**Exhibit 10.6**

**K-V PHARMACEUTICAL COMPANY**

**SECOND AMENDED AND RESTATED REGISTRATIONRIGHTS AGREEMENT**

**March 2, 2011**

**TABLE OF CONTENTS**

Page 

 
Section 1.  Definitions   1  Section 2.  Initial Shelf Registration; Liquidated Damages   5  Section 3.  Registrations   9  Section 4.  Piggyback Registrations   11  Section 5.  Registration Procedures   12  Section 6.  Registration Expenses   16  Section 7.  Indemnification and Contribution   17  Section 8.  Underwritten Registrations; Suspended Distributions   19  Section 9.  Current Public Information   20  Section 10.  Subsidiary Public Offering   21  Section 11.  Lock-up   21  Section 12.  General Provisions   21  
 
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**K-V PHARMACEUTICAL COMPANY**

**SECOND AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT**

THIS SECOND AMENDED AND RESTATED REGISTRATION RIGHTS AGREEMENT (this “Agreement”) is made as of March 2, 2011, byand among K-V Pharmaceutical Company, a Delaware corporation (the “Company”), U.S. Healthcare I, L.L.C. (“U.S. Healthcare I”) and U.S. Healthcare II, L.L.C., (“U.S. Healthcare II”, and together withU.S. Healthcare I and their registered assigns collectively referred to herein as the “USH Investor”), and hereby amends and replaces in its entirety that certain Amended and Restated Registration Rights Agreement (the“Amended and Restated Registration Rights Agreement”), dated as of February 10, 2011, by and among the Company, U.S. Healthcare I and U.S. Healthcare II. Except as otherwise specified herein, all capitalized terms used in thisAgreement are defined in Section 1. 

The Company and the USH Investor are parties to that certain (i) StockWarrant Purchase Agreement, dated as of November 17, 2010 (the “Purchase Agreement”), and (ii) Stock Warrant Purchase Agreement (Third Warrants), dated as of the date hereof (the “Additional PurchaseAgreement”, and together with the Original Purchase Agreement, the “Purchase Agreements”), pursuant to which the USH Investor purchased warrants to purchase shares of Class A Common Stock from the Company(collectively, the “Warrants”). In order to induce the USH Investor to enter into the Purchase Agreements, the Company has agreed to provide the registration rights set forth in this Agreement. The execution and delivery of thisAgreement is a condition to the consummation of the transactions under the Purchase Agreements. 

The Company is party to aRegistration Rights Agreement dated as of February 14, 2011 (the “PIPE Registration Rights Agreement”), by and among the Company and the investors listed on the “Schedule of Investors” attached thereto (each a“PIPE Investor” and collectively, the “PIPE Investors”). Pursuant to the PIPE Registration Rights Agreement, the Company has agreed, among other things, to register under the Securities Act an aggregate of 9,950,000shares of the Class A Common Stock of the Company issued to the PIPE Investors (the “PIPE Securities”). 

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt andsufficiency of which are hereby acknowledged, the parties to this Agreement hereby agree as follows: 

Section 1.Definitions. Unless otherwise set forth below or elsewhere in this Agreement, other capitalized terms contained herein have the meanings set forth in the Purchase Agreements. 

“Affiliate” of any Person means any other Person controlled by, controlling or under common control with such Person;provided that the Company and its Subsidiaries shall not be deemed to be Affiliates of any holder of Registrable Securities. As used in this definition, “control” (including, with its correlative meanings, “controlling,”“controlled by” and “under common control with”) shall mean possession, directly or indirectly, of power to direct or cause the direction of management or policies (whether through ownership of securities, by contract orotherwise). With respect to any Person who is an individual, “Affiliates” shall also include, without limitation, any member of such individual’s Family Group. 

“Agreement” has the meaning set forth in the recitals. 

“Allowable Grace Period” has the meaning set forth in Section 2(c). 

“Amended and Restated Registration Rights Agreement” has the meaning set forth in the recitals. 

“Capital Stock” means (i) with respect to any Person that is a corporation, any and all shares, interests orequivalents in capital stock of such corporation (whether voting or nonvoting and whether common or preferred) and (ii) with respect to any Person that is not a corporation, individual or governmental entity, any and all partnership,membership, limited liability company or other equity interests of such Person that confer on the holder thereof the right to receive a share of the profits and losses of, or the distribution of assets of, the issuing Person, including in each caseany and all warrants (other than the Warrants), rights (including conversion and exchange rights) and options to purchase any of the foregoing. 

“Common Stock” means the Company’s Class A common stock, par value $0.01 per share. 

“Company” has the meaning set forth in the preamble. 

“Cut Back Shares” has the meaning set forth in Section 2(a)(i). 

“Demand Registrations” has the meaning set forth in Section 3(a). 

“Disclosure Date” has the meaning set forth in Section 2(d)(i). 

“Effectiveness Period” has the meaning set forth in Section 2(a)(i). 

“Event” has the meaning set forth in Section 2(b). 

“Event Date” has the meaning set forth in Section 2(b). 

“Exchange Act” means the Securities Exchange Act of 1934, as amended from time to time, or any successor federal lawthen in force, together with all rules and regulations promulgated thereunder. 

“Family Group” means, withrespect to a Person who is an individual, (i) such individual’s spouse and descendants (whether natural or adopted) (collectively, for purposes of this definition, “relatives”), (ii) such individual’s executor orpersonal representative, (iii) any trust, the trustee of which is such individual or such individual’s executor or personal representative and which at all times is and remains solely for the benefit of such individual and/or suchindividual’s relatives, (iv) any corporation, limited partnership, limited liability company or other tax flow-through entity the governing instruments of which provide that such individual or such individual’s executor or personalrepresentative shall have the exclusive, 

 
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nontransferable power to direct the management and policies of such entity and of which the sole owners of stock, partnership interests, membership interests or any other equity interests arelimited to such individual, such individual’s relatives and/or the trusts described in clause (iii) above, and (v) any retirement plan for such individual or such individual’s relatives. 

“Filing Deadline” has the meaning set forth in Section 2(a)(i). 

“FINRA” means the Financial Industry Regulatory Authority. 

“Grace Period” has the meaning set forth in Section 2(c). 

“Indemnified Parties” has the meaning set forth in Section 7(a). 

“Initial Shelf Registration” has the meaning set forth in Section 2(a)(i). 

“Issuer Free-Writing Prospectus” means an issuer free-writing prospectus as defined in Rule 433 under the SecuritiesAct. 

“Long-Form Registrations” has the meaning set forth in Section 3(a). 

“Person” means an individual, a partnership, a corporation, a limited liability company, an association, a joint stockcompany, a trust, a joint venture, an unincorporated organization and a governmental entity or any department, agency or political subdivision thereof. 

“Piggyback Registrations” has the meaning set forth in Section 4(a). 

“PIPE Investor” and “PIPE Investors” has the meaning set forth in the recitals. 

“PIPE Registration Rights Agreement” has the meaning set forth in the recitals. 

“PIPE Securities” has the meaning set forth in the recitals. 

“Public Offering” means any sale or distribution by the Company and/or holders of Registrable Securities to the publicof Common Stock of the Company pursuant to an offering registered under the Securities Act. 

“PurchaseAgreements” has the meaning set forth in the recitals. 

“Registrable Securities” means(i) any Common Stock issued pursuant to the exercise of the Warrants or distributed (directly or indirectly) to the USH Investor or any of their respective Affiliates, and (ii) any Capital Stock of the Company or any Subsidiary of theCompany issued or issuable with respect to the securities referred to in clause (i) above by way of dividend, distribution, split or combination of securities, or any recapitalization, merger, consolidation or other reorganization. As toany particular Registrable Securities, such securities shall cease to be Registrable Securities when they have been (a) sold or distributed pursuant to a Public Offering, (b) disposed of pursuant to Rule 144 or when all of the RegistrableSecurities owned by the USH Investor and its Affiliates may be disposed of pursuant to Rule 144(b)(1) 

 
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without compliance with the current public information requirements of such rule, or subject to any volume, manner of sale or timing restrictions or conditions, or (c) repurchased by theCompany or a Subsidiary of the Company. For purposes of this Agreement, a Person shall be deemed to be a holder of Registrable Securities, and the Registrable Securities shall be deemed to be in existence, whenever such Person has the right toacquire, directly or indirectly, such Registrable Securities (upon conversion or exercise in connection with a transfer of securities or otherwise, but disregarding any restrictions or limitations upon the exercise of such right), whether or notsuch acquisition has actually been effected, and such Person shall be entitled to exercise the rights of a holder of Registrable Securities hereunder. 

