Document:

EX-4.1

 Exhibit 4.1 

THIS SECURITY HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”) OR APPLICABLE STATE SECURITIES
LAWS. THIS SECURITY MAY NOT BE OFFERED FOR SALE, SOLD, TRANSFERRED OR ASSIGNED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT FOR THE SECURITIES UNDER THE SECURITIES ACT OR APPLICABLE STATE SECURITIES LAWS OR AN EXEMPTION THEREFROM. 

THIS NOTE IS SUBJECT TO THE TERMS AND CONDITIONS OF THE INTERCREDITOR AND SUBORDINATION AGREEMENT, DATED AS OF APRIL 29, 2015, BY AND AMONG SOUTHWEST BANK,
AS ADMINISTRATIVE AGENT, USMD HOLDINGS, INC. AND THE HOLDER OF THIS NOTE, AS SUCH INTERCREDITOR AND SUBORDINATION AGREEMENT MAY BE AMENDED, RESTATED, REPLACED, REFINANCED, SUPPLEMENTED OR MODIFIED FROM TIME TO TIME (THE “SUBORDINATION
AGREEMENT”). 
 7.25% CONVERTIBLE SUBORDINATED NOTE DUE 2020 

NOTE NO. [        ] 
  

			
	US$[        ]		April 29, 2015

 USMD Holdings, Inc., a Delaware corporation (the “Company”), for value received, hereby
promises to pay to the order of [        ] or his/her/its assigns (the “Holder”), at the time and in the manner hereinafter provided, the principal sum of
[        ] U.S. Dollars and No/100 (US$[        ]). This Note is issued pursuant to that certain Subscription Agreement dated on or about the date hereof. 

1. Payment. 
 (a)
Principal Amount. The outstanding principal amount of this Note together with all interest accrued thereon, shall be due and payable on November 1, 2020. 

(b) Interest. Interest shall accrue on the unpaid principal balance of this Note at the rate of 7.25% per annum. Accrued and
unpaid interest shall be due and payable on May 31, 2015, and thereafter on the last day of each month, until the principal amount of this Note, plus all accrued interest thereon, has been paid in full. Interest under this Note shall accrue
based on the actual number of days elapsed in a year assumed to consist of 365 days. Upon the occurrence of an Event of Default (as defined herein), and for so long as such Event of Default continues, interest shall accrue on the outstanding
principal amount of this Note at the rate of 9.25% per annum. 
 (c) Manner of Payment. Payment shall be made, at the
Company’s option (i) in cash by immediately available funds in accordance with the written wire transfer instructions supplied by the Holder from time to time to the Company, or (ii) in shares of common stock of the Company
(“Common Stock”). If the Company elects to make an interest payment in shares of Common Stock, the Company will issue to the Holder on the interest payment date the 

 
number of shares of Common Stock obtained by dividing (A) the amount of accrued interest to be paid on the applicable interest payment date, by (B) the “Closing Price” on the
first trading day immediately preceding such interest payment date. As used herein, “Closing Price” shall mean the closing price of the Common Stock on the principal national securities exchange on which the Common Stock is then
quoted or listed or admitted to trading, or (if not so available) a price determined in good faith by the Board of Directors, whose determination shall be conclusive and described in a board resolution. 

2. Prepayment. Subject to the terms of the Subordination Agreement, this Note may be prepaid in whole or in part from time to time on
and after April 29, 2016 upon 60 days’ prior written notice to the Holder. Any partial prepayment shall be applied first to accrued but unpaid interest hereon, if any, with the remainder of any such prepayment being applied to the
reduction of principal. 
 3. Conversion. 

(a) Right of Conversion; Procedures for Conversion. Subject to the prior receipt of any approvals required by applicable federal and
state securities laws and the rules of the NASDAQ Capital Market or other applicable securities exchange, and so long as the conversion (considered together with the receipt of any shares pursuant to a prior conversion of a portion of the Note other
notes) would not result in the cumulative issuance by the Company to holders of these Notes of an aggregate number of shares of Common Stock that equals or exceeds 20% of the aggregate shares of common stock of the Company issued and outstanding on
the date of such conversion date, the Holder shall have the right at any time after April 29, 2016 to convert all or any part of the unpaid principal balance of this Note into that number of shares of Common Stock obtained by dividing the
principal amount to be converted by a conversion price (the “Conversion Price”) equal to $10.61, subject to adjustment pursuant to the provisions hereof. In order to exercise the right of conversion, the Holder shall surrender this
Note to the Company at its principal offices, accompanied by a completed Conversion Notice (in the form of Exhibit A hereto) notifying the Company that the Holder elects to convert all or a portion of this Note into shares of Common Stock
(such shares issued upon conversion being referred to herein as the “Conversion Shares”). The conversion shall be deemed to have been effected as to this Note (or portion thereof) on the date on which the requirements set forth in
this Section 3(a) have been satisfied (such date, the “Conversion Date”), and the person in whose name any Conversion Shares shall be issuable upon such conversion shall be deemed to have become on the Conversion Date
the holder of record of the shares represented thereby; provided, however, that any such surrender on any date when the stock transfer books of the Company shall be closed shall constitute the person in whose name the certificates are to be issued
as the record holder thereof for all purposes on the next succeeding day on which such stock transfer books are open, but such conversion shall be at the Conversion Price in effect on the date upon which this Note shall be surrendered. 

(b) Payment of Interest upon Conversion. The Company shall pay in cash, upon the surrender of this Note (or portion thereof) for
conversion during the period from the close of business on any interest payment date to which interest has been fully paid through the close of business on the business day preceding the next such interest payment date, all accrued and unpaid
interest, if any, on this Note (or portion thereof surrendered for conversion) accruing 

  
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prior to, but excluding, the Conversion Date. Any such payment of interest shall be made with respect to this Note within five business days after the Conversion Date. Except as provided in this
Section 3(b), no adjustment shall be made for interest accrued on the portion of this Note converted or for dividends on any shares issuable upon the conversion of this Note as provided in this Section 3. 

(c) Adjustment of Conversion Price. The Conversion Price and the number of Conversion Shares shall be subject to adjustment from time
to time as follows: 
 (i) Consolidation, Merger, Sale, Conveyance. If the Company at any time shall consolidate or
merge with, or sell or convey all or substantially all of its assets to, any other corporation (each of which shall constitute a “Major Event”), the Holder shall thereafter be entitled to purchase at the Conversion Price then in
effect such number and kind of securities as would have been issuable or distributable on account of such Major Event upon or with respect to this Note immediately prior to such Major Event. The Company shall take such steps in connection with such
Major Event as may be necessary to assure that the provisions hereof shall thereafter be applicable, as nearly as reasonably may be, in relation to any securities or property thereafter deliverable upon the conversion of this Note. The foregoing
provisions shall similarly apply to successive transactions of a similar nature by any such successor or purchaser. Without limiting the generality of the foregoing, the provisions of this Section 3 shall apply to such securities of such
successor or purchaser after a Major Event. 
 (ii) Stock Dividend, Reclassification, etc. If the Company shall
(A) pay a dividend in or make a distribution of shares of its capital stock, (B) subdivide its outstanding Common Stock, (C) combine its outstanding Common Stock into a smaller number of shares of Common Stock, or (D) issue any
securities in a reclassification of its Common Stock (including any such reclassification in connection with a consolidation or merger in which the Company is the continuing corporation), the number of Conversion Shares shall be adjusted so that the
Holder shall be entitled to receive the kind and number of shares or other securities of the Company which the Holder would have owned or would have been entitled to receive after the happening of any of the events described above, had this Note
been converted and the Conversion Shares been issued pursuant to this Section 3 immediately prior to the happening of such event or any record date with respect thereto. 

4. Cash Payments in Lieu of Fractional Shares. No fractional shares of Common Stock or scrip representing fractional shares shall be
issued upon the payment of any interest due and owing in shares of Common Stock pursuant to Section 1(c) or upon the conversion of this Note pursuant to Section 3. If any fractional share of stock otherwise would be issuable
upon such payment or conversion, the Company shall calculate and pay a cash adjustment in lieu of such fractional share at the current market value thereof to the Holder. The current market value of a share of Common Stock shall be the Closing Price
on the first trading day immediately preceding the interest payment date or the date on which this Note is deemed to have been converted, as the case may be. 

  
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 5. Transfers of the Note. 

(a) Transfers Generally. This Note may not be transferred to any person without the prior written consent of the Company, which shall
not be unreasonably withheld. Notwithstanding the foregoing sentence, the Holder may transfer this Note to any entity that is controlled by, under common control with or controlling the Holder. 

(b) Note Register; Process of Transfer. The Company shall cause to be kept at its principal executive office a register in which,
subject to such reasonable regulations as it may prescribe, the Company shall provide for the registration of the holders of this Note and of transfers of this Note. If the Holder desires to transfer this Note, the Holder shall complete the
Certificate of Transfer (in the form of Exhibit B hereto) and the proposed transferee shall complete the Letter of Representations (in the form of Exhibit C hereto), each of which shall be presented to the Company with the original of
this Note. Upon receipt and, if necessary, approval by the Company of such requested transfer, the Company shall execute, in the name of the designated transferee or transferees, one or more new notes of any authorized denominations and of a like
aggregate principal amount and bearing such restrictive legends as may be required by applicable law. No service charge shall be charged to the Holder for any exchange or registration of transfer of this Note, but the Company may require payment of
a sum sufficient to cover any tax, assessments or other governmental charges that may be imposed in connection therewith. Notwithstanding the foregoing, the Company shall not be required to exchange or register a transfer of this Note if it has been
called for redemption or surrendered for conversion. 
 (c) Newly Issued Notes. Any note issued upon any transfer or exchange of, or
in replacement for, this Note shall be the valid obligation of the Company, evidencing the same debt, and entitled to the same benefits as this Note surrendered upon such registration of transfer or exchange and shall be expressly subject to the
terms and conditions of the Subordination Agreement. 
 (d) Reliance on Named Holder. Prior to due presentment for the registration
of a transfer of this Note, the Company may deem and treat the person in whose name this Note is registered as the absolute owner of this Note for the purpose of receiving payments of principal and interest and for all other purposes. 

(e) Mutilated, Destroyed, Lost or Stolen Notes. In case this Note shall become mutilated or be destroyed, lost or stolen, the Company,
in its discretion, may execute a new note in exchange and substitution for the mutilated Note, or in lieu of and in substitution for the destroyed, lost or stolen Note. The Company may require indemnity to save it harmless from any loss, liability,
cost or expense caused by or connected with such substitution, and, in every case of destruction, loss or theft, the applicant shall also furnish to the Company, evidence to the Company’s reasonable satisfaction of the destruction, loss or
theft of this Note and of the ownership thereof. 
 6. Subordination. By acceptance of this Note, the Holder unconditionally and
irrevocably acknowledges and agrees that the Company’s obligations and the Holder’s rights hereunder shall be and hereby are at all times and in all respects, and for all purposes, subject to the terms and conditions of the Subordination
Agreement. 

  
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 7. Events of Default. Should any of the following events (each of which is herein called
an “Event of Default”) occur, the Company shall be in default hereunder: 
 (a) the Company defaults in the payment of the
principal of, or interest on, this Note, and such failure continues for a period of three business days after written notice of such default; or 

(b) the Company defaults with respect to any Senior Indebtedness (as defined herein), which default results in the acceleration of Senior
Indebtedness in excess of $2,500,000.00, and such Senior Indebtedness shall not have been discharged or such acceleration shall not have been rescinded or annulled for a period of 30 days after there shall have been given to the Company a written
notice specifying such default and requiring the Company to cause such Senior Indebtedness to be discharged or cause such default to be cured or waived or such acceleration to be rescinded or annulled; or 

(c) the Company or any material subsidiary makes an assignment for the benefit of creditors or admits in writing its inability to pay its
debts generally as they become due; or an order, judgment or decree is entered into adjudicating the Company or any material subsidiary bankrupt or insolvent; or any order for relief with respect to the Company or any material subsidiary is entered
under the Federal Bankruptcy Code; or the Company or any material subsidiary petitions or applies to any tribunal for the appointment of a custodian, trustee, receiver or liquidator of the Company or any material subsidiary or any substantial part
of the assets of the Company or any material subsidiary, or commences any proceeding (other than a proceeding for the voluntary liquidation and dissolution of a subsidiary) relating to the Company or any material subsidiary under any bankruptcy,
reorganization, arrangement, insolvency, readjustment of debt, dissolution or liquidation law of any jurisdiction; or any such petition or application is filed, or any such proceeding is commenced, against the Company or any material subsidiary and
either (i) the Company or any such material subsidiary by any act indicates its approval thereof, consent thereto or acquiescence therein or (ii) such petition, application or proceeding is not dismissed within 60 days. 

(d) As used herein, “Senior Indebtedness” means the principal of, and premium, if any, and interest on, reimbursement
obligations, indemnification obligations, fees, costs and expenses in connection with and other amounts accrued or due on or in connection with (i) all indebtedness of the Company for monies borrowed, including, without limitation, commercial
paper and accounts receivable sold or assigned by the Company, (ii) all obligations of the Company evidenced by any notes, debentures, bonds or other instruments issued to banks, trust companies, insurance companies, other financial
institutions and other entities that in the ordinary course of business make loans, (iii) all obligations of the Company under any interest or currency swap agreements, hedging agreements, cap, floor and collar agreements, spot and forward
contracts and other similar agreements, (iv) obligations in respect of letters of credit, bank guarantees and bankers acceptances, (v) obligations secured by a mortgage, pledge, security interest, lien or encumbrance affecting title to any
of the Company’s assets, (vi) principal of, and interest on any indebtedness or obligations of others of the kinds described in (i)

  
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through (vi) above directly or indirectly assumed or guaranteed in any manner by the Company, and (vii) deferrals, renewals, increases, extensions, refinancings and refundings of, or
amendments, modifications, restatements or supplements to, any such indebtedness or obligations described in (i) through (vi) above, in each case unless the instrument creating or evidencing the same or pursuant to which the same is
outstanding expressly provides that the same is not senior in right of payment to this Note. Notwithstanding the foregoing, “Senior Indebtedness” with respect to this Note shall not include: (A) any obligation of the Company to any
subsidiary of the Company, (B) any liability for federal, state, local or other taxes owed or owing by the Company, (C) any accounts payable or other liability to trade creditors arising in the ordinary course of business (including
guarantees thereof or instruments evidencing such liabilities), (D) any indebtedness or obligation of the Company (and any accrued and unpaid interest in respect thereof) that by its terms is subordinate or junior in right of payment to any
other indebtedness or obligation of the Company or (E) any obligation with respect to any shares, interest, rights to purchase, warrants, options, participations or other equivalents of, or interests in, the equity of the Company. 

8. Remedies. Subject to the terms of the Subordination Agreement, upon the occurrence of an Event of Default, the Holder may declare
the principal of and premium, if any, on this Note and the interest accrued thereon to be due and payable immediately, and upon any such declaration the same shall become and shall be immediately due and payable. Subject to the terms of the
Subordination Agreement, the Holder shall further be entitled and empowered to institute any actions or proceedings at law or in equity for the collection of the sums so due and unpaid, and may prosecute any such action or proceeding to judgment or
final decree, and may enforce any such judgment or final decree against the Company or any other obligor on this Note and collect in the manner provided by law out of the property of the Company or any other obligor on this Note wherever situated
the monies adjudged or decreed to be payable. 
 9. Company Waivers. The Company and all other parties now or hereafter liable
hereon, severally waive grace, demand, presentment for payment, notice of dishonor, protest and notice of protest, notice of intention to accelerate, notice of acceleration, any other notice and diligence in collecting and bringing suit against any
party hereto and agree: (a) to all extensions and partial payments, with or without notice, before or after maturity, (b) to any substitution, exchange or release of any security now or hereafter given for this Note, and (c) to the
release of any party primarily or secondarily liable hereon. No delay on the part of the Holder in exercising any power or right under this Note shall operate as a waiver of such power or right, nor shall any single or partial exercise of any power
or right preclude further exercise of that power or right. 
 10. Collection Fees. If an Event of Default occurs hereunder and this
Note is placed in the hands of an attorney for collection (whether or not suit is filed), or if this Note is collected by suit or legal proceedings or through bankruptcy proceedings, the Company agrees to pay in addition to all sums then due hereon,
including principal and interest, all expenses of collection, including, without limitation, reasonable attorneys’ fees. 
 11.
Successors and Assigns. All references to the Company herein shall, and shall be deemed to, include its successors and assigns, and all covenants, stipulations, promises and agreements contained herein by or on behalf of the Company shall be
binding upon its successors and permitted assigns, whether so expressed or not. 

  
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 12. Amendments and Waivers. The Note may be amended or modified only by written consent of
the Company and the Holder. The Holder may waive any past default or Event of Default and its consequences. Any such amendment, modification or waiver shall be conclusive and binding upon the Holder and upon all future holders and owners of this
Note and any notes which may be issued in exchange or substitution hereof, irrespective of whether any notation thereof is made upon this Note or such other notes. 

13. Severability Clause. In case any provision in this Note shall be invalid, illegal or unenforceable, the validity, legality and
enforceability of the remaining provisions shall not in any way be affected or impaired thereby. 
 14. Notice. All notices to the
Company required or permitted by this Note shall be sufficient if given in writing and executed by the Holder. All such notices to the Company shall be delivered by registered or certified mail, return receipt requested, or personally delivered, to
the Company at its principal place of business on the date of the execution of this Note, or such other address as the Company may designate by written notice to the Holder of this Note. 

15. Governing Law and Venue. This Note shall be deemed to be a contract made under the laws of the State of Texas, and for all purposes
shall be governed by and construed in accordance with the laws of the State of Texas, exclusive of any such law under with the law of any other jurisdiction would apply. If any action is brought to enforce or interpret this Note, venue for such
action shall be in Dallas County, Texas. 
 (Signature Page Follows.) 

  
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 IN WITNESS WHEREOF, the Company has caused this Note to be duly executed and delivered as of the
date first written above. 
  

			
	USMD Holdings, Inc.
		
	By:		  

	Name:		John M. House, M.D.
	Title:		Chief Executive Officer

 Signature Page – 7.25% Convertible Subordinated Note due 2020 

 Exhibit A 

Form of Conversion Notice 

(See attached.) 

 CONVERSION NOTICE 

USMD Holdings, Inc. 
 6333 North State Highway 161, Suite 200

 Irving, Texas 75038 
 Attention: Chief Financial Officer 

Gentlemen: 
 The undersigned registered holder
of this Note hereby irrevocably exercises the option to convert this Note, or the portion hereof (which is $1,000 principal amount or an integral multiple thereof) designated below, into shares of common stock of USMD Holdings, Inc. in accordance
with the terms of this Note. The undersigned further directs that the shares issuable and deliverable upon such conversion, together with a check in payment for any fractional shares and a note representing any unconverted principal amount of the
Note, if any, be issued and delivered to the registered holder of the Note unless a different name has been indicated below. If shares or any portion of this Note not converted are to be issued in the name of a person other than the undersigned, the
undersigned will pay all transfer taxes payable with respect thereto. 
  

			
	Dated:		  

 Principal amount to be converted: $         

($1,000 principal amount or an integral multiple thereof): 
  

			
	If an individual:
		
	Signature:		  

 
			
		
	Printed Name:		  

 
			
	
	If an entity:
		
	Name of entity:		  

 
			
		
	Signature:		  

 
			
		
	Printed Name:		  

 
			
		
	Title:		  

 If shares are to be issued, and a note (if to be delivered) is to be delivered, other than to and in the name of the
registered holder: 
  

			
	Name:		  

		
	Address:		  

		
			  

 

					
	Taxpayer Identification Number:		  
		

 Exhibit B 

Form of Certificate of Transfer 

(See attached.) 

 CERTIFICATE OF TRANSFER 

USMD Holdings, Inc. 
 6333 North State Highway 161, Suite 200

 Irving, Texas 75038 
 Attention: Chief Financial Officer 

Gentlemen: 
  

	 	Re:	7.25% Convertible Subordinated Note due 2020 

 Reference is hereby made to the 7.25%
Convertible Subordinated Note due 2020 (the “Note”) issued by USMD Holdings, Inc. (the “Company”). Capitalized terms used but not defined herein shall have the meanings given to them in the Note. 

                     (the
“Transferor”) owns and proposes to transfer the Note, in the principal amount of $        , to
                    (the “Transferee”). Transferor hereby certifies that it has complied with the terms and conditions of the
Subordination Agreement and that (please check the appropriate space): 
  

			
			Approval of the transfer by the Company is not required because the Transferee is an entity controlled by, under common control with or controlling the Transferor.
		
			Approval of the transfer by the Company is required.

  

			
	If an individual:
		
	Signature:		  

 
			
		
	Printed Name:		  

	
	If an entity:

 
			
		
	Name of entity:		  

 
			
		
	Signature:		  

 
			
		
	Printed Name:		  

 
			
		
	Title:		  

 Exhibit C 

Form of Letter of Representations 

(See attached.) 

 LETTER OF REPRESENTATIONS 

USMD Holdings, Inc. 
 6333 North State Highway 161, Suite 200

 Irving, Texas 75038 
 Attention: Chief Financial Officer 

Gentlemen: 
  

	 	Re:	7.25% Convertible Subordinated Note due 2020 

 Reference is hereby made to the 7.25%
Convertible Subordinated Note due 2020 (the “Note”) issued by USMD Holdings, Inc. (the “Company”). Capitalized terms used but not defined herein shall have the meanings given to them in the Note.
                     owns and proposes to transfer the Note, in the principal amount of $        , to us. We
are delivering this letter in connection with such transfer and we hereby confirm that: 
  

	 	(i)	We are an “accredited investor” within the meaning of Rule 501(a) under the Securities Act of 1933, as amended (the “Securities Act”); 

 

	 	(ii)	Any purchase or receipt of the Note by us will be for investment purposes and for our own account, not as a nominee or agent; 

  

	 	(iii)	We have such knowledge and experience in financial and business matters that we are capable of evaluating the merits and risks of purchasing or receiving the Note; 

 

	 	(iv)	We do not have need for liquidity in our investment in the Note, we have the ability to bear the economic risks of our investment in the Note for an indefinite period of time and we are able to afford the complete loss
of our investment in the Note; 

  

	 	(v)	We are not acquiring the Note with a view to any distribution thereof in a transaction that would violate the Securities Act or the securities laws of any state of the United States or any other applicable jurisdiction,
and we have no present intention of selling, granting any participation in, or otherwise distributing the same; 

  

	 	(vi)	We have had access to such information regarding the Company necessary in order for us to make an informed decision and any such information which we have requested have been made available for us or our attorney,
accountant, or advisor; and 

  

	 	(vii)	We or our attorney, accountant, or advisor have had a reasonable opportunity to ask questions of and receive answers from a person or persons acting on behalf of the Company concerning the business, management and
financial affairs of the Company and the terms and conditions of the acquisition by us of the Note and all such questions have been answered to our full satisfaction, and we have acquired sufficient information about the Company to make an informed
and knowledgeable decision to acquire the Note. 

 We understand that the Note has not been registered under the Securities Act, and we agree, on
our own behalf and on behalf of each account for which we acquire the Note, that the Note may be offered, resold, pledged or otherwise transferred only (a) in accordance with an exemption from the registration requirements of the Securities
Act, (b) to the Company or (c) pursuant to an effective registration statement, and, in each case, in accordance with any applicable securities laws of any state of the United States or any other applicable jurisdiction. 

We acknowledge that the Company and others will rely upon our confirmations, acknowledgements and agreements set forth herein, and we agree to
notify you promptly in writing if any of our representations or warranties herein ceases to be accurate and complete. 
  

			
	If an individual:
		
	Signature:		  

 
			
		
	Printed Name:		  

 
			
		
	Address:		  

		
			  

 
			
		
	Social Security No.:		  

 
			
	
	If an entity:

 
			
		
	Name of entity:		  

 
			
		
	Signature:		  

 
			
		
	Printed Name:		  

 
			
		
	Title:		  

 
			
		
	Address:		  

		
			  

 
			
		
	Taxpayer ID No.:EX-10.1

 Exhibit 10.1 

EXECUTION VERSION 

AMENDMENT NO. 8 TO CREDIT AGREEMENT 

This AMENDMENT NO. 8 TO CREDIT AGREEMENT (this “Amendment”) dated as of April 29, 2015 (the “Amendment
No. 8 Effective Date”), among USMD HOLDINGS, INC., a Delaware corporation “Holdings”), UROLOGY ASSOCIATES OF NORTH TEXAS, P.L.L.C., Texas professional limited liability company, USMD INC., a Texas corporation, IMPEL
MANAGEMENT SERVICES, L.L.C., a Texas limited liability company, IMPEL CONSULTING EXPERTS, L.L.C., a Texas limited liability company, MAT-RX DEVELOPMENT, L.L.C., a Texas limited liability company, USMD OF ARLINGTON GP, L.L.C., a Texas limited
liability company, US LITHOTRIPSY, L.P., a Texas limited partnership, USMD CANCER TREATMENT CENTERS, L.L.C., a Texas limited liability company, USMD CANCER TREATMENT CENTERS GP, L.L.C., Texas limited liability company, USMD PPM, LLC, a Texas limited
liability company, USMD DIAGNOSTIC SERVICES, LLC, a Texas limited liability company, MAT-RX FORT WORTH GP, L.L.C., a Texas limited liability company, USMD ADMINISTRATIVE SERVICES, L.L.C., Texas limited liability company, USGP, LLC., a Texas limited
liability company, LITHO GP, LLC., a Texas limited liability company, METRO I STONE MANAGEMENT, LTD., a Texas limited partnership, USMD AFFILIATED SERVICES, a Texas not for profit corporation, MEDICAL CLINIC OF NORTH TEXAS PLLC, a Texas professional
limited liability company, and USMD CTC (MO), LLC, a Missouri limited liability company (individually a “Borrower” and collectively, the “Borrowers”), the undersigned Lenders (as defined below), and SOUTHWEST BANK,
a Texas state bank, as administrative agent for the Lenders (the “Administrative Agent”). 
 PRELIMINARY STATEMENTS:

 (1) The Borrowers, the lenders party thereto (the “Lenders”), and the Administrative Agent are parties to that
certain Credit Agreement dated as of August 31, 2012, as amended by that certain Amendment No. 1 to Credit Agreement dated as of February 28, 2013, as further amended by that certain Amendment No. 2 to Credit Agreement dated as
of September 13, 2013, as further amended by that certain Amendment No. 3 to Credit Agreement dated as of February 25, 2014, as further amended by that certain Waiver and Amendment No. 4 to Credit Agreement dated as of
April 14, 2014, as further amended by that certain Amendment No. 5 to Credit Agreement dated as of September 23, 2014, as further amended by that certain Amendment No. 6 to Credit Agreement and Amendment No. 1 to Guarantee
and Collateral Agreement, dated as of December 22, 2014, as further amended by that certain Amendment No. 7 to Credit Agreement, dated as of March 13, 2015 (the “Credit Agreement”). 

(2) The Borrowers have requested that the Credit Agreement be amended in the manner provided for in this Amendment. 

NOW, THEREFORE, in consideration of the premises contained herein and for other good and valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, the parties hereto, intending to be legally bound hereby, hereby agree as follows: 
 SECTION 1.
Defined Terms. Unless otherwise defined herein, capitalized terms which are defined in the Credit Agreement are used herein as therein defined. 

 SECTION 2. Amendment to Credit Agreement. The Credit Agreement is, effective as of
the Amendment No. 8 Effective Date, hereby amended as follows: 
 (a) The following definitions of “Amendment No. 8 Effective
Date,” “7.25% Convertible Subordinated Notes Due 2020,” “Additional Permitted Convertible Subordinated Notes Transaction” and “Additional Permitted Convertible Subordinated Notes” are hereby added to
Section 1.01 of the Credit Agreement in the correct alphabetical locations: 
 “Amendment No. 8 Effective
Date” means April 29, 2015. 
 “7.25% Convertible Subordinated Notes Due 2020” means the
collective reference to the 7.25% Convertible Subordinated Notes Due 2020 issued by Holdings in the aggregate principal amount of $1,550,000, and all notes issued in substitution, replacement or exchange thereof or in connection with any Transfer
(as defined in the Convertible Note Subordination Agreements). 
 “Additional Permitted Convertible Subordinated
Notes Transaction” means each transaction under which Borrower seeks to issue Additional Permitted Convertible Subordinated Notes. 

“Additional Permitted Convertible Subordinated Notes” means the collective reference to the Convertible
Subordinated Notes, approved after the Amendment No. 8 Effective Date, by Administrative Agent on behalf of the Lenders under Section 6.02(f)(ii) of the Credit Agreement, and issued by Holdings in the aggregate original principal amount
not to exceed $3,450,000, and all notes issued in substitution, replacement or exchange thereof or in connection with any Transfer (as defined in the Convertible Note Subordination Agreements). For purposes of the calculation of the aggregate
principal amount permitted under this definition, the aggregate amount shall reduce as Additional Permitted Convertible Subordinated Notes are paid or reduced and shall not thereafter increase. 

(b) The definition of “Convertible Notes” contained in Section 1.01 of the Credit Agreement is amended and restated in its
entirety to read as follows: 
 “Convertible Notes” means the collective reference to the 5% Convertible
Subordinated Notes Due 2019, the 7.75% Convertible Subordinated Notes Due 2020, the 7.25% Convertible Subordinated Notes Due 2020 and the Additional Permitted Convertible Subordinated Notes. 

(c) Paragraph (f) of Section 6.02 of the Credit Agreement is hereby amended and restated in its entirety to read as follows: 

“(f)(i) Indebtedness of the Borrowers in respect of the Subordinated Debt and extensions thereof permitted by the
Subordination Agreement, and Indebtedness of Holdings under the Convertible Notes and extensions thereof permitted by the Convertible Note Subordination Agreements; provided, however, that (a) the aggregate principal amount of the
5% Convertible Subordinated Notes Due 2019 shall not exceed $27,869,305; provided, further, that if Holdings elects to not purchase 26,041 Class P 

  
 -2- 

 
Units from Arlington Neurological Association, the aggregate consideration for the acquisition of Class P Units by Holdings shall not exceed $24,341,764; (b) the aggregate principal amount
of the 7.75% Convertible Subordinated Notes Due 2020 shall not exceed $3,500,000; (c) the aggregate principal amount of the 7.25% Convertible Subordinated Notes Due 2020 shall not exceed $1,550,000; and (d) the aggregate principal amount
of Additional Permitted Convertible Subordinated Notes shall not exceed $3,450,000.” 
 (ii) Prior to completion of any
Additional Permitted Convertible Subordinated Notes Transaction or issuance of any Additional Permitted Convertible Subordinated Notes, Borrowers shall have received the written consent of the Administrative Agent, acting on behalf of the Lenders,
to the Additional Permitted Convertible Subordinated Notes Transaction and to the satisfaction of the following conditions precedent, which consent may be given or withheld in Administrative Agent’s sole discretion: 

(A) The Administrative Agent shall have received all certificates, documents, agreements and information requested by the
Administrative Agent regarding the terms and conditions of each applicable Additional Permitted Convertible Subordinated Notes Transaction and issuance of Additional Permitted Convertible Subordinated Notes in connection therewith; 

(B) The Administrative Agent shall have received true and correct copies of subscription agreements in connection with such
Additional Permitted Convertible Subordinated Notes Transaction duly executed and delivered by Holdings and each holder of an Additional Permitted Convertible Subordinated Note issued by Holdings; 

(C) The Administrative Agent shall have received true and correct copies of (i) resolutions of the Board of Directors (or
comparable managing body) of Holdings, and each holder (other than an individual) of Additional Permitted Convertible Subordinated Note(s), authorizing the Additional Permitted Convertible Subordinated Notes Transaction, and in the case of each such
holder, authorizing such holder to execute, deliver and perform the Convertible Note Subordination Agreement to which it is a party, and (ii) all documents evidencing other necessary organizational action and governmental and third party
approvals, if any, with respect to each applicable Additional Permitted Convertible Subordinated Notes Transaction and the other matters contemplated hereby and thereby; 

(D) The Administrative Agent shall have received a certificate of the Secretary or an Assistant Secretary of (i) Holdings
certifying the names and signatures of its officers authorized to execute and deliver the documents executed by it in connection with the applicable Additional Permitted Convertible Subordinated Notes Transaction, and (ii) each holder of an
Additional Permitted Convertible Subordinated Note (other than an individual) certifying the names and signatures of its officers authorized to execute and deliver the Convertible Note Subordination Agreement to which such holder is a party; 

  
 -3- 

 (E) The Administrative Agent shall have received copies of each of the executed
Additional Permitted Convertible Subordinated Notes (in form and substance satisfactory to Administrative Agent) issued by Holdings, certified as to authenticity by Holdings; 

(F) The Administrative Agent shall have received a separate Convertible Note Subordination Agreement duly executed and
delivered by Holdings and each holder of an Additional Permitted Convertible Subordinated Note issued by Holdings; 
 (G) The
Administrative Agent shall have received evidence that the Borrowers shall have paid to the Administrative Agent all reasonable out-of-pocket fees and expenses of the Administrative Agent incurred in connection with the Additional Permitted
Convertible Subordinated Notes Transaction and the transactions contemplated thereby (including, to the extent invoiced, the reasonable out-of-pocket fees, disbursements and charges of counsel to the Administrative Agent); 

(H) The final terms and conditions of each aspect of the Additional Permitted Convertible Subordinated Notes Transaction, shall
be in all material respects as described in the certificates, documents, agreements and information delivered to Administrative Agent and Lenders under subsection (A) of this Section 6.02(f)(ii) above and in the other written information
provided by Holdings to the Administrative Agent and the Lenders with respect thereto, and to the extent not described therein, shall be otherwise satisfactory to the Administrative Agent and the Lenders in their sole discretion; 

(I) No Default or Event of Default shall have occurred and be continuing or would result from the Additional Permitted
Convertible Subordinated Notes Transaction or issuance of Additional Permitted Convertible Subordinated Notes or application of the proceeds thereof; and 

(J) The Administrative Agent shall have received such other certificates, documents and agreements as the Administrative Agent
may reasonably request.” 
 SECTION 3. Conditions of Effectiveness. This Amendment shall become effective when, and only
when, on or before the Amendment No. 8 Effective Date: 
 (a) Counterparts. The Administrative Agent shall have received
counterparts of this Amendment duly executed and delivered by the Lenders and all of the Borrowers. 
 (b) Officers’
Certificate. The Administrative Agent shall have received a certificate of the Borrower Representative, on behalf of each Borrower, certifying (i) that resolutions of the board of directors, board of managers or other appropriate governing
body of each Borrower, previously certified and delivered to the Administrative Agent, authorize the execution, delivery and performance by such Borrower of this Amendment and each of the other documents required to be executed by such Borrower
hereunder and such resolutions are in full force and effect and 

  
 -4- 

 
have not been amended or modified, (ii) the officers of each Borrower (A) who are authorized to sign this Amendment and the other documents required hereby and to which such Borrower is
a party and (B) who will, until replaced by another officer or officers duly authorized for that purpose, act as its representative for the purposes of signing documents and giving notices and other communications in connection with this
Amendment, the Credit Agreement and the other Loan Documents, (iii) specimen signatures of such authorized officers, and (iv) that the Organizational Documents of each Borrower most recently certified and delivered to the Administrative
Agent, are in full force effect and have not been amended or modified. The Administrative Agent and the Lenders may conclusively rely on such certificate until the Administrative Agent receives notice in writing from the Borrower Representative.

 (c) Convertible Note Subordination Agreements. The Administrative Agent shall have received a separate Convertible Note
Subordination Agreement duly executed and delivered by Holdings and each holder of a 7.25% Convertible Subordinated Note Due 2020 issued by Holdings. 

(d) 7.25% Convertible Subordinated Notes Due 2020. The Administrative Agent shall have received copies of the executed 7.25%
Convertible Subordinated Notes Due 2020 issued by Holdings, certified as to authenticity by Holdings. 
 (e) Fees and Expenses. The
Administrative Agent shall have received evidence that the Borrowers shall have paid to the Administrative Agent all out-of-pocket fees and expenses of the Administrative Agent incurred in connection with this Amendment and the transactions
contemplated hereby (including, to the extent invoiced, the out-of-pocket fees, disbursements and charges of counsel to the Administrative Agent). 

(f) Other Documents. The Administrative Agent shall have received such other certificates, documents and agreements as the
Administrative Agent may reasonably request. 
 SECTION 4. Representations and Warranties of the Borrowers. To induce the
Administrative Agent and the Lenders to enter into this Amendment, each of the Borrowers hereby represents and warrants to the Administrative Agent and all of the Lenders as of the date hereof that: 

(a) Existence; etc. Each Borrower is duly organized, validly existing and in good standing under the laws of the jurisdiction indicated
in the preamble of this Amendment. 
 (b) No Legal Bar. Each Borrower has the power, authority, and legal right to execute, deliver
and perform its obligations under this Amendment and each other document or instrument required to be executed and delivered by it hereunder. The execution, delivery and performance by each Borrower of this Amendment and each other document or
instrument required to be executed and delivered by such Borrower hereunder have been duly authorized by all necessary organizational action and do not and will not (i) contravene or violate any of the Organizational Documents of such Borrower,
(ii) violate any Requirement of Law, (iii) violate any Contractual Obligation binding on or affecting such Borrower or any of its assets, (iv) violate any order, injunction, writ or decree of any Governmental Authority or any arbitral
award to which such Borrower or its property is subject or (v) result in, or require, the creation or 

  
 -5- 

 
imposition of any mortgage, deed of trust, pledge, Lien, security interest or other charge, encumbrance or preferential arrangement of any nature (other than pursuant to the Security Documents)
upon or with respect to any of the properties now owned or hereafter acquired by such Borrower. 
 (c) Approvals. No consent or
authorization of, approval by, notice to, filing with or other act by or in respect of, any Governmental Authority or any other Person is required in connection with the execution, delivery and performance of this Amendment by any of the Borrowers.

 (d) Enforceable Obligations. This Amendment has been duly executed and delivered by each Borrower. This Amendment constitutes a
legal, valid and binding obligation of each Borrower enforceable against each Borrower in accordance with its terms, except as enforceability may be limited by bankruptcy, insolvency, reorganization, moratorium and other similar laws affecting the
enforcement of creditors’ rights generally and general equitable principles. 
 (e) Security Documents. The Security Documents
constitute valid and perfected security interests and liens in and to the Collateral covered thereby with the priority required thereunder and secure the payment and performance of the Secured Obligations, and all action required to perfect fully
such security interests and liens has been taken and completed, and the execution, delivery and performance of this Amendment do not adversely affect any such security interests and liens or the perfection or priority thereof. 

(f) No Default. No Default or Event of Default has occurred and is continuing. 

(g) Representations and Warranties. The representations and warranties made by each of the Borrowers in the Credit Agreement and the
other Loan Documents are true and correct in all material respects on and as of the date hereof (except to the extent such representations and warranties relate, by their terms, to a specific earlier date, in which case they shall be true and
correct on and as of such earlier date). 
 SECTION 5. RELEASE; COVENANT NOT TO SUE; ACKNOWLEDGMENT. (a) EACH BORROWER
(COLLECTIVELY, THE “RELEASING PARTIES”) HEREBY ABSOLUTELY AND UNCONDITIONALLY RELEASES AND FOREVER DISCHARGES THE ADMINISTRATIVE AGENT AND EACH LENDER, AND ANY AND ALL RELATED PARTIES OF ANY OF THE FOREGOING (EACH A
“RELEASED PARTY”), FROM ANY AND ALL CLAIMS, DEMANDS OR CAUSES OF ACTION OF ANY KIND, NATURE OR DESCRIPTION RELATING TO OR ARISING OUT OF OR IN CONNECTION WITH OR AS A RESULT OF ANY OF THE OBLIGATIONS, THE CREDIT AGREEMENT, THIS
AMENDMENT, OR ANY OF THE OTHER LOAN DOCUMENTS, WHETHER ARISING IN LAW OR EQUITY OR UPON CONTRACT OR TORT OR UNDER ANY STATE OR FEDERAL LAW OR OTHERWISE, WHICH EACH RELEASING PARTY HAS HAD, NOW HAS OR HAS MADE CLAIM TO HAVE AGAINST ANY RELEASED PARTY
FOR OR BY REASON OF ANY ACT, OMISSION, MATTER, CAUSE OR THING WHATSOEVER ARISING FROM THE BEGINNING OF TIME TO AND INCLUDING THE DATE OF THIS AMENDMENT, WHETHER SUCH CLAIMS, DEMANDS AND CAUSES OF ACTION ARE

  
 -6- 

 
MATURED OR UNMATURED OR KNOWN OR UNKNOWN. IT IS THE INTENTION OF EACH RELEASING PARTY IN PROVIDING THIS RELEASE THAT THE SAME SHALL BE EFFECTIVE AS A BAR TO EACH AND EVERY CLAIM, DEMAND AND CAUSE
OF ACTION SPECIFIED. EACH RELEASING PARTY ACKNOWLEDGES THAT IT MAY HEREAFTER DISCOVER FACTS DIFFERENT FROM OR IN ADDITION TO THOSE NOW KNOWN OR BELIEVED TO BE TRUE WITH RESPECT TO SUCH CLAIMS, DEMANDS, OR CAUSES OF ACTION AND AGREE THAT THIS
INSTRUMENT SHALL BE AND REMAIN EFFECTIVE IN ALL RESPECTS NOTWITHSTANDING ANY SUCH DIFFERENCES OR ADDITIONAL FACTS. EACH RELEASING PARTY UNDERSTANDS, ACKNOWLEDGES AND AGREES THAT THE RELEASE SET FORTH ABOVE MAY BE PLEADED AS A FULL AND COMPLETE
DEFENSE AND MAY BE USED AS A BASIS FOR AN INJUNCTION AGAINST ANY ACTION, SUIT OR OTHER PROCEEDING WHICH MAY BE INSTITUTED, PROSECUTED OR ATTEMPTED IN BREACH OF THE PROVISIONS OF SUCH RELEASE. 

(b) EACH RELEASING PARTY, ON BEHALF OF ITSELF AND ITS SUCCESSORS, ASSIGNS, AND OTHER LEGAL REPRESENTATIVES, HEREBY ABSOLUTELY, UNCONDITIONALLY
AND IRREVOCABLY, COVENANTS AND AGREES WITH AND IN FAVOR OF EACH RELEASED PARTY THAT IT WILL NOT SUE (AT LAW, IN EQUITY, IN ANY REGULATORY PROCEEDING OR OTHERWISE) ANY RELEASED PARTY ON THE BASIS OF ANY CLAIM RELEASED, REMISED AND DISCHARGED BY SUCH
RELEASING PARTY PURSUANT TO THE ABOVE RELEASE. IF ANY RELEASING PARTY OR ANY OF ITS SUCCESSORS, ASSIGNS OR OTHER LEGAL REPRESENTATIVES VIOLATES THE FOREGOING COVENANT, SUCH RELEASING PARTY, FOR ITSELF AND ITS SUCCESSORS, ASSIGNS AND LEGAL
REPRESENTATIVES, AGREES TO PAY, IN ADDITION TO SUCH OTHER DAMAGES AS ANY RELEASED PARTY MAY SUSTAIN AS A RESULT OF SUCH VIOLATION, ALL ATTORNEYS’ FEES AND COSTS INCURRED BY SUCH RELEASED PARTY AS A RESULT OF SUCH VIOLATION. 

(c) EACH RELEASING PARTY HEREBY ACKNOWLEDGES ITS STATUS AS A BORROWER AND AFFIRMS ITS OBLIGATIONS UNDER THE CREDIT AGREEMENT AND THE OTHER
LOAN DOCUMENTS AND EACH RELEASING PARTY REPRESENTS AND WARRANTS THAT THERE ARE NO LIABILITIES, CLAIMS, SUITS, DEBTS, LIENS, LOSSES, CAUSES OF ACTION, DEMANDS, RIGHTS, DAMAGES OR COSTS, OR EXPENSES OF ANY KIND, CHARACTER OR NATURE WHATSOEVER, KNOWN
OR UNKNOWN, FIXED OR CONTINGENT, WHICH SUCH RELEASING PARTY MAY HAVE OR CLAIM TO HAVE AGAINST ANY RELEASED PARTY ARISING UNDER, IN CONNECTION WITH, AND/OR WITH RESPECT TO THE OBLIGATIONS, THE CREDIT AGREEMENT, THIS AMENDMENT OR ANY OF THE OTHER LOAN
DOCUMENTS, AND EACH RELEASING PARTY FURTHER ACKNOWLEDGES THAT, AS OF THE DATE HEREOF, IT DOES NOT HAVE ANY COUNTERCLAIM, SET-OFF, OR DEFENSE AGAINST ANY OF THE RELEASED PARTIES, EACH OF WHICH SUCH RELEASING PARTY HEREBY EXPRESSLY WAIVES. 

SECTION 6. Reference to and Effect on the Loan Documents. (a) Upon the effectiveness of this Amendment, on and after the date
hereof each reference in the Credit 

  
 -7- 

 
Agreement to “this Agreement”, “hereunder”, “hereof” or words of like import referring to the Credit Agreement, and each reference in the other Loan Documents to
“the Credit Agreement”, “thereunder”, “thereof” or words of like import referring to the Credit Agreement, shall mean and be a reference to the Credit Agreement as amended hereby. 

(b) Except as specifically amended or modified above, the Credit Agreement and all other Loan Documents, are and shall continue to be in full
force and effect in accordance with their respective terms and are hereby in all respects ratified and confirmed by each Borrower. 
 (c)
The execution, delivery and effectiveness of this Amendment shall not, except as expressly provided herein, operate as a waiver of any right, power or remedy of any Lender or the Administrative Agent under any of the Loan Documents, nor constitute a
waiver of any provision of any of the Loan Documents. 
 (d) This Amendment is a Loan Document in all respects and for all purposes. 

SECTION 7. Further Assurances. Each Borrower agrees that it shall, at such Borrower’s expense and upon the request of the
Administrative Agent, duly execute and deliver, or cause to be duly executed and delivered, to the Administrative Agent such further documents and do and cause to be done such further acts as may be necessary or proper in the opinion of the
Administrative Agent to carry out more effectively the provisions and purposes of this Amendment and each of the other Loan Documents. 

SECTION 8. Costs and Expenses. The Borrowers jointly and severally agree to pay or reimburse the Administrative Agent on demand
for all of its out-of-pocket costs and expenses incurred in connection with this Amendment, any other documents prepared in connection herewith and the transactions contemplated hereby, including, without limitation, the fees and disbursements of
counsel to the Administrative Agent. 
 SECTION 9. Binding Agreement; Assignment. This Amendment shall be binding on the parties
hereto and their respective successors and assigns; provided, however, that none of the Borrowers may assign or delegate any of its rights or obligations hereunder without the prior written consent of the Administrative Agent and each
Lender. 
 SECTION 10. Execution in Counterparts. This Amendment may be executed in any number of counterparts and by different
parties hereto in separate counterparts, each of which when so executed and delivered shall be deemed to be an original and all of which taken together shall constitute but one and the same agreement. Delivery of an executed counterpart of a
signature page of this Amendment by facsimile or in electronic (i.e., “pdf” or “tif”) format shall be effective as delivery of a manually executed counterpart of this Amendment. 

SECTION 11. Acknowledgment. Each Borrower hereby acknowledges that it has been advised by counsel in the negotiation, preparation,
execution and delivery of this Amendment. 
 SECTION 12. Governing Law. This Amendment shall be governed by, and construed in
accordance with, the laws of the State of Texas. 

  
 -8- 

 SECTION 13. Time of the Essence. Time is of the essence of this Amendment and the
other Loan Documents. 
 SECTION 14. Survival. All representations and warranties made in this Amendment or any other Loan
Document shall survive the execution and delivery of this Amendment, and no investigation by the Administrative Agent or the Lenders or any closing will affect such representations and warranties or the right of the Administrative Agent or the
Lenders to rely upon them. 
 SECTION 15. Headings. The section headings hereof are inserted for convenience of reference only
and shall in no way alter, amend, define or be used in the construction or interpretation of the text of such section. 
 SECTION 16.
ENTIRE AGREEMENT. THIS AMENDMENT, THE CREDIT AGREEMENT AND THE OTHER LOAN DOCUMENTS COLLECTIVELY REPRESENT THE FINAL AGREEMENT AMONG THE PARTIES AND MAY NOT BE CONTRADICTED BY EVIDENCE OF PRIOR, CONTEMPORANEOUS, OR SUBSEQUENT ORAL AGREEMENTS
OF THE PARTIES. THERE ARE NOT UNWRITTEN ORAL AGREEMENTS AMONG THE PARTIES. 
 [Signature Pages Follow] 

  
 -9- 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed and delivered by
their proper and duly authorized officers as of the date first above written. 
  

			
	ADMINISTRATIVE AGENT:
	
	SOUTHWEST BANK,
	a Texas state bank, as Administrative Agent
		
	By:		 /s/ Josh Burleson

	Name:		Josh Burleson
	Title:		Vice President

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	LENDER:
	
	 SOUTHWEST BANK,
 a Texas
state bank, as the sole Lender

		
	By:		 /s/ Josh Burleson

	Name:		Josh Burleson
	Title:		Vice President

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	BORROWERS:
	
	USMD HOLDINGS, INC.
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	IMPEL MANAGEMENT SERVICES, L.L.C.
		
	By:		USMD Holdings, Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	IMPEL CONSULTING EXPERTS, L.L.C.
		
	By:		Impel Management Services, L.L.C., its sole member
		
	By:		USMD Holdings, Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	USMD INC.
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	MAT-RX DEVELOPMENT, L.L.C.
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	MAT-RX FORT WORTH GP, L.L.C.
		
	By:		MAT-RX DEVELOPMENT, L.L.C., its sole member
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	USMD OF ARLINGTON GP, L.L.C.
		
	By:		MAT-RX DEVELOPMENT, L.L.C., its sole member
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	USGP, LLC.
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	US LITHOTRIPSY, L.P.
		
	By:		USGP, LLC., its general partner
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	LITHