and 
 (9) that Holders whose Notes were purchased only in part shall be issued new Notes
equal in principal amount to the unpurchased portion of the Notes surrendered (or transferred by book-entry transfer). 
 On or
before the Purchase Date, the Issuer shall, to the extent lawful, accept for payment, on a pro rata basis to the extent necessary, the Offer Amount of Notes or portions thereof tendered pursuant to the Asset Sale Offer, or if less than the Offer
Amount has been tendered, all Notes tendered, and shall deliver or cause to be delivered to the Trustee the Notes properly accepted together with an Officer’s Certificate stating that such Notes or portions thereof were accepted for payment by
the Issuer in accordance with the terms of this Section 3.09. The Issuer, the Depositary or the Paying Agent, as the case may be, shall promptly (but in any case not later than five days after the Purchase Date) mail or deliver to each
tendering Holder an amount equal to the purchase price of the Notes tendered by such Holder and accepted by the Issuer for purchase, and the Issuer shall promptly issue a new Note, and the Trustee, upon written request from the Issuer, shall
authenticate and mail or deliver (or cause to be transferred by book entry) such new Note to such Holder, in a principal amount equal to any unpurchased portion of the Note surrendered. Any Note not so accepted shall be promptly mailed or delivered
by the Issuer to the Holder thereof. The Issuer shall publicly announce the results of the Asset Sale Offer on the Purchase Date. 
 Other than as specifically provided in this Section 3.09, any purchase pursuant to this Section 3.09 shall be made pursuant to the provisions of Sections 3.01 through 3.06. 

ARTICLE 4. 

COVENANTS 
 SECTION 4.01
Payment of Notes. 
 The Issuer shall pay or cause to be paid the principal of, premium, if any, and interest and
Additional Interest, if any, on the Notes on the dates and in the manner provided in the Notes. Principal, premium, if any, and interest and Additional Interest, if any, shall be considered paid on the date due if the Paying Agent, if other than the
Issuer or a Subsidiary thereof, holds on the due date money deposited by or on behalf of the Issuer in immediately available funds and designated for and sufficient to pay all principal, premium, if any, and interest then due. The Issuer shall pay
all Additional Interest, if any, in the same manner on the dates and in the amounts set forth in the Registration Rights Agreement. 

  
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 The Issuer shall pay interest (including post-petition interest in any proceeding under any
Bankruptcy Law) on overdue principal at the rate equal to the then applicable interest rate on the Notes to the extent lawful; it shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on overdue
installments of interest and Additional Interest (without regard to any applicable grace period) at the same rate to the extent lawful. Interest on the Notes shall accrue from the date of original issuance or, if interest has already been paid, from
the date it was most recently paid. Interest shall be computed on the basis of a 360-day year comprised of twelve 30-day months. 
 SECTION 4.02
Maintenance of Office or Agency. 
 The Issuer shall maintain in the Borough of Manhattan, the City of New York, an office
or agency (which may be an office of the Trustee or an affiliate of the Trustee, Registrar or co-registrar) where Notes may be surrendered for registration of transfer or for exchange and where notices and demands to or upon the Issuer in respect of
the Notes and this Indenture may be served. The Issuer shall give prompt written notice to the Trustee of the location, and any change in the location, of such office or agency. If at any time the Issuer fails to maintain any such required office or
agency or fails to furnish the Trustee with the address thereof, such presentations, surrenders, notices and demands may be made or served at the Corporate Trust Office of the Trustee. 

The Issuer may also from time to time designate one or more other offices or agencies where the Notes may be presented or surrendered for
any or all such purposes and may from time to time rescind such designations; provided, however, that no such designation or rescission shall in any manner relieve the Issuer of its obligation to maintain an office or agency in the
Borough of Manhattan, the City of New York for such purposes. The Issuer shall give prompt written notice to the Trustee of any such designation or rescission and of any change in the location of any such other office or agency. 

SECTION 4.03 Reports. 
 (a) Whether or not required by the rules and regulations of the SEC, so long as any Notes are outstanding, the Issuer shall furnish to the Trustee and to Cede & Co., the nominee of DTC and the
Holders, within the time periods that are applicable to the Issuer (or, if not applicable, would be if the Issuer were required to file such reports under Section 13(a) or 15(d) of the Exchange Act as a non-accelerated filer): 

(1) all quarterly and annual financial information that would be required to be contained in a filing with the SEC on
Forms 10-Q and 10-K, if the Issuer were required to file such Forms, including a “Management’s Discussion and Analysis of Historical Financial Condition and Results of Operations” that describes the Issuer’s consolidated
financial condition and results of operation and, with respect to the annual information only, a report thereon by the Issuer’s independent registered public accountants, and 

(2) all current reports that would be required to be filed with the SEC on Form 8-K if the Issuer were required to file
such reports. 
 (b) The Issuer may satisfy its obligation to furnish such information to the Trustee and
Cede & Co. at any time by filing such information with the SEC. If, notwithstanding the foregoing, the SEC will not accept such filings for any reason, the Issuer will post the reports specified in the preceding sentence on its website
within the time periods that would apply if the Issuer were required to file those reports with the SEC. In addition, the Issuer agrees that, for so long as any Notes remain outstanding, the Issuer will furnish to any Beneficial Owner of Notes or to
any prospective purchaser of Notes in connection with any sale thereof, upon their request, the information required to be delivered pursuant to Rule 144A(d)(4) under the Securities Act. 

  
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 (c) If at any time Holdings (or any other direct or indirect parent company
of the Issuer) becomes a Guarantor of the Notes (there being no obligation of Holdings or any other direct or indirect parent company of the Issuer to do so), and Holdings (or such other parent company) holds no material assets other than cash, Cash
Equivalents and the Capital Stock of the Issuer, Holdings or any other direct or indirect parent company of the Issuer (and performs the related incidental activities associated with such ownership) and complies with the requirements of Rule 3-10 of
Regulation S-X promulgated by the SEC (or any successor provision), the reports, information and other documents required to be furnished to the Trustee and Cede & Co. or filed with the SEC pursuant to this Section 4.03 may, at the
option of the Issuer, be those of Holdings (or such other parent company) rather than the Issuer. 
 (d)
Notwithstanding anything herein to the contrary, the Issuer will not be deemed to have failed to comply with any of its obligations hereunder for purposes of Section 6.01(4) until 120 days after the date any report hereunder is due. To the
extent that the Issuer fails to furnish any such information within the time periods specified in this Section 4.03 and such information is subsequently furnished prior to the time such failure results in an Event of Default, the Issuer will be
deemed to have satisfied its obligations with respect thereto and any Default with respect thereto shall be deemed to have been cured. 
 (e) Delivery of such reports, information and documents to the Trustee is for informational purposes only and the Trustee’s receipt of such shall not constitute constructive notice of any information
contained therein or determinable from information contained therein, including the Issuer’ compliance with any of their covenants hereunder (as to which the Trustee is entitled to rely exclusively on Officer’s Certificates). 

SECTION 4.04 Compliance Certificate. 
 (a) The Issuer shall deliver to the Trustee, within 120 days after the end of each fiscal year of the Issuer, an Officer’s Certificate stating that a review of the activities of the Issuer and its
Subsidiaries during the preceding fiscal year has been made under the supervision of the signing Officers with a view to determining whether the Issuer has kept, observed, performed and fulfilled its obligations under this Indenture, and further
stating, as to each such Officer signing such certificate, that to his or her knowledge the Issuer has kept, observed, performed and fulfilled each and every covenant contained in this Indenture and is not in default in the performance or observance
of any of the terms, provisions and conditions of this Indenture (or, if a Default or Event of Default has occurred, describing all such Defaults or Events of Default of which he or she may have knowledge and what action the Issuer is taking or
proposes to take with respect thereto). 
 (b) So long as any of the Notes are outstanding, the Issuer shall
deliver to the Trustee, within 30 days upon any Officer becoming aware of any Default or Event of Default, an Officer’s Certificate specifying such Default or Event of Default and what action the Issuer is taking or proposes to take with
respect thereto. 
 SECTION 4.05 Stay, Extension and Usury Laws. 

The Issuer and each of the Guarantors covenant (to the extent that they may lawfully do so) that they shall not at any time insist upon,
plead, or in any manner whatsoever claim or take the benefit or advantage of, any stay, extension or usury law wherever enacted, now or at any time hereafter in force, that may affect the covenants or the performance of this Indenture; and the
Issuer and each of the Guarantors (to the extent that they may lawfully do so) hereby expressly waive all benefit or advantage of any such law, and covenant that they shall not, by resort to any such law, hinder, delay or impede the execution of any
power herein granted to the Trustee, but shall suffer and permit the execution of every such power as though no such law has been enacted. 

  
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 SECTION 4.06 Restricted Payments. 

(a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly or indirectly: 

(A) declare or pay any dividend or make any other payment or distribution on account of the Issuer’s or any of its
Restricted Subsidiaries’ Equity Interests (including, without limitation, any payment in connection with any merger or consolidation involving the Issuer or any of its Restricted Subsidiaries) or to the direct or indirect holders of the
Issuer’s or any of its Restricted Subsidiaries’ Equity Interests in their capacity as such (other than dividends or distributions payable in Equity Interests (other than Disqualified Stock) of the Issuer); provided that the
repurchase, redemption or other acquisition or retirement for value of any Equity Interests of a Restricted Subsidiary shall not constitute a Restricted Payment; 

(B) purchase, redeem or otherwise acquire or retire for value (including, without limitation, in connection with any
merger or consolidation involving the Issuer) any Equity Interests of the Issuer, Holdings or any other direct or indirect parent of the Issuer; 
 (C) make any payment on or with respect to, or purchase, repurchase, redeem, defease or otherwise acquire or retire for value any Subordinated Indebtedness of the Issuer or any Guarantor (excluding any
intercompany Indebtedness between or among the Issuer and any of its Restricted Subsidiaries), except (i) a payment of interest or principal at the Stated Maturity thereof or (ii) the purchase, repurchase, redemption, defeasance or other
acquisition or retirement of any such Subordinated Indebtedness purchased in anticipation of satisfying a sinking fund obligation, principal installment or payment at final maturity, in each case within one year of the date of such purchase,
repurchase, redemption, defeasance or other acquisition or retirement; or 
 (D) make any Restricted Investment;

 (all such payments and other actions set forth in these clauses (A) through (D) above being collectively referred to as
“Restricted Payments”), unless, at the time of and after giving effect to such Restricted Payment: 

(1) no Default or Event of Default has occurred and is continuing or would occur as a consequence of such Restricted
Payment; 
 (2) the Issuer would, at the time of such Restricted Payment and after giving pro forma effect
thereto as if such Restricted Payment had been made at the beginning of the applicable four-quarter period, have been permitted to incur at least $1.00 of additional Indebtedness pursuant to the Fixed Charge Coverage Ratio test set forth in
Section 4.08(a) of this Indenture; and 
 (3) such Restricted Payment, together with the aggregate amount of
all other Restricted Payments made by the Issuer and its Restricted Subsidiaries since the Effective Date (including Restricted Payments permitted by clauses (1), (11), and (14), but excluding all other Restricted Payments permitted by
Section 4.06(b)), is less than the sum, without duplication, of: 

  
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 (A) 50% of the Consolidated Net Income of the Issuer for the period (taken
as one accounting period) from April 1, 2012 to the end of the Issuer’s most recently ended fiscal quarter for which internal financial statements are available at the time of such Restricted Payment (or, if such Consolidated Net Income
for such period is a deficit, less 100% of such deficit); plus 
 (B) 100% of the aggregate Qualified
Proceeds received by the Issuer since the Effective Date as a contribution to its equity capital (other than Disqualified Stock) or from the issue or sale of Equity Interests of the Issuer (other than Disqualified Stock and Excluded Contributions)
or from the issue or sale of convertible or exchangeable Disqualified Stock or convertible or exchangeable debt securities of the Issuer that have been converted into or exchanged for such Equity Interests (other than Equity Interests (or
Disqualified Stock or debt securities) sold to a Subsidiary of the Issuer); plus 
 (C) an amount equal to
the net reduction in Investments by the Issuer and its Restricted Subsidiaries resulting from (i) the sale or other disposition (other than to the Issuer or a Restricted Subsidiary) of any Restricted Investment that was made after the Effective
Date and (ii) repurchases, redemptions and repayments of such Restricted Investments and the receipt of any dividends or distributions from such Restricted Investments; plus 

(D) to the extent that any Unrestricted Subsidiary of the Issuer designated as such after the Effective Date is
redesignated as a Restricted Subsidiary after the Effective Date, an amount equal to the lesser of (i) the Fair Market Value of the Issuer’s interest in such Subsidiary immediately prior to such redesignation and (ii) the aggregate
amount of the Issuer’s Investments in such Subsidiary that was previously treated as a Restricted Payment; plus 
 (E) in the event the Issuer and/or any Restricted Subsidiary makes any Investment in a Person that, as a result of or in connection with such Investment, becomes a Restricted Subsidiary, an amount equal
to the existing Investment of the Issuer and/or any of its Restricted Subsidiaries in such Person that was previously treated as a Restricted Payment. 
 (b) The preceding Section 4.06(a) shall not prohibit: 
 (1)
the payment of any dividend or other distribution or the consummation of any irrevocable redemption within 60 days after the date of declaration of the dividend or giving of the redemption notice, as the case may be, if at the date of declaration or
notice, the dividend or redemption payment would have complied with the provisions of this Indenture; 
 (2) the
making of any Restricted Payment in exchange for, or out of the net cash proceeds of the substantially concurrent sale (other than to a Restricted Subsidiary) of, Equity Interests of the Issuer (other than Disqualified Stock) or from the
substantially concurrent contribution of equity capital to the Issuer (other than Disqualified Stock); provided that the amount of any such net cash proceeds that are utilized for any such Restricted Payment shall be excluded from clause
(3)(B) of Section 4.06(a); 

  
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 (3) the repurchase, redemption, defeasance or other acquisition or
retirement for value of Subordinated Indebtedness of the Issuer or any Guarantor with the net cash proceeds from a substantially concurrent incurrence of Permitted Refinancing Indebtedness, or from the substantially concurrent sale (other than to a
Restricted Subsidiary) of, Equity Interests of the Issuer (other than Disqualified Stock) or from the substantially concurrent contribution of equity capital to the Issuer (other than Disqualified Stock); provided that the amount of any such
net cash proceeds that are utilized for any such Restricted Payment will be excluded from clause (3)(B) of Section 4.06(a); 
 (4) the declaration and payment of regularly scheduled or accrued dividends to holders of any class or series of Disqualified Stock of the Issuer or any Restricted Subsidiary of which Disqualified Stock
was issued after the Effective Date in accordance with Section 4.08; 
 (5) the repurchase, redemption or
other acquisition or retirement for value of Disqualified Stock of the Issuer or any Restricted Subsidiary made by exchange for, or out of the proceeds of the substantially concurrent sale of Replacement Preferred Stock that is permitted to be
incurred pursuant to Section 4.08; 
 (6) the payment of any dividend (or any similar distribution) by a
Restricted Subsidiary to the holders of its Equity Interests on a pro rata basis; 
 (7) the purchase, redemption
or other acquisition or retirement for value of shares of Capital Stock of a Qualified Restricted Subsidiary owned by a Strategic Investor if such purchase, redemption or other acquisition or retirement for value is made for consideration not in
excess of the Fair Market Value of such Capital Stock; 
 (8) the repurchase, redemption or other acquisition or
retirement for value of any Equity Interests of the Issuer or any Restricted Subsidiary held by any current or former officer, director, employee or consultant of the Issuer or any of its Restricted Subsidiaries, and any dividend payment or other
distribution by the Issuer or a Restricted Subsidiary to Holdings or any other direct or indirect parent holding company of the Issuer utilized for the repurchase, redemption or other acquisition or retirement for value of any Equity Interests of
Holdings or such other direct or indirect parent holding company held by any current or former officer, director, employee or consultant of the Issuer or any of its Restricted Subsidiaries or Holdings or such other parent holding company, in each
case, pursuant to any equity subscription agreement, stock option agreement, shareholders’ agreement or similar agreement or benefit plan of any kind; provided that the aggregate price paid for all such repurchased, redeemed, acquired or
retired Equity Interests may not exceed $5.0 million in any fiscal year (it being understood, however, that unused amounts permitted to be paid pursuant to this proviso are available to be carried over to subsequent fiscal years); provided
further that such amount in any fiscal year may be increased by an amount not to exceed: 
 (A) the cash
proceeds from the sale of Equity Interests of the Issuer and, to the extent contributed to the Issuer as equity capital (other than Disqualified Stock), Equity Interests of Holdings or any other direct or indirect parent company of the Issuer, in
each case to members of management, directors or consultants of the Issuer, any of its Subsidiaries, Holdings or any other direct or indirect parent company of the Issuer that occurs after the Effective Date, to the extent the cash proceeds from the
sale of such Equity Interests have not otherwise been applied to the payment of Restricted Payments by virtue of clause (3)(B) of Section 4.06(a), and excluding Excluded Contributions, plus 

  
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 (B) the cash proceeds of key man life insurance policies received by the
Issuer and its Restricted Subsidiaries after the Effective Date, less 
 (C) the amount of any Restricted
Payments made since the Effective Date pursuant to clauses (A) and (B) of this clause (8); 
 and provided,
further, that cancellation of Indebtedness owing to the Issuer or any Restricted Subsidiary from members of management of the Issuer, any of the Issuer’s direct or indirect parent companies or any of the Issuer’s Restricted
Subsidiaries in connection with a repurchase of Equity Interests of the Issuer or any of its direct or indirect parent companies will not be deemed to constitute a Restricted Payment for purposes of this covenant or any other provision of the
Indenture; 
 (9) the repurchase of Equity Interests deemed to occur upon the exercise of options, rights or
warrants to the extent such Equity Interests represent a portion of the exercise price of those options, rights or warrants; 
 (10) the repurchase, redemption, defeasance or other acquisition or retirement for value of Subordinated Indebtedness of the Issuer or any Guarantor with any Excess Proceeds that remain after consummation
of an Asset Sale Offer; 
 (11) after the occurrence of a Change of Control and within 60 days after the
completion of the offer to repurchase the Notes pursuant to Section 4.13 (including the purchase of the Notes tendered), any purchase or redemption of Subordinated Indebtedness required pursuant to the terms thereof as a result of such Change
of Control at a purchase or redemption price not to exceed 101% of the outstanding principal amount thereof, plus any accrued and unpaid interest; 
 (12) cash payments in lieu of fractional shares issuable as dividends on preferred stock or upon the conversion of any preferred stock or convertible debt securities of the Issuer or any of its Restricted
Subsidiaries; 
 (13) Permitted Payments to Parent; 

(14) so long as no Default has occurred and is continuing or would be caused thereby, the payment: 

(A) by the Issuer or any Restricted Subsidiary to Holdings or any other direct or indirect parent of the Issuer, which
payment is used by the Person receiving such payment, upon or following the first initial public offering of common Equity Interests by such Person, to pay dividends of up to 6% per annum of the net proceeds received by such Person in such
public offering (or any subsequent public offering of common Equity Interests of such Person) that are contributed to the Issuer as equity capital (other than Disqualified Stock), or 

(B) by the Issuer, upon or following the first initial public offering of common Equity Interests by the Issuer, to pay
dividends of up to 6% per annum of the net proceeds received by or contributed to the Issuer in such public offering (or any subsequent public offering of common Equity Interests by the Issuer); 

  
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 (excluding, in the case of both clause (A) and clause (B), public offerings of common
Equity Interests registered on Form S-8, or any successor form, and any other public sale to the extent the proceeds thereof are Excluded Contributions); 
 (15) Investments that are made with Excluded Contributions; 
 (16)
distributions or payments of Receivables Fees; 
 (17) payment of fees and reimbursement of other expenses to the
Permitted Holders and/or their Affiliates in connection with the Transactions as described in the Offering Memorandum under the caption “Certain Relationships and Related Party Transactions”; 

(18) all other payments made or to be made in connection with the Transactions as described in the Offering Memorandum;

 (19) the distribution, dividend or otherwise, of shares of Capital Stock of, or Indebtedness owed to the
Issuer or a Restricted Subsidiary by Unrestricted Subsidiaries (other than Unrestricted Subsidiaries, the primary assets of which (i) are cash and/or Cash Equivalents or (ii) were contributed to such Unrestricted Subsidiary in anticipation
of such distribution, dividend or other payment, as determined in good faith by the Issuer); 
 (20) the 2012
Dividend; 
 (21) so long as no Default has occurred and is continuing or would be caused thereby, other
Restricted Payments in an aggregate amount taken together with all other Restricted Payments made pursuant to this clause (21) not to exceed the greater of (a) $50.0 million and (b) 2.5% of Total Assets at the time made; and

 (22) so long as no Default has occurred and is continuing or would be caused thereby; on or prior to the third
anniversary of the Issue Date, in connection with a Recapitalization Transaction, Restricted Payments in an aggregate amount not to exceed $300.0 million; provided, after giving effect to such Restricted Payments, the Consolidated Leverage
Ratio of the Issuer and its Restricted Subsidiaries shall be equal to or less than 6.0 to 1.0 for the Issuer’s most recently ended four fiscal quarters for which internal financial statements are available immediately preceding the date on
which such Restricted Payments are made; provided, further, that Restricted Payments pursuant to this clause (22) shall be permitted only one time after the Issue Date. 

(c) The amount of all Restricted Payments (other than cash) shall be the Fair Market Value on the date of the Restricted Payment of the
asset(s) or securities proposed to be transferred or issued by the Issuer or such Restricted Subsidiary, as the case may be, pursuant to the Restricted Payment. The Fair Market Value of any assets or securities that are required to be valued by this
Section 4.06 shall, if the fair market value thereof exceeds $20.0 million, be determined by the Board of Directors of the Issuer, whose resolution with respect thereto shall be delivered to the Trustee. 

(d) For purposes of determining compliance with the provisions of this Section 4.06, in the event that a Restricted Payment meets the
criteria of more than one of the types of Restricted Payments described in the above clauses, the Issuer, in its sole discretion, may order and classify, and from time to time may reorder and reclassify, such Restricted Payment, if it would have
been permitted at the time such Restricted Payment was made and at the time of any such reclassification. 

  
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 SECTION 4.07 Dividend and Other Payment Restrictions Affecting Restricted Subsidiaries. 

(a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly or indirectly, create or
permit to exist or become effective any consensual encumbrance or restriction on the ability of any Restricted Subsidiary to: 
 (1) pay dividends or make any other distributions on its Capital Stock to the Issuer or any of its Restricted Subsidiaries, or with respect to any other interest or participation in, or measured by, its
profits, or pay any indebtedness owed to the Issuer or any of its Restricted Subsidiaries; 
 (2) make loans or
advances to the Issuer or any of its Restricted Subsidiaries; or 
 (3) sell, lease or transfer any of its
properties or assets to the Issuer or any of its Restricted Subsidiaries. 
 (b) Section 4.07(a) shall not
apply to encumbrances or restrictions existing under or by reason of: 
 (1) agreements governing Existing
Indebtedness and the Credit Agreement as in effect on the Effective Date; 
 (2) this Indenture, the Notes and
the Subsidiary Guarantees; 
 (3) applicable law, rule, regulation or order; 

(4) any instrument or agreement governing Indebtedness or Capital Stock of a Restricted Subsidiary acquired by the Issuer
or any of its Restricted Subsidiaries as in effect at the time of such acquisition (except to the extent such Indebtedness or Capital Stock was incurred in connection with or in contemplation of such acquisition), which encumbrance or restriction is
not applicable to any Person, or the properties or assets of any Person, other than the Person or any of its Subsidiaries, or the property or assets of the Person or any of its Subsidiaries, so acquired; provided that, in the case of
Indebtedness, such Indebtedness was permitted by the terms of this Indenture to be incurred; 
 (5) customary
non-assignment provisions in contracts, leases, subleases, licenses and sublicenses entered into in the ordinary course of business; 
 (6) customary restrictions in leases (including capital leases), security agreements or mortgages or other purchase money obligations for property acquired in the ordinary course of business that impose
restrictions on the property purchased or leased of the nature described in clause (3) of Section 4.07(a); 
 (7) any agreement for the sale or other disposition of all or substantially all the Capital Stock or the assets of a Restricted Subsidiary that restricts distributions by that Restricted Subsidiary
pending the sale or other disposition; 
 (8) any instrument or agreement governing Permitted Refinancing
Indebtedness; provided that the restrictions contained therein are not materially more restrictive (as determined in good faith by the Issuer), taken as a whole, than those contained in the agreements governing the Indebtedness being
refinanced; 

  
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 (9) Liens permitted to be incurred under Section 4.11 of this Indenture
that limit the right of the debtor to dispose of the assets subject to such Liens; 
 (10) provisions limiting
the disposition or distribution of assets or property in joint venture agreements, asset sale agreements, sale-leaseback agreements, stock sale agreements and other similar agreements, which limitation is applicable only to the assets that are the
subject of such agreements, and customary provisions in joint venture and other similar agreements, including agreements related to the ownership and operation of surgical facilities, relating solely to such joint venture or facilities or Equity
Interests therein; 
 (11) restrictions on cash or other deposits or net worth imposed by customers under
contracts entered into in the ordinary course of business; 
 (12) customary provisions imposed on the transfer
of copyrighted or patented materials; 
 (13) customary provisions restricting dispositions of real property
interests set forth in any reciprocal easement agreements of the Issuer or any Restricted Subsidiary; 
 (14)
Indebtedness or other contractual requirements of a Receivables Subsidiary in connection with a Qualified Receivables Transaction; provided that such restrictions apply only to such Receivables Subsidiary; 

(15) contracts entered into in the ordinary course of business, not relating to any Indebtedness, and that do not,
individually or in the aggregate, detract from the value of property or assets of the Issuer or any Restricted Subsidiary in any manner material to the Issuer or any Restricted Subsidiary; 

(16) restrictions on the transfer of property or assets required by any regulatory authority having jurisdiction over the
Issuer or any Restricted Subsidiary or any of their businesses; 
 (17) any instrument or agreement governing
Indebtedness or preferred stock (i) of any Foreign Subsidiary and (ii) of the Issuer or any Restricted Subsidiary that is incurred or issued subsequent to the Effective Date and not in violation of Section 4.08; provided that
(x) in the case of preferred stock, such encumbrances and restrictions are not materially more restrictive in the aggregate than the restrictions contained in this Indenture and (y) in the case of Pari Passu Indebtedness, are not
materially more restrictive in the aggregate than the restrictions contained in the Credit Agreement, in each case, as determined in good faith by the Issuer; 
 (18) restrictions in Management Agreements that require the payment of management fees to the Issuer or one of its Restricted Subsidiaries prior to payment of dividends or distributions; 

(19) Permitted Payment Restrictions; and 

  
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 (20) any amendments, modifications, restatements, renewals, increases,
supplements, refundings, replacements or refinancings of the Indebtedness, preferred stock, Liens, agreements, contracts, licenses, leases, subleases, instruments or obligations referred to in clauses (1), (2), (4) through (15), (17) and
(18) above; provided, however, that such amendments, modifications, restatements, renewals, increases, supplements, refundings, replacements or refinancings are in the good faith judgment of the Issuer’s Board of Directors,
whose determination shall be conclusive, not materially more restrictive, taken as a whole, than those restrictions contained in the Indebtedness, preferred stock, Liens, agreements, contracts, licenses, leases, subleases, instruments or obligations
referred to in clauses (1), (2), (4) through (15), (17) and (18) above, as applicable prior to such amendment, modification, restatement, renewal, increase, supplement, refunding, replacement or refinancing. 

(c) For purposes of determining compliance with this covenant, (i) the priority of any preferred stock in receiving
dividends or liquidating distributions prior to dividends or liquidating distributions being paid on common stock shall not be deemed a restriction on the ability to make distributions on Capital Stock and (ii) the subordination of loans and
advances made to the issuer or a Restricted Subsidiary to other Indebtedness incurred by the Issuer or any such Restricted Subsidiary shall not be deemed a restriction on the ability to make loans or advances. 

SECTION 4.08 Incurrence of Indebtedness and Issuance of Disqualified Stock and Preferred Stock. 

(a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly or indirectly, create,
incur, issue, assume, guarantee or otherwise become directly or indirectly liable, contingently or otherwise, with respect to (collectively, “incur”) any Indebtedness (including Acquired Debt), and the Issuer shall not issue any
Disqualified Stock and shall not permit any of its Restricted Subsidiaries to issue any shares of Disqualified Stock or preferred stock; provided, however, that (x) the Issuer may incur Indebtedness (including Acquired Debt) or
issue shares of Disqualified Stock and any Guarantor may incur Indebtedness (including Acquired Debt), issue shares of Disqualified Stock and issue shares of preferred stock, if the Fixed Charge Coverage Ratio for the Issuer’s most recently
ended four full fiscal quarters for which internal financial statements are available immediately preceding the date on which such additional Indebtedness is incurred or such Disqualified Stock or such preferred stock is issued, as the case may be,
would have been at least 2.0 to 1.0, determined on a pro forma basis (including a pro forma application of the net proceeds therefrom), as if the additional Indebtedness had been incurred or the Disqualified Stock or the preferred stock had been
issued, as the case may be, at the beginning of such four-quarter period and (y) Restricted Subsidiaries may incur Indebtedness (including Acquired Debt) or issue Disqualified Stock or preferred stock if all such Indebtedness incurred, or
Disqualified Stock or preferred stock issued, in reliance upon this clause (y) (together with the aggregate principal amount of all Indebtedness of the Restricted Subsidiaries outstanding on the Effective Date (other than the Credit Agreement,
the Notes or the related Guarantees)), but only to the extent such Indebtedness or any refinancing Indebtedness in respect thereof remains outstanding (provided, that any Indebtedness under a revolving credit facility will not be deemed
outstanding only if it has been permanently repaid and has not been replaced) on the date of on which such additional Indebtedness is incurred does not exceed 1.25x Facility-Level EBITDA for the Issuer’s most recently ended four full fiscal
quarters for which internal financial statements are available immediately preceding the date on which such additional Indebtedness is incurred or such Disqualified Stock or such preferred stock is issued, as the case may be, determined on a pro
forma basis (including a pro forma application of net proceeds therefrom), as if the additional Indebtedness has been incurred or the Disqualified Stock or the preferred stock had been issued, as the case may be. 

  
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 (b) Section 4.08(a) shall not prohibit the incurrence of any of the
following items of Indebtedness or the issuance of any of the following items of Disqualified Stock or preferred stock (collectively, “Permitted Debt”): 

(1) the incurrence by the Issuer and/or any Restricted Subsidiary of Indebtedness under the Credit Agreement and other
Credit Facilities entered into after the date of the Credit Agreement in an aggregate principal amount at any one time outstanding under this clause (1) not to exceed $1,160.0 million, less the aggregate amount of all Net Proceeds of
Asset Sales of the Issuer or any Domestic Subsidiary applied since the Effective Date to repay any term Indebtedness under a Credit Facility or to repay any revolving credit Indebtedness under a Credit Facility and effect a corresponding commitment
reduction thereunder pursuant to Section 4.09; 
 (2) the incurrence by the Issuer and its Restricted
Subsidiaries of the Existing Indebtedness after giving effect to the Transactions; 
 (3) the incurrence by the
Issuer and the Guarantors of Indebtedness represented by the Notes to be issued on the Issue Date, replacement Notes in respect thereof, if any, and the related Subsidiary Guarantees and the Exchange Notes and related Subsidiary Guarantees to be
issued pursuant to the Registration Rights Agreement; 
 (4) the incurrence or issuance by the Issuer or any of
its Restricted Subsidiaries of Indebtedness (including Capital Lease Obligations), Disqualified Stock or preferred stock, in each case, incurred or issued for the purpose of financing all or any part of the purchase price or cost of design,
construction, lease, installation or improvement of property, plant or equipment used or useful in a Permitted Business, in an aggregate principal amount, including all Permitted Refinancing Indebtedness and Replacement Preferred Stock incurred to
renew, refund, refinance, replace, defease or discharge any Indebtedness incurred pursuant to this clause (4) not to exceed the greater of (a) $50.0 million or (b) 2.5% of Total Assets at any time outstanding; 

(5) the incurrence by the Issuer or any of its Restricted Subsidiaries of Permitted Refinancing Indebtedness or
Replacement Preferred Stock in exchange for, or the net proceeds of which are used to renew, refund, refinance, replace, defease or discharge any Indebtedness (other than intercompany Indebtedness) or any Disqualified Stock or preferred stock that
was permitted by this Indenture to be incurred under Section 4.08(a) or clauses (2), (3), (4), (5), (14), (16), (18), (19) or (20) of this Section 4.08(b); 

(6) the incurrence by the Issuer or any of its Restricted Subsidiaries of intercompany Indebtedness between or among the
Issuer and any of its Restricted Subsidiaries; provided, however, that: 
 (A) if the Issuer or any
Guarantor is the obligor on such Indebtedness and the payee is not the Issuer or a Guarantor, such Indebtedness must be expressly subordinated to the prior payment in full in cash of all Obligations with respect to the Notes, in the case of the
Issuer or the Subsidiary Guarantee, in the case of a Guarantor, except to the extent such subordination would violate any applicable law, rule or regulation; and 

(B) (i) any subsequent issuance or transfer of Equity Interests that results in any such Indebtedness being held by a
Person other than the Issuer or a Restricted Subsidiary and (ii) any sale or other transfer of any such Indebtedness to a Person that is not either the Issuer or a Restricted Subsidiary, shall be deemed, in each case, to constitute a new
incurrence of such Indebtedness by the Issuer or such Restricted Subsidiary, as the case may be, which new incurrence is not permitted by this clause (6); 

  
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 (7) the issuance by any Restricted Subsidiaries to the Issuer or to any of
its Restricted Subsidiaries of shares of preferred stock; provided, however, that: 
 (A) any
subsequent issuance or transfer of Equity Interests that results in any such preferred stock being held by a Person other than the Issuer or a Restricted Subsidiary; and 

(B) any sale or other transfer of any such preferred stock to a Person that is not either the Issuer or a Restricted
Subsidiary, 
 will be deemed, in each case, to constitute a new issuance of such preferred stock by such Restricted Subsidiary
which new issuance is not permitted by this clause (7); 
 (8) the incurrence by the Issuer or any of its
Restricted Subsidiaries of Hedging Obligations (excluding Hedging Obligations entered into for speculative purposes) for the purpose of limiting interest rate, currency or commodity risk; 

(9) the Guarantee: 
 (A) by the Issuer or any of the Guarantors of Indebtedness of the Issuer or a Restricted Subsidiary that was permitted to be incurred by another provision of this Section 4.08; provided that
if the Indebtedness being guaranteed is subordinated to the Notes, then the Guarantee shall be subordinated to the same extent as the Indebtedness guaranteed; and 

(B) by any Non-Guarantor Subsidiary of Indebtedness of a Non-Guarantor Subsidiary incurred in accordance with the terms of
this Indenture; 
 (10) the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness in
respect of workers’ compensation claims, self-insurance obligations, bankers’ acceptances, letters of credit, performance bonds, surety bonds, appeal bonds or other similar bonds in the ordinary course of business; provided,
however, that upon the drawing of letters of credit for reimbursement obligations, including with respect to workers’ compensation claims, or the incurrence of other Indebtedness with respect to reimbursement type obligations regarding
workers’ compensation claims, such obligations are reimbursed within 30 days following such drawing or incurrence; 
 (11) the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness arising from the honoring by a bank or other financial institution of a check, draft or similar instrument
inadvertently (except in the case of daylight overdrafts) drawn against insufficient funds in the ordinary course of business, so long as such Indebtedness is extinguished within five Business Days; 

(12) the incurrence of Indebtedness arising from agreements of the Issuer or a Restricted Subsidiary providing for
indemnification, adjustment of purchase price, holdback, contingency payment obligations or similar obligations, in each case, incurred or assumed in connection with the disposition or acquisition of any business, assets or Capital Stock of the
Issuer or any Restricted Subsidiary; 

  
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 (13) Indebtedness of the Issuer or any of its Restricted Subsidiaries
supported by a letter of credit issued pursuant to any Credit Facilities, in a principal amount not in excess of the stated amount of such letter of credit; 
 (14) the incurrence of Indebtedness resulting from endorsements of negotiable instruments for collection in the ordinary course of business; 

(15) Indebtedness, Disqualified Stock or preferred stock of (x) the Issuer or a Restricted Subsidiary incurred or
issued to finance an acquisition or (y) Persons that are acquired by the Issuer or any Restricted Subsidiary (including by way of merger or consolidation) in accordance with the terms of this Indenture; provided that after giving effect
to such acquisition or merger, in each case, either: 
 (A) the Issuer would be permitted to incur at least $1.00
of additional Indebtedness pursuant to the Fixed Charge Coverage Ratio; or 
 (B) the Issuer’s Fixed Charge
Coverage Ratio after giving pro forma effect to such acquisition or merger would be greater than the Issuer’s actual Fixed Charge Coverage Ratio immediately prior to such acquisition or merger; 

(16) Indebtedness of the Issuer or a Restricted Subsidiary in respect of netting services, overdraft protection and
otherwise in connection with deposit accounts; provided that such Indebtedness remains outstanding for ten Business Days or less; 
 (17) the incurrence by a Receivables Subsidiary of Indebtedness in a Qualified Receivables Transaction; 
 (18) the incurrence or issuance by the Issuer or any of its Restricted Subsidiaries of additional Indebtedness, Disqualified Stock or preferred stock in an aggregate principal amount (or accreted value or
liquidation preference, as applicable) at any time outstanding, including all Permitted Refinancing Indebtedness and all Replacement Preferred Stock incurred to renew, refund, refinance, replace, defease or discharge any Indebtedness, Disqualified
Stock and preferred stock incurred or issued pursuant to this clause (18), not to exceed $100.0 million; 
 (19)
the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness in the form of loans from a Captive Insurance Subsidiary; and 
 (20) Indebtedness in respect of promissory notes issued to physicians, consultants, employees or directors or former employees, consultants or directors in connection with repurchases of Equity Interests
permitted by Section 4.06(b)(8). 
 For purposes of determining compliance with this Section 4.08, in the event that
an item of proposed Indebtedness meets the criteria of more than one of the categories of Permitted Debt described in clauses (1) through (20) above, or is entitled to be incurred pursuant to Section 4.08(a), the Issuer shall be
permitted to classify such item of Indebtedness on the date of its incurrence, or later reclassify all or a portion of such item of Indebtedness, in any manner that complies with this Section 4.08 except that Indebtedness under the Credit
Agreement (including revolving credit commitments) outstanding on the Effective Date and any refinancing thereof will be deemed to have been incurred in reliance on the exception provided by clause (1) of this Section 4.08(b). The accrual
of interest, the accretion or amortization of original issue discount, the payment of interest on any Indebtedness in the form of additional Indebtedness 

  
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 with the same terms, the reclassification of preferred stock as Indebtedness due to a change
in accounting principles, and the payment of dividends on Disqualified Stock or preferred stock in the form of additional shares of the same class of Disqualified Stock or preferred stock shall not be deemed to be an incurrence of Indebtedness or an
issuance of Disqualified Stock or preferred stock for purposes of this Section 4.08; provided in each such case, that the amount thereof is included in Fixed Charges of the Issuer as accrued (other than the reclassification of preferred
stock as Indebtedness due to a change in accounting principles). 
 The amount of any Indebtedness outstanding as of any date
will be: 
 (1) the accreted value of the Indebtedness, in the case of any Indebtedness issued with original
issue discount; 
 (2) the principal amount of the Indebtedness, in the case of any other Indebtedness; and

 (3) in respect of Indebtedness of another Person secured by a Lien on the assets of the specified Person, the
lesser of: 
 (A) the Fair Market Value of such assets at the date of determination; and 

(B) the amount of the Indebtedness of the other Person. 

(c) For purposes of determining compliance with any U.S. dollar-denominated restriction on the incurrence of Indebtedness, the U.S.
dollar-equivalent principal amount of Indebtedness denominated in another currency shall be calculated based on the relevant currency exchange rate in effect on the date such Indebtedness was incurred, in the case of term debt, or first committed,
in the case of revolving credit debt; provided that if such Indebtedness is incurred to Refinance other Indebtedness denominated in another currency, and such Refinancing would cause the applicable U.S. dollar-denominated restriction to be
exceeded if calculated at the relevant currency exchange rate in effect on the date of such Refinancing, such U.S. dollar-denominated restriction shall be deemed not to have been exceeded so long as the principal amount of such Permitted Refinancing
Indebtedness does not exceed (i) the principal amount of such Indebtedness being Refinanced plus (ii) the aggregate amount of fees, underwriting discounts, premiums and other costs and expenses incurred in connection with such Refinancing.

 (d) The principal amount of any Indebtedness incurred to Refinance other Indebtedness, if incurred in a different currency
from the Indebtedness being Refinanced, shall be calculated based on the currency exchange rate applicable to the currencies in which such respective Indebtedness is denominated that is in effect on the date of such Refinancing. 

(a) The Issuer shall not, and shall not permit any Guarantor to, directly or indirectly, incur any Indebtedness that is subordinated or
junior in right of payment to any Indebtedness of the Issuer or such Guarantor, as the case may be, unless such Indebtedness is expressly subordinated in right of payment to the Notes or such Guarantor’s Guarantee to the extent and in the same
manner as such Indebtedness is subordinated to other Indebtedness of the Issuer or such Guarantor, as the case may be. For purposes of this Indenture, Indebtedness that is unsecured is not deemed to be subordinated or junior to Secured Indebtedness
merely because it is unsecured, and Pari Passu Indebtedness is not deemed to be subordinated or junior to any other Pari Passu Indebtedness merely because it has a junior priority with respect to the same collateral. 

  
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 SECTION 4.09 Asset Sales. 

(a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, consummate, directly or indirectly,
an Asset Sale unless: 
 (1) the Issuer (or such Restricted Subsidiary, as the case may be) receives
consideration at the time of the Asset Sale at least equal to the Fair Market Value (as determined at the time of contractually agreeing to such Asset Sale) of the assets or Equity Interests issued or sold or otherwise disposed of; and 

(2) at least 75% of the consideration received in the Asset Sale by the Issuer or such Restricted Subsidiary is in the
form of cash. For purposes of this paragraph (2), each of the following shall be deemed to be cash: 
 (A) Cash
Equivalents; 
 (B) any liabilities, as shown on the Issuer’s or such Restricted Subsidiary’s most
recent consolidated balance sheet or in the footnotes thereto (other than contingent liabilities and liabilities that are by their terms subordinated to the Notes or any Subsidiary Guarantee) that are assumed by the transferee of any such assets
pursuant to a customary novation agreement that releases the Issuer or such Restricted Subsidiary from further liability by all creditors; 
 (C) any securities, notes or other obligations received by the Issuer or any such Restricted Subsidiary from such transferee that are converted by the Issuer or such Restricted Subsidiary into cash within
180 days of receipt, to the extent of the cash received in that conversion; 
 (D) (i) any Designated
Noncash Consideration received by the Issuer or such Restricted Subsidiary in connection with the sale or contribution of assets by the Issuer or a Restricted Subsidiary to a joint venture with a Strategic Investor, provided, however,
that (x) any such Designated Noncash Consideration that is converted into Cash Equivalents shall be treated as Net Proceeds in the manner set forth below and (y) in the event such Designated Noncash Consideration is other than in the form
of Indebtedness, such Designated Noncash Consideration shall be deemed to have been acquired and consequently reduce amounts available under clause (15) or (18) of the definition of “Permitted Investments” as determined by the
Issuer and (ii) other Designated Noncash Consideration the Fair Market Value of which, when taken together with all other Designated Noncash Consideration received pursuant to this clause (ii) that is at that time outstanding, does not
exceed 5% of Total Assets at the time of receipt of such Designated Noncash Consideration, with the Fair Market Value of each item of Designated Noncash Consideration being measured at the time received and without giving effect to subsequent
changes in value; and 
 (E) any stock or assets of the kind referred to in clauses (5) or (7) of
Section 4.09(b). 
 Notwithstanding the foregoing, the 75% requirement referred to in clause (2) above shall not apply
to any Asset Sale in which the cash or Cash Equivalents portion of the consideration received therefrom, determined in accordance with the foregoing provision, is equal to or greater than what the after-tax proceeds would have been had such Asset
Sale complied with the aforementioned 75% requirement. 

  
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 (b) Within 450 days after the receipt of any Net Proceeds from an Asset
Sale, the Issuer (or the applicable Restricted Subsidiary, as the case may be) may apply such Net Proceeds at its option: 
 (1) to repay or reduce secured Obligations under a Credit Facility to the extent such Obligations were incurred under Section 4.08(b)(1) and to correspondingly reduce commitments with respect
thereto; 
 (2) to repay or reduce Obligations under other Secured Indebtedness, which is secured by a Lien that
is permitted by this Indenture, and to correspondingly reduce commitments with respect thereto; 
 (3) to repay
or reduce other Pari Passu Indebtedness (and to correspondingly reduce commitments with respect thereto); provided that the Issuer shall reduce Obligations under the Notes on a pro rata basis by, at its option, (A) redeeming such
Notes as provided under “Optional Redemption” or (B) purchasing such Notes (i) through open-market purchases (at a price equal to or above 100% of the principal amount thereof), in a manner that complies with this Indenture and
applicable securities laws or (ii) by making an offer (in accordance with the procedures set forth below for an Asset Sale Offer) to all Holders to purchase their Notes at 100% of the principal amount thereof, plus the amount of accrued but
unpaid interest, if any, and Additional Interest, if any, on the amount of notes to be purchased, to the date of repurchase; 
 (4) Indebtedness of a Non-Guarantor Subsidiary, other than Indebtedness owed to the Issuer or another Restricted Subsidiary (and to correspondingly reduce commitments with respect thereto); 

(5) to (x) acquire all or substantially all of the assets of, or any Capital Stock of, another Permitted Business,
if, after giving effect to any such acquisition of Capital Stock, the Permitted Business is or becomes a Restricted Subsidiary or (y) make Investments pursuant to clause (15) or (18) of the definition of “Permitted
Investments;” 
 (6) to make a capital expenditure with respect to a Permitted Business; or 

(7) to acquire Additional Assets; 
 provided that the requirements of clauses (5) through (7) above shall be deemed to be satisfied if an agreement (including a lease, whether a capital lease or an operating lease)
committing to make the acquisitions or expenditures referred to in any of clauses (5) through (7) above is entered into by the Issuer or such Restricted Subsidiary within 450 days after the receipt of such Net Proceeds with the good faith
expectation that such Net Proceeds will be applied to satisfy such commitment in accordance with such agreement within 180 days of such commitment and if such Net Proceeds are not so applied within such 180 day period, then such Net Proceeds shall
constitute Excess Proceeds (as defined below). 
 Pending the final application of any Net Proceeds pursuant to this
Section 4.09, the holder of such Net Proceeds may apply such Net Proceeds to temporarily reduce revolving credit borrowings or otherwise invest such Net Proceeds in any manner that is not prohibited by this Indenture. 

  
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 (c) Any Net Proceeds from Asset Sales that are not applied or invested as
provided in Section 4.09(b) shall constitute “Excess Proceeds.” When the aggregate amount of Excess Proceeds exceeds $25.0 million, within ten Business Days thereof, the Issuer shall make an Asset Sale Offer to all Holders and if the
Issuer elects (or is required by the terms of such other Pari Passu Indebtedness), all holders of such Pari Passu Indebtedness. The offer price in any Asset Sale Offer shall be equal to 100% of the principal amount plus accrued and unpaid interest
and Additional Interest, if any, to the date of purchase, and shall be payable in cash. If any Excess Proceeds remain after consummation of an Asset Sale Offer, the Issuer may use those Excess Proceeds for any purpose not otherwise prohibited by
this Indenture. If the aggregate principal amount of Notes and other Pari Passu Indebtedness tendered into such Asset Sale Offer exceeds the amount of Excess Proceeds, the Issuer shall select the Notes and such other Pari Passu Indebtedness to be
purchased on a pro rata basis. In the event that the Issuer or a Restricted Subsidiary prepays any Pari Passu Indebtedness that is outstanding under a revolving credit or other committed loan facility pursuant to an Asset Sale Offer, the Issuer or
such Restricted Subsidiary shall cause the related loan commitment to be reduced in an amount equal to the principal amount so prepaid. Upon completion of each Asset Sale Offer, the amount of Excess Proceeds shall be reset at zero. 

(d) The Issuer shall comply with the requirements of Rule 14e-1 under the Exchange Act and any other securities laws and
regulations thereunder to the extent such laws and regulations are applicable in connection with each repurchase of Notes pursuant to an Asset Sale Offer. To the extent that the provisions of any securities laws or regulations conflict with the
provisions of Section 3.09 or this Section 4.09, the Issuer shall comply with the applicable securities laws and regulations and shall not be deemed to have breached its obligations under Section 3.09 or this Section 4.09 by
virtue of such compliance. 
 SECTION 4.10 Transactions with Affiliates. 

(a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, make any payment to, or sell, lease,
transfer or otherwise dispose of any of its properties or assets to, or purchase any property or assets from, or enter into or make or amend any transaction, contract, agreement, understanding, loan, advance or guarantee with, or for the benefit of,
any Affiliate of the Issuer involving aggregate consideration in excess of $5.0 million (each, an “Affiliate Transaction”), unless: 
 (1) the Affiliate Transaction is on terms that, taken as a whole, are not materially less favorable to the Issuer or the relevant Restricted Subsidiary than those that would have been obtained in a
comparable transaction by the Issuer or such Restricted Subsidiary with an unrelated Person; and 
 (2) with
respect to any Affiliate Transaction or series of related Affiliate Transactions involving aggregate consideration in excess of $20.0 million, the Issuer delivers to the Trustee a resolution adopted by the majority of the members of the Board of
Directors of the Issuer approving such Affiliate Transaction and set forth in an Officer’s Certificate certifying that such Affiliate Transaction complies with clause (1) above. 

(b) The following items shall not be deemed to be Affiliate Transactions and, therefore, shall not be subject to the
provisions of Section 4.10(a): 
 (1) any employment agreement, employee benefit plan, officer or director
indemnification agreement or any similar arrangement entered into by the Issuer or any of its Restricted Subsidiaries in the ordinary course of business and payments pursuant thereto; 

  
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 (2) transactions between or among the Issuer and/or its Restricted
Subsidiaries; 
 (3) transactions with a Person (other than an Unrestricted Subsidiary of the Issuer) that is an
Affiliate of the Issuer solely because the Issuer owns, directly or through a Restricted Subsidiary, an Equity Interest in, or controls, such Person; 
 (4) payment of reasonable directors’ fees; 
 (5) any issuance
of Equity Interests (other than Disqualified Stock) of the Issuer to Affiliates of the Issuer; 
 (6) Permitted
Investments or Restricted Payments that do not violate Section 4.06; 
 (7) payment of fees and the
reimbursement of other expenses to the Permitted Holders and/or their Affiliates in connection with the Transactions as described in the Offering Memorandum under the caption “Certain Relationships and Related Party Transactions”;

 (8) payments by the Issuer or any of its Restricted Subsidiaries to the Sponsor for any financial advisory,
financing, underwriting or placement services or in respect of other investment banking activities, including, without limitation, in connection with acquisitions or divestitures, which payments are approved by the majority of the disinterested
members of the Board of Directors of the Issuer in good faith in an aggregate amount for all such fees not to exceed 2.00% of the aggregate transaction value in respect of which such services are rendered; 

(9) loans (or cancellation of loans) or advances to employees in the ordinary course of business; 

(10) transactions with customers, suppliers, contractors, joint venture partners or purchasers or sellers of goods or
services, in each case which are in the ordinary course of business (including, without limitation, pursuant to joint venture agreements) and otherwise in compliance with the terms of this Indenture, and which are fair to the Issuer or its
Restricted Subsidiaries, as applicable, in the reasonable determination of the Board of Directors, chief executive officer or chief financial officer of the Issuer or its Restricted Subsidiaries, as applicable, or are on terms at least as favorable
as might reasonably have been obtained at such time from an unaffiliated party; 
 (11) the existence of, or the
performance by the Issuer or any Restricted Subsidiary of their obligations, if any, or obligations of Holdings under the terms of, any subscription, registration rights or stockholders agreement, partnership agreement or limited liability company
agreement to which Holdings, the Issuer or any Restricted Subsidiary is a party as of the Effective Date and which is disclosed in the Offering Memorandum under the caption “Certain Relationships and Related Party Transactions” and any
similar agreements which the Issuer, any Restricted Subsidiary, Holdings or any other direct or indirect parent company of the Issuer may enter into thereafter; provided, however, that the entering into by the Issuer or any Restricted
Subsidiary or the performance by the Issuer or any Restricted Subsidiary of obligations under any future amendment to any such existing agreement or under any similar agreement entered into after the Effective Date will only be permitted by this
clause to the extent that the terms of any such amendment or new agreement, taken as a whole, are not materially disadvantageous to the Holders, as determined in good faith by the Board of Directors, chief executive officer or chief financial
officer of the Issuer; 

  
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 (12) the Transactions, including all payments made or to be made in
connection with the Transactions as described in the Offering Memorandum; 
 (13) any customary transaction with
a Receivables Subsidiary effected as part of a Qualified Receivables Transaction; 
 (14) Permitted Payments to
Parent; 
 (15) any management, consulting, monitoring, advisory, financing, underwriting or placement services
or any other investment banking, banking or similar services involving the Issuer and any of its Restricted Subsidiaries (including without limitation any payments in cash, Equity Interests or other consideration made by the Issuer or any of its
Restricted Subsidiaries in connection therewith) on the one hand and the Permitted Holders on the other hand, which services (and payments and other transactions in connection therewith) are approved as fair to the Issuer or such Restricted
Subsidiary by a majority of the members of the Board of Directors of the Issuer in good faith; 
 (16) the
issuance of Equity Interests (other than Disqualified Stock) in the Issuer or any Restricted Subsidiary for compensation purposes; 
 (17) any lease or sublease entered into between the Issuer or any Restricted Subsidiary, as lessee and any Affiliate of the Issuer, as lessor or sublessor, which is approved by a majority of the
disinterested members of the Board of Directors of the Issuer in good faith; 
 (18) intellectual property
licenses in the ordinary course of business; 
 (19) transactions in which the Issuer or any Restricted
Subsidiary delivers to the Trustee a letter from an accounting, appraisal or investment banking firm of national standing stating that such transaction is fair to the Issuer or such Restricted Subsidiary from a financial point of view and which are
approved by a majority of the disinterested members of the Board of Directors of the Issuer in good faith; 

(20) payments by the Issuer or any of its Restricted Subsidiaries of reasonable insurance premiums to, and any borrowings
or dividends received from, any Captive Insurance Subsidiary; 
 (21) [Reserved]; 

(22) any agreements and arrangements existing on the Effective Date and described in the Offering Memorandum, including
any amendment thereto (so long as such amendment is not disadvantageous to the Holders in any material respect). 
 SECTION 4.11 Liens.

 The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to create, incur, assume or otherwise cause or
suffer to exist or become effective any Lien of any kind (other than Permitted Liens) securing Indebtedness upon any of their property or assets, now owned or hereafter acquired, unless 

  
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 (a) in the case of Liens securing Subordinated Indebtedness, the Notes and
related Guarantees are secured by a Lien on such property, assets or proceeds that is senior in priority to such Liens; and 
 (b) in all other cases, all payments due under this Indenture and the Notes are secured on an equal and ratable basis with the obligations so secured. 

Any Lien created for the benefit of the Holders pursuant to the preceding paragraph shall provide by its terms that such Lien shall be
automatically and unconditionally released and discharged upon the release and discharge of the Lien that gave rise to the obligation to secure the Notes. 
 SECTION 4.12 Corporate Existence. 
 Subject to Article 5, the Issuer shall
do or cause to be done all things necessary to preserve and keep in full force and effect its corporate existence in accordance with its organizational documents (as the same may be amended from time to time). 

SECTION 4.13 Offer To Repurchase Upon Change of Control. 
 (a) If a Change of Control occurs after the Effective Date, each Holder shall have the right to require the Issuer to make an offer (a “Change of Control Offer”) to repurchase all or any part
(equal to $2,000 or an integral multiple of $1,000) of that Holder’s Notes at a purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid interest and Additional Interest, if any, on the Notes repurchased to
the date of purchase subject to the rights of Holders on the relevant record date to receive interest due on the relevant interest payment date (the “Change of Control Payment”). Within 30 days following any Change of Control, the Issuer
shall mail a notice to each Holder describing the transaction or transactions that constitute the Change of Control and stating: 
 (1) that the Change of Control Offer is being made pursuant to this Section 4.13 and that all Notes tendered shall be accepted for payment; 

(2) the purchase price and the purchase date, which shall be no earlier than 30 days and no later than 60 days from the
date such notice is mailed (the “Change of Control Payment Date”); 
 (3) that any Note not tendered
shall continue to accrue interest; 
 (4) that, unless the Issuer defaults in the payment of the Change of
Control Payment, all Notes accepted for payment pursuant to the Change of Control Offer shall cease to accrue interest and Additional Interest after the Change of Control Payment Date; 

(5) that Holders electing to have any Notes purchased pursuant to a Change of Control Offer shall be required to surrender
the Notes, with the form entitled “Option of Holder to Elect Purchase” attached to the Notes completed, or transfer by book-entry transfer, to the Paying Agent at the address specified in the notice prior to the close of business on the
third Business Day preceding the Change of Control Payment Date; 
 (6) that Holders shall be entitled to
withdraw their election if the Paying Agent receives, not later than the close of business on the second Business Day preceding the Change of Control Payment Date, a facsimile transmission or letter setting forth the name of the Holder, the
principal amount of Notes delivered for purchase, and a statement that such Holder is withdrawing his election to have the Notes purchased; 

  
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 (7) that Holders whose Notes are being purchased only in part shall be
issued new Notes equal in principal amount to the unpurchased portion of the Notes surrendered, which unpurchased portion must be equal to $2,000 in principal amount or an integral multiple of $1,000 in excess thereof; and 

(8) that Holders electing to have a Note purchased pursuant to a Change of Control Offer may elect to have Notes purchased
in a minimum amount of $2,000 or an integral multiple of $1,000 in excess thereof only. 
 The Issuer shall comply with the
requirements of Rule 14e-1 under the Exchange Act and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable in connection with the repurchase of the Notes as a result of a Change of Control. To
the extent that the provisions of any securities laws or regulations conflict with the provisions of Sections 3.09 or 4.13 of this Indenture, the Issuer shall comply with the applicable securities laws and regulations and shall not be deemed to have
breached its obligations under Section 3.09 or this Section 4.13 by virtue of such compliance. 
 (b)
On the Change of Control Payment Date, the Issuer shall, to the extent lawful: 
 (1) accept for payment all
Notes or portions of Notes properly tendered pursuant to the Change of Control Offer; 
 (2) deposit with the
Paying Agent an amount equal to the Change of Control Payment in respect of all Notes or portions of Notes properly tendered; and 
 (3) deliver or cause to be delivered to the Trustee the Notes so accepted together with an Officer’s Certificate stating the aggregate principal amount of Notes or portions of Notes being purchased
by the Issuer. 
 The Paying Agent shall promptly mail (but in any case not later than five days after the Change of Control
Payment Date) to each Holder of Notes properly tendered the Change of Control Payment for such Notes, and the Trustee shall promptly authenticate and mail (or cause to be transferred by book entry) to each Holder a new Note equal in principal amount
to any unpurchased portion of the Notes surrendered, if any. The Issuer shall publicly announce the results of the Change of Control Offer on or as soon as practicable after the Change of Control Payment Date. 

(c) Notwithstanding anything to the contrary in this Section 4.13, the Issuer shall not be required to make a Change
of Control Offer upon a Change of Control if (1) a third party makes the Change of Control Offer in the manner, at the times and otherwise in compliance with the requirements set forth in this Section 4.13 and purchases all Notes validly
tendered and not withdrawn under the Change of Control Offer, or (2) notice of redemption has been given pursuant to Section 3.07 of this Indenture, unless and until there is a Default in payment of the applicable redemption price. A
Change of Control Offer may be made in advance of a Change of Control, conditional upon such Change of Control, if a definitive agreement is in place for the Change of Control at the time of making of the Change of Control Offer. 

  
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 (d) Other than as specifically provided in this Section 4.13, any
purchase pursuant to this Section 4.13 shall be made pursuant to the provisions of Sections 3.02, 3.05 and 3.06 hereof. 
 SECTION 4.14
Designation of Restricted and Unrestricted Subsidiaries. 
 The Board of Directors of the Issuer may designate any
Restricted Subsidiary to be an Unrestricted Subsidiary if that designation would not cause a Default. If a Restricted Subsidiary is designated as an Unrestricted Subsidiary, the aggregate Fair Market Value of all outstanding Investments owned by the
Issuer and its Restricted Subsidiaries in the Subsidiary designated as an Unrestricted Subsidiary shall be deemed to be an Investment made as of the time of the designation and shall reduce the amount available for Restricted Payments under
Section 4.06 or under one or more clauses of the definition of Permitted Investments, as determined by the Issuer. That designation shall only be permitted if the Investment would be permitted at that time and if the Restricted Subsidiary
otherwise meets the definition of an Unrestricted Subsidiary. 
 Any designation of a Subsidiary of the Issuer as an
Unrestricted Subsidiary shall be evidenced to the Trustee by filing with the Trustee a certified copy of a resolution of the Board of Directors of the Issuer giving effect to such designation and an Officer’s Certificate certifying that such
designation complied with the preceding conditions and was permitted by Section 4.06. If, at any time, any Unrestricted Subsidiary would fail to meet the preceding requirements as an Unrestricted Subsidiary, it shall thereafter cease to be an
Unrestricted Subsidiary for purposes of this Indenture and any Indebtedness of such Subsidiary shall be deemed to be incurred by a Restricted Subsidiary as of such date and, if such Indebtedness is not permitted to be incurred as of such date under
Section 4.08, the Issuer shall be in Default of Section 4.08. The Board of Directors of the Issuer may at any time designate any Unrestricted Subsidiary to be a Restricted Subsidiary; provided that such designation shall be deemed
to be an incurrence of Indebtedness by a Restricted Subsidiary of any outstanding Indebtedness of such Unrestricted Subsidiary, and such designation shall only be permitted if such Indebtedness is permitted under Section 4.08 and no Default or
Event of Default would be in existence following such designation. 
 SECTION 4.15 Payments for Consent. 

The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly or indirectly, pay or cause to be paid any
consideration to or for the benefit of any Holder for or as an inducement to any consent, waiver or amendment of any of the terms or provisions of this Indenture or the Notes unless such consideration is offered to be paid and is paid to all Holders
that are QIBs, who, upon request, confirm that they QIBs, that consent, waive or agree to amend in the time frame set forth in the solicitation documents relating to such consent, waiver or amendment. 

SECTION 4.16 Additional Subsidiary Guarantees. 
 If the Issuer or any of its Restricted Subsidiaries, acquires or creates another Subsidiary, other than a Non-Guarantor Subsidiary, after the Effective Date that incurs or guarantees Indebtedness of the
Issuer or any Guarantor under the Credit Agreement, then that newly acquired or created Subsidiary shall become a Guarantor and execute a supplemental indenture substantially in the form attached as Exhibit E and deliver an Opinion of Counsel
to the Trustee within 30 Business Days of the date on which such guarantee was created. 

  
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 SECTION 4.17 Distributions by Qualified Restricted Subsidiaries. 

Except to the extent restricted pursuant to any Permitted Payment Restrictions, the Issuer shall cause each, and shall cause each
Restricted Subsidiary that is the parent of a Qualified Restricted Subsidiary to declare and pay regular monthly, quarterly or semiannual dividends or distributions to the holders of its Capital Stock in an amount equal to substantially all of the
available cash flow of such Restricted Subsidiary for such period as determined in good faith by the board of directors, board of governors or such other individuals performing similar functions, subject to such ordinary and customary reserves and
other amounts as, in the good faith judgment of such individuals, may be necessary so that the business of such Restricted Subsidiary may be properly and advantageously conducted at all times. 

If, at any time, any Restricted Subsidiary would fail to meet the requirements set forth in the definition of “Qualified Restricted
Subsidiary,” it will thereafter cease to be a Qualified Restricted Subsidiary for purposes of this Indenture and any Indebtedness of such Subsidiary will be deemed to be incurred by a Restricted Subsidiary that is not a Qualified Restricted
Subsidiary as of such date and, if such Indebtedness is not permitted to be incurred as of such date under Section 4.08, the Issuer will be in default of such covenant. The Board of Directors of the Issuer may at any time designate any
Restricted Subsidiary not to be a Qualified Restricted Subsidiary; provided that such designation will be deemed to be an incurrence of Indebtedness by such Restricted Subsidiary of any outstanding Indebtedness of such Restricted Subsidiary,
and such designation will only be permitted if (1) such Indebtedness is permitted under Section 4.08 and (2) no Default or Event of Default would be in existence following such designation. In the event (x) a Restricted
Subsidiary fails to meet the requirements to be a Qualified Restricted Subsidiary or (y) the Board of Directors designates a Qualified Restricted Subsidiary not to be a Qualified Restricted Subsidiary, then all Investments in such Subsidiary
since the Effective Date shall be deemed to have been acquired and consequently reduce the amount available for Restricted Payments under Section 4.06 or the amount available for Restricted Investments under clauses (15) or (18) of
the definition of “Permitted Investments” as determined by the Issuer. As of the Effective Date, all of the Issuer’s Restricted Subsidiaries will be Qualified Restricted Subsidiaries. 

SECTION 4.18 Discharge and Suspension of Covenants. 
 (a) After the Effective Date, during any period of time that: (i) the Notes have Investment Grade Ratings from both Rating Agencies and (ii) no Default has occurred and is continuing under this
Indenture (the occurrence of the events described in the foregoing clauses (i) and (ii) being collectively referred to as a “Covenant Suspension Event”), the Issuer and the Restricted Subsidiaries will not be subject to
Section 4.06 hereof, Section 4.07 hereof, Section 4.08 hereof, Section 4.09 hereof, Section 4.10 hereof and 5.01(a)(4) hereof (the “Suspended Covenants”). Upon the occurrence of a Covenant Suspension Event (the
date of such occurrence, the “Suspension Date”), the amount of Excess Proceeds from Net Proceeds shall be set at zero. 
 (b) In the event that the Issuer and the Restricted Subsidiaries are not subject to the Suspended Covenants for any period of time as a result of the foregoing, and on any subsequent date (the
“Reversion Date”) one or both of the Rating Agencies withdraws its Investment Grade Rating or downgrades the rating assigned to the Notes below an Investment Grade Rating or a Default or an Event of Default occurs and is continuing, then
the Issuer and the Restricted Subsidiaries will thereafter again be subject to the Suspended Covenants with respect to future events under this Indenture. The period of time between the Suspension Date and the Reversion Date is referred to in this
description as the “Suspension Period.” Notwithstanding that the Suspended Covenants may be reinstated, no Default, Event of Default or breach of any kind shall be deemed to exist under this Indenture, the Registration Rights Agreement,
the Notes or the Subsidiary Guarantees with respect to the Suspended Covenants, and none 

  
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of the Issuer or any of its Subsidiaries shall bear any liability for any actions taken or events occurring during the Suspension Period, or any actions taken at any time pursuant to any
contractual obligation arising prior to the Reversion Date, as a result of a failure to comply with the Suspended Covenants during the Suspension Period (or upon termination of the Suspension Period or after that time based solely on events that
occurred during the Suspension Period). 
 (c) On the Reversion Date, all Indebtedness incurred, or Disqualified
Stock issued, during the Suspension Period will be classified to have been incurred or issued pursuant to Section 4.08(b)(2). On the Reversion Date, all Liens created, incurred or assumed during the Suspension Period in compliance with this
Indenture will be deemed to have been outstanding on the Effective Date, so that they are classified as permitted under clause (6) of the definition of “Permitted Liens.” Calculations made after the Reversion Date of the amount
available to be made as Restricted Payments under Section 4.06 will be made as though Section 4.06 had been in effect prior to, but not during, the Suspension Period. No Subsidiaries shall be designated as Unrestricted Subsidiaries during
any Suspension Period. 
 (d) The Issuer shall deliver promptly to the Trustee an Officer’s Certificate
notifying it of any such occurrence under this Section 4.18. 
 SECTION 4.19 Activities Prior to the Merger. 

(a) USPI Finance is a limited purpose corporation. Prior to the consummation of the Merger, USPI Finance’s primary
activities will be restricted to issuing the Notes, issuing Capital Stock to, and receiving capital contributions from, USPI Group Holdings, Inc., performing its obligations in respect of the Notes under this Indenture, performing its obligations
under the merger agreement between USPI Finance and USPI, consummating the Transactions and Release and redeeming the Notes, if applicable, and conducting such other activities as are necessary or appropriate to carry out the activities described
above. 
 (b) Prior to the consummation of the Merger, USPI Finance and its Restricted Subsidiaries shall not
engage in any business activity or enter into any transaction or agreement (including, without limitation, making any restricted payment, incurring any debt, incurring any Liens except in favor of the Holders, entering into any merger, consolidation
or sale of all or substantially all of its assets or engaging in any transaction with its Affiliates) except in the ordinary course of business or necessary to effectuate the Merger and the Transactions substantially in accordance with the
description of the Transactions set forth in the Offering Memorandum, together with such amendments, modifications and waivers that are not, individually or in the aggregate, materially adverse to USPI and its Subsidiaries (after giving effect to
the consummation of the Transactions), taken as a whole, or to the Holders. 
 ARTICLE 5. 

SUCCESSORS 
 SECTION 5.01
Merger, Consolidation, or Sale of Assets. 
 (a) The Issuer shall not, directly or indirectly: consolidate
or merge with or into another Person (whether or not the Issuer is the surviving corporation); or sell, assign, transfer, lease, convey or otherwise dispose of all or substantially all of the properties or assets of the Issuer and its Restricted
Subsidiaries taken as a whole, in one or more related transactions, to another Person, unless: 

  
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 (1) either: 

(A) the Issuer is the surviving entity; or 

(B) the Person formed by or surviving any such consolidation or merger (if other than the Issuer) or to which such sale,
assignment, transfer, lease, conveyance or other disposition has been made is an entity organized or existing under the laws of the United States, any state of the United States or the District of Columbia; 

(2) the Person formed by or surviving any such consolidation or merger (if other than the Issuer) or the Person to which
such sale, assignment, transfer, lease, conveyance or other disposition has been made expressly assumes all the obligations of the Issuer under the Notes, this Indenture and the Registration Rights Agreement pursuant to supplemental indentures or
other documents or instruments in form reasonably satisfactory to the Trustee; provided, however, that at all times, a corporation organized and existing under the laws of the United States of America, any State thereof or the District
of Columbia must be a co-issuer or the issuer of the Notes if such surviving Person is not a corporation; 
 (3)
immediately after such transaction, no Default or Event of Default exists; and 
 (4) the Issuer or the Person
formed by or surviving any such consolidation or merger (if other than the Issuer), or to which such sale, assignment, transfer, lease, conveyance or other disposition has been made would, on the date of such transaction after giving pro forma
effect thereto and any related financing transactions, as if the same had occurred at the beginning of the applicable four-quarter period: 
 (A) be permitted to incur at least $1.00 of additional Indebtedness pursuant to the Fixed Charge Coverage Ratio test set forth in Section 4.08(a) or 

(B) have a Fixed Charge Coverage Ratio that is greater than the actual Fixed Charge Coverage Ratio of the Issuer
immediately prior to such transaction. 
 (b) The Person formed by or surviving any such consolidation or merger
or the Person to which such sale, assignment, transfer, lease or conveyance or other disposition has been made will succeed to, and be substituted for, the Issuer, under this Indenture, the Registration Rights Agreement and the Notes. This
Section 5.01 will not apply to the Merger. Notwithstanding the foregoing, clauses (3) and (4) above will not apply to: 
 (1) a merger of the Issuer with an Affiliate solely for the purpose of reincorporating the Issuer in another state of the United States, the District of Columbia or any territory thereof so long as the
amount of Indebtedness of the Issuer and the Restricted Subsidiaries is not increased thereby; 
 (2) any
consolidation or merger, or any sale, assignment, transfer, conveyance, lease or other disposition of assets between or among the Issuer and its Restricted Subsidiaries; and 

(3) transfers of accounts receivable and related assets of the type specified in the definition of Qualified Receivables
Transaction (or a fractional undivided interest therein) by a Receivables Subsidiary in a Qualified Receivables Transaction. 

  
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 (c) Subject to certain limitations described in this Indenture governing
release of a Subsidiary Guarantee upon the sale, disposition or transfer of a Guarantor, no Guarantor will, and the Issuer will not permit a Guarantor to sell or otherwise dispose of all or substantially all of its assets to, or consolidate with or
merge with or into (whether or not such Guarantor is the surviving Person) another Person, other than the Issuer or another Guarantor, unless: 
 (1) (A) such Guarantor is the surviving corporation or the Person formed by or surviving any such consolidation or merger (if other than such Guarantor) or to which such sale or other disposition will
have been made is a Person organized or existing under the laws of the jurisdiction of organization of such Guarantor, or the laws of the United States, any state thereof, the District of Columbia or any territory thereof (such Guarantor or such
Person, as the case may be, being herein called the “Successor Person”); 
 (B) the Successor Person,
if other than such Guarantor, expressly assumes all the obligations of such Guarantor under this Indenture, the Registration Rights Agreement and such Guarantor’s related Subsidiary Guarantee pursuant to supplemental indentures or other
documents or instruments in form reasonably satisfactory to the Trustee; 
 (C) immediately after giving effect
to that transaction, no Default or Event of Default exists; and 
 (D) the Issuer shall have delivered to the
Trustee an Officer’s Certificate and an Opinion of Counsel, each stating that such consolidation, merger or transfer and such supplemental indentures, if any, comply with this Indenture; or 

(2) the transaction (a) does not constitute an “Asset Sale” in accordance with the definition thereof or
(b) constitutes an Asset Sale and is made in compliance with Section 4.09. 
 (d) Subject to certain
limitations described in this Indenture, the Successor Person will succeed to, and be substituted for, such Guarantor under this Indenture and such Guarantor’s Subsidiary Guarantee. Notwithstanding the foregoing, any Guarantor may
(i) merge into or transfer all or part of its properties and assets to another Guarantor or the Issuer, (ii) merge with an Affiliate of the Issuer solely for the purpose of reincorporating or reorganizing the Guarantor in the United
States, any state thereof, the District of Columbia or any territory thereof so long as the amount of Indebtedness of the Issuer and its Restricted Subsidiaries is not increased thereby or (iii) convert into a Person organized or existing under
the laws of the jurisdiction of such Guarantor or the laws of another jurisdiction in the United States. 
 SECTION 5.02 Successor
Corporation Substituted. 
 Upon any consolidation or merger, or any sale, assignment, transfer, lease, conveyance or other
disposition of all or substantially all of the assets of the Issuer in a transaction that is subject to, and that complies with the provisions of, Section 5.01, the successor Person formed by such consolidation or into or with which the Issuer
is merged or to which such sale, assignment, transfer, lease, conveyance or other disposition is made shall succeed to, and be substituted for (so that from and after the date of such consolidation, merger, sale, assignment, transfer, lease,
conveyance or other disposition, the provisions of this Indenture referring to the “Issuer” shall refer instead to the successor Person and not to the Issuer), and may exercise every right and power of the Issuer under this Indenture with
the same effect as if such successor Person had been named as the Issuer herein, and when a successor Person assumes all obligations of its predecessor under this Indenture or the Notes, the predecessor shall be released from those obligations;
provided, however, that in the case of a transfer by lease, the predecessor shall not be released from those obligations. 

  
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 ARTICLE 6. 
 DEFAULTS AND REMEDIES 
 SECTION 6.01 Events of Default. 

(a) Each of the following is an “Event of Default”: 

(1) default for 30 days in the payment when due of interest on, or Additional Interest, if any, with respect to, the
Notes; 
 (2) default in the payment when due (at maturity, upon redemption or otherwise) of the principal of, or
premium, if any, on, the Notes; 
 (3) failure by the Issuer or any of its Restricted Subsidiaries to comply with
the provisions of Section 5.01 hereof; 
 (4) failure by the Issuer or any of its Restricted Subsidiaries
for 60 days after notice to the Issuer by the Trustee or the Holders of at least 25% in aggregate principal amount of the Notes then outstanding voting as a single class to comply with any of the other agreements in this Indenture; 

(5) default under any mortgage, indenture or instrument under which there may be issued or by which there may be secured
or evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries (or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries), whether such Indebtedness or Guarantee now exists, or
is created after the Effective Date, if that default: 
 (A) is caused by a failure to pay principal at the final
Stated Maturity of such Indebtedness (a “Payment Default”); or 
 (B) results in the acceleration of
such Indebtedness prior to its express maturity; 
 and, in each case, the principal amount of such Indebtedness, together with
the principal amount of any other such Indebtedness under which there has been a Payment Default or the maturity of which has been so accelerated, aggregates $35.0 million or more; 

(6) with respect to any judgment or decree for the payment of money (net of any amount covered by insurance issued by a
reputable and creditworthy insurer that has not contested coverage or reserved rights with respect to an underlying claim) in excess of $35.0 million or its foreign currency equivalent against the Issuer or any Significant Subsidiary, the failure by
the Issuer or such Significant Subsidiary, as applicable, to pay such judgment or decree, which judgment or decree has remained outstanding for a period of 60 days after such judgment or decree became final and nonappealable without being paid,
discharged, waived or stayed; 

  
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 (7) except as permitted by this Indenture, any Subsidiary Guarantee of any
Significant Subsidiary is declared to be unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any reason to be in full force and effect, or any Guarantor that is a Significant Subsidiary or any Person acting on
behalf of any Guarantor that is a Significant Subsidiary denies or disaffirms its obligations in writing under its Subsidiary Guarantee and such Default continues for 10 days after receipt of notice thereof by the Trustee or the Holders of at least
25% in aggregate principal amount of the Notes then outstanding voting as a single class; 
 (8) the Issuer or
any of the Restricted Subsidiaries that is a Significant Subsidiary pursuant to or within the meaning of Bankruptcy Law: 
 (A) commences a voluntary case, 
 (B) consents to the entry of an
order for relief against it in an involuntary case, 
 (C) consents to the appointment of a custodian of it or
for all or substantially all of its property, 
 (D) makes a general assignment for the benefit of its creditors,
or 
 (E) generally is not paying its debts as they become due; and 

(9) a court of competent jurisdiction enters an order or decree under any Bankruptcy Law that: 

(A) is for relief against the Issuer or any of the Issuer’s Restricted Subsidiaries that is a Significant Subsidiary
in an involuntary case; 
 (B) appoints a custodian of the Issuer or any of the Issuer’s Restricted
Subsidiaries that is a Significant Subsidiary for all or substantially all of the property of the Issuer or any of the Issuer’s Restricted Subsidiaries that is a Significant Subsidiary; or 

(C) orders the liquidation of the Issuer or any of the Issuer’s Restricted Subsidiaries that is a Significant
Subsidiary; 
 and the order or decree remains unstayed and in effect for 60 consecutive days. 

(b) In the event of any Event of Default specified in clause (5) above, such Event of Default and all consequences
thereof (excluding any resulting payment default, other than as a result of acceleration of the Notes) shall be annulled, waived and rescinded, automatically and without action by the Trustee or the Holders, if within 20 days after such Event of
Default arose: 
 (1) the Indebtedness or Guarantee that is the basis for such Event of Default has been
discharged; 
 (2) holders thereof have rescinded or waived the acceleration, notice or action (as the case may
be) giving rise to such Event of Default; or 
 (3) the default that is the basis for such Event of Default has
been cured. 

  
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 SECTION 6.02 Acceleration. 

In the case of an Event of Default arising under clause (8) or (9) of Section 6.01, all outstanding Notes
shall become due and payable immediately without further action or notice. If any other Event of Default occurs and is continuing, the Trustee or the Holders of at least 25% in aggregate principal amount of the then outstanding Notes may declare all
the Notes to be due and payable immediately; 
 Upon any such declaration, the Notes shall become due and payable immediately.
The Holders of a majority in aggregate principal amount of the then outstanding Notes by written notice to the Trustee may, on behalf of all of the Holders, rescind an acceleration or waive any existing Default or Event of Default and its
consequences under this Indenture except a continuing Default or Event of Default in the payment of interest or premium or Additional Interest, if any, on, or the principal of, the Notes. 
 SECTION 6.03 Other Remedies. 
 If an Event of Default occurs and is
continuing, the Trustee may pursue any available remedy to collect the payment of principal, premium and Additional Interest, if any, and interest on the Notes or to enforce the performance of any provision of the Notes or this Indenture.

 The Trustee may maintain a proceeding even if it does not possess any of the Notes or does not produce any of them in the
proceeding. A delay or omission by the Trustee or any Holder of a Note in exercising any right or remedy accruing upon an Event of Default shall not impair the right or remedy or constitute a waiver of or acquiescence in the Event of Default. All
remedies are cumulative to the extent permitted by law. 
 SECTION 6.04 Waiver of Past Defaults. 

Holders of a majority in aggregate principal amount of the then outstanding Notes by notice to the Trustee may on behalf of the Holders of
all of the Notes waive an existing Default or Event of Default and its consequences hereunder, except a continuing Default or Event of Default in the payment of interest on, premium, if any, Additional Interest, if any, or the principal of any Note
held by a non-consenting Holder (including in connection with an offer to purchase); provided, however, that the Holders of a majority in aggregate principal amount of the then outstanding Notes may rescind an acceleration and its
consequences, including any related payment default that resulted from such acceleration. Upon any such waiver, such Default shall cease to exist, and any Event of Default arising therefrom shall be deemed to have been cured for every purpose of
this Indenture; but no such waiver shall extend to any subsequent or other Default or impair any right consequent thereon. In case of any such waiver, the Issuer, the Trustee and the Holders shall be restored to their former positions and rights
hereunder and under the Notes, respectively. 
 SECTION 6.05 Control by Majority. 

Holders of a majority in principal amount of the then outstanding Notes may direct the time, method and place of conducting any proceeding
for exercising any remedy available to the Trustee or exercising any trust or power conferred on it. However, the Trustee may refuse to follow any direction that conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the Trustee in personal liability. Prior to taking any action under this Indenture, the Trustee shall be entitled to reasonable indemnification against all losses and expenses caused by
taking or not taking such action. 

  
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 SECTION 6.06 Limitation on Suits. 

A Holder may pursue a remedy with respect to this Indenture or the Notes only if: 

(1) such Holder has previously given the Trustee notice that an Event of Default is continuing; 

(2) Holders of at least 25% in aggregate principal amount of the then outstanding Notes have requested the Trustee to
pursue the remedy; 
 (3) such Holders have offered the Trustee reasonable security or indemnity against any
loss, liability or expense; 
 (4) the Trustee has not complied with such request within 60 days after the
receipt of the request and the offer of security or indemnity; and 
 (5) Holders of a majority in aggregate
principal amount of the then outstanding Notes have not given the Trustee a direction inconsistent with such request within such 60-day period. 

SECTION 6.07 Rights of Holders To Receive Payment. 
 Notwithstanding any other provision of this Indenture, the right of any Holder of a Note to receive payment of principal, premium and Additional Interest, if any, and interest on the Note, on or after the
respective due dates expressed in the Note (including in connection with an Asset Sale Offer or a Change of Control Offer), or to bring suit for the enforcement of any such payment on or after such respective dates, shall not be impaired or affected
without the consent of such Holder. 
 SECTION 6.08 Collection Suit by Trustee. 

If an Event of Default specified in clauses (1) or (2) of Section 6.01 occurs and is continuing, the Trustee is authorized
to recover judgment in its own name and as trustee of an express trust against the Issuer and each Guarantor for the whole amount of principal of, premium and Additional Interest, if any, and interest remaining unpaid on the Notes and interest on
overdue principal and, to the extent lawful, interest and such further amount as shall be sufficient to cover the costs and expenses of collection, including the reasonable compensation, expenses, disbursements and advances of the Trustee, its
agents and counsel. 
 SECTION 6.09 Trustee May File Proofs of Claim. 

The Trustee is authorized to file such proofs of claim and other papers or documents as may be necessary or advisable in order to have the
claims of the Trustee (including any claim for the reasonable compensation, expenses, disbursements and advances of the Trustee, its agents and counsel) and the Holders allowed in any judicial proceedings relative to the Issuer (or any other obligor
upon the Notes), its creditors or its property and shall be entitled and empowered to collect, receive and distribute any money or other property payable or deliverable on any such claims and any custodian in any such judicial proceeding is hereby
authorized by each Holder to make such payments to the Trustee, and in the event 

  
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that the Trustee shall consent to the making of such payments directly to the Holders, to pay to the Trustee any amount due to it for the reasonable compensation, expenses, disbursements and
advances of the Trustee, its agents and counsel, and any other amounts due to the Trustee under Section 7.07. Nothing herein contained shall be deemed to authorize the Trustee to authorize or consent to or accept or adopt on behalf of any
Holder any plan of reorganization, arrangement, adjustment or composition affecting the Notes or the rights of any Holder, or to authorize the Trustee to vote in respect of the claim of any Holder in any such proceeding. The Trustee may participate
as a member of any official committee of creditors appointed in the matters as it deems necessary or advisable. 
 SECTION 6.10
Priorities. 
 If the Trustee collects any money pursuant to this Article 6, it shall pay out the money in the following
order: 
 First: to the Trustee, its agents and attorneys for amounts due under Section 7.07, including
payment of all compensation, expenses and liabilities incurred, and all advances made, by the Trustee and the costs and expenses of collection; 
 Second: to Holders for amounts due and unpaid on the Notes for principal, premium and Additional Interest, if any, and interest, ratably, without preference or priority of any kind, according to the
amounts due and payable on the Notes for principal, premium and Additional Interest, if any, and interest, respectively; and 
 Third: to the Issuer or to such party as a court of competent jurisdiction shall direct. 
 The Trustee may fix a record date and payment date for any payment to Holders pursuant to this Section 6.10. 
 SECTION 6.11 Undertaking for Costs. 
 In any suit for the enforcement of any
right or remedy under this Indenture or in any suit against the Trustee for any action taken or omitted by it as a Trustee, a court in its discretion may require the filing by any party litigant in the suit of an undertaking to pay the costs of the
suit, and the court in its discretion may assess reasonable costs, including reasonable attorneys’ fees and expenses, against any party litigant in the suit, having due regard to the merits and good faith of the claims or defenses made by the
party litigant. This Section 6.11 does not apply to a suit by the Trustee, a suit by a Holder pursuant to Section 6.07, or a suit by Holders of more than 10% in principal amount of the then outstanding Notes. 

ARTICLE 7. 

TRUSTEE 
 SECTION 7.01 Duties
of Trustee. 
 (a) If an Event of Default has occurred and is continuing, the Trustee shall exercise such of
the rights and powers vested in it by this Indenture, and use the same degree of care and skill in its exercise, as a prudent person would exercise or use under the circumstances in the conduct of such person’s own affairs. 

  
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 (b) Except during the continuance of an Event of Default: 

(1) the duties of the Trustee shall be determined solely by the express provisions of this Indenture and the Trustee need
perform only those duties that are specifically set forth in this Indenture and no others, and no implied covenants or obligations shall be read into this Indenture against the Trustee; and 

(2) in the absence of bad faith on its part, the Trustee may conclusively rely, as to the truth of the statements and the
correctness of the opinions expressed therein, upon certificates or opinions furnished to the Trustee and conforming to the requirements of this Indenture. However, in the case of certificates or opinions specifically required by any provision
hereof to be furnished to it, the Trustee shall examine the certificates and opinions to determine whether or not they conform to the requirements of this Indenture. 

(c) The Trustee may not be relieved from liabilities for its own negligent action, its own negligent failure to act, or
its own willful misconduct, except that: 
 (1) this paragraph does not limit the effect of paragraph (b) of
this Section 7.01; 
 (2) the Trustee shall not be liable for any error of judgment made in good faith by a
Responsible Officer, unless it is proved that the Trustee was negligent in ascertaining the pertinent facts; and 

(3) the Trustee shall not be liable with respect to any action it takes or omits to take in good faith in accordance with
a direction received by it pursuant to Section 6.05 hereof. 
 (d) Whether or not therein expressly so
provided, every provision of this Indenture that in any way relates to the Trustee is subject to paragraphs (a) and (b) of this Section 7.01. 
 (e) No provision of this Indenture shall require the Trustee to expend or risk its own funds or incur any liability if it shall have reasonable grounds to believe that repayment of such funds or adequate
indemnity against such risk or liability is not reasonably assured to it. 
 (f) The Trustee shall not be liable
for interest on any money received by it except as the Trustee may agree in writing with the Issuer. Money held in trust by the Trustee need not be segregated from other funds except to the extent required by law. 

(g) In the absence of bad faith, negligence or willful misconduct on the part of the Trustee, the Trustee shall not be
responsible for the application of any money by any Paying Agent other than the Trustee. 
 SECTION 7.02 Rights of Trustee. 

(a) The Trustee may conclusively rely upon any document believed by it to be genuine and to have been signed or presented
by the proper Person. The Trustee need not investigate any fact or matter stated in the document. 
 (b) Before
the Trustee acts or refrains from acting, it may require an Officer’s Certificate or an Opinion of Counsel or both. The Trustee shall not be liable for any action it takes or omits to take in good faith in reliance on such Officer’s
Certificate or Opinion of Counsel. The Trustee may consult with counsel of its own selection and the written advice of such counsel or any Opinion of Counsel shall be full and complete authorization and protection from liability in respect of any
action taken, suffered or omitted by it hereunder in good faith and in reliance thereon. 

  
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 (c) The Trustee may act through its attorneys and agents and shall not be
responsible for the misconduct or negligence of any agent appointed with due care. 
 (d) The Trustee shall not
be liable for any action it takes or omits to take in good faith that it believes to be authorized or within the rights or powers conferred upon it by this Indenture provided, however, that the Trustee’s conduct does not
constitute willful misconduct, bad faith or negligence. 
 (e) Unless otherwise specifically provided in this
Indenture, any demand, request, direction or notice from the Issuer shall be sufficient if signed by an Officer of the Issuer. 
 (f) The Trustee shall be under no obligation to exercise any of the rights or powers vested in it by this Indenture at the request or direction of any of the Holders unless such Holders have offered to
the Trustee security or indemnity reasonably satisfactory to it against the costs, expenses and liabilities that might be incurred by it in compliance with such request or direction. 

(g) Except with respect to Section 4.01, the Trustee shall have no duty to inquire as to the performance of the
Issuer with respect to the covenants contained in Article 4. In addition, the Trustee shall not be deemed to have knowledge of an Event of Default except (i) any Default or Event of Default occurring pursuant to Sections 4.01, 6.01(1) or
6.01(2) or (ii) any Default or Event of Default of which the Trustee shall have received written notification or obtained actual knowledge. 
 (h) The rights, privileges, protections, immunities and benefits given to the Trustee, including, without limitation, its right to be indemnified, are extended to, and shall be enforceable by, the Trustee
in each of its capacities hereunder. 
 (i) The Trustee may request that the Issuer deliver an Officer’s
Certificate setting forth the names of individuals and/or titles of officers authorized at such time to take specified actions pursuant to this Indenture, which Officer’s Certificate may be signed by any person authorized to sign an
Officer’s Certificate, including any person specified as so authorized in any such certificate previously delivered and not superseded. 
 (j) The Trustee shall not be bound to make any investigation into the facts or matters stated in any resolution, certificate (including any Officer’s Certificate), statement, instrument, opinion
(including any Opinion of Counsel), notice, request, direction, consent, order, bond, debenture, or other paper or document. 
 (k) The Trustee shall not be required to give any bond or surety in respect of the performance of its powers and duties hereunder. 

(l) The permissive rights of the Trustee to do things enumerated in this Indenture shall not be construed as duties.


  
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 SECTION 7.03 Individual Rights of Trustee. 

The Trustee in its individual or any other capacity may become the owner or pledgee of Notes and may otherwise deal with the Issuer or any
Affiliate of the Issuer with the same rights it would have if it were not Trustee. However, in the event that the Trustee acquires any conflicting interest it must eliminate such conflict within 90 days, apply to the SEC for permission to continue
as Trustee (if this Indenture has been qualified under the TIA) or resign. Any Agent may do the same with like rights and duties. The Trustee is also subject to Sections 7.10 and 7.11 hereof. 
 SECTION 7.04 Trustee’s Disclaimer. 
 The Trustee shall not be
responsible for and makes no representation as to the validity or adequacy of this Indenture or the Notes, it shall not be accountable for the Issuer’s use of the proceeds from the Notes or any money paid to the Issuer or upon the Issuer’s
direction under any provision of this Indenture, it shall not be responsible for the use or application of any money received by any Paying Agent other than the Trustee, and it shall not be responsible for any statement or recital herein or any
statement in the Notes or any other document in connection with the sale of the Notes or pursuant to this Indenture other than its certificate of authentication. 
 SECTION 7.05 Notice of Defaults. 
 If a Default or Event of Default occurs
and is continuing and if it is known to the Trustee, the Trustee shall mail to Holders a notice of the Default or Event of Default within 90 days after it occurs. Except in the case of a Default or Event of Default in payment of principal of,
premium or Additional Interest, if any, or interest on, any Note, the Trustee may withhold the notice if and so long as a committee of its Responsible Officers in good faith determines that withholding the notice is in the interests of the Holders
of the Notes. 
 SECTION 7.06 Reports by Trustee to Holders of the Notes. 

(a) Within 60 days after each May 15 beginning with the May 15 following the date of this Indenture, and for so
long as Notes remain outstanding, the Trustee shall mail to the Holders of the Notes a brief report dated as of such reporting date that complies with TIA Section 313; provided that if no event described in TIA Section 313 has
occurred within the twelve months preceding such reporting date, no report need be transmitted. The Trustee also shall comply with TIA Section 313(b)(2). The Trustee shall also transmit by mail all reports as required by TIA
Section 313(c). 
 (b) A copy of each report at the time of its mailing to the Holders shall be mailed by
the Trustee to the Issuer and filed by the Trustee with the SEC and each stock exchange on which the Notes are listed in accordance with TIA Section 313(d). The Issuer shall promptly notify the Trustee when the Notes are listed on any stock
exchange or delisted therefrom. 
 SECTION 7.07 Compensation and Indemnity. 

(a) The Issuer shall pay to the Trustee from time to time reasonable compensation as agreed to between the Issuer and the
Trustee for its acceptance of this Indenture and services hereunder. The Trustee’s compensation shall not be limited by any law on compensation of a trustee of an express trust. The Issuer shall reimburse the Trustee promptly upon request for
all reasonable disbursements, advances and expenses incurred or made by it in addition to the compensation for its services. Such expenses shall include the reasonable compensation, disbursements and expenses of the Trustee’s agents and
counsel. 
 (b) The Issuer shall indemnify the Trustee against any and all losses, liabilities, claims, damages
or expenses incurred by it arising out of or in connection with the acceptance or administration 

  
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of its duties under this Indenture, including the costs and expenses of enforcing this Indenture against the Issuer and the Guarantors (including this Section 7.07) and defending itself
against any claim (whether asserted by the Issuer, the Guarantors, any Holder or any other Person) or liability in connection with the exercise or performance of any of its powers or duties hereunder, except to the extent any such loss, liability or
expense shall be determined to have been caused by its own negligence or willful misconduct. The Trustee shall notify the Issuer promptly of any claim for which it may seek indemnity. Failure by the Trustee to so notify the Issuer shall not relieve
the Issuer of its obligations hereunder. The Issuer shall defend the claim and the Trustee shall cooperate in the defense. The Trustee may have separate counsel and the Issuer shall pay the reasonable fees and expenses of such counsel; provided that
the Issuer shall not be required to pay such fees and expenses if it assumes the Trustee’s defense, and, in the Trustee’s reasonable judgment, there is no conflict of interest between the Issuer and the Trustee in connection with such
defense. The Issuer shall not be required to pay for any settlement made without its consent, which consent shall not be unreasonably withheld. 
 (c) The obligations of the Issuer under this Section 7.07 shall survive the satisfaction and discharge of this Indenture. 

(d) To secure the Issuer’s payment obligations in this Section 7.07, the Trustee shall have a Lien prior to the
Notes on all money or property held or collected by the Trustee, except that held in trust to pay principal and interest on particular Notes. Such Lien shall survive the satisfaction and discharge of this Indenture. 

(e) When the Trustee incurs expenses or renders services after an Event of Default specified in Section 6.01(8) or
(9) occurs, the expenses and the compensation for the services (including the fees and expenses of its agents and counsel) are intended to constitute expenses of administration under any Bankruptcy Law. 

(f) The Trustee shall comply with the provisions of TIA Section 313(b) to the extent applicable. 

SECTION 7.08 Replacement of Trustee. 
 (a) A resignation or removal of the Trustee and appointment of a successor Trustee shall become effective only upon the successor Trustee’s acceptance of appointment as provided in this
Section 7.08. 
 (b) The Trustee may resign in writing at any time and be discharged from the trust hereby
created by so notifying the Issuer. The Holders of a majority in principal amount of the then outstanding Notes may remove the Trustee by so notifying the Trustee and the Issuer in writing. The Issuer may remove the Trustee if: 

(1) the Trustee fails to comply with Section 7.10 hereof; 

(2) the Trustee is adjudged bankrupt or insolvent or an order for relief is entered with respect to the Trustee under any
Bankruptcy Law; 
 (3) a custodian or public officer takes charge of the Trustee or its property; or 

(4) the Trustee becomes incapable of acting. 

  
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 (c) If the Trustee resigns or is removed or if a vacancy exists in the
office of the Trustee for any reason, the Issuer shall promptly appoint a successor Trustee. Within one year after the successor Trustee takes office, the Holders of a majority in principal amount of the then outstanding Notes may appoint a
successor Trustee to replace the successor Trustee appointed by the Issuer. 
 (d) If a successor Trustee does
not take office within 60 days after the retiring Trustee resigns or is removed, the retiring Trustee, the Issuer, or the Holders of at least 10% in principal amount of the then outstanding Notes may petition, at the expense of the Issuer, any court
of competent jurisdiction for the appointment of a successor Trustee. 
 (e) If the Trustee, after written
request by any Holder who has been a Holder for at least six months, fails to comply with Section 7.10, such Holder may petition any court of competent jurisdiction for the removal of the Trustee and the appointment of a successor Trustee.

 (f) A successor Trustee shall deliver a written acceptance of its appointment to the retiring Trustee and to
the Issuer. Thereupon, the resignation or removal of the retiring Trustee shall become effective, and the successor Trustee shall have all the rights, powers and duties of the Trustee under this Indenture. The successor Trustee shall mail a notice
of its succession to the Holders. The retiring Trustee shall promptly transfer all property held by it as Trustee to the successor Trustee, provided all sums owing to the Trustee hereunder have been paid and subject to the Lien provided for
in Section 7.07. Notwithstanding replacement of the Trustee pursuant to this Section 7.08, the Issuer’s obligations under Section 7.07 shall continue for the benefit of the retiring Trustee. 

SECTION 7.09 Successor Trustee by Merger, etc. 
 If the Trustee consolidates, merges or converts into, or transfers all or substantially all of its corporate trust business to, another corporation, the successor corporation without any further act shall
be the successor Trustee. 
 SECTION 7.10 Eligibility; Disqualification. 

There shall at all times be a Trustee hereunder that is a corporation organized and doing business under the laws of the United States of
America or of any state thereof that is authorized under such laws to exercise corporate trustee power, that is subject to supervision or examination by federal or state authorities and that together with its affiliates has a combined capital and
surplus of at least $100.0 million as set forth in its most recent published annual report of condition. 
 This Indenture shall
always have a Trustee who satisfies the requirements of TIA Sections 310(a)(1), (2) and (5). The Trustee is subject to TIA Section 310(b). 
 SECTION 7.11 Preferential Collection of Claims Against Issuer. 
 The Trustee
is subject to TIA Section 311(a), excluding any creditor relationship listed in TIA Section 311(b). A Trustee who has resigned or been removed shall be subject to TIA Section 311 to the extent indicated therein. 

  
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 ARTICLE 8. 
 LEGAL DEFEASANCE AND COVENANT DEFEASANCE 
 SECTION 8.01 Option To Effect Legal Defeasance or
Covenant Defeasance. 
 The Issuer may, at any time, elect to have either Section 8.02 or 8.03 be applied to all
outstanding Notes and all obligations of the Guarantors with respect to the Subsidiary Guarantees upon compliance with the conditions set forth below in this Article 8. 
 SECTION 8.02 Legal Defeasance and Discharge. 
 Upon the Issuer’s
exercise under Section 8.01 of the option applicable to this Section 8.02, the Issuer and each of the Guarantors shall, subject to the satisfaction of the conditions set forth in Section 8.04, be deemed to have been discharged from
their obligations with respect to all outstanding Notes (including the Subsidiary Guarantees) on the date the conditions set forth in Section 8.04 are satisfied (hereinafter, “Legal Defeasance”). For this purpose, Legal Defeasance
means that the Issuer and the Guarantors shall be deemed to have paid and discharged the entire Indebtedness represented by the outstanding Notes (including the Subsidiary Guarantees), which shall thereafter be deemed to be “outstanding”
only for the purposes of Section 8.05 and the other Sections of this Indenture referred to in clauses (1) and (2) below, and to have satisfied all their other obligations under such Notes, the Subsidiary Guarantees and this Indenture
(and the Trustee, on demand of and at the expense of the Issuer, shall execute proper instruments acknowledging the same), except for the following provisions which shall survive until otherwise terminated or discharged hereunder: 

(1) the rights of Holders of outstanding Notes to receive payments in respect of the principal of, or interest or premium
and Additional Interest, if any, on such Notes when such payments are due from the trust referred to in Section 8.04 hereof; 
 (2) the Issuer’s obligations with respect to such Notes under Sections 2.05, 2.06, 2.07, 2.08 and 4.02 hereof; 
 (3) the rights, powers, trusts, duties and immunities of the Trustee hereunder and the Issuer’s and the Guarantors’ obligations in connection therewith; and 

(4) this Article 8. 
 Subject to compliance with this Section 8.02, the Issuer may exercise its option under this Section 8.02 notwithstanding the prior exercise of its option under Section 8.03 hereof.

 SECTION 8.03 Covenant Defeasance. 
 Upon the Issuer’s exercise under Section 8.01 of the option applicable to this Section 8.03, the Issuer and the Guarantors shall, subject to the satisfaction of the conditions set forth in
Section 8.04, be released from each of their obligations under Sections 4.03, 4.06, 4.07, 4.08, 4.09, 4.10, 4.11, 4.13, 4.14, 4.15 and 4.16 and Section 5.01(a) with respect to the outstanding Notes on and after the date the conditions set
forth in Section 8.04 are satisfied (hereinafter, “Covenant Defeasance”), and the Notes shall thereafter be deemed not “outstanding” for the purposes of any direction, waiver, consent or declaration or act of Holders (and
the consequences of any thereof) in connection with such covenants, but shall continue to be deemed “outstanding” for all other purposes hereunder (it being understood that such Notes shall


  
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not be deemed outstanding for accounting purposes). For this purpose, Covenant Defeasance means that, with respect to the outstanding Notes and the Subsidiary Guarantees, the Issuer and the
Guarantors may omit to comply with and shall have no liability in respect of any term, condition or limitation set forth in any such covenant, whether directly or indirectly, by reason of any reference elsewhere herein to any such covenant or by
reason of any reference in any such covenant to any other provision herein or in any other document and such omission to comply shall not constitute a Default or an Event of Default under Section 6.01, but, except as specified above, the
remainder of this Indenture and such Notes and Subsidiary Guarantees shall be unaffected thereby. In addition, upon the Issuer’s exercise under Section 8.01 of the option applicable to this Section 8.03 subject to the satisfaction of
the conditions set forth in Section 8.04, Sections 6.01(a)(4) through 6.01(a)(7) and, to the extent relating to a Significant Subsidiary, 6.01(a)(8) and 6.01(a)(9) shall not constitute Events of Default. 

SECTION 8.04 Conditions to Legal or Covenant Defeasance. 
 In order to exercise either Legal Defeasance or Covenant Defeasance under either Section 8.02 or 8.03 hereof: 
 (1) the Issuer must irrevocably deposit with the Trustee, in trust, for the benefit of the Holders of the Notes, cash in U.S. dollars, non-callable Government Securities, or a combination of cash in U.S.
dollars and non-callable Government Securities, in amounts as shall be sufficient, in the opinion of a nationally recognized investment bank, appraisal firm or firm of independent public accountants, to pay the principal of, or interest and premium
and Additional Interest, if any, on, the outstanding Notes on the stated date for payment thereof or on the applicable redemption date, as the case may be, and the Issuer must specify whether the Notes are being defeased to such stated date for
payment or to a particular redemption date; 
 (2) in the case of Legal Defeasance, the Issuer must deliver to
the Trustee an Opinion of Counsel reasonably acceptable to the Trustee confirming that the Issuer has received from, or there has been published by, the Internal Revenue Service a ruling or since the Issue Date, there has been a change in the
applicable federal income tax law, in either case to the effect that, and based thereon such Opinion of Counsel shall confirm that, the Holders of the outstanding Notes shall not recognize income, gain or loss for federal income tax purposes as a
result of such Legal Defeasance and shall be subject to federal income tax on the same amounts, in the same manner and at the same times as would have been the case if such Legal Defeasance had not occurred; 

(3) in the case of Covenant Defeasance, the Issuer must deliver to the Trustee an Opinion of Counsel reasonably acceptable
to the Trustee confirming that the Holders of the outstanding Notes shall not recognize income, gain or loss for federal income tax purposes as a result of such Covenant Defeasance and shall be subject to federal income tax on the same amounts, in
the same manner and at the same times as would have been the case if such Covenant Defeasance had not occurred; 

(4) such Legal Defeasance or Covenant Defeasance shall not result in a breach or violation of, or constitute a default
under, any material agreement (including, without limitation, the Credit Agreement) or instrument (other than this Indenture) to which the Issuer or any of its Subsidiaries is a party or by which the Issuer or any of its Subsidiaries is bound;

 (5) the Issuer must deliver to the Trustee an Officer’s Certificate stating that the deposit was not made
by the Issuer with the intent of preferring the Holders over the other creditors of the Issuer with the intent of defeating, hindering, delaying or defrauding any creditors of the Issuer or others; and 

  
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 (6) the Issuer must deliver to the Trustee an Officer’s Certificate and
an Opinion of Counsel, each stating that all conditions precedent relating to the Legal Defeasance or the Covenant Defeasance have been complied with. 
 SECTION 8.05 Deposited Money and Government Securities To Be Held in Trust; Other Miscellaneous Provisions. 
 Subject to Section 8.06, all money and non-callable Government Securities (including the proceeds thereof) deposited with the Trustee (or other qualifying trustee, collectively for purposes of this
Section 8.05, the “Trustee”) pursuant to Section 8.04 in respect of the outstanding Notes shall be held in trust and applied by the Trustee, in accordance with the provisions of such Notes and this Indenture, to the payment,
either directly or through any Paying Agent (including the Issuer acting as Paying Agent) as the Trustee may determine, to the Holders of such Notes of all sums due and to become due thereon in respect of principal, premium and Additional Interest,
if any, and interest, but such money need not be segregated from other funds except to the extent required by law. 
 The Issuer
shall pay and indemnify the Trustee against any tax, fee or other charge imposed on or assessed against the cash or non-callable Government Securities deposited pursuant to Section 8.04 or the principal and interest received in respect thereof
other than any such tax, fee or other charge which by law is for the account of the Holders of the outstanding Notes. 

Notwithstanding anything in this Article 8 to the contrary, the Trustee shall deliver or pay to the Issuer from time to time upon the
request of the Issuer any money or non-callable Government Securities held by it as provided in Section 8.04 which, in the opinion of a nationally recognized firm of independent public accountants expressed in a written certification thereof
delivered to the Trustee (which may be the opinion delivered under Section 8.04 hereof), are in excess of the amount thereof that would then be required to be deposited to effect an equivalent Legal Defeasance or Covenant Defeasance.

 SECTION 8.06 Repayment to Issuer. 
 Any money deposited with the Trustee or any Paying Agent, or then held by the Issuer, in trust for the payment of the principal of, premium or Additional Interest, if any, or interest on any Note and
remaining unclaimed for two years after such principal, premium or Additional Interest, if any, or interest has become due and payable shall be paid to the Issuer on its request or (if then held by the Issuer) shall be discharged from such trust;
and the Holder of such Note shall thereafter be permitted to look only to the Issuer for payment thereof, and all liability of the Trustee or such Paying Agent with respect to such trust money, and all liability of the Issuer as trustee thereof,
shall thereupon cease; provided, however, that the Trustee or such Paying Agent, before being required to make any such repayment, may at the expense of the Issuer cause to be published once, in The New York Times and The
Wall Street Journal (national edition), notice that such money remains unclaimed and that, after a date specified therein, which shall not be less than 30 days from the date of such notification or publication, any unclaimed balance of such
money then remaining shall be repaid to the Issuer. 

  
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 SECTION 8.07 Reinstatement. 
 If the Trustee or Paying Agent is unable to apply any United States dollars or non-callable Government Securities in accordance with Section 8.02 or 8.03, as the case may be, by reason of any order
or judgment of any court or governmental authority enjoining, restraining or otherwise prohibiting such application, then the Issuer’s and the Guarantors’ obligations under this Indenture and the Notes and the Subsidiary Guarantees shall
be revived and reinstated as though no deposit had occurred pursuant to Section 8.02 or 8.03 until such time as the Trustee or Paying Agent is permitted to apply all such money in accordance with Section 8.02 or 8.03, as the case may be;
provided, however, that, if the Issuer makes any payment of principal of, premium or Additional Interest, if any, or interest on any Note following the reinstatement of their obligations, the Issuer shall be subrogated to the rights of
the Holders of such Notes to receive such payment from the cash or Government Securities held by the Trustee or Paying Agent. 

ARTICLE 9. 

AMENDMENT, SUPPLEMENT AND WAIVER 

SECTION 9.01 Without Consent of Holders. 
 (a) Notwithstanding Section 9.02 of this Indenture, the Issuer and the Trustee may amend or supplement this Indenture, the Subsidiary Guarantees or the Notes without the consent of any Holder of a
Note: 
 (1) to cure any ambiguity, defect or inconsistency; 

(2) to provide for uncertificated Notes in addition to or in place of certificated Notes; 

(3) to provide for the assumption of the Issuer’s or a Guarantor’s obligations to the Holders and Subsidiary
Guarantees by a successor to the Issuer pursuant to Article 5 or Section 10.05, respectively, hereof; 
 (4)
to make any change that would provide any additional rights or benefits to the Holders or that does not adversely affect the legal rights hereunder of any Holder; 

(5) to comply with requirements of the SEC in order to effect or maintain the qualification of this Indenture under the
TIA; 
 (6) to conform the text of this Indenture, the Subsidiary Guarantees or the Notes to any provision of the
“Description of Notes” section of the Offering Memorandum to the extent that such provision in that “Description of Notes” section was intended to be a verbatim recitation of a provision of this Indenture, the Subsidiary
Guarantees or the Notes; 
 (7) to provide for the issuance of Additional Notes in accordance with the
limitations set forth in this Indenture as of the Issue Date; 
 (8) to allow any Guarantor to execute a
supplemental indenture and/or a Subsidiary Guarantee with respect to the Notes, or to secure the Notes; or 
 (9)
to issue the Additional Notes in accordance with the terms herein. 
 (b) Upon the request of the Issuer
accompanied by a resolution of its Board of Directors authorizing the execution of any such amended or supplemental indenture, and upon receipt by the Trustee of the documents described in Section 7.02, the Trustee shall join with the Issuer in
the execution of any amended or supplemental indenture authorized or permitted by the terms of this Indenture 

  
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and to make any further appropriate agreements and stipulations that may be therein contained, but the Trustee shall not be obligated to enter into such amended or supplemental indenture that
affects its own rights, duties or immunities under this Indenture or otherwise. Notwithstanding the foregoing, no Opinion of Counsel shall be required in connection with (i) the addition of a Guarantor under this Indenture upon execution and
delivery by such Guarantor and the Trustee of a supplemental indenture to this Indenture, the form of which is attached as Exhibit E hereto, and delivery of an Officer’s Certificate or (ii) the execution and delivery of a
supplemental indenture to this Indenture on the Effective Date, the form of which is attached as Exhibit F hereto, and delivery of an Officer’s Certificate. 
 SECTION 9.02 With Consent of Holders. 
 (a) Except as
provided below in this Section 9.02, the Issuer and the Trustee may amend or supplement this Indenture (including, without limitation, Section 3.09, 4.09 and 4.13 hereof), the Subsidiary Guarantees and the Notes with the consent of the
Holders of at least a majority in aggregate principal amount of the Notes (including, without limitation, consents obtained in connection with a tender offer or exchange offer for, or purchase of, the Notes); provided, however, that,
subject to Sections 6.04 and 6.07, any existing Default or Event of Default (other than a Default or Event of Default in the payment of the principal of, premium or Additional Interest, if any, or interest on the Notes, except a payment default
resulting from an acceleration that has been rescinded) or compliance with any provision of this Indenture, the Subsidiary Guarantees or the Notes may be waived with the consent of the Holders of a majority in aggregate principal amount of the then
outstanding Notes (including consents obtained in connection with a tender offer or exchange offer for, or purchase of, the Notes). 
 (b) Upon the request of the Issuer accompanied by a resolution of its Board of Directors authorizing the execution of any such amended or supplemental indenture, and upon the filing with the Trustee of
evidence satisfactory to the Trustee of the consent of the Holders as aforesaid, and upon receipt by the Trustee of the documents described in Section 7.02, the Trustee shall join with the Issuer in the execution of such amended or supplemental
indenture unless such amended or supplemental indenture directly affects the Trustee’s own rights, duties or immunities under this Indenture or otherwise, in which case the Trustee may in its discretion, but shall not be obligated to, enter
into such amended or supplemental indenture. 
 (c) It is not be necessary for the consent of the Holders under
this Section 9.02 to approve the particular form of any proposed amendment or waiver, but it is sufficient if such consent approves the substance thereof. 
 (d) After an amendment, supplement or waiver under this Section 9.02 becomes effective, the Issuer shall mail to the Holders affected thereby a notice briefly describing the amendment, supplement or
waiver. Any failure of the Issuer to mail such notice, or any defect therein, shall not, however, in any way impair or affect the validity of any such amended or supplemental indenture or waiver. Subject to Sections 6.04 and 6.07, the Holders of a
majority in aggregate principal amount of the Notes then outstanding, voting as a single class, may waive compliance in a particular instance by the Issuer and the Guarantors with any provision of this Indenture, the Notes, or the Subsidiary
Guarantees. However, without the consent of each Holder affected, an amendment, supplement or waiver under this Section 9.02 may not (with respect to any Notes held by a non-consenting Holder): 

(1) reduce the principal amount of Notes whose Holders must consent to an amendment, supplement or waiver; 

  
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 (2) reduce the principal of or change the fixed maturity of any Note or
alter the provisions with respect to the optional redemption of the Notes contained in Section 5 of the Notes (except the notice period contained therein or in Sections 3.01, 3.02 and 3.03); 

(3) reduce the rate of or change the time for payment of interest, including default interest, on any Note; 

(4) waive a Default or Event of Default in the payment of principal of, or interest or premium, or Additional Interest, if
any, on, the Notes (except a rescission of acceleration of the Notes by the Holders of at least a majority in aggregate principal amount of the then outstanding Notes and a waiver of the payment default that resulted from such acceleration);

 (5) make any Note payable in money other than that stated in the Notes; 

(6) make any change in the provisions of this Indenture relating to waivers of past Defaults or the rights of Holders to
receive payments of principal of, or interest or premium or Additional Interest, if any, on, the Notes on or after the due date therefor; or 
 (7) make any change in the preceding amendment and waiver provisions. 
 SECTION 9.03 Amendments
regarding Change of Control. 
 Notwithstanding Section 9.01 and 9.02, except as provided in Section 9.01(a)(6),
the defined term “Change of Control” and Section 4.13 hereof maybe waived or modified with the written consent of the Holders of a majority in aggregate principal amount of the Notes then outstanding (including, without limitation,
consents obtained in connection with a tender offer or exchange offer for, or purchase of, the Notes). 
 SECTION 9.04 Compliance with Trust
Indenture Act. 
 Every amendment or supplement to this Indenture or the Notes shall be set forth in an amended or
supplemental indenture that complies with the TIA as then in effect. 
 SECTION 9.05 Revocation and Effect of Consents. 

Until an amendment, supplement or waiver becomes effective, a consent to it by a Holder of a Note is a continuing consent by the Holder of
a Note and every subsequent Holder of a Note or portion of a Note that evidences the same debt as the consenting Holder’s Note, even if notation of the consent is not made on any Note. However, any such Holder of a Note or subsequent Holder of
a Note may revoke the consent as to its Note if the Trustee receives written notice of revocation before the date the waiver, supplement or amendment becomes effective. An amendment, supplement or waiver becomes effective in accordance with its
terms and thereafter binds every Holder. 
 SECTION 9.06 Notation on or Exchange of Notes. 

The Trustee may place an appropriate notation about an amendment, supplement or waiver on any Note thereafter authenticated. The Issuer in
exchange for all Notes may issue and the Trustee shall, upon receipt of an Authentication Order, authenticate new Notes that reflect the amendment, supplement or waiver. 

  
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 Failure to make the appropriate notation or issue a new Note shall not affect the validity
and effect of such amendment, supplement or waiver. 
 SECTION 9.07 Trustee To Sign Amendments, etc. 

The Trustee shall sign any amended or supplemental indenture authorized pursuant to this Article 9 if the amendment or supplement does not
adversely affect the rights, duties, liabilities or immunities of the Trustee. The Issuer may not sign an amended or supplemental indenture until the Board of Directors approves it. In executing any amended or supplemental indenture, the Trustee
shall be provided with and (subject to Section 7.01 hereof) shall be fully protected in relying upon, in addition to the documents required by Section 12.04, an Officer’s Certificate and an Opinion of Counsel stating that the
execution of such amended or supplemental indenture is authorized or permitted by this Indenture. 
 ARTICLE 10. 

SUBSIDIARY GUARANTEES 
 SECTION
10.01 Guarantee; Right of Payment. 
 (a) Subject to this Article 10, each of the Guarantors hereby,
jointly and severally, unconditionally guarantees to each Holder of a Note authenticated and delivered by the Trustee and to the Trustee and its successors and assigns, irrespective of the validity and enforceability of this Indenture, the Notes or
the obligations of the Issuer hereunder or thereunder, that: 
 (1) the principal of, premium and Additional
Interest, if any, and interest on the Notes shall be promptly paid in full when due, whether at maturity, by acceleration, redemption or otherwise, and interest on the overdue principal of and interest on the Notes, if any, if lawful, and all other
Obligations of the Issuer to the Holders or the Trustee hereunder or thereunder shall be promptly paid in full or performed, all in accordance with the terms hereof and thereof; and 

(2) in case of any extension of time of payment or renewal of any Notes or any of such other Obligations, that same shall
be promptly paid in full when due or performed in accordance with the terms of the extension or renewal, whether at stated maturity, by acceleration or otherwise. 
 Failing payment when due of any amount so guaranteed or any performance so guaranteed for whatever reason, the Guarantors shall be jointly and severally obligated to pay the same immediately. Each
Guarantor agrees that this is a guarantee of payment and not a guarantee of collection. 
 (b) The Guarantors
hereby agree that their obligations hereunder are unconditional, irrespective of the validity, regularity or enforceability of the Notes or this Indenture, the absence of any action to enforce the same, any waiver or consent by any Holder of the
Notes with respect to any provisions hereof or thereof, the recovery of any judgment against the Issuer, any action to enforce the same or any other circumstance which might otherwise constitute a legal or equitable discharge or defense of a
guarantor. Each Guarantor hereby waives diligence, presentment, demand of payment, filing of claims with a court in the event of insolvency or bankruptcy of the Issuer, any right to require a proceeding first against the Issuer, protest, notice and
all demands whatsoever and covenant that this Subsidiary Guarantee shall not be discharged except by complete performance of the obligations contained in the Notes and this Indenture or by release in accordance with the provisions of this Indenture.


  
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 (c) If any Holder or the Trustee is required by any court or otherwise to
return to the Issuer, the Guarantors or any custodian, trustee, liquidator or other similar official acting in relation to either the Issuer or the Guarantors, any amount paid by the Issuer or the Guarantors to the Trustee or such Holder, this
Subsidiary Guarantee, to the extent theretofore discharged, shall be reinstated in full force and effect. 
 (d)
Each Guarantor agrees that it shall not be entitled to any right of subrogation in relation to the Holders in respect of any obligations guaranteed hereby until payment in full of all Obligations guaranteed hereby. Each Guarantor further agrees
that, as between the Guarantors, on the one hand, and the Holders and the Trustee, on the other hand, the maturity of the Obligations guaranteed hereby may be accelerated as provided in Article 6 for the purposes of this Subsidiary Guarantee,
notwithstanding any stay, injunction or other prohibition preventing such acceleration in respect of the Obligations guaranteed hereby, and in the event of any declaration of acceleration of such Obligations as provided in Article 6, such
Obligations (whether or not due and payable) shall forthwith become due and payable by the Guarantors for the purpose of this Subsidiary Guarantee. The Guarantors shall have the right to seek contribution from any non-paying Guarantor so long as the
exercise of such right does not impair the rights of the Holders under the Subsidiary Guarantee. 
 SECTION 10.02 [Reserved]. 

SECTION 10.03 Limitation on Guarantor Liability. 
 Each Guarantor, and by its acceptance of Notes, each Holder, hereby confirms that it is the intention of all such parties that the Subsidiary Guarantee of such Guarantor not constitute a fraudulent
transfer or conveyance for purposes of Bankruptcy Law, the Uniform Fraudulent Conveyance Act, the Uniform Fraudulent Transfer Act or any similar federal or state law to the extent applicable to any Subsidiary Guarantee. To effectuate the foregoing
intention, the Trustee, the Holders and the Guarantors hereby irrevocably agree that the obligations of such Guarantor shall be limited to the maximum amount that shall, after giving effect to such maximum amount and all other contingent and fixed
liabilities of such Guarantor that are relevant under such laws, and after giving effect to any collections from, rights to receive contribution from or payments made by or on behalf of any other Guarantor in respect of the obligations of such other
Guarantor under this Article 10, result in the obligations of such Guarantor under its Subsidiary Guarantee not constituting a fraudulent transfer or conveyance. 
 SECTION 10.04 Execution and Delivery of Subsidiary Guarantee. 
 To evidence
its Subsidiary Guarantee set forth in Section 10.01, each Guarantor hereby agrees that a notation of such Subsidiary Guarantee substantially in the form attached as Exhibit D shall be endorsed by an Officer (or other person serving in a
similar capacity) of such Guarantor on each Note authenticated and delivered by the Trustee and that this Indenture shall be executed on behalf of such Guarantor by one of its Officers (or other person serving in a similar capacity). 

Each Guarantor hereby agrees that its Subsidiary Guarantee set forth in Section 10.01 shall remain in full force and effect
notwithstanding any failure to endorse on each Note a notation of such Subsidiary Guarantee. 
 If an Officer (or other person
serving in a similar capacity) whose signature is on this Indenture or on the Subsidiary Guarantee no longer holds that office at the time the Trustee authenticates the Note on which a Subsidiary Guarantee is endorsed, the Subsidiary Guarantee shall
be valid nevertheless. 

  
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 The delivery of any Note by the Trustee, after the authentication thereof hereunder, shall
constitute due delivery of the Subsidiary Guarantee set forth in this Indenture on behalf of the Guarantors. 
 In the event
that the Issuer or any of its Restricted Subsidiaries creates or acquires any Subsidiary after the date of this Indenture, if required by Section 4.16, the Issuer shall cause such Subsidiary to comply with the provisions of Section 4.16
and this Article 10, to the extent applicable. 
 SECTION 10.05 [Reserved]. 

SECTION 10.06 Releases. 
 The Subsidiary Guarantee of a Guarantor shall be automatically and unconditionally released and discharged upon: 
 (a) (1) any sale or other disposition of all or substantially all of the assets of that Guarantor (including by way of merger or otherwise) to a Person that is not (either before or after giving effect to
such transaction) the Issuer or a Restricted Subsidiary (other than a Non-Guarantor Subsidiary), if the sale or other disposition is made in compliance with the applicable provisions of this Indenture; 

(2) any sale or other disposition of all of the Capital Stock of that Guarantor to a Person that is not (either before or
after giving effect to such transaction) the Issuer or a Restricted Subsidiary (other than a Non-Guarantor Subsidiary), after which the applicable Guarantor is no longer a Restricted Subsidiary; 

(3) the proper designation of any Restricted Subsidiary that is a Guarantor to be an Unrestricted Subsidiary or a
Non-Guarantor Subsidiary in accordance with the applicable provisions of this Indenture; 
 (4) the release or
discharge of the guarantee by such Guarantor of the Credit Agreement or the guarantee which resulted in the creation of such Guarantee, except a discharge or release by or as a result of payment under such guarantee; or 

(5) the Issuer exercising its legal defeasance option or covenant defeasance option or the Issuer’s obligations under
this Indenture being satisfied and discharged in accordance with Article 8 or Article 11 hereof. 
 (b) such Guarantor
delivering to the Trustee an Officer’s Certificate and an Opinion of Counsel, each stating that all conditions precedent provided for in this Indenture relating to such transaction have been complied with. 

If any Guarantor is released from its Subsidiary Guarantee, any of its Subsidiaries that are Guarantors will be released from their
Subsidiary Guarantees, if any. 
 Any Guarantor not released from its obligations under its Subsidiary Guarantee as provided in
this Section 10.06 shall remain liable for the full amount of principal of and interest on the Notes and for the other obligations of any Guarantor under this Indenture as provided in this Article 10. 

  
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 ARTICLE 11. 
 SATISFACTION AND DISCHARGE 
 SECTION 11.01 Satisfaction and Discharge. 

This Indenture shall be discharged and shall cease to be of further effect as to all Notes issued hereunder, when: 

(1) either: 
 (a) all Notes that have been authenticated, except lost, stolen or destroyed Notes that have been replaced or paid and Notes for whose payment money has theretofore been deposited in trust and thereafter
repaid to the Issuer, have been delivered to the Trustee for cancellation; or 
 (b) all Notes that have not been
delivered to the Trustee for cancellation have become due and payable by reason of the mailing of a notice of redemption or otherwise or shall become due and payable within one year or are to be called for redemption within one year under
arrangements satisfactory to the Trustee for the giving of notice of redemption by the Trustee in the name, and at the expense, of the Issuer, and the Issuer or any Guarantor has irrevocably deposited or caused to be deposited with the Trustee as
trust funds in trust solely for the benefit of the Holders, cash in U.S. dollars, non-callable Government Securities, or a combination of cash in U.S. dollars and non- callable Government Securities, in amounts as shall be sufficient, without
consideration of any reinvestment of interest, to pay and discharge the entire Indebtedness on the Notes not delivered to the Trustee for cancellation for principal, premium and Additional Interest, if any, and accrued interest to the date of
maturity or redemption thereof, as the case may be (provided, that if such redemption is made pursuant to Section 3.07 hereof and Section 5(c) of the Notes, (x) the amount of cash in U.S. dollars or U.S. dollar-denominated Government
Securities, or a combination thereof, that the Issuer must irrevocably deposit or cause to be deposited will be determined using an assumed Applicable Premium calculated as of the date of such deposit, and (y) the Issuer must irrevocably
deposit or cause to be deposited additional money in trust on the redemption date as necessary to pay the Applicable Premium as determined on such date); 
 (2) no Default or Event of Default has occurred and is continuing on the date of the deposit (other than a Default or Event of Default resulting from the borrowing of funds to be applied to such deposit)
and the deposit shall not result in a breach or violation of, or constitute a default under any other instrument (other than this Indenture) to which the Issuer or any Guarantor is a party or by which the Issuer or any Guarantor is bound (other than
resulting from any borrowing of funds to be applied to make such deposit and any similar and simultaneous deposit relating to other Indebtedness and, in each case, the granting of Liens in connection therewith); 

(3) the Issuer or any Guarantor has paid or caused to be paid all sums payable by it under this Indenture; and 

(4) the Issuer has delivered irrevocable instructions to the Trustee under this Indenture to apply the deposited money
toward the payment of the Notes at maturity or on the redemption date, as the case may be. 

  
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 In addition, the Issuer must deliver an Officer’s Certificate and an Opinion of Counsel
to the Trustee stating that all conditions precedent to satisfaction and discharge have been satisfied. 
 Notwithstanding the
satisfaction and discharge of this Indenture, if money has been deposited with the Trustee pursuant to sub-clause of clause of this Section, the provisions of Sections 11.02 and 8.06 shall survive. In addition, nothing in this Section 11.01
shall be deemed to discharge those provisions of Section 7.07, that, by their terms, survive the satisfaction and discharge of this Indenture. 
 SECTION 11.02 Application of Trust Money. 
 Subject to the provisions of
Section 8.06, all money deposited with the Trustee pursuant to Section 11.01 shall be held in trust and applied by it, in accordance with the provisions of the Notes and this Indenture, to the payment, either directly or through any Paying
Agent (including the Issuer acting as its own Paying Agent) as the Trustee may determine, to the Persons entitled thereto, of the principal (and premium, if any) and interest for whose payment such money has been deposited with the Trustee; but such
money need not be segregated from other funds except to the extent required by law. 
 To the extent that and so long as the
Trustee or Paying Agent is unable to apply any money or Government Securities in accordance with Section 11.01 by reason of any legal proceeding or by reason of any order or judgment of any court or governmental authority enjoining, restraining
or otherwise prohibiting such application, the Issuer’s and any Guarantor’s obligations under this Indenture and the Notes shall be revived and reinstated as though no deposit had occurred pursuant to Section 11.01; provided,
however, that if the Issuer has made any payment of principal of, premium, if any, or interest on any Notes following the reinstatement of their obligations, the Issuer shall be subrogated to the rights of the Holders of such Notes to receive
such payment from the money or Government Securities held by the Trustee or Paying Agent. 
 ARTICLE 12. 

MISCELLANEOUS 
 SECTION 12.01
Trust Indenture Act Controls. 
 If any provision of this Indenture limits, qualifies or conflicts with the duties imposed
by TIA Section 318(c), the imposed duties shall control at all times after the effectiveness of a registration statement under the Registration Rights Agreement. 
 SECTION 12.02 Notices. 
 Any notice or communication by either of the
Issuer, any Guarantor or the Trustee to the others is duly given if in writing and delivered in Person or mailed by first class mail (registered or certified, return receipt requested), facsimile or overnight air courier guaranteeing next day
delivery, to the others’ address: 

  
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 If to the Issuer and/or any Guarantor: 

United Surgical Partners International, Inc. 

15305 Dallas Parkway, Suite 1600 
 Addison, Texas 75001 
 Telecopier No.: (972) 767-0604

 Attention: Secretary 
 If to the Trustee: 
 U.S. Bank National Association 

60 Livingston Avenue 
 EP-MN-WS3C 
 St. Paul, MN 55107-2292 

Tellecopier No.: (651) 495-8097 

Attn: Corporate Trust Administration 
 The Issuer, any Guarantor or the Trustee, by notice to the others, may designate additional or different addresses for subsequent notices or communications. 

All notices and communications (other than those sent to Holders) shall be deemed to have been duly given: at the time delivered by hand,
if personally delivered; five Business Days after being deposited in the mail, postage prepaid, if mailed; when receipt acknowledged, if faxed; and the next Business Day after timely delivery to the courier, if sent by overnight air courier
guaranteeing next day delivery; and, subject to compliance with the TIA, on the first date on which publication is made, if given by publication; provided that any notice or communication delivered to the Trustee shall be deemed effective upon
actual receipt thereof. 
 Any notice or communication to a Holder shall be mailed by first class mail, certified or registered,
return receipt requested, or by overnight air courier guaranteeing next day delivery to its address shown on the register kept by the Registrar. Any notice or communication shall also be so mailed to any Person described in TIA Section 313(c),
to the extent required by the TIA. Failure to mail a notice or communication to a Holder or any defect in it shall not affect its sufficiency with respect to other Holders. 
 If a notice or communication is mailed in the manner provided above within the time prescribed, it is duly given, whether or not the addressee receives it. 

If the Issuer mails a notice or communication to Holders, it shall mail a copy to the Trustee and each Agent at the same time.

 SECTION 12.03 Communication by Holders with Other Holders. 
 Holders may communicate pursuant to TIA Section 312 with other Holders with respect to their rights under this Indenture or the Notes. The Issuer, the Trustee, the Registrar and anyone else shall
have the protection of TIA Section 312(c). 
 SECTION 12.04 Certificate and Opinion as to Conditions Precedent. 

Upon any request or application by the Issuer to the Trustee to take any action under this Indenture, the Issuer shall furnish to the
Trustee: 

  
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 (1) an Officer’s Certificate in form and substance reasonably
satisfactory to the Trustee (which must include the statements set forth in Section 12.05) stating that, in the opinion of the signers, all conditions precedent and covenants, if any, provided for in this Indenture relating to the proposed
action have been satisfied; and 
 (2) an Opinion of Counsel in form and substance reasonably satisfactory to the
Trustee (which must include the statements set forth in Section 12.05) stating that, in the opinion of such counsel, all such conditions precedent and covenants have been satisfied. 
 SECTION 12.05 Statements Required in Certificate or Opinion. 
 Each
certificate or opinion with respect to compliance with a condition or covenant provided for in this Indenture (other than a certificate provided pursuant to TIA Section 314(a)(4)) must comply with the provisions of TIA Section 314 and must
include: 
 (1) a statement that the Person making such certificate or opinion has read such covenant or
condition; 
 (2) a brief statement as to the nature and scope of the examination or investigation upon which the
statements or opinions contained in such certificate or opinion are based; 
 (3) a statement that, in the
opinion of such Person, he or she has made such examination or investigation as is necessary to enable him or her to express an informed opinion as to whether or not such covenant or condition has been complied with (and, in the case of an Opinion
of Counsel, may be limited to reliance on an Officer’s Certificate as to matters of fact); and 
 (4) a
statement as to whether or not, in the opinion of such Person, such condition or covenant has been complied with; provided, however, that with respect to matters of fact, an Opinion of Counsel may rely on an Officer’s Certificate
or certificates of public officials. 
 SECTION 12.06 Rules by Trustee and Agents. 

The Trustee may make reasonable rules for action by or at a meeting of Holders. The Registrar or Paying Agent may make reasonable rules
and set reasonable requirements for its functions. 
 SECTION 12.07 No Personal Liability of Directors, Officers, Employees and
Stockholders. 
 No director, officer, employee, incorporator, stockholder, member, partner or other holder of Equity
Interests of the Issuer or any Guarantor, as such, shall have any liability for any obligations of the Issuer or the Guarantors under the Notes, this Indenture or the Subsidiary Guarantees or for any claim based on, in respect of, or by reason of,
such obligations or their creation. Each Holder by accepting a Note waives and releases all such liability. The waiver and release are part of the consideration for issuance of the Notes. The waiver may not be effective to waive liabilities under
the federal securities laws. 
 SECTION 12.08 Governing Law. 
 THIS INDENTURE, THE NOTES AND THE SUBSIDIARY GUARANTEES SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 

  
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 SECTION 12.09 No Adverse Interpretation of Other Agreements. 

This Indenture may not be used to interpret any other indenture, loan or debt agreement of the Issuer or its Subsidiaries or of any other
Person. Any such indenture, loan or debt agreement may not be used to interpret this Indenture. 
 SECTION 12.10 Successors. 

All agreements of the Issuer in this Indenture and the Notes shall bind its successors. All agreements of the Trustee in this Indenture
shall bind its successors. All agreements of each Guarantor in this Indenture shall bind its successors, except as otherwise provided in Section 10.05. 
 SECTION 12.11 Severability. 
 In case any provision in this Indenture or in
the Notes is invalid, illegal or unenforceable, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby. 
 SECTION 12.12 Counterpart Originals. 
 The parties may sign any number of
copies of this Indenture. Each signed copy shall be an original, but all of them together represent the same agreement. 
 SECTION 12.13
Table of Contents, Headings, etc. 
 The Table of Contents, Cross-Reference Table and Headings of the Articles and
Sections of this Indenture have been inserted for convenience of reference only, are not to be considered a part of this Indenture and shall in no way modify or restrict any of the terms or provisions hereof. 

(Signature Pages Follow) 

  
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 IN WITNESS WHEREOF, the parties hereto have caused this Indenture to be duly executed and
attested, all as of the date first above written. 
  

			
	USPI FINANCE CORP.,
		
	By:	 	/s/ John J. Wellik
		 	Name: John J. Wellik
		 	Title: Vice President, Secretary and Treasurer


 [Signature page to Indenture] 







 IN WITNESS WHEREOF, the parties hereto have caused this Indenture to be duly executed and
attested, all as of the date first above written. 
  

			
	 U.S. BANK NATIONAL ASSOCIATION,
 as Trustee

		
	By:	 	/s/ Donald T. Hurrelbrink
		 	Name: Donald T. Hurrelbrink 
		 	Title: Vice President


 [Signature page to Indenture] 







 EXHIBIT A1 
 [Face of Note] 

CUSIP             

9.000% Senior Note due 2020 
  

			
	No.            	  	$            

 USPI FINANCE CORP. 
 (to be merged with and into United Surgical Partners International, Inc., with United Surgical Partners International, Inc. as the surviving entity (the “Issuer”)) 

promises to pay to [            ] or registered assigns, the principal sum
of                     DOLLARS on April 1, 2020. 
 Interest Payment Dates: April 1 and October 1 
 Record Dates: March 15 and
September 15 
 Dated: April 3, 2012 

 

			
	USPI FINANCE CORP.
		
	By:	 	 
		 	Name:
		 	Title:



  
 A1-1









 This is one of the Notes referred to 
 in the within-mentioned Indenture: 
 U.S. BANK NATIONAL ASSOCIATION, 

    as Trustee 
  

			
		
	By:	 	 
		 	Authorized Signatory


  
 A1-2









 [Back of Note] 
 9.000% Senior Note due 2020 
 [Insert the Global Note Legend, if applicable
pursuant to the provisions of the Indenture] 
 [Insert the Private Placement Legend, if applicable pursuant to the provisions
of the Indenture] 
 Capitalized terms used herein have the meanings assigned to them in the Indenture referred to below unless
otherwise indicated. 
 (1) INTEREST. The Issuer promises to pay interest on the principal amount of this Note at
9.000% per annum from April 3, 2012 until maturity and shall pay the Additional Interest, if any, payable pursuant to the Registration Rights Agreement referred to below. The Issuer shall pay interest and Additional Interest, if any,
semi-annually in arrears on April 1 and October 1 of each year, or if any such day is not a Business Day, on the next succeeding Business Day (each, an “Interest Payment Date”). Interest on the Notes shall accrue from the most
recent date to which interest has been paid or, if no interest has been paid, from the date of issuance; provided that the first Interest Payment Date shall be October 1, 2012. The Issuer shall pay interest (including post-petition
interest in any proceeding under any Bankruptcy Law) on overdue principal and premium, if any, from time to time on demand at a rate equal to the then applicable interest rate on the notes to the extent lawful; it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of interest and Additional Interest, if any, (without regard to any applicable grace periods) from time to time on demand at the same rate to the extent
lawful. Interest shall be computed on the basis of a 360-day year of twelve 30-day months. 
 (2) METHOD OF PAYMENT. The
Issuer shall pay interest on the Notes and Additional Interest, if any, to the Persons who are registered Holders at the close of business on the March 15 or September 15 next preceding the Interest Payment Date, even if such Notes are
canceled after such record date and on or before such Interest Payment Date, except as provided in Section 2.12 of the Indenture with respect to defaulted interest. The Notes shall be payable as to principal, interest and premium and Additional
Interest, if any, at the office or agency of the Paying Agent within the City and State of New York, or payment of interest and Additional Interest, if any, may, at the option of the Issuer, be made by check mailed to the Holders at their addresses
set forth in the register of Holders; provided that payment by wire transfer of immediately available funds shall be required with respect to principal of and interest, premium and Additional Interest, if any, on, all certificated Global
Notes and all other certificated Notes the Holder of which shall have provided wire transfer instructions to the Issuer no less than 30 days prior to the record date. Payment of principal of, premium, if any, and interest and Additional Interest on,
Global Notes registered in the name of or held by DTC or any successor depositary or its nominee will be made by wire transfer of immediately available funds to such depositary or its nominee, as the case may be, as the registered Holder of such
Global Note. Such payment shall be in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public and private debts. 
 (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuer may change any Paying Agent or
Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may act in any such capacity. 

  
 A1-3









 (4) INDENTURE. The Issuer issued the Notes under an Indenture dated as of
April 3, 2012 (the “Indenture”), between the Issuer and the Trustee. The terms of the Notes include those stated in the Indenture and those made part of the Indenture by reference to the TIA (15 U.S. Code Sections 77aaa-77bbbb). The
Notes are subject to all such terms, and Holders are referred to the Indenture and such Act for a statement of such terms. To the extent any provision of this Note conflicts with the express provisions of the Indenture, the provisions of the
Indenture shall govern and be controlling. The Notes are general unsecured obligations of the Issuer. Subject to the conditions set forth in the Indenture, the Issuer may issue Additional Notes. 

(5) OPTIONAL REDEMPTION. 
 (a) Except as set forth in subparagraph (b) or (c) of this Paragraph 5, on or after April 1, 2015, the Issuer may redeem all or a part of the Notes upon notice as described in
Section 3.02 of the Indenture, at the redemption prices (expressed as percentages of principal amount) set forth below plus accrued and unpaid interest and Additional Interest, if any, on the Notes redeemed, to the applicable redemption date,
if redeemed during the twelve-month period beginning on April 1 of the years indicated below, subject to the rights of holders of Notes on the relevant record date to receive interest on the relevant interest payment date: 

 

					
	 Year
	  	Percentage	 
	 2015
	  	 	106.750	% 
	 2016
	  	 	104.500	% 
	 2017
	  	 	102.250	% 
	 2018 and thereafter
	  	 	100.000	% 

 (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior to
April 1, 2015, the Issuer may, upon notice as described in Section 3.02 of the Indenture, on any one or more occasions, redeem up to 40% of the aggregate principal amount of Notes issued under the Indenture at a redemption price of
109.000% of the principal amount, plus accrued and unpaid interest and Additional Interest, if any, to the redemption date, subject to the rights of the Holders on the relevant record date to receive interest on the relevant interest payment date,
with the net cash proceeds of one or more Equity Offerings by the Issuer or a contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net proceeds of one or more Equity Offerings by Holdings or any other direct or
indirect parent of the Issuer (in each case, other than Excluded Contributions); provided that: 
 (1) at
least 50% of the aggregate principal amount of Notes originally issued under the Indenture (excluding Notes held by the Issuer and its Subsidiaries) remains outstanding immediately after the occurrence of such redemption; and 

(2) the redemption occurs within 90 days of the date of the closing of such Equity Offering or equity contribution.

 (c) Before April 1, 2015, the Issuer may also redeem all or any portion of the Notes upon notice as described in
Section 3.02 of the Indenture, at a redemption price equal to 100% of the principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest thereon, if any, to, the date of redemption (a “Make-Whole Redemption
Date”), subject to the rights of holders of Notes on the relevant record date to receive interest on the relevant interest payment date. 
 (6) MANDATORY REDEMPTION. The Issuer shall not be required to make mandatory redemption or sinking fund payments with respect to the Notes. 

(7) [Reserved]. 

  
 A1-4









 (8) REPURCHASE AT THE OPTION OF HOLDER. 

(a) If there is a Change of Control after the Effective Date, each Holder shall have the right to require the Issuer to make an offer (a
“Change of Control Offer”) to repurchase all or any part (a minimum amount of $2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Notes at a purchase price equal to 101% of the aggregate principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, on the Notes repurchased, if any, to the date of purchase, subject to the rights of the Holders on the relevant record date to receive interest due on the relevant Interest
Payment Date (the “Change of Control Payment”). Within 30 days following any Change of Control, the Issuer shall mail a notice to each Holder setting forth the procedures governing the Change of Control Offer as required by the Indenture.

 (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business Days of each date on which the
aggregate amount of Excess Proceeds exceeds $25.0 million, the Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required by the terms of such other Pari Passu Indebtedness) all holders of such Pari Passu
Indebtedness to purchase the maximum principal amount of Notes and other Pari Passu Indebtedness that may be purchased out of the Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount thereof plus accrued and
unpaid interest and Additional Interest, if any, to the Purchase Date in accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount of Notes and other Pari Passu Indebtedness tendered pursuant to an Asset Sale
Offer is less than the Excess Proceeds, the Issuer may use the remaining Excess Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate principal amount of Notes and other Pari Passu Indebtedness surrendered by holders
thereof exceeds the amount of Excess Proceeds, the Trustee or the Issuer, as applicable, shall select the Notes and other Pari Passu Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale Offer is addressed shall receive an
Asset Sale Offer from the Issuer prior to the related Purchase Date and may elect to have such Notes purchased by completing the form entitled “Option of Holder to Elect Purchase” attached to the Notes. 

(9) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but not more than 60 days before the redemption
date to each Holder whose Notes are to be redeemed at its registered address, except that redemption notices may be mailed more than 60 days prior to a redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes held by a Holder are to be redeemed. On and after the
redemption date interest and Additional Interest will cease to accrue on Notes or portions thereof called for redemption. 

(10) DENOMINATIONS, TRANSFER, EXCHANGE. The Notes are in registered form without coupons in denominations of $2,000 and integral
multiples of $1,000 in excess thereof. The transfer of Notes may be registered and Notes may be exchanged as provided in the Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish appropriate endorsements and
transfer documents and the Issuer may require a Holder to pay any taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or register the transfer of any Note or portion of a Note selected for redemption, except
for the unredeemed portion of any Note being redeemed in part. Also, the Issuer need not exchange or register the transfer of any Notes for a period of 15 days before a selection of Notes to be redeemed or during the period between a record date and
the corresponding Interest Payment Date. 

  
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 (11) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as its
owner for all purposes. 
 (12) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture, the
Subsidiary Guarantees or the Notes may be amended or supplemented with the consent of the Holders of at least a majority in aggregate principal amount of the then outstanding Notes, including without limitation, consents obtained in connection with
a purchase of, or tender offer or exchange offer for, Notes, and any existing Default or Event of Default or compliance with any provision of the Indenture, the Subsidiary Guarantees or the Notes may be waived with the consent of the Holders of a
majority in aggregate principal amount of the then outstanding Notes, including without limitation, consents obtained in connection with a purchase of, or tender offer or exchange offer for, Notes. Without the consent of any Holder, the Indenture,
the Subsidiary Guarantees or the Notes may be amended or supplemented (i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated Notes in addition to or in place of certificated Notes, (iii) to provide for
the assumption of the Issuer’s or any Guarantor’s obligations to Holders of the Notes in case of a merger or consolidation, (iv) to make any change that would provide any additional rights or benefits to the Holders or that does not
adversely affect the legal rights under the Indenture of any such Holder, (v) to comply with the requirements of the SEC in order to effect or maintain the qualification of the Indenture under the TIA, (vi) to conform the text of the
Indenture, the Subsidiary Guarantees or the Notes to any provision of the “Description of Notes” section of the Offering Memorandum to the extent that such provision in that “Description of Notes” was intended to be a verbatim
recitation of a provision of the Indenture, the Subsidiary Guarantees or the Notes, (vii) to provide for the issuance of Additional Notes in accordance with the limitations set forth in the Indenture as of the Issue Date, (viii) to allow
any Guarantor to execute a supplemental indenture and/or a Subsidiary Guarantee with respect to the Notes or to secure the Notes, or (ix) to issue additional notes in accordance with the terms of the Indenture. 

(13) DEFAULTS AND REMEDIES. Events of Default include: (i) default for 30 days in the payment when due of interest on or
Additional Interest, if any, with respect to, the Notes; (ii) default in payment when due (at maturity, upon redemption or otherwise) of the principal of, or premium, if any, on the Notes; (iii) failure by the Issuer to comply with
Section 5.01 of the Indenture; (iv) failure by the Issuer or any of its Restricted Subsidiaries for 60 days after notice to the Issuer by the Trustee or the Holders of at least 25% in aggregate principal amount of Notes then outstanding
voting as a single class to comply with any of the other agreements in the Indenture; (v) default under any mortgage, indenture or instrument under which there may be issued or by which there may be secured or evidenced any Indebtedness for
money borrowed by the Issuer or any of its Significant Subsidiaries (or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries), whether such Indebtedness or Guarantee now exists, or is created after the Effective
Date, if that default: (A) is caused by a failure to pay principal at the final Stated Maturity of such Indebtedness (a “Payment Default”) or (B) results in the acceleration of such Indebtedness prior to its express maturity,
and, in each case, the principal amount of such Indebtedness, together with the principal amount of any other such Indebtedness under which there has been a Payment Default or the maturity of which has been so accelerated, aggregates $35.0 million
or more; (vi) certain final judgments and decrees for the payment of money that remain undischarged for a period of 60 days after such judgment or decree has become final and nonappealable without being paid, discharged, waived or stayed;
(vii) except as permitted by the Indenture, any Subsidiary Guarantee of any Significant Subsidiary is declared to be unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any reason to be in full force and
effect, or any Guarantor that is a Significant Subsidiary or any Person acting on behalf of any Guarantor that is a Significant Subsidiary denies or disaffirms its obligations in writing under its Subsidiary Guarantee and such Default continues for
10 days after receipt of the notice specified in the Indenture and (viii) certain events of bankruptcy or insolvency with respect to the Issuer or any of the Issuer’s Restricted Subsidiaries that is a Significant Subsidiary. In the event
of 

  
 A1-6









 
any Event of Default specified in clause (v) above, such Event of Default and all consequences thereof (excluding any resulting payment default, other than as a result of acceleration of the
Notes) shall be annulled, waived and rescinded, automatically and without action by the Trustee or the Holders, if within 20 days after such Event of Default arose (1) the Indebtedness or Guarantee that is the basis for such Event of Default
has been discharged; (2) holders thereof have rescinded or waived the acceleration, notice or action (as the case may be) giving rise to such Event of Default; or (3) the default that is the basis for such Event of Default has been cured.
Notwithstanding the foregoing, in the case of an Event of Default arising from certain events of bankruptcy or insolvency, all outstanding Notes shall become due and payable without further action or notice. If any other Event of Default occurs and
is continuing, the Trustee or the Holders of at least 25% in aggregate principal amount of the then outstanding Notes may declare all the Notes to be due and payable immediately. Holders may not enforce the Indenture or the Notes except as provided
in the Indenture. Subject to certain limitations, Holders of a majority in principal amount of the then outstanding Notes may direct the Trustee in its exercise of any trust or power. The Trustee may withhold from Holders notice of any continuing
Default or Event of Default (except a Default or Event of Default relating to the payment of principal, premium or interest or Additional Interest) if a committee of its Responsible Officer determines in good faith that withholding notice is in
their interest. The Holders of a majority in aggregate principal amount of the Notes then outstanding by notice to the Trustee may on behalf of the Holders of all of the Notes waive any existing Default or Event of Default and its consequences under
the Indenture except a continuing Default or Event of Default in the payment of interest on, premium, if any, Additional Interest, if any, or the principal of any of the Notes held by a non-consenting Holder (including in connection with an offer to
purchase). 
 (14) TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other capacity, may make loans to,
accept deposits from, and perform services for the Issuer or its Affiliates, and may otherwise deal with the Issuer or its Affiliates, as if it were not the Trustee. 
 (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator, stockholder, member, partner or other holder of Equity Interests of the Issuer or any Guarantor, as such, shall have
any liability for any obligations of the Issuer or the Guarantors under the Notes, this Indenture or the Subsidiary Guarantees or for any claim based on, in respect of, or by reason of, such obligations or their creation. Each Holder by accepting a
Note waives and releases all such liability. The waiver and release are part of the consideration for issuance of the Notes. The waiver may not be effective to waive liabilities under the federal securities laws. 

(16) AUTHENTICATION. This Note shall not be valid until authenticated by the manual signature of the Trustee or an authenticating
agent. 
 (17) ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an assignee, such as: TEN
COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (= joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts to Minors Act). 

(18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE NOTES. In addition to the rights provided
to Holders under the Indenture, Holders of Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the Registration Rights Agreement. 
 (20) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on Uniform Security Identification Procedures, the Issuer has caused CUSIP numbers to be printed on the Notes and the
Trustee may use CUSIP numbers in notices of redemption as a convenience to Holders. No representation is made as to the accuracy of such numbers either as printed on the Notes or as contained in any notice of redemption and reliance may be placed
only on the other identification numbers placed thereon. 

  
 A1-7









 The Issuer shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to: 
 United Surgical Partners
International, Inc. 
 15305 Dallas Parkway, Suite 1600 

Addison, Texas 75001 
 Telecopier No.: (972) 767-0604 
 Attention: Secretary


  
 A1-8









 ASSIGNMENT FORM 
 To assign this Note, fill in the form below: 
  

			
	 (I) or (we) assign and transfer this Note to:
	  	 

     (Insert assignee’s legal name) 

 
  
 (Insert assignee’s soc. sec. or tax I.D. no.) 
  

 
  

 
  

 
  

 
 (Print or type assignee’s name,
address and zip code) 
 and irrevocably appoint
                     to transfer this Note on the books of the Issuer. The agent may substitute another to act for him. 

Date:                      

 

			
	
		
	Your Signature:	 	 
		 	(Sign exactly as your name appears on the face of this Note)


 Signature
Guarantee*:                                       
                          
  

	*	Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee). 


  
 A1-9









 OPTION OF HOLDER TO ELECT PURCHASE 

If you want to elect to have this Note purchased by the Issuer pursuant to Section 4.09 or 4.13 of the Indenture, check the
appropriate box below: 
 [    ]
Section 4.09                     [    ] Section 4.13 

If you want to elect to have only part of the Note purchased by the Issuer pursuant to Section 4.09 or Section 4.13 of the
Indenture, state the amount you elect to have purchased: 

$                      
   

Date:                        
  
  

			
	
	Your Signature:                        
                                         
                
	
                         
   (Sign exactly as your name appears

                         
   on the face of this Note)

	Tax Identification No.:                      
                                         
      


 Signature
Guarantee*:                                       
          
  

	*	Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee). 


  
 A1-10









 SCHEDULE OF EXCHANGES OF GLOBAL NOTE 

The following exchanges of a part of this Global Note for an interest in another Global Note, or exchanges in part of another other
Restricted Global Note for an interest in this Global Note, have been made: 
  

									
	 Date of
 Exchange
	  	 Amount of

decrease in

Principal Amount

of this Global Note
	  	 Amount of

increase in

Principal Amount

of this Global

Note
	  	 Principal Amount

of this
 Global
Note
 following such
 decrease (or
 increase)
	  	 Signature of

authorized
 officer
of Trustee
 or Custodian


  

	*	This schedule should be included only if the Note is issued in global form. 


  
 A1-11









 EXHIBIT A2 
 [Face of Regulation S Temporary Global Note] 

CUSIP                    

 9.000% Senior Note due 2020 
  

			
	No.                	  	$                    

 USPI FINANCE CORP. 
 (to be merged with and into United Surgical Partners International, Inc., with United Surgical Partners International, Inc. as the surviving entity (the “Issuer”) 

promises to pay to [            ] or registered assigns, the principal sum
of                     DOLLARS on April 1, 2020. 
 Interest Payment Dates: April 1 and October 1 
 Record Dates: March 15 and
September 15 
 Dated: April 3, 2012 

 

			
	USPI FINANCE CORP.
		
	By:	 	 
		 	Name:
		 	Title:



  
 A2-1









 This is one of the Notes referred to 
 in the within-mentioned Indenture: 
  

			
	 U.S. BANK NATIONAL ASSOCIATION
     as Trustee

		
	By:	 	 
		 	        Authorized Signatory

  
  

  
 A2-2









 [Back of Regulation S Temporary Global Note] 

9.000% Senior Note due 2020 
 THE
RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF THIS
REGULATION S TEMPORARY GLOBAL NOTE SHALL BE ENTITLED TO RECEIVE PAYMENT OF PRINCIPAL HEREOF OR INTEREST HEREON. 
 THIS GLOBAL NOTE IS HELD BY
THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING THIS NOTE) OR ITS NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS HEREOF, AND IS NOT TRANSFERABLE TO ANY PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT (1) THE TRUSTEE MAY MAKE SUCH
NOTATIONS HEREON AS MAY BE REQUIRED PURSUANT TO SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3) THIS GLOBAL NOTE MAY BE
DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 2.11 OF THE INDENTURE AND (4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF THE ISSUERS. 

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM, THIS NOTE MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY
TO A NOMINEE OF THE DEPOSITARY OR BY A NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY. UNLESS THIS
CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY (55 WATER STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE
ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS MAY BE REQUESTED BY AN AUTHORIZED
REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. 

THIS NOTE HAS NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), OR UNDER THE SECURITIES LAWS OF ANY
STATE OR OTHER JURISDICTION, AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD WITHIN THE UNITED STATES OR TO, OR FOR THE ACCOUNT OR BENEFIT OF, U.S. PERSONS EXCEPT AS SET FORTH BELOW. EACH PURCHASER OF THIS NOTE IS HEREBY NOTIFIED THAT THE SELLER OF
THIS NOTE MAY BE RELYING ON THE EXEMPTION FROM THE PROVISIONS OF SECTION 5 OF THE SECURITIES ACT PROVIDED BY RULE 144A THEREUNDER OR ANOTHER EXEMPTION UNDER THE SECURITIES ACT. 

“BY ITS ACCEPTANCE HEREOF, THE HOLDER OF THIS NOTE (1) REPRESENTS THAT (A) IT IS A “QUALIFIED INSTITUTIONAL
BUYER” (AS DEFINED IN RULE 144A UNDER THE SECURITIES ACT), (B) IT IS NOT A U.S. PERSON AND IS ACQUIRING THIS NOTE IN AN OFFSHORE TRANSACTION IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES


  
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ACT OR (C) IT IS AN “INSTITUTIONAL” ACCREDITED INVESTOR (AS DEFINED IN RULE 501(a)(1), (2), (3) OR, (7) UNDER REGULATION D PROMULGATED UNDER THE SECURITIES ACT (AN
“ACCREDITED INVESTOR”) AND (2) AGREES THAT IT WILL NOT, WITHIN ONE YEAR FOR” NOTES ISSUED PURSUANT TO RULE 144A OR WITHIN 40 DAYS FOR NOTES ISSUED IN OFFSHORE TRANSACTIONS PURSUANT TO REGULATION S, AFTER THE LATER OF THE DATE OF
THE ORIGINAL ISSUANCE OF THIS NOTE AND THE DATE ON WHICH THE COMPANY OR ANY OF ITS RESPECTIVE AFFILIATES OWNED THIS NOTE, OFFER, RESELL OR OTHERWISE TRANSFER THIS NOTE EXCEPT (A) (I) TO THE COMPANY OR ANY SUBSIDIARY THEREOF, (II) FOR SO
LONG AS THIS NOTE IS ELIGIBLE FOR RESALE PURSUANT TO RULE 144A UNDER THE SECURITIES ACT INSIDE THE UNITED STATES TO A PERSON WHOM THE SELLER REASONABLY BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER IN COMPLIANCE WITH RULE 144A UNDER THE SECURITIES
ACT, (III) INSIDE THE UNITED STATES TO AN ACCREDITED INVESTOR THAT IS ACQUIRING THE NOTES FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF SUCH AN ACCREDITED INVESTOR, IN EACH CASE IN A MINIMUM PRINCIPAL AMOUNT OF THE NOTES OF $250,000, FOR INVESTMENT
PURPOSES AND NOT WITH A VIEW TO OR FOR THE OFFER OR SALE IN CONNECTION WITH ANY DISTRIBUTION IN VIOLATION OF THE SECURITIES ACT, AND THAT PRIOR TO SUCH TRANSFER, FURNISHES (OR HAS FURNISHED ON ITS BEHALF BY A U.S. BROKER-DEALER) TO THE TRUSTEE A
SIGNED LETTER CONTAINING CERTAIN REPRESENTATIONS AND AGREEMENTS RELATING TO THE RESTRICTIONS ON TRANSFER OF THIS NOTE (THE FORM OF WHICH LETTER CAN BE OBTAINED FROM THE TRUSTEE FOR THIS NOTE), (IV) OUTSIDE THE UNITED STATES IN AN OFFSHORE
TRANSACTION IN COMPLIANCE WITH REGULATION S UNDER THE SECURITIES ACT (IF AVAILABLE), (V) PURSUANT TO THE EXEMPTION FROM REGISTRATION PROVIDED BY RULE 144 UNDER THE SECURITIES ACT (IF AVAILABLE), (VI) IN ACCORDANCE WITH ANOTHER EXEMPTION FROM
THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT (AND BASED UPON AN OPINION OF COUNSEL IF THE COMPANY SO REQUESTS), OR (VII) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND (B) IN ACCORDANCE WITH ALL APPLICABLE
SECURITIES LAWS OF THE STATES OF THE UNITED STATES AND OTHER JURISDICTIONS. BY ITS ACCEPTANCE HEREOF, THE HOLDER OF THIS NOTE FURTHER AGREES THAT IT WILL GIVE TO EACH PERSON TO WHOM THIS NOTE IS TRANSFERRED A NOTICE SUBSTANTIALLY TO THE EFFECT OF
THIS LEGEND. IN CONNECTION WITH ANY TRANSFER OF THIS NOTE PURSUANT TO SUBCLAUSES (III) TO (VI) OF CLAUSE (A) ABOVE, AND THAT, THE HOLDER MUST, PRIOR TO SUCH TRANSFER, FURNISH TO THE TRUSTEE AND THE COMPANY SUCH CERTIFICATIONS, LEGAL OPINIONS OR
OTHER INFORMATION AS EITHER OF THEM MAY REASONABLY REQUIRE TO CONFIRM THAT SUCH TRANSFER IS BEING MADE PURSUANT TO AN EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT. AS USED HEREIN, THE TERMS
“OFFSHORE TRANSACTION,” “UNITED STATES” AND “U.S. PERSON” HAVE THE MEANINGS GIVEN TO THEM BY REGULATION S UNDER THE SECURITIES ACT. 
 Capitalized terms used herein have the meanings assigned to them in the Indenture referred to below unless otherwise indicated. 
 (1) INTEREST. The Issuer promises to pay interest on the principal amount of this Note at 9.000% per annum from April 3, 2012 until maturity and shall pay the Additional Interest, if any,
payable pursuant to the Registration Rights Agreement referred to below. The Issuer shall pay interest and Additional Interest, if any, semi-annually in arrears on April 1 and October 1 of each year, or if any such day is not a Business
Day, on the next succeeding Business Day (each, an “Interest Payment Date”). Interest on 

  
 A2-4









 
the Notes shall accrue from the most recent date to which interest has been paid or, if no interest has been paid, from the date of issuance; provided that the first Interest Payment Date
shall be October 1, 2012. The Issuer shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on overdue principal and premium, if any, from time to time on demand at a rate equal to the then applicable
interest rate on the notes to the extent lawful; it shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of interest and Additional Interest, if any, (without regard to any
applicable grace periods) from time to time on demand at the same rate to the extent lawful. Interest shall be computed on the basis of a 360-day year of twelve 30-day months. 
 (2) METHOD OF PAYMENT. The Issuer shall pay interest on the Notes and Additional Interest, if any, to the Persons who are registered Holders at the close of business on the March 15 or
September 15 next preceding the Interest Payment Date, even if such Notes are canceled after such record date and on or before such Interest Payment Date, except as provided in Section 2.12 of the Indenture with respect to defaulted
interest. The Notes shall be payable as to principal, interest and premium and Additional Interest, if any, at the office or agency of the Paying Agent within the City and State of New York, or payment of interest and Additional Interest, if any,
may, at the option of the Issuer, be made by check mailed to the Holders at their addresses set forth in the register of Holders; provided that payment by wire transfer of immediately available funds shall be required with respect to
principal of and interest, premium and Additional Interest, if any, on, all certificated Global Notes and all other certificated Notes the Holder of which shall have provided wire transfer instructions to the Issuer no less than 30 days prior to the
record date. Payment of principal of, premium, if any, and interest and Additional Interest on, Global Notes registered in the name of or held by DTC or any successor depositary or its nominee will be made by wire transfer of immediately available
funds to such depositary or its nominee, as the case may be, as the registered Holder of such Global Note. Such payment shall be in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public
and private debts. 
 (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the Trustee under the
Indenture, shall act as Paying Agent and Registrar. The Issuer may change any Paying Agent or Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may act in any such capacity. 

(4) INDENTURE. The Issuer issued the Notes under an Indenture dated as of April 3, 2012 (the “Indenture”), between
the Issuer and the Trustee. The terms of the Notes include those stated in the Indenture and those made part of the Indenture by reference to the TIA (15 U.S. Code Sections 77aaa-77bbbb). The Notes are subject to all such terms, and Holders are
referred to the Indenture and such Act for a statement of such terms. To the extent any provision of this Note conflicts with the express provisions of the Indenture, the provisions of the Indenture shall govern and be controlling. The Notes are
general unsecured obligations of the Issuer. Subject to the conditions set forth in the Indenture, the Issuer may issue Additional Notes. 
 (5) OPTIONAL REDEMPTION. 
 (a) Except as set forth in subparagraph
(b) or (c) of this Paragraph 5, on or after April 1, 2015, the Issuer may redeem all or a part of the Notes upon notice as described in Section 3.02 of the Indenture, at the redemption prices (expressed as percentages of
principal amount) set forth below plus accrued and unpaid interest and Additional Interest, if any, on the Notes redeemed, to the applicable redemption date, if redeemed during the twelve-month period beginning on April 1 of the years indicated


  
 A2-5









 
below, subject to the rights of holders of Notes on the relevant record date to receive interest on the relevant interest payment date: 

 

					
	 Year
	  	Percentage	 
	 2015
	  	 	106.750	% 
	 2016
	  	 	104.500	% 
	 2017
	  	 	102.250	% 
	 2018 and thereafter
	  	 	100.000	% 

 (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior to
April 1, 2015, the Issuer may, on any one or more occasions, redeem up to 40% of the aggregate principal amount of Notes issued under the Indenture at a redemption price of 109.000% of the principal amount, plus accrued and unpaid interest and
Additional Interest, if any, to the redemption date, subject to the rights of the Holders on the relevant record date to receive interest on the relevant interest payment date, with the net cash proceeds of one or more Equity Offerings by the Issuer
or a contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net proceeds of one or more Equity Offerings by Holdings or any other direct or indirect parent of the Issuer (in each case, other than Excluded
Contributions); provided that: 
 (1) at least 50% of the aggregate principal amount of Notes originally
issued under the Indenture (excluding Notes held by the Issuer and its Subsidiaries) remains outstanding immediately after the occurrence of such redemption; and 

(2) the redemption occurs within 90 days of the date of the closing of such Equity Offering or equity contribution.

 (c) Before April 1, 2015, the Issuer may also redeem all or any portion of the Notes upon notice as described in
Section 3.02 of the Indenture, at a redemption price equal to 100% of the principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest thereon, if any, to, the date of redemption (a “Make-Whole Redemption
Date”), subject to the rights of holders of Notes on the relevant record date to receive interest on the relevant interest payment date. 
 (6) MANDATORY REDEMPTION. The Issuer shall not be required to make mandatory redemption or sinking fund payments with respect to the Notes. 

(7) [Reserved]. 
 (8) REPURCHASE AT THE OPTION OF HOLDER. 
 (a) If there is a Change of
Control after the Effective Date, each Holder shall have the right to require the Issuer to make an offer (a “Change of Control Offer”) to repurchase all or any part (a minimum amount of $2,000 or an integral multiple of $1,000 in excess
thereof) of that Holder’s Notes at a purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid interest and Additional Interest, if any, on the Notes repurchased, if any, to the date of purchase, subject to
the rights of the Holders on the relevant record date to receive interest due on the relevant Interest Payment Date (the “Change of Control Payment”). Within 30 days following any Change of Control, the Issuer shall mail a notice to each
Holder setting forth the procedures governing the Change of Control Offer as required by the Indenture. 

  
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 (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business
Days of each date on which the aggregate amount of Excess Proceeds exceeds $25.0 million, the Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required by the terms of such other Pari Passu Indebtedness) all
holders of such Pari Passu Indebtedness to purchase the maximum principal amount of Notes and other Pari Passu Indebtedness that may be purchased out of the Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, to the Purchase Date in accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount of Notes and other Pari Passu Indebtedness tendered
pursuant to an Asset Sale Offer is less than the Excess Proceeds, the Issuer may use the remaining Excess Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate principal amount of Notes and other Pari Passu
Indebtedness surrendered by holders thereof exceeds the amount of Excess Proceeds, the Trustee or the Issuer, as applicable, shall select the Notes and other Pari Passu Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale
Offer is addressed shall receive an Asset Sale Offer from the Issuer prior to the related Purchase Date and may elect to have such Notes purchased by completing the form entitled “Option of Holder to Elect Purchase” attached to the Notes.

 (9) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but not more than 60 days before the
redemption date to each Holder whose Notes are to be redeemed at its registered address, except that redemption notices may be mailed more than 60 days prior to a redemption date if the notice is issued in connection with a defeasance of the Notes
or a satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes held by a Holder are to be redeemed. On and after
the redemption date interest and Additional Interest will cease to accrue on Notes or portions thereof called for redemption. 

(10) DENOMINATIONS, TRANSFER, EXCHANGE. The Notes are in registered form without coupons in denominations of $2,000 and integral
multiples of $1,000 in excess thereof. The transfer of Notes may be registered and Notes may be exchanged as provided in the Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish appropriate endorsements and
transfer documents and the Issuer may require a Holder to pay any taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or register the transfer of any Note or portion of a Note selected for redemption, except
for the unredeemed portion of any Note being redeemed in part. Also, the Issuer need not exchange or register the transfer of any Notes for a period of 15 days before a selection of Notes to be redeemed or during the period between a record date and
the corresponding Interest Payment Date. 
 (11) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as
its owner for all purposes. 
 (12) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture, the
Subsidiary Guarantees or the Notes may be amended or supplemented with the consent of the Holders of at least a majority in aggregate principal amount of the then outstanding Notes, including without limitation, consents obtained in connection with
a purchase of, or tender offer or exchange offer for, Notes, and any existing Default or Event of Default or compliance with any provision of the Indenture, the Subsidiary Guarantees or the Notes may be waived with the consent of the Holders of a
majority in aggregate principal amount of the then outstanding Notes, including without limitation, consents obtained in connection with a purchase of, or tender offer or exchange offer for, Notes. Without the consent of any Holder, the Indenture,
the Subsidiary Guarantees or the Notes may be amended or supplemented (i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated Notes in addition to or 

  
 A2-7









 
in place of certificated Notes, (iii) to provide for the assumption of the Issuer’s or any Guarantor’s obligations to Holders of the Notes in case of a merger or consolidation,
(iv) to make any change that would provide any additional rights or benefits to the Holders or that does not adversely affect the legal rights under the Indenture of any such Holder, (v) to comply with the requirements of the SEC in order
to effect or maintain the qualification of the Indenture under the TIA, (vi) to conform the text of the Indenture, the Subsidiary Guarantees or the Notes to any provision of the “Description of Notes” section of the Offering
Memorandum to the extent that such provision in that “Description of Notes” was intended to be a verbatim recitation of a provision of the Indenture, the Subsidiary Guarantees or the Notes, (vii) to provide for the issuance of
Additional Notes in accordance with the limitations set forth in the Indenture as of the Issue Date, (viii) to allow any Guarantor to execute a supplemental indenture and/or a Subsidiary Guarantee with respect to the Notes or to secure the
Notes, or (ix) to issue additional notes in accordance with the terms of the Indenture. 
 (13) DEFAULTS AND
REMEDIES. Events of Default include: (i) default for 30 days in the payment when due of interest on or Additional Interest, if any, with respect to, the Notes; (ii) default in payment when due (at maturity, upon redemption or
otherwise) of the principal of, or premium, if any, on the Notes; (iii) failure by the Issuer to comply with Section 5.01 of the Indenture; (iv) failure by the Issuer or any of its Restricted Subsidiaries for 60 days after notice to
the Issuer by the Trustee or the Holders of at least 25% in aggregate principal amount of Notes then outstanding voting as a single class to comply with any of the other agreements in the Indenture; (v) default under any mortgage, indenture or
instrument under which there may be issued or by which there may be secured or evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries (or the payment of which is guaranteed by the Issuer or any of its
Significant Subsidiaries), whether such Indebtedness or Guarantee now exists, or is created after the Effective Date, if that default: (A) is caused by a failure to pay principal at the final Stated Maturity of such Indebtedness (a
“Payment Default”) or (B) results in the acceleration of such Indebtedness prior to its express maturity, and, in each case, the principal amount of such Indebtedness, together with the principal amount of any other such Indebtedness
under which there has been a Payment Default or the maturity of which has been so accelerated, aggregates $35.0 million or more; (vi) certain final judgments and decrees for the payment of money that remain undischarged for a period of 60 days
after such judgment or decree has become final and nonappealable without being paid, discharged, waived or stayed; (vii) except as permitted by the Indenture, any Subsidiary Guarantee of any Significant Subsidiary is declared to be
unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any reason to be in full force and effect, or any Guarantor that is a Significant Subsidiary or any Person acting on behalf of any Guarantor that is a
Significant Subsidiary denies or disaffirms its obligations in writing under its Subsidiary Guarantee and such Default continues for 10 days after receipt of the notice specified in the Indenture and (viii) certain events of bankruptcy or
insolvency with respect to the Issuer or any of the Issuer’s Restricted Subsidiaries that is a Significant Subsidiary. In the event of any Event of Default specified in clause (v) above, such Event of Default and all consequences thereof
(excluding any resulting payment default, other than as a result of acceleration of the Notes) shall be annulled, waived and rescinded, automatically and without action by the Trustee or the Holders, if within 20 days after such Event of Default
arose (1) the Indebtedness or Guarantee that is the basis for such Event of Default has been discharged; (2) holders thereof have rescinded or waived the acceleration, notice or action (as the case may be) giving rise to such Event of
Default; or (3) the default that is the basis for such Event of Default has been cured. Notwithstanding the foregoing, in the case of an Event of Default arising from certain events of bankruptcy or insolvency, all outstanding Notes shall
become due and payable without further action or notice. If any other Event of Default occurs and is continuing, the Trustee or the Holders of at least 25% in aggregate principal amount of the then outstanding Notes may declare all the Notes to be
due and payable immediately. Holders may not enforce the Indenture or the Notes except as provided in the Indenture. Subject to certain limitations, Holders of a majority in principal amount of the then outstanding Notes may direct the Trustee in
its exercise of any trust or power. The Trustee may 

  
 A2-8









 
withhold from Holders notice of any continuing Default or Event of Default (except a Default or Event of Default relating to the payment of principal, premium or interest or Additional Interest)
if a committee of its Responsible Officer determines in good faith that withholding notice is in their interest. The Holders of a majority in aggregate principal amount of the Notes then outstanding by notice to the Trustee may on behalf of the
Holders of all of the Notes waive any existing Default or Event of Default and its consequences under the Indenture except a continuing Default or Event of Default in the payment of interest on, premium, if any, Additional Interest, if any, or the
principal of any of the Notes held by a non-consenting Holder (including in connection with an offer to purchase. 
 (14)
TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other capacity, may make loans to, accept deposits from, and perform services for the Issuer or its Affiliates, and may otherwise deal with the Issuer or its Affiliates, as
if it were not the Trustee. 
 (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator,
stockholder, member, partner or other holder of Equity Interests of the Issuer or any Guarantor, as such, shall have any liability for any obligations of the Issuer or the Guarantors under the Notes, this Indenture or the Subsidiary Guarantees or
for any claim based on, in respect of, or by reason of, such obligations or their creation. Each Holder by accepting a Note waives and releases all such liability. The waiver and release are part of the consideration for issuance of the Notes. The
waiver may not be effective to waive liabilities under the federal securities laws. 
 (16) AUTHENTICATION. This Note
shall not be valid until authenticated by the manual signature of the Trustee or an authenticating agent. 
 (17)
ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (= joint tenants with right of survivorship and not as tenants in
common), CUST (= Custodian), and U/G/M/A (= Uniform Gifts to Minors Act). 
 (18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED
GLOBAL NOTES AND RESTRICTED DEFINITIVE NOTES. In addition to the rights provided to Holders under the Indenture, Holders of Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the Registration Rights
Agreement. 
 (20) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on Uniform Security
Identification Procedures, the Issuer has caused CUSIP numbers to be printed on the Notes and the Trustee may use CUSIP numbers in notices of redemption as a convenience to Holders. No representation is made as to the accuracy of such numbers either
as printed on the Notes or as contained in any notice of redemption and reliance may be placed only on the other identification numbers placed thereon. 
 The Issuer shall furnish to any Holder upon written request and without charge a copy of the Indenture and/or the Registration Rights Agreement. Requests may be made to: 

United Surgical Partners International, Inc. 

15305 Dallas Parkway, Suite 1600 
 Addison, Texas 75001 
 Telecopier No.: (972) 767-0604

 Attention: Secretary 

  
 A2-9









 ASSIGNMENT FORM 
 To assign this Note, fill in the form below: 

(I) or (we) assign and transfer this Note to:        
                                         
                                         
                                         
                                    

(Insert assignee’s legal name) 
  

 
 (Insert assignee’s soc. sec. or
tax I.D. no.) 
  
  

 
  
  

 
  

 
 (Print or type assignee’s name,
address and zip code) 
 and irrevocably
appoint                     to transfer this Note on the books of the Issuer. The agent may substitute another to act for him. 

Date:                      

 

			
		
	Your Signature:	 	 
		 	(Sign exactly as your name appears on the face of this Note)


 Signature
Guarantee*:                                       
                
  

	*	Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee). 


  
 A2-10









 OPTION OF HOLDER TO ELECT PURCHASE 

If you want to elect to have this Note purchased by the Issuer pursuant to Section 4.09 or 4.13 of the Indenture, check the
appropriate box below: 
 [    ] Section 4.09
                [    ] Section 4.13 
 If you want to elect to have only part of the Note purchased by the Issuer pursuant to Section 4.09 or Section 4.13 of the Indenture, state the amount you elect to have purchased: 

$                    

 Date:                    

  

			
	
	Your Signature:                        
                                         
                
	
                         
   (Sign exactly as your name appears

                         
   on the face of this Note)

	Tax Identification No.:                      
                                         
      


 Signature
Guarantee*:                                       
                  
  

	*	Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee). 


  
 A2-11









 SCHEDULE OF EXCHANGES OF REGULATION S TEMPORARY GLOBAL NOTE 

The following exchanges of a part of this Regulation S Temporary Global Note for an interest in another Global Note, or exchanges in
part of another other Restricted Global Note for an interest in this Regulation S Temporary Global Note, have been made: 
  

									
	 Date of
Exchange
	  	 Amount of
decrease in
Principal Amount
of this
Global Note
	  	 Amount of
increase in
Principal Amount
of this
Global
 Note
	  	 Principal Amount
of this
Global Note
following
such
decrease (or
 increase)
	  	 Signature of
authorized
officer of Trustee
or
Custodian


  

	*	This schedule should be included only if the Note is issued in global form. 


  
 A2-12









 EXHIBIT B 
 FORM OF CERTIFICATE OF TRANSFER 
 [USPI Finance Corp.][United Surgical Partners International,
Inc.] 
 15305 Dallas Parkway 
 Suite
1600 
 Addison, Texas 75001 
 U.S.
Bank National Association 
 Corporate Trust Services 
 100 Wall Street—Suite 1600 
 New York, New York 10005 

Re: 9.000% Senior Notes due 2020 
 Reference is hereby made to the Indenture, dated as of April 3, 2012 (as amended, supplemented or otherwise modified, the “Indenture”), by and between USPI Finance Corp., a Delaware
corporation (the “Issuer”), and U.S. Bank National Association as trustee. Capitalized terms used but not defined herein shall have the meanings given to them in the Indenture. 

                    (the
“Transferor”) owns and proposes to transfer the Note[s] or interest in such Note[s] specified in Annex A hereto, in the principal amount of
$                     in such Note[s] or interests (the “Transfer”),
to                     (the “Transferee”), as further specified in Annex A hereto. In connection with the Transfer, the Transferor
hereby certifies that: 
 [CHECK ALL THAT APPLY] 
 1. [ ] CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE 144A GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO RULE 144A. The Transfer is being effected pursuant to and
in accordance with Rule 144A under the Securities Act of 1933, as amended (the “Securities Act”), and, accordingly, the Transferor hereby further certifies that the beneficial interest or Definitive Note is being transferred to a Person
that the Transferor reasonably believes is purchasing the beneficial interest or Definitive Note for its own account, or for one or more accounts with respect to which such Person exercises sole investment discretion, and such Person and each such
account is a “qualified institutional buyer” within the meaning of Rule 144A in a transaction meeting the requirements of Rule 144A, and such Transfer is in compliance with any applicable blue sky securities laws of any state of the United
States. Upon consummation of the proposed Transfer in accordance with the terms of the Indenture, the transferred beneficial interest or Definitive Note shall be subject to the restrictions on transfer enumerated in the Private Placement Legend
printed on the 144A Global Note and/or the Restricted Definitive Note and in the Indenture and the Securities Act. 
 2.
[ ] CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE REGULATION S GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO REGULATION S. The Transfer is being effected pursuant to and in accordance with Rule 903 or Rule
904 under the Securities Act and, accordingly, the Transferor hereby further certifies that (i) the Transfer is not being made to a Person in the United States and (x) at the time the buy order was


  
 B-1









 
originated, the Transferee was outside the United States or such Transferor and any Person acting on its behalf reasonably believed and believes that the Transferee was outside the United States
or (y) the transaction was executed in, on or through the facilities of a designated offshore securities market and neither such Transferor nor any Person acting on its behalf knows that the transaction was prearranged with a buyer in the
United States, (ii) no directed selling efforts have been made in contravention of the requirements of Rule 903 or Rule 904 of Regulation S under the Securities Act, (iii) the transaction is not part of a plan or scheme to evade the
registration requirements of the Securities Act and (iv) if the proposed transfer is being made prior to the expiration of the Restricted Period, the transfer is not being made to a U.S. Person or for the account or benefit of a U.S. Person
(other than an Initial Purchaser). Upon consummation of the proposed transfer in accordance with the terms of the Indenture, the transferred beneficial interest or Definitive Note shall be subject to the restrictions on Transfer enumerated in the
Private Placement Legend printed on the Regulation S Global Note and/or the Restricted Definitive Note and in the Indenture and the Securities Act. 
 3. [ ] CHECK AND COMPLETE IF TRANSFEREE WILL TAKE DELIVERY OF A BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO ANY PROVISION OF THE SECURITIES ACT OTHER
THAN RULE 144A OR REGULATION S. The Transfer is being effected in compliance with the transfer restrictions applicable to beneficial interests in Restricted Global Notes and Restricted Definitive Notes and pursuant to and in accordance with the
Securities Act and any applicable blue sky securities laws of any state of the United States, and accordingly the Transferor hereby further certifies that (check one): 

(a) [ ] such Transfer is being effected pursuant to and in accordance with Rule 144 under the Securities Act;

 or 
 (b) [ ] such Transfer is being effected to the Issuer or a subsidiary thereof; 

or 
 (c) [ ] such Transfer is being effected pursuant to an effective registration statement under the Securities Act. 
 4. [ ] CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN AN UNRESTRICTED GLOBAL NOTE OR OF AN UNRESTRICTED DEFINITIVE NOTE. 

(a) [ ] CHECK IF TRANSFER IS PURSUANT TO RULE 144. (i) The Transfer is being effected pursuant to and in accordance with Rule
144 under the Securities Act and in compliance with the transfer restrictions contained in the Indenture and any applicable blue sky securities laws of any state of the United States and (ii) the restrictions on transfer contained in the
Indenture and the Private Placement Legend are not required in order to maintain compliance with the Securities Act. Upon consummation of the proposed Transfer in accordance with the terms of the Indenture, the transferred beneficial interest or
Definitive Note shall no longer be subject to the restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes, on Restricted Definitive Notes and in the Indenture. 

(b) [ ] CHECK IF TRANSFER IS PURSUANT TO REGULATION S. (i) The Transfer is being effected pursuant to and in accordance with
Rule 903 or Rule 904 under the Securities Act and in compliance with the transfer restrictions contained in the Indenture and any applicable blue sky securities laws of any state of the United States and (ii) the restrictions on transfer
contained in the Indenture and 

  
 B-2









 
the Private Placement Legend are not required in order to maintain compliance with the Securities Act. Upon consummation of the proposed Transfer in accordance with the terms of the Indenture,
the transferred beneficial interest or Definitive Note shall no longer be subject to the restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes, on Restricted Definitive Notes and in the Indenture.

 (c) [ ] CHECK IF TRANSFER IS PURSUANT TO OTHER EXEMPTION. (i) The Transfer is being effected pursuant to and in
compliance with an exemption from the registration requirements of the Securities Act other than Rule 144, Rule 903 or Rule 904 and in compliance with the transfer restrictions contained in the Indenture and any applicable blue sky securities laws
of any State of the United States and (ii) the restrictions on transfer contained in the Indenture and the Private Placement Legend are not required in order to maintain compliance with the Securities Act. Upon consummation of the proposed
Transfer in accordance with the terms of the Indenture, the transferred beneficial interest or Definitive Note shall not be subject to the restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes or
Restricted Definitive Notes and in the Indenture. 
 This certificate and the statements contained herein are made for your
benefit and the benefit of the Issuer. 
  

	
	
	  
	[Insert Name of Transferor]


  

			
		
	By:	 	 
		 	Name:
		 	Title:



Dated:                      

  
 B-3









 ANNEX A TO CERTIFICATE OF TRANSFER 

 

	 	1.	The Transferor owns and proposes to transfer the following: 

 [CHECK ONE OF (a) OR (b)] 
  

	 	(a)	[ ] a beneficial interest in the: 

  

	 	(i)	[ ] 144A Global Note (CUSIP                     ), or


  

	 	(ii)	[ ] Regulation S Global Note (CUSIP
                    ), or 

  

	 	(b)	[ ] a Restricted Definitive Note. 

  

	 	2.	After the Transfer the Transferee shall hold: 

 [CHECK ONE] 
  

	 	(a)	[ ] a beneficial interest in the: 

  

	 	(i)	[ ] 144A Global Note (CUSIP                     ), or


  

	 	(ii)	[ ] Regulation S Global Note (CUSIP
                    ), or 

  

	 	(iii)	[ ] Unrestricted Global Note (CUSIP
                    ); or 

  

	 	(b)	[ ] a Restricted Definitive Note; or 

  

	 	(c)	[ ] an Unrestricted Definitive Note, 

 in
accordance with the terms of the Indenture. 







 EXHIBIT C 
 FORM OF CERTIFICATE OF EXCHANGE 
 [USPI Finance Corp.][United Surgical Partners International,
Inc.] 
 15305 Dallas Parkway 
 Suite
1600 
 Addison, Texas 75001 
 U.S.
Bank National Association 
 Corporate Trust Services 
 100 Wall Street—Suite 1600 
 New York, New York 10005 

Re: 9.000% Senior Notes due 2020 
 (CUSIP                     ) 

Reference is hereby made to the Indenture, dated as of April 3, 2012 (as amended, supplemented or otherwise modified, the
“Indenture”), by and between USPI Finance Corp., a Delaware corporation (the “Issuer”), and U.S. Bank National Association as trustee. Capitalized terms used but not defined herein shall have the meanings given to them in the
Indenture. 

                    (the “Owner”)
owns and proposes to exchange the Note[s] or interest in such Note[s] specified herein, in the principal amount of $                     in
such Note[s] or interests (the “Exchange”). In connection with the Exchange, the Owner hereby certifies that: 
 1.
EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN A RESTRICTED GLOBAL NOTE FOR UNRESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN AN UNRESTRICTED GLOBAL NOTE 

(a) [ ] CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO BENEFICIAL INTEREST IN AN UNRESTRICTED GLOBAL
NOTE. In connection with the Exchange of the Owner’s beneficial interest in a Restricted Global Note for a beneficial interest in an Unrestricted Global Note in an equal principal amount, the Owner hereby certifies (i) the beneficial
interest is being acquired for the Owner’s own account without transfer, (ii) such Exchange has been effected in compliance with the transfer restrictions applicable to the Global Notes and pursuant to and in accordance with the Securities
Act of 1933, as amended (the “Securities Act”), (iii) the restrictions on transfer contained in the Indenture and the Private Placement Legend are not required in order to maintain compliance with the Securities Act and (iv) the
beneficial interest in an Unrestricted Global Note is being acquired in compliance with any applicable blue sky securities laws of any state of the United States. 
 (b) [ ] CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO UNRESTRICTED DEFINITIVE NOTE. In connection with the Exchange of the Owner’s beneficial interest in a
Restricted Global Note for an Unrestricted Definitive Note, the Owner hereby certifies (i) the Definitive Note is being acquired for the Owner’s own account without transfer, (ii) such Exchange has been effected in compliance with the
transfer restrictions applicable to the Restricted Global Notes and pursuant to and in accordance with the Securities Act, (iii) the restrictions on 

  
 C-1









 
transfer contained in the Indenture and the Private Placement Legend are not required in order to maintain compliance with the Securities Act and (iv) the Definitive Note is being acquired
in compliance with any applicable blue sky securities laws of any state of the United States. 
 (c) [ ] CHECK IF EXCHANGE
IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN AN UNRESTRICTED GLOBAL NOTE. In connection with the Owner’s Exchange of a Restricted Definitive Note for a beneficial interest in an Unrestricted Global Note, the Owner hereby
certifies (i) the beneficial interest is being acquired for the Owner’s own account without transfer, (ii) such Exchange has been effected in compliance with the transfer restrictions applicable to Restricted Definitive Notes and
pursuant to and in accordance with the Securities Act, (iii) the restrictions on transfer contained in the Indenture and the Private Placement Legend are not required in order to maintain compliance with the Securities Act and (iv) the
beneficial interest is being acquired in compliance with any applicable blue sky securities laws of any state of the United States. 
 (d) [ ] CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO UNRESTRICTED DEFINITIVE NOTE. In connection with the Owner’s Exchange of a Restricted Definitive Note for an Unrestricted
Definitive Note, the Owner hereby certifies (i) the Unrestricted Definitive Note is being acquired for the Owner’s own account without transfer, (ii) such Exchange has been effected in compliance with the transfer restrictions
applicable to Restricted Definitive Notes and pursuant to and in accordance with the Securities Act, (iii) the restrictions on transfer contained in the Indenture and the Private Placement Legend are not required in order to maintain compliance
with the Securities Act and (iv) the Unrestricted Definitive Note is being acquired in compliance with any applicable blue sky securities laws of any state of the United States. 

2. EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES FOR RESTRICTED DEFINITIVE NOTES OR
BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES 
 (a) [ ] CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED
GLOBAL NOTE TO RESTRICTED DEFINITIVE NOTE. In connection with the Exchange of the Owner’s beneficial interest in a Restricted Global Note for a Restricted Definitive Note with an equal principal amount, the Owner hereby certifies that the
Restricted Definitive Note is being acquired for the Owner’s own account without transfer. Upon consummation of the proposed Exchange in accordance with the terms of the Indenture, the Restricted Definitive Note issued shall continue to be
subject to the restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted Definitive Note and in the Indenture and the Securities Act. 
 (b) [ ] CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE. In connection with the Exchange of the Owner’s Restricted Definitive Note for a
beneficial interest in the [CHECK ONE] “144A Global Note,” Regulation S Global Note with an equal principal amount, the Owner hereby certifies (i) the beneficial interest is being acquired for the Owner’s own account without
transfer and (ii) such Exchange has been effected in compliance with the transfer restrictions applicable to the Restricted Global Notes and pursuant to and in accordance with the Securities Act, and in compliance with any applicable blue sky
securities laws of any state of the United States. Upon consummation of the proposed Exchange in accordance with the terms of the Indenture, the beneficial interest issued shall be subject to the restrictions on transfer enumerated in the Private
Placement Legend printed on the relevant Restricted Global Note and in the Indenture and the Securities Act. 
 This certificate
and the statements contained herein are made for your benefit and the benefit of the Issuer. 

  
 C-2









 
	
	
	  
	[Insert Name of Transferor]


  

			
		
	By:	 	 
		 	Name:
		 	Title:



Dated:                      

  
 C-3









 EXHIBIT D 
 [FORM OF NOTATION OF SUBSIDIARY GUARANTEE] 
 For value received, each Guarantor
(which term includes any successor Person under the Indenture) has, jointly and severally, unconditionally guaranteed, to the extent set forth in, and subject to the provisions contained in, the Indenture dated as of April 3, 2012 (as amended,
supplemented or otherwise modified, the “Indenture”) by and between USPI Finance Corp., a Delaware corporation (the “Issuer”) and U.S. Bank National Association (the “Trustee”), the due and punctual payment of the
principal of, premium and Additional Interest, if any, and interest on, the Notes, whether at maturity, by acceleration, redemption or otherwise, the due and punctual payment of interest on overdue principal of and interest on the Notes, if any, if
lawful, and the due and punctual performance of all other Obligations of the Issuer to the Holders or the Trustee all in accordance with the terms of the Indenture and in case of any extension of time of payment or renewal of any Notes or any of
such other Obligations, that the same shall be promptly paid in full when due or performed in accordance with the terms of the extension or renewal, whether at stated maturity, by acceleration or otherwise. The obligations of the Guarantors to the
Holders and to the Trustee pursuant to the Subsidiary Guarantee and the Indenture are expressly set forth in Article 10 of the Indenture and reference is hereby made to the Indenture for the precise terms of the Subsidiary Guarantee. Each Holder of
a Note, by accepting the same, agrees to and shall be bound by such provisions, authorizes and directs the Trustee, on behalf of such Holder, to take such action as may be necessary or appropriate to effectuate the subordination as provided in the
Indenture and appoints the Trustee attorney-in-fact of such Holder for such purpose. 
 Capitalized terms used but not defined
herein have the meanings given to them in the Indenture. 
  

			
	[NAME OF GUARANTOR(S)]
		
	By:	 	 
		 	Name:
		 	Title:



  
 D-1









 EXHIBIT E 
 FORM OF SUPPLEMENTAL INDENTURE 
 TO BE DELIVERED BY SUBSEQUENT GUARANTORS

 SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of
            , 200            , among
            (the “Guaranteeing Subsidiary”), a subsidiary of [USPI Finance Corp.][United Surgical Partners International, Inc.], a Delaware corporation, the Issuer and U.S.
Bank National Association, as trustee under the Indenture referred to below (the “Trustee”). 
 WITNESSETH 

WHEREAS, the Issuer has heretofore executed and delivered to the Trustee an indenture (as amended, supplemented or otherwise modified,
the “Indenture”), dated as of April 3, 2012, providing for the issuance of 9.000% Senior Notes due 2020 (the “Notes”); 
 WHEREAS, the Indenture provides that under certain circumstances the Guaranteeing Subsidiary shall execute and deliver to the Trustee a supplemental indenture pursuant to which the Guaranteeing Subsidiary
shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on the terms and conditions set forth herein (the “Subsidiary Guarantee”); and 

WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is authorized to execute and deliver this Supplemental Indenture.

 NOW THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is
hereby acknowledged, the Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders as follows: 
 1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture. 
 2. AGREEMENT TO GUARANTEE. The Guaranteeing Subsidiary hereby agrees to provide an unconditional Guarantee on the terms and subject to the conditions set forth in the Subsidiary Guarantee and in this
Indenture including but not limited to Article 10 thereof. 
 3. NO RECOURSE AGAINST OTHERS. No director, officer, employee,
incorporator, stockholder or agent of the Guaranteeing Subsidiary, as such, shall have any liability for any obligations of the Issuer or any Guaranteeing Subsidiary under the Notes, any Subsidiary Guarantees, the Indenture or this Supplemental
Indenture or for any claim based on, in respect of, or by reason of, such obligations or their creation. Each Holder by accepting a Note waives and releases all such liability. The waiver and release are part of the consideration for issuance of the
Notes. Such waiver may not be effective to waive liabilities under the federal securities laws and it is the view of the SEC that such a waiver is against public policy. 
 4. NEW YORK LAW TO GOVERN. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 

  
 E-1









 5. COUNTERPARTS. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. 
 6. EFFECT OF HEADINGS. The
Section headings herein are for convenience only and shall not affect the construction hereof. 
 7. THE TRUSTEE. The Trustee
shall not be responsible in any manner whatsoever for or in respect of the validity or sufficiency of this Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Guaranteeing
Subsidiary and the Issuer. 

  
 E-2









 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly
executed and attested, all as of the date first above written. 
 Dated:
            , 20             

 

			
	[GUARANTEEING SUBSIDIARY]
		
	By:	 	 
		 	Name:
		 	Title:
	
	[USPI FINANCE CORP.][UNITED SURGICAL PARTNERS INTERNATIONAL, INC.]
		
	By:	 	 
		 	Name:
		 	Title:
	
	 U.S. BANK NATIONAL ASSOCIATION,
     as Trustee

		
	By:	 	 



  
 E-3









 EXHIBIT F 
 FORM OF SUPPLEMENTAL INDENTURE 
 TO BE DELIVERED ON THE EFFECTIVE DATE 

SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as
of                    , 2012, among United Surgical Partners International, Inc., a Delaware corporation (the “Company”),
each of the Guarantors listed on the signature pages hereto, (each a “Guaranteeing Subsidiary” and, collectively, the “Guaranteeing Subsidiaries”), and U.S. Bank National Association, as trustee (the
“Trustee”). 
 WITNESSETH 
 WHEREAS, USPI Finance Corp. (“USPI Finance”) and the Trustee entered into that certain Indenture, dated as of
                    , 2012 (the “Indenture”), related to the 9.000% Senior Notes of USPI Finance due 2020 in original
principal amount of $440,000,000 (the “Securities”); 
 WHEREAS, each Guaranteeing Subsidiary is to become a
Guarantor under the Indenture and shall unconditionally guarantee all of the Issuer’s Obligations under the Notes and the Indenture on terms and conditions set forth herein; 

WHEREAS, on the date hereof, USPI Finance is merging with and into the Company, with the Company being the surviving Person of such
merger (the “Merger”); and 
 WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is
authorized to execute and deliver this Supplemental Indenture. 
 NOW THEREFORE, in consideration of the foregoing and for other
good and valuable consideration, the receipt of which is hereby acknowledged, each Guaranteeing Subsidiary and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders as follows: 

1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the meanings assigned to them in the Indenture.

 2. AGREEMENT TO GUARANTEE. Effective upon consummation of the Merger, each Guaranteeing Subsidiary shall be a Guarantor under
the Indenture and be bound by the terms thereof applicable to Guarantors, including, but not limited to, Article 10 thereof. 

3. ASSUMPTION OF OBLIGATIONS. Effective upon consummation of the Merger, the Company, pursuant to Section 5.01 of the Indenture,
expressly assumes all of the Obligations of USPI Finance under the Indenture and the Securities. 
 4. EFFECT OF SUPPLEMENTAL
INDENTURE. This Supplemental Indenture is an amendment supplement to the Indenture, and the Indenture and this Supplemental Indenture will henceforth be read together. 
 5. NEW YORK LAW TO GOVERN. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 

  
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 6. COUNTERPARTS. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement. 
 7. EFFECT OF HEADINGS. The
Section headings herein are for convenience only and shall not affect the construction hereof. 
 8. THE TRUSTEE. The Trustee
shall not be responsible in any manner whatsoever for or in respect of the validity or sufficiency of this Supplemental Indenture or for or in respect of the recitals contained herein, all of which recitals are made solely by the Guaranteeing
Subsidiary and the Issuer 

  
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 IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly
executed and attested, all as of the date first above written. 
  

			
	UNITED SURGICAL PARTNERS INTERNATIONAL, INC.
		
	By:	 	 
		 	Name:
		 	Title:
	
	[GUARANTEEING SUBSIDIARIES]
		
	By:	 	 
		 	Name:
		 	Title:


 [Signature page to Supplemental Indenture] 







 
			
	 U.S. BANK NATIONAL ASSOCIATION,
     as Trustee

		
	By:	 	 
		 	


 [Signature page to Supplemental Indenture]