“Registration Deadline” has the meaning set forth in Section 2(b)(ii). 

“Registration Expenses” has the meaning set forth in Section 6(a). 

“Registration Statement” has the meaning set forth in Section 4(a). 

“Restriction Termination Date” has the meaning set forth in Section 2(a)(ii). 

“Rule 144”, “Rule 158”, “Rule 405”, “Rule 415” and “Rule 462” mean, in each case, such rule promulgated under theSecurities Act (or any successor provision) by the SEC, as the same shall be amended from time to time, or any successor rule then in force. 

“SEC” means the United States Securities and Exchange Commission. 

“SEC Restrictions” has the meaning set forth in Section 2(a)(ii). 

“Securities Act” means the Securities Act of 1933, as amended from time to time, or any successor federal law then inforce, together with all rules and regulations promulgated thereunder. 

“Shelf Registration” has the meaningset forth in Section 3(c). 

“Short-Form Registrations” has the meaning set forth inSection 3(a). 

“Subsidiary” means, with respect to the Company, any corporation, limitedliability company, partnership, association or other business entity of which (i) if a corporation, a majority of the total voting power of shares of stock entitled (without regard to the occurrence of any contingency) to vote in the electionof directors, managers or trustees thereof is at the time owned or controlled, directly or indirectly, by the Company or one or more of the other Subsidiaries of the Company or a combination thereof, or (ii) if a limited liability company,partnership, association or other business entity, a majority of the limited liability company, partnership or other similar ownership interest thereof is at the time owned or controlled, directly or indirectly, by the Company or one or moreSubsidiaries of the Company or a combination thereof. For purposes hereof, a Person or Persons shall be deemed to have a majority ownership interest in a limited liability company, partnership, association or other business entity if such Person orPersons shall be allocated a majority of limited liability company, partnership, association or other business entity gains or losses or shall be or control the managing director or general partner of such limited liability company, partnership,association or other business entity. 

 
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“Violation” has the meaning set forth in Section 7(a).

“Warrants” has the meaning set forth in the recitals. 

“WKSI” means a “well-known seasoned issuer” as defined under Rule 405. 

“USH Investor” has the meaning set forth in the recitals. 

Section 2.Initial Shelf Registration; Liquidated Damages.

(a) Initial Shelf Registration. 

(i) Subject to the terms and conditions of this Agreement, the Company agrees to use its best efforts to prepare and file with the SEC, as soon as reasonably practicable, but in no event later thanJune 15, 2011 (the “Filing Deadline”), a registration statement (together with the prospectus, amendments and supplements to such registration statement or prospectus, including pre- and post-effective amendments, all exhibitsthereto, and all material incorporated by reference or deemed to be incorporated by reference in such registration statement, the “Initial Shelf Registration”) covering the resale of all of the Registrable Securities that are ownedby the USH Investor or its Affiliates for an offering to be made on a continuous basis; provided, however, that the USH Investor shall not be named as an “underwriter” in the Initial Shelf Registration without the USHInvestor’s prior written consent. Subject to the terms of this Agreement, the Company shall use its best efforts to cause such Initial Shelf Registration to be declared effective under the Securities Act as promptly as possible after the filingthereof, but in any event prior to July 31, 2011, and shall use its best efforts to keep such Initial Shelf Registration continuously effective under the Securities Act during the period (the “Effectiveness Period”) ending onthe earlier of (i) the date on which all Registrable Securities included in such registration have been sold or distributed pursuant to the Initial Shelf Registration, or (ii) the date as of which no Registrable Securities are outstanding.The Initial Shelf Registration Statement may be used by the USH Investor and/or Affiliates from time to time to complete one or more underwritten offerings as contemplated by this Agreement. 

(ii) If at any time the SEC takes the position that the offering of some or all of the Registrable Securities in a InitialShelf Registration is not eligible to be made on a delayed or continuous basis under the provisions of Rule 415 under the Securities Act or requires the USH Investor to be named as an “underwriter”, the Company shall use its best effortsto persuade the SEC that the offering contemplated by the Initial Shelf Registration is a valid secondary offering and not an offering “by or on behalf of the issuer” as defined in Rule 415 and that the USH Investor is not an“underwriter”. The USH Investor shall have the right to participate or have their counsel participate in any meetings or discussions with the SEC regarding the SEC’s position and to comment or have their counsel comment on any writtensubmission made to the SEC with respect thereto. No such written submission shall be made to the SEC to which the USH 

 
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Investor’s counsel reasonably objects. In the event that, despite the Company’s best efforts and compliance with the terms of this Section 2(a)(ii), the SEC refuses to alter itsposition, the Company shall (i) remove from the Initial Shelf Registration such portion of the Registrable Securities (the “Cut Back Shares”) and/or (ii) agree to such restrictions and limitations on the registration andresale of the Registrable Securities as the SEC may require to assure the Company’s compliance with the requirements of Rule 415 (collectively, the “SEC Restrictions”); provided, however, that the Company shallnot agree to name the USH Investor as an “underwriter” in such Initial Shelf Registration without the prior written consent of the USH Investor. The Company shall use it best efforts to allocate any cut-back imposed on the USH Investorpursuant to this Section 2(a)(ii) among the USH Investor and the PIPE Investors on a pro rata basis. No liquidated damages under Section 2(b) shall accrue as to any Cut Back Shares until such date as the Company is able to effect theregistration of such Cut Back Shares in accordance with any SEC Restrictions (such date, the “Restriction Termination Date” of such Cut Back Shares). From and after the Restriction Termination Date applicable to any Cut Back Shares,all of the provisions of this Section 2(a) (including the liquidated damages provisions) shall again be applicable to such Cut Back Shares; provided, however, that (i) the filing deadline for the Initial Shelf Registrationincluding such Cut Back Shares shall be the later of June 15, 2011 and ten (10) Business Days after such Restriction Termination Date, and (ii) the date by which the Company is required to obtain effectiveness with respect to such CutBack Shares under Section 2(b) shall be the later of July 15, 2011 (or within 16 days thereafter, to the extent such extension is required a result of the SEC processing responses to SEC comments made regarding the filed RegistrationStatement) and the 90th day immediately after the Restriction Termination Date. 

(b) Liquidated Damages. If:(i) the Initial Shelf Registration is not filed on or prior to Filing Deadline, (ii) the Company fails to have the Initial Shelf Registration declared effective under the Securities Act prior to July 31, 2011 (the“Registration Deadline”), or (iii) after a Initial Shelf Registration is declared effective, such Initial Shelf Registration ceases for any reason to remain continuously effective as to all Registrable Securities included insuch Initial Shelf Registration, or the holders of such Registrable Securities are otherwise not permitted to utilize the prospectus therein to resell such Registrable Securities (other than during an Allowable Grace Period (as defined below)), or(iv) a Grace Period (as defined below) exceeds the Allowable Grace Period (any such failure or breach being referred to as an “Event,” and for purposes of clause (i) and (ii), the date on which such Event occurs, or forpurposes of clause (iii) the date on which such Initial Shelf Registration ceases to be effective, or the holders of such Registrable Securities are otherwise not permitted to utilize the prospectus therein to resell such Registrable Securities(other than during an Allowable Grace Period), or for purposes of clause (iv) the date on which the Allowable Grace Period is exceeded, being referred to as “Event Date”), then, in addition to any other rights the holders ofsuch Registrable Securities may have hereunder or under applicable law, on each such Event Date and on each monthly anniversary of each such Event Date (for the avoidance of doubt, if an Event is cured prior to a monthly anniversary of an EventDate, the Company shall be responsible for paying to the holders of Registrable Securities their pro rata portion of the liquidated damages for that portion of the monthly anniversary period during which such Event is not cured) until the applicableEvent is cured, the Company shall pay to each holder of Registrable Securities their pro rata 

 
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portion of $900,000 in cash, for any month when the Event remains uncured, as partial liquidated damages and not as a penalty. Notwithstanding the foregoing, (A) no liquidated damages shallaccrue after the date as of which all of the Registrable Securities included in such registration are able to be sold by the USH Investor and its Affiliates and all other holders of Registrable Securities pursuant to Rule 144(b)(1) withoutcompliance with the current public information requirements of such rule, and (B) no liquidated damages shall accrue during any period during which the Company has advised the holders of Registrable Securities to suspend the use of anyprospectus, provided such period does not exceed the Allowable Grace Period. If the Company fails to pay any partial liquidated damages pursuant to this Section in full within seven calendar days after the date payable, the Company will pay interestthereon at a rate of 12% per annum (or such lesser maximum amount that is permitted to be paid by applicable law) to the holders, accruing daily from the date such partial liquidated damages are due until such amounts, plus all such interestthereon, are paid in full. The partial liquidated damages pursuant to the terms hereof shall apply on a daily pro rata basis for any portion of a month prior to the cure of an Event. Notwithstanding the foregoing, an “Event” shall notinclude a Initial Shelf Registration not remaining effective if the Company has advised the holders of Registrable Securities to suspend the use of any prospectus pursuant to Section 2(c), provided such period does not exceed theAllowable Grace Period. In addition, an “Event” with respect to the USH Investor shall not include an Event that occurs as a result of a Initial Shelf Registration not being filed, not being declared effective, or not remaining effectiveas a result of the USH Investor failing to timely provide the Company with information requested by the Company and necessary to complete the Initial Shelf Registration in accordance with the requirements of the Securities Act, and then theliquidated damages shall not be accrued or payable to the USH Investor who has not provided such information. 

(c) GracePeriods. Notwithstanding anything to the contrary herein, at any time after any Registration Statement (as defined below) has been declared effective by the SEC, the Company may delay the disclosure of material non-public information concerningthe Company if the disclosure of such information at the time is not, in the good faith judgment of the Company, in the best interests of the Company (a “Grace Period”); provided, however, the Company shall promptly(i) notify the holders of Registrable Securities in writing (including via facsimile or other electronic transmission) of the existence of material non-public information giving rise to a Grace Period (provided that the Company shall notdisclose the content of such material non-public information to the holders) or the need to file a supplement or post-effective amendment, as applicable, and the date on which such Grace Period will begin, and (ii) notify the holders ofRegistrable Securities in writing (including via facsimile or other electronic transmission) of the date on which the Grace Period ends; provided, further, that no single Grace Period shall exceed thirty (30) consecutive days, and during anythree hundred sixty-five (365) day period, the aggregate of all Grace Periods shall not exceed an aggregate of sixty (60) days (each Grace Period complying with this provision being an “Allowable Grace Period”). Forpurposes of determining the length of a Grace Period, the Grace Period shall be deemed to begin on and include the date the holders receive the notice referred to in clause (i) above and shall end on and include the later of the date theholders receive the notice referred to in clause (ii) above and the date referred to in such notice; provided, however, that no Grace Period shall be longer than an Allowable Grace Period. 

 
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(d) Public Disclosure. The Company shall, and shall provide the USH Investor with awritten confirmation of the same, upon (x) the earliest to occur of (i) the announcement of the closing of the proposed $200 million senior secured note offering announced by the Company on a press release dated March 1, 2011 (the“Note Offering”), which announcement must be made no later than one Business Day after the closing of the Note Offering, (ii) the termination or abandonment of the Note Offering, (iii) the refinancing of the Credit andGuaranty Agreement, dated November 17, 2010, as amended by that certain Amended and Restated Amendment No. 1 to Credit Agreement dated as of January 6, 2011 and as amended by that certain Amendment No. 2 to Credit Agreement datedas of March 2, 2011, by and among the Company, certain of the Company’s subsidiaries, U.S. Healthcare I and U.S. Healthcare II and (iv) March 31, 2011 (the “First Disclosure Date”), (y) the earlier of(i) the Registration Deadline or (ii) the time the Initial Registration Statement is declared effective by the SEC as contemplated by Section 2(a)(i) of this Agreement (the “Second Disclosure Date”) and (z) anytime following the First Disclosure Date and for so long as the USH Investor or any of its Affiliates continues to own any Warrants, within three Business Days of being requested by the USH Investor (a “Subsequent Disclosure Date”,and each of the First Disclosure Date, the Second Disclosure Date and a Subsequent Disclosure Date, a “Disclosure Date”), publicly disclose in a Current Report on Form 8-K or such other periodic report required or permitted to befiled under the Exchange Act with the SEC all of the previously publicly undisclosed confidential information provided to the USH Investor or its Affiliates by the Company that in the Company’s reasonable judgment, after consultation with itsoutside counsel, constitutes material non-public information (such disclosure made on the First Disclosure Date, the “First Disclosure”, such disclosure made on the Second Disclosure Date, the “Second Disclosure”and such disclosure made on a Subsequent Disclosure Date, a “Subsequent Disclosure”, and each of the First Disclosure, the Second Disclosure and a Subsequent Disclosure, a “Disclosure”). Any such request for aSubsequent Disclosure by the USH Investor shall be in writing and shall contain a representation by the USH Investor that it has a good faith belief that such disclosure is required in order for the USH Investor to engage in any type of transactionthat relates, directly or indirectly, to the Company’s Capital Stock, or other securities related thereto, when such three Business Day period expires. The Company shall provide the USH Investor with a copy of each Disclosure at least twoBusiness Days prior to its release. If the USH Investor has not delivered a Potential Supplemental Disclosure Notice (as defined below) with respect to a Disclosure prior to its release, the USH Investor shall not have the right to make a USHInvestor Disclosure (as defined below) with respect to such Disclosure. If the USH Investor believes the Company may have failed to make a Disclosure on or before the applicable Disclosure Date, fails to include in any Disclosure, or draftDisclosure provided to the USH Investor prior to its release, all of the material non-public information previously provided to the USH Investor, the USH Investor may provide the Company with a written notice setting forth the material non-publicinformation which the Company has failed to disclose or include in such draft disclosure (a “Potential Supplemental Disclosure Notice”). The Company may, within two Business Days of receiving a Potential Supplemental DisclosureNotice, provide the USH Investor with a written certification that, based on the reasonable advice of its outside counsel, the Company has determined that all or part of the information specified in the Potential Supplemental Disclosure Notice isnot material and therefore the USH Investor is not in possession of material non-public information received from the Company. The Company shall be obligated to publicly disclose all of the information in the Potential Supplemental Disclosure Noticewhich it has failed to so certify is 

 
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not material (the “Supplemental Material Information”). If the Company fails to publicly disclose the Supplemental Material Information on or before the later of (i) theapplicable Disclosure Date and (ii) two Business Days after receiving the Potential Supplemental Disclosure Notice, then, without limitation on any other rights available to the USH Investor, the Company agrees that the USH Investor isauthorized to make the Supplemental Material Information or any portion thereof available to the public generally (a “USH Investor Disclosure”). The USH Investor shall not have any liability to the Company, its subsidiaries, or anyof its or their respective officers, directors, employees, stockholders or agents for any such disclosure. Notwithstanding the foregoing, solely after the First Disclosure Date, no disclosure of confidential information by the Company contemplatedby this Section 2(d) shall be required (i) during a Grace Period or (ii) if the USH Investor has accepted material non-public information for review after the First Disclosure Date in accordance with clause (i) of the lastparagraph of Section 9(a), if such disclosure would cause the Company to breach any material confidentiality obligation or the terms of any other material contract or agreement of the Company; provided, however, that the Company shall usecommercially reasonable efforts to amend or eliminate such confidentially obligations or contract or agreement terms that prevent such disclosure. 

(e) Lock Up Agreement. During the period commencing on the date of this Agreement and continuing until the time the Initial Registration Statement is declared effective by the SEC as contemplatedpursuant to Section 2(a)(i) of this Agreement, the Company shall not: (i) offer, pledge, sell, contract to sell, sell any option or contract to purchase, purchase any option or contract to sell, grant any option, right or warrant topurchase, lend, or otherwise transfer or dispose of, directly or indirectly, any shares of Common Stock or any securities convertible into or exercisable or exchangeable for Common Stock, (ii) enter into any swap or other arrangement thattransfers to another, in whole or in part, any of the economic consequences of ownership of the Common Stock, whether any such transaction described in clause (i) or (ii) above is to be settled by delivery of Common Stock or such othersecurities, in cash or otherwise or (iii) permit any registration statement filed with the SEC relating to the offering of the PIPE Securities or any shares of Common Stock or any securities convertible into or exercisable or exchangeable forCommon Stock held by the PIPE Investors (or any of their transferees) to be declared effective by the SEC. Notwithstanding the foregoing, clauses (i) and (ii) of the immediately preceding sentence shall not apply to any Excluded Shares (asdefined in the Warrants). 

Section 3.Registrations. 

(a) Requests for Registration. Subject to the terms and conditions of this Agreement, at any time, the holders of 25% or more ofthe Registrable Securities may request registration under the Securities Act of all or any portion of their Registrable Securities on Form S-1 or any similar long-form registration (“Long-Form Registrations”), and the holders of 5%or more of the Registrable Securities may request registration under the Securities Act of all or any portion of their Registrable Securities on Form S-3 (including pursuant to Rule 415) or any similar short-form registration(“Short-Form Registrations”) if available. All registrations requested pursuant to this Section 3(a) are referred to herein as “Demand Registrations”. Each request for a Demand Registration shall specify theapproximate number of Registrable Securities requested to be registered and the intended method of distribution. Within ten days 

 
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after the filing of the registration statement relating to the Demand Registration, the Company shall give written notice of the Demand Registration to all other holders of Registrable Securitiesand, subject to the terms of Section 2(d), shall include in such Demand Registration (and in all related registrations and qualifications under state blue sky laws and in any related underwriting) all Registrable Securities with respect towhich the Company has received written requests for inclusion therein within 15 days after the receipt of the Company’s notice. 

(b) Long-Form Registrations. The holders of Registrable Securities shall be entitled to request up to three Long-Form Registrations in which the Company shall pay all Registration Expenses (asdefined in Section 6(a)), whether or not any such registration is consummated. 

(c) Short-Form Registrations. Inaddition to the Long-Form Registrations provided pursuant to Section 3(b), the holders of Registrable Securities shall be entitled to request an unlimited number of Short-Form Registrations in which the Company shall pay all RegistrationExpenses. Demand Registrations shall be Short-Form Registrations whenever the Company is permitted to use any applicable short form and if the managing underwriters (if any) agree to the use of a Short-Form Registration. The Company shall makeShort-Form Registrations available for the sale of Registrable Securities. If the holders of the Registrable Securities request that a Short-Form Registration be filed pursuant to Rule 415 (a “Shelf Registration”), the Company shalluse best efforts to cause the Shelf Registration to be declared effective under the Securities Act as soon as practicable after filing, and once effective, the Company shall use best efforts to cause the Shelf Registration to remain effective for aperiod ending on the earlier of (i) the date on which all Registrable Securities included in such registration have been sold or distributed pursuant to the Shelf Registration or (ii) the date as of which all of the Registrable Securitiesincluded in such registration are able to be sold within a 90-day period in compliance with Rule 144. If for any reason the Company ceases to be a WKSI or becomes ineligible to utilize Form S-3, the Company shall prepare and file with the SEC aregistration statement or registration statements on such form that is available for the sale of Registrable Securities. 

(d)Priority on Registration Statements. The Company shall not include in any Registration Statement filed pursuant Section 2 or this Section 3 any securities which are not Registrable Securities without the prior written consent of amajority of the holders of the Registrable Securities. If a Registration Statement is an underwritten offering and the managing underwriters advise the Company in writing that in their opinion the number of Registrable Securities and, if permittedhereunder, other securities requested to be included in such offering exceeds the number of Registrable Securities and other securities, if any, which can be sold therein without adversely affecting the marketability, proposed offering price, timingor method of distribution of the offering, the Company shall include in such registration prior to the inclusion of any securities which are not Registrable Securities the number of Registrable Securities requested to be included which, in theopinion of such underwriters, can be sold, without any such adverse effect, pro rata among the respective holders thereof on the basis of the amount of Registrable Securities owned by each such holder. 

(e) Selection of Underwriters. The holders of a majority of the Registrable Securities included in an underwritten offering shallhave the right to select the investment banker(s) and manager(s) to administer the offering and the Company shall pay all reasonable expenses in connection therewith. 

 
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(f) Other Registration Rights. The parties to this Agreement acknowledge that theCompany is party to a Settlement Agreement, dated as of November 15, 2010 (the “Settlement Agreement”), by among the Company, The Office of Inspector General of the United States Department of Health and Human Services, SarahWeltscheff and Marc Hermelin. Pursuant to the Settlement Agreement, the Company has agreed, among other things, to register under the Securities Act certain shares of the Class A Common Stock and Class B Common Stock of the Company beneficiallyowned by Ms. Weltscheff and Mr. Hermelin. The parties acknowledge and agree that the Company shall be entitled to register such shares pursuant to a registration statement filed under the Securities Act and take such other actionsnecessary to fulfill its obligations under the Settlement Agreement. During any period in which any amount remains unpaid under that certain Credit and Guaranty Agreement, dated as of November 17, 2010, by and among the Company, as borrower andcertain of its subsidiaries, as guarantors, the lenders party thereto from time to time and U.S. Healthcare I, as administrative agent and collateral agent (as amended, supplemented or otherwise modified from time to time, the “CreditAgreement”), the Company shall not grant to any Persons the right to request the Company or any Subsidiary to register any Class A Common Stock or Class B Common Stock of the Company, or any securities convertible or exchangeable intoor exercisable for such securities, without the prior written consent of a majority of the holders of the Registrable Securities, except in respect of the Settlement Agreement. Following the repayment of all amounts under the Credit Agreement, theCompany shall not grant to any Persons the right to request the Company or any Subsidiary to register any Class A Common Stock or Class B Common Stock of the Company, or any securities convertible or exchangeable into or exercisable for suchsecurities, that are superior to or materially interfere with the intended plan of distribution of the holders of the Registrable Securities, except in respect of the Settlement Agreement. Furthermore, the Company shall cause the RegistrableSecurities to be registered under the Securities Act no later than the date of registration of the shares of the Class A Common Stock and Class B Common Stock of the Company to be registered in accordance with the Settlement Agreement.

Section 4. Piggyback Registrations. 

(a) Right to Piggyback. Whenever the Company proposes to register any of its securities under the Securities Act (other than (i) pursuant to a Demand Registration or (ii) in connectionwith registrations on Form S-4 or S-8 promulgated by the SEC or any successor or similar forms) and the registration form to be used may be used for the registration of Registrable Securities (a “Piggyback Registration”, andtogether with the Initial Shelf Registration, the Demand Registration, the Shelf Registration, and any other registration of the Company’s securities under the Securities Act contemplated hereunder, each a “RegistrationStatement” ), the Company shall give prompt written notice to all holders of Registrable Securities of its intention to effect such Piggyback Registration and, subject to the terms of Section 4(c) and Section 4(d), shall includein such Piggyback Registration (and in all related registrations or qualifications under blue sky laws and in any related underwriting) all Registrable Securities with respect to which the Company has received written requests for inclusion thereinwithin 20 days after delivery of the Company’s notice. 

 
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(b) Piggyback Expenses. The Registration Expenses of the holders of RegistrableSecurities shall be paid by the Company in all Piggyback Registrations, whether or not any such registration became effective. 

(c) Priority on Primary Registrations. If a Piggyback Registration is an underwritten primary registration on behalf of theCompany, and the managing underwriters advise the Company in writing that in their opinion the number of securities requested to be included in such registration exceeds the number which can be sold in such offering without adversely affecting themarketability, proposed offering price, timing or method of distribution of the offering, the Company shall include in such registration (i) first, the securities the Company proposes to sell, (ii) second, the Registrable Securitiesrequested to be included in such registration which, in the opinion of the underwriters, can be sold without any such adverse effect, pro rata among the holders of such Registrable Securities on the basis of the number of shares owned by each suchholder, and (iii) third, other securities requested to be included in such registration which, in the opinion of the underwriters, can be sold without any such adverse effect. 

(d) Priority on Secondary Registrations. If a Piggyback Registration is an underwritten secondary registration on behalf ofholders of the Company’s securities, and the managing underwriters advise the Company in writing that in their opinion the number of securities requested to be included in such registration exceeds the number which can be sold in such offeringwithout adversely affecting the marketability, proposed offering price, timing or method of distribution of the offering, the Company shall include in such registration (i) first, the securities requested to be included therein by the holdersrequesting such registration and the Registrable Securities requested to be included in such registration which, in the opinion of the underwriters, can be sold without any such adverse effect, pro rata among the holders of such securities on thebasis of the number of securities owned by each such holder, and (ii) second, securities proposed to be included by the Company, and (iii) third, other securities requested to be included in such registration which, in the opinion of theunderwriters, can be sold without any such adverse effect. 

Section 5.Registration Procedures. 

(a) Whenever the holders of Registrable Securities have requested that any Registrable Securities be registered pursuantto this Agreement, the Company shall effect the registration and the sale of such Registrable Securities in accordance with the intended method of disposition thereof, and pursuant thereto the Company shall as promptly as reasonably practicable:

(i) in accordance with the Securities Act and all applicable rules and regulations promulgated thereunder,prepare and file with the SEC a registration statement, and all amendments and supplements thereto and related prospectuses, with respect to such Registrable Securities and use best efforts to cause such registration statement to become effective(provided that before filing a registration statement or prospectus or any amendments or supplements thereto, the Company shall furnish to the counsel selected by the holders of the Registrable Securities covered by such registration statementcopies of all such documents proposed to be filed); 

 
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(ii) notify each holder of Registrable Securities of (A) the issuanceby the SEC of any stop order suspending the effectiveness of any registration statement or the initiation of any proceedings for that purpose, (B) the receipt by the Company or its counsel of any notification with respect to the suspension ofthe qualification of the Registrable Securities for sale in any jurisdiction or the initiation or threatening of any proceeding for such purpose, and (C) the effectiveness of each registration statement filed hereunder; 

(iii) prepare and file with the SEC such amendments and supplements to such registration statement and the prospectus usedin connection therewith as may be necessary to keep such registration statement effective for a period ending the earlier of (i) the Effectiveness Period, (ii) when all of the securities covered by such registration statement have beendisposed of in accordance with the intended methods of distribution by the sellers thereof set forth in such registration statement, and (iii) such date as when all Registrable Securities covered by the registration statement have been disposedof or may be disposed of without volume or timing restrictions pursuant to Rule 144 (but not in any event before the expiration of any longer period required under the Securities Act or, if such registration statement relates to an underwrittenPublic Offering, such longer period as in the opinion of counsel for the underwriters a prospectus is required by law to be delivered in connection with sale of Registrable Securities by an underwriter or dealer), and comply with the provisions ofthe Securities Act with respect to the disposition of all securities covered by such registration statement during such period in accordance with the intended methods of disposition by the sellers thereof set forth in such registration statement;

(iv) provide copies to and permit counsel designated by the USH Investor to review each Registration Statementand all amendments and supplements thereto as far in advance as reasonably practicable prior to their filing with the SEC and not file any document to which such counsel reasonably objects; 

(v) furnish to each seller of Registrable Securities thereunder such number of copies of such registration statement, eachamendment and supplement thereto, the prospectus included in such registration statement (including each preliminary prospectus), each Issuer Free-Writing Prospectus and such other documents as such seller may reasonably request in order tofacilitate the disposition of the Registrable Securities owned by such seller; 

(vi) register or qualify suchRegistrable Securities under such other securities or blue sky laws of such jurisdictions as any seller reasonably requests and do any and all other acts and things which may be reasonably necessary or advisable to enable such seller to consummatethe disposition in such jurisdictions of the Registrable Securities owned by such seller, except that the Company shall not for any such purpose be required to (i) qualify generally to do business in any jurisdiction where it is not then soqualified, (ii) subject itself to taxation in any such jurisdiction where it is not then so subject; 

 
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(vii) notify each seller of such Registrable Securities (A) promptlyafter it receives notice thereof, of the date and time when such registration statement and each post-effective amendment thereto has become effective or a prospectus or supplement to any prospectus relating to a registration statement has beenfiled and when any registration or qualification has become effective under a state securities or blue sky law or any exemption thereunder has been obtained, (B) promptly after receipt thereof, of any request by the SEC for the amendment orsupplementing of such registration statement or prospectus or for additional information, and (C) at any time when a prospectus relating thereto is required to be delivered under the Securities Act, of the happening of any event as a result ofwhich the prospectus included in such registration statement contains an untrue statement of a material fact or omits any fact necessary to make the statements therein not misleading, and, at the request of any such seller, the Company shall preparea supplement or amendment to such prospectus so that, as thereafter delivered to the purchasers of such Registrable Securities, such prospectus shall not contain an untrue statement of a material fact or omit to state any fact necessary to make thestatements therein not misleading; 

(viii) use best efforts to cause all such Registrable Securities to belisted on each securities exchange on which similar securities issued by the Company are then listed and, if not so listed, to be listed on a securities exchange and, if not then listed on NYSE, to use its best efforts to arrange for at least twomarket markers to register as such with respect to such Registrable Securities with FINRA; 

(ix) provide atransfer agent and registrar for all such Registrable Securities not later than the effective date of such registration statement; 

(x) enter into and perform such customary agreements (including underwriting agreements in customary form) and take all such other actions as the holders of the Registrable Securities being sold or theunderwriters, if any, reasonably request in order to expedite or facilitate the disposition of such Registrable Securities (including, without limitation, effecting a stock split, combination of shares, recapitalization or reorganization);

(xi) subject to execution of customary confidentiality arrangements, make available for inspection by anyseller of Registrable Securities, any underwriter participating in any disposition pursuant to such registration statement and any attorney, accountant or other agent retained by any such seller or underwriter, all financial and other records,pertinent corporate and business documents and properties of the Company as shall be necessary to enable them to exercise their due diligence responsibility, and cause the Company’s officers, directors, employees, agents, representatives andindependent accountants to supply all information reasonably requested by any such seller, underwriter, attorney, accountant or agent in connection with such registration statement; 

(xii) take all reasonable actions to ensure that any Issuer Free-Writing Prospectus utilized in connection with anyRegistration Statement hereunder complies in all material respects with the Securities Act, is filed in accordance with the Securities Act 

 
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to the extent required thereby, is retained in accordance with the Securities Act to the extent required thereby and, when taken together with the related prospectus, shall not contain any untruestatement of a material fact or omit to state a material fact necessary to make the statements therein, in light of the circumstances under which they were made, not misleading; 

(xiii) otherwise comply with all applicable rules and regulations of the SEC, and make available to its security holders,as soon as reasonably practicable, an earning statement covering the period of at least twelve months beginning with the first day of the Company’s first full calendar quarter after the effective date of the registration statement, whichearnings statement shall satisfy the provisions of Section 11(a) of the Securities Act and Rule 158. 

(xiv) permit any holder of Registrable Securities which holder, in its sole and exclusive judgment, might be deemed to bean underwriter or a controlling person of the Company, to participate in the preparation of such registration or comparable statement and to allow such holder to provide language for insertion therein, in form and substance satisfactory to theCompany, which in the judgment of such holder and its counsel should be included; 

(xv) in the event of theissuance of any stop order suspending the effectiveness of a registration statement, or the issuance of any order suspending or preventing the use of any related prospectus or suspending the qualification of any Common Stock included in suchregistration statement for sale in any jurisdiction, use best efforts to promptly to obtain the withdrawal of such order; 

(xvi) cause such Registrable Securities covered by such registration statement to be registered with or approved by such other governmental agencies or authorities as may be necessary to enable thesellers thereof to consummate the disposition of such Registrable Securities; 

(xvii) cooperate with theholders of Registrable Securities covered by the registration statement and the managing underwriter or agent, if any, to facilitate the timely preparation and delivery of certificates (not bearing any restrictive legends) representing securities tobe sold under the registration statement and enable such securities to be in such denominations and registered in such names as the managing underwriter, or agent, if any, or such holders may request; 

(xviii) cooperate with each holder of Registrable Securities covered by the registration statement and each underwriter oragent participating in the disposition of such Registrable Securities and their respective counsel in connection with any filings required to be made with FINRA; 

(xix) in connection with any underwritten offering, make available the executive officers of the Company to participatewith the holders of Registrable Securities and any underwriters in any “road shows” or other selling efforts that may be reasonably requested by the holders in connection with the methods of distribution for the Registrable Securities;

 
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(xx) in connection with any underwritten offering, use best efforts toobtain one or more cold comfort letters from the Company’s independent public accountants in customary form and covering such matters of the type customarily covered by cold comfort letters; and 

(xxi) in connection with any underwritten offering, use best efforts to provide a legal opinion of the Company’soutside counsel, dated the effective date of such registration statement**.**

(b) The Company shall not undertake anyvoluntary act intended to cause a Violation or result in the declaration of a Grace Period. During any Grace Period, and as may be extended hereunder, the Company shall correct or update any disclosure causing the Company to provide notice of theGrace Period, and to file and cause to become effective or terminate the suspension of use or effectiveness, as the case may be, the subject registration statement. In the event that the Company shall exercise its right to delay or suspend thefiling or effectiveness of a registration hereunder, the applicable time period during which the registration statement is to remain effective shall be extended by a period of time equal to the duration of the Grace Period. The Company may extendthe Grace Period, for an additional consecutive 60 days with the consent of the holders of a majority of the Registrable Securities registered under the applicable registration statement, which consent shall not be unreasonably withheld. If sodirected by the Company, all holders of Registrable Securities registering shares under such registration statement shall (i) not offer to sell any Registrable Securities pursuant to the registration statement during the period in which thedelay or suspension is in effect after receiving notice of such delay or suspension and (ii) deliver to the Company (at the Company’s expense) all copies, other than permanent file copies then in such holders’ possession, of theprospectus relating to such Registrable Securities current at the time of receipt of such notice. 

Section 6.Registration Expenses.

(a) The Company’s Obligation. All expenses incident to the Company’sperformance of or compliance with this Agreement (including, without limitation, all registration, qualification and filing fees, fees and expenses of compliance with securities or blue sky laws, printing expenses, messenger and delivery expenses,fees and disbursements of custodians, and fees and disbursements of counsel for the Company, reasonable fees and expenses billed at the standard hourly rates of one counsel to the USH Investor and the USH Investor’s reasonable expenses inconnection with the registration, and all independent certified public accountants, underwriters and other Persons retained by the Company) (all such expenses being herein called “Registration Expenses”), shall be borne by theCompany. 

(b) Counsel Fees and Disbursements. In connection with each Registration Statement, the Company shallreimburse the holders of Registrable Securities included in such registration for the reasonable fees and disbursements of one counsel chosen by a majority of the 

 
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holders of the Registrable Securities requesting such registration for the purpose of rendering a legal opinion on behalf of such holder in connection with any underwritten RegistrationStatement. 

Section 7.Indemnification and Contribution. 

(a) By the Company. The Company shall indemnify and hold harmless, to the extent permitted by law, each holder of RegistrableSecurities, such holder’s officers, directors employees, agents and representatives, and each Person who controls such holder (within the meaning of the Securities Act) (the “Indemnified Parties”) against all losses, claims,actions, damages, liabilities and expenses (including with respect to actions or proceedings, whether commenced or threatened, and including attorney fees and expenses) caused by, resulting from, arising out of, based upon or related to any of thefollowing statements, omissions or violations (each a “Violation”) by the Company: (i) any untrue or alleged untrue statement of material fact contained in (A) any registration statement pursuant to which RegistrableSecurities are registered, any prospectus, preliminary prospectus or Issuer Free-Writing Prospectus included in any such registration statement, or any amendment thereof or supplement thereto or (B) any application or other document orcommunication (in this Section 7, collectively called an “application”) executed by or on behalf of the Company or based upon written information furnished by or on behalf of the Company filed in any jurisdiction inorder to qualify any Registrable Securities covered by such registration under the securities laws thereof, (ii) any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein notmisleading or (iii) any violation or alleged violation by the Company of the Securities Act or any other similar federal or state securities laws or any rule or regulation promulgated thereunder applicable to the Company and relating to actionor inaction required of the Company in connection with any such registration, qualification or compliance; provided that the Company will not be liable for losses arising out of written information provided by a holder for inclusion in theregistration statement or sales of Registrable Securities made during a Grace Period, after notice has been given by the Company. In addition, the Company will reimburse such Indemnified Party for any reasonable legal or any other expenses incurredby them in connection with investigating or defending any such losses. 

(b) By Each Security Holder. In connection withany registration statement in which a holder of Registrable Securities is participating, each such holder shall furnish to the Company in writing such information and affidavits as the Company reasonably requests for use in connection with any suchregistration statement or prospectus and, to the extent permitted by law, shall indemnify the Company, its officers, directors, employees, agents and representatives, and each Person who controls the Company (within the meaning of the SecuritiesAct) against any losses, claims, damages, liabilities and expenses resulting from any untrue or alleged untrue statement of material fact contained in the registration statement, prospectus, preliminary prospectus or Issuer Free-Writing Prospectusor any amendment thereof or supplement thereto or any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein not misleading, but only to the extent that such untrue statement oromission is contained in any information or affidavit so furnished in writing by such holder specifically for inclusion in such registration statement or prospectus or amendment or supplement thereto; provided that the obligation to indemnifyshall be individual, not joint and several, for each holder (with no holder being responsible for any misstatements or omissions of 

 
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any other holder) and shall be limited to the amount of proceeds (net of all expense paid by such holder in connection with any claim relating to this Section 7 and the amount of anydamages such holder has otherwise been required to pay by reason of such untrue statement or omission) received by such holder from the sale of securities pursuant to such registration statement giving rise to such indemnification obligation.

(c) Claim Procedure. Any Person entitled to indemnification hereunder shall (i) give prompt written notice to theindemnifying party of any claim with respect to which it seeks indemnification (provided that the failure to give prompt notice shall impair any Person’s right to indemnification hereunder only to the extent such failure has prejudiced theindemnifying party) and (ii) unless in such indemnified party’s judgment a conflict of interest between such indemnified and indemnifying parties may exist with respect to such claim, permit such indemnifying party to assume the defense ofsuch claim with counsel reasonably satisfactory to the indemnified party. If such defense is assumed, the indemnifying party shall not be subject to any liability for any settlement made by the indemnified party without its consent (but such consentshall not be unreasonably withheld, conditioned or delayed). An indemnifying party who is not entitled to, or elects not to, assume the defense of a claim shall not be obligated to pay the fees and expenses of more than one counsel for all partiesindemnified by such indemnifying party with respect to such claim, unless in the judgment of any indemnified party a conflict of interest may exist between such indemnified party and any other of such indemnified parties with respect to such claim.In such instance, the conflicted indemnified parties shall have a right to retain one separate counsel, chosen by the holders of the Registrable Securities included in the registration if such holders are indemnified parties, at the expense of theindemnifying party. 

(d) Contribution. If the indemnification provided for in this Section 7 is held by acourt of competent jurisdiction to be unavailable to, or is insufficient to hold harmless, an indemnified party or is otherwise unenforceable with respect to any loss, claim, damage, liability or action referred to herein, then the indemnifyingparty shall contribute to the amounts paid or payable by such indemnified party as a result of such loss, claim, damage, liability or action in such proportion as is appropriate to reflect the relative fault of the indemnifying party on the one handand of the indemnified party on the other hand in connection with the statements or omissions which resulted in such loss, claim, damage, liability or action as well as any other relevant equitable considerations. The relative fault of theindemnifying party and of the indemnified party shall be determined by reference to, among other things, whether the untrue or alleged untrue statement of a material fact or the omission to state a material fact relates to information supplied bythe indemnifying party or by the indemnified party and the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent such statement or omission. The parties hereto agree that it would not be just orequitable if the contribution pursuant to this Section 7(d) were to be determined by pro rata allocation or by any other method of allocation that does not take into account such equitable considerations. The amount paid or payable by anindemnified party as a result of the losses, claims, damages, liabilities or expenses referred to herein shall be deemed to include any legal or other expenses reasonably incurred by such indemnified party in connection with investigating ordefending against any action or claim which is the subject hereof. No person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any Person who is not guiltyof such fraudulent misrepresentation. 

 
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Notwithstanding anything to the contrary, in no event shall the contribution obligation of a holder of Registrable Securities be greater in amount than the dollar amount of the proceeds (net ofall expenses paid by such holder in connection with any claim relating to this Section 7 and the amount of any damages such holder has otherwise been required to pay by reason of such untrue or alleged untrue statement or omission oralleged omission) received by it upon the sale of the Registrable Securities giving rise to such contribution obligation. 

(e)Release. No indemnifying party shall, except with the consent of the indemnified party, consent to the entry of any judgment or enter into any settlement that does not include as an unconditional term thereof giving by the claimant orplaintiff to such indemnified party of a release from all liability in respect to such claim or litigation. 

(f)Non-exclusive Remedy; Survival. The indemnification and contribution provided for under this Agreement shall be in addition to any other rights to indemnification or contribution that any indemnified party may have pursuant to law or contractand shall remain in full force and effect regardless of any investigation made by or on behalf of the indemnified party or any officer, director or controlling Person of such indemnified party and shall survive the transfer of Registrable Securitiesand the termination or expiration of this Agreement. 

Section 8.Underwritten Registrations; SuspendedDistributions.

(a) Participation. No Person may participate in any registration hereunder which is underwrittenunless such Person (i) agrees to sell such Person’s securities on the basis provided in any underwriting arrangements approved by the Person or Persons entitled hereunder to approve such arrangements (including, without limitation,pursuant to any over-allotment or “green shoe” option requested by the underwriters; provided that no holder of Registrable Securities shall be required to sell more than the number of Registrable Securities such holder hasrequested to include) and (ii) completes and executes all questionnaires, powers of attorney, indemnities, underwriting agreements and other documents required under the terms of such underwriting arrangements; provided that no holder ofRegistrable Securities included in any underwritten registration shall be required to make any representations or warranties to the Company or the underwriters (other than representations and warranties regarding such holder and such holder’sintended method of distribution) or to undertake any indemnification obligations to the Company or the underwriters with respect thereto that are materially more burdensome than those provided in Section 7. 

(b) Suspended Distributions. Each Person that is participating in any registration under this Agreement, upon receipt of anynotice from the Company of the happening of any event giving rise to a Grace Period, shall immediately discontinue the disposition of its Registrable Securities pursuant to the registration statement until such Person’s receipt of the copies ofa supplemented or amended prospectus as contemplated by Section 5(a)(vii). In the event the Company has given any such notice, the applicable time period set forth in Section 5(a)(ii) during which a Registration Statement isto remain effective shall be extended by the number of days during the period from and including the date of the giving of such notice pursuant to this Section 8(b) to and including the date when each seller of Registrable Securitiescovered by such registration statement shall have received the copies of the supplemented or amended prospectus contemplated by Section 5(a)(vii). 

 
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Section 9.Current Public Information At all times after the earlier of(i) the Registration Deadline or (ii) the time the Initial Registration Statement is declared effective by the SEC as contemplated pursuant to Section 2(a)(i) of this Agreement, the Company shall file all reports required to be filedby it under the Securities Act and the Exchange Act (including all reports that were previously required to be filed prior to such time) on or prior to the date that is required to be so filed under the applicable rules and regulations of the SEC(which date shall include any additional period provided in Rule 12b-25 under the Exchange Act for the filing to be deemed timely filed, provided that the Company makes such filing within the applicable additional period) and shall take such furtheraction as any holder or holders of Registrable Securities may reasonably request, all to the extent required to enable such holders to sell Registrable Securities pursuant to Rule 144. Upon request, the Company shall deliver to any holder ofRegistrable Securities a written statement as to whether it has complied with such requirements. If at any time following the date on which the Company is required to comply with this Section 9, Company fails to file a report required by theExchange Act on or prior to the date that is required to be so filed under the applicable rules and regulations of the SEC (a “Reporting Event”), in addition to any other rights the holders of such Registrable Securities may havehereunder or under applicable law, on each such Reporting Event and on each monthly anniversary of each such Reporting Event (for the avoidance of doubt, if a Reporting Event is cured prior to a monthly anniversary of a Reporting Event, the Companyshall be responsible for paying to the holders of Registrable Securities their pro rata portion of the liquidated damages for that portion of the monthly anniversary period during which such Reporting Event is not cured) until the applicableReporting Event is cured, the Company shall pay to each holder of Registrable Securities their pro rata portion of $900,000 in cash, as partial liquidated damages and not as a penalty. Notwithstanding the foregoing, the amount of any such partialliquidated damages payable under this Section 9 shall be reduced by the amount of any liquidated damages payable by the Company pursuant to Section 2(b) hereof. If the Company fails to pay any partial liquidated damages pursuant to thisSection 9 in full within seven calendar days after the date payable, the Company will pay interest thereon at a rate of 12% per annum (or such lesser maximum amount that is permitted to be paid by applicable law) to the holders, accruingdaily from the date such partial liquidated damages are due until such amounts, plus all such interest thereon, are paid in full. The partial liquidated damages pursuant to the terms hereof shall apply on a daily pro rata basis for any portion of amonth prior to the cure of a Reporting Event. 

(a) Due Diligence Review; Information. Subject to the followingparagraph of this section, the Company shall make available, during normal business hours, for inspection and review by the USH Investor, advisors to and representatives of the USH Investor (who may or may not be affiliated with the USH Investor andwho are reasonably acceptable to the Company), all financial and other records, all 1934 Act Filings and other filings with the SEC, and all other corporate documents and properties of the Company as may be reasonably necessary for the purpose ofsuch review, and cause the Company’s officers, directors and employees, within a reasonable time period, to supply all such information reasonably requested by the USH Investor or any such representative, advisor or underwriter in connectionwith such Registration Statement (including, without limitation, in response to all questions and other inquiries reasonably made or submitted by any of them), prior to and from time to time after the filing and effectiveness of the RegistrationStatement for the sole purpose of enabling the USH Investor and such representatives, advisors and underwriters and their respective accountants and attorneys to conduct initial and ongoing due diligence with respect to the Company and the accuracyof such Registration Statement. 

 
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Anything in the foregoing notwithstanding, after the First Disclosure Date, the Companyshall not disclose material nonpublic information to the USH Investor, or to advisors to or representatives of the USH Investor, unless prior to disclosure of such information the Company identifies such information as being material nonpublicinformation and provides the USH Investor, such advisors and representatives with the opportunity to (i) accept such material nonpublic information for review, (ii) refuse to accept such material nonpublic information for review or(iii) to direct the Company to deliver any such material, nonpublic information to a division, affiliate or advisor of the USH Investor which is segregated from the USH Investor such that its receipt of such material, nonpublic information doesnot restrict such USH Investor from trading in the securities of the Company and any USH Investor, division, affiliate, advisor or representative, as applicable, wishing to obtain such information enters into an appropriate confidentiality agreementwith the Company with respect thereto. 

Section 10.Subsidiary Public Offering. If, after an initial PublicOffering of the Capital Stock of one of its Subsidiaries, the Company distributes securities of such Subsidiary to its equity holders, then the rights and obligations of the Company pursuant to this Agreement shall apply, *mutatis mutandis*, tosecurities of such Subsidiary, and the Company shall cause such Subsidiary to comply with such Subsidiary’s obligations under this Agreement. 

Section 11.Lock-up. For a period of 45 days after the date of the effectiveness of the Registration Statement the Company will not offer, sell, contract to sell, pledge or otherwise disposeof, directly or indirectly any additional shares of its securities or securities convertible into or exchangeable or exercisable for any shares of its securities, excluding (i) options granted to employees, directors or consultants under theCompany’s stock option plans, (ii) the conversion or exercise of convertible or exercisable securities outstanding on the date hereof, (iii) the issuance of shares in connection with debt financing or similar transactions that areprimarily of a non-equity financing nature and approved by the Company’s Board of Directors, (iv) securities issued pursuant to acquisitions or strategic transactions approved by the Company’s Board of Directors, and(v) securities issued in exchange for outstanding debt. 

Section 12.General Provisions. 

(a) Amendments and Waivers. Except as otherwise provided herein, the provisions of this Agreement may be amended, modified orwaived only with the prior written consent of the Company and a majority of the holders of the Registrable Securities. The failure or delay of any Person to enforce any of the provisions of this Agreement shall in no way be construed as a waiver ofsuch provisions and shall not affect the right of such Person thereafter to enforce each and every provision of this Agreement in accordance with its terms. A waiver or consent to or of any breach or default by any Person in the performance by thatPerson of his, her or its obligations under this Agreement shall not be deemed to be a consent or waiver to or of any other breach or default in the performance by that Person of the same or any other obligations of that Person under this Agreement.

 
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(b) Remedies. The parties to this Agreement shall be entitled to enforce their rightsunder this Agreement specifically (without posting a bond or other security), to recover damages caused by reason of any breach of any provision of this Agreement and to exercise all other rights existing in their favor. The parties hereto agree andacknowledge that a breach of this Agreement would cause irreparable harm and money damages would not be an adequate remedy for any such breach and that, in addition to any other rights and remedies existing hereunder, any party shall be entitled tospecific performance and/or other injunctive relief from any court of law or equity of competent jurisdiction (without posting any bond or other security) in order to enforce or prevent violation of the provisions of this Agreement. 

(c) Severability. Whenever possible, each provision of this Agreement shall be interpreted in such manner as to be effective andvalid under applicable law, but if any provision of this Agreement is held to be prohibited, invalid, illegal or unenforceable in any respect under any applicable law or regulation in any jurisdiction, such prohibition, invalidity, illegality orunenforceability shall not affect the validity, legality or enforceability of any other provision of this Agreement in such jurisdiction or in any other jurisdiction, but this Agreement shall be reformed, construed and enforced in such jurisdictionas if such prohibited, invalid, illegal or unenforceable provision had never been contained herein. 

(d) EntireAgreement. Except as otherwise provided herein, this Agreement contains the complete agreement and understanding among the parties hereto with respect to the subject matter hereof and supersedes and preempts any prior understandings, agreementsor representations by or among the parties hereto, written or oral, which may have related to the subject matter hereof in any way, except as may be contained in the Purchase Agreements or the Warrants. 

(e) Successors and Assigns. Except as otherwise provided herein, this Agreement shall bind and inure to the benefit and beenforceable by the Company and its successors and assigns and the holders of Registrable Securities and their respective successors and permitted assigns (whether so expressed or not). In addition, whether or not any express assignment has beenmade, the provisions of this Agreement which are for the benefit of purchasers or holders of Registrable Securities are also for the benefit of, and enforceable by, any subsequent holder of Registrable Securities. 

(f) Notices. All notices, demands or other communications to be given or delivered under or by reason of the provisions of thisAgreement will be in writing and will be delivered personally, mailed by certified or registered mail, return receipt requested and postage prepaid, or sent by reputable overnight courier service (charges prepaid), to the recipient. Such notices,demands and other communications will be sent to the Company or the USH Investor specified below: 

**The Company:**

K-V Pharmaceutical Company 

One Corporate Woods Drive 

Bridgeton, MO 63044 

Attn: CEO and President 

Fax: 314-646-3785 

 
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With a copy to: 

Thompson Coburn LLP 

One US Bank Plaza 

St. Louis, MO 63101 

Attention: Thomas A. Litz 

Facsimile: 314-552-7000 

**USH Investors:**

U.S. Healthcare I, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

U.S. Healthcare II, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

or to such other address or to the attention of such other person as the recipient party has specified by prior written notice to the sending party. Allsuch notices, demands or other communications will be deemed to have been given when actually received or refused by the recipient or when returned to the sender as undeliverable. 

(g) Business Days. If any time period for giving notice or taking action hereunder expires on a day that is not a Business Day,the time period shall automatically be extended to the Business Day immediately following such Saturday, Sunday or legal holiday. 

(h) Governing Law. The corporation laws of the State of Delaware shall govern all issues concerning the relative rights of the Company and its stockholders. All other questions concerning theconstruction, validity, enforcement and interpretation of this Agreement shall be governed by the internal law of the State of New York, without giving effect to any choice of law or conflict of law provision or rule (whether of the State of NewYork or any other jurisdictions) that would cause the application of the laws of any jurisdictions other than the State of New York. 

(i) MUTUAL WAIVER OF JURY TRIAL. AS A SPECIFICALLY BARGAINED FOR INDUCEMENT FOR EACH OF THE PARTIES HERETO TO ENTER INTO THIS AGREEMENT (AFTER HAVING THE OPPORTUNITY TO CONSULT WITH COUNSEL), EACHPARTY HERETO EXPRESSLY WAIVES THE RIGHT TO TRIAL BY JURY IN ANY LAWSUIT OR PROCEEDING RELATING TO OR ARISING IN ANY WAY FROM THIS AGREEMENT OR THE MATTERS CONTEMPLATED HEREBY. 

 
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(j) CONSENT TO JURISDICTION AND SERVICE OF PROCESS. EACH OF THE PARTIES IRREVOCABLYSUBMITS TO THE NON-EXCLUSIVE JURISDICTION OF THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF NEW YORK, FOR THE PURPOSES OF ANY SUIT, ACTION OR OTHER PROCEEDING ARISING OUT OF THIS AGREEMENT, ANY RELATED AGREEMENT OR ANY TRANSACTIONCONTEMPLATED HEREBY OR THEREBY. EACH OF THE PARTIES HERETO FURTHER AGREES THAT SERVICE OF ANY PROCESS, SUMMONS, NOTICE OR DOCUMENT BY U.S. REGISTERED MAIL TO SUCH PARTY’S RESPECTIVE ADDRESS SET FORTH ABOVE SHALL BE EFFECTIVE SERVICE OF PROCESSFOR ANY ACTION, SUIT OR PROCEEDING WITH RESPECT TO ANY MATTERS TO WHICH IT HAS SUBMITTED TO JURISDICTION IN THIS PARAGRAPH. EACH OF THE PARTIES HERETO IRREVOCABLY AND UNCONDITIONALLY WAIVES ANY OBJECTION TO THE LAYING OF VENUE OF ANY ACTION, SUIT ORPROCEEDING ARISING OUT OF THIS AGREEMENT, ANY RELATED DOCUMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY AND THEREBY IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE, AND HEREBY AND THEREBY FURTHER IRREVOCABLY AND UNCONDITIONALLYWAIVES AND AGREES NOT TO PLEAD OR CLAIM IN ANY SUCH COURT THAT ANY SUCH ACTION, SUIT OR PROCEEDING BROUGHT IN ANY SUCH COURT HAS BEEN BROUGHT IN AN INCONVENIENT FORUM. 

(k) No Recourse. Notwithstanding anything to the contrary in this Agreement, the Company and each holder of Registrable Securities agrees and acknowledges that no recourse under this Agreement orany documents or instruments delivered in connection with this Agreement, shall be had against any current or future director, officer, employee, general or limited partner or member of any holder of Registrable Securities or of any Affiliate orassignee thereof, whether by the enforcement of any assessment or by any legal or equitable proceeding, or by virtue of any statute, regulation or other applicable law, it being expressly agreed and acknowledged that no personal liability whatsoevershall attach to, be imposed on or otherwise be incurred by any current or future officer, agent or employee of any holder of Registrable Securities or any current or future member of any holder of Registrable Securities or any current or futuredirector, officer, employee, partner or member of any holder of Registrable Securities or of any Affiliate or assignee thereof, as such for any obligation of any holder of Registrable Securities under this Agreement or any documents or instrumentsdelivered in connection with this Agreement for any claim based on, in respect of or by reason of such obligations or their creation. 

 
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(l) Descriptive Headings; Interpretation. The descriptive headings of this Agreementare inserted for convenience only and do not constitute a part of this Agreement. The use of the word “including” in this Agreement shall be by way of example rather than by limitation. 

(m) No Strict Construction. The language used in this Agreement shall be deemed to be the language chosen by the parties hereto toexpress their mutual intent, and no rule of strict construction shall be applied against any party. 

(n) Counterparts.This Agreement may be executed in multiple counterparts, any one of which need not contain the signature of more than one party, but all such counterparts taken together shall constitute one and the same agreement. 

(o) Electronic Delivery. This Agreement, the agreements referred to herein, and each other agreement or instrument entered into inconnection herewith or therewith or contemplated hereby or thereby, and any amendments hereto or thereto, to the extent executed and delivered by means of a photographic, photostatic, facsimile or similar reproduction of such signed writing using afacsimile machine or electronic mail shall be treated in all manner and respects as an original agreement or instrument and shall be considered to have the same binding legal effect as if it were the original signed version thereof delivered inperson. At the request of any party hereto or to any such agreement or instrument, each other party hereto or thereto shall re-execute original forms thereof and deliver them to all other parties. No party hereto or to any such agreement orinstrument shall raise the use of a facsimile machine or electronic mail to deliver a signature or the fact that any signature or agreement or instrument was transmitted or communicated through the use of a facsimile machine or electronic mail as adefense to the formation or enforceability of a contract and each such party forever waives any such defense. 

(p) FurtherAssurances. In connection with this Agreement and the transactions contemplated hereby, each holder of Registrable Securities shall execute and deliver any additional documents and instruments and perform any additional acts that may benecessary or appropriate to effectuate and perform the provisions of this Agreement and the transactions contemplated hereby. 

(q) No Inconsistent Agreements. The Company shall not hereafter enter into any agreement with respect to its securities which isinconsistent with or violates the rights granted to the holders of Registrable Securities in this Agreement. 

*    *    *    *    * 

 
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IN WITNESS WHEREOF, the parties have executed this Second Amended and Restated RegistrationRights Agreement as of the date first written above. 

 
**U.S. Healthcare I, L.L.C.**By: 
/s/ Kevin Fusco
 Name: Kevin Fusco Title: Authorized Person**U.S. Healthcare II, L.L.C.**By: 
/s/ Kevin Fusco
 Name: Kevin Fusco Title: Authorized Person**K-V Pharmaceutical Company**By: 
/s/ Gregory J. Divis
 Name: Gregory J. Divis Title: President and CEO
 
[SecondAmended and Restated Registration Rights Agreement] 

**SCHEDULE OF USH INVESTORS**

U.S. Healthcare I, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

U.S. Healthcare II, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

 
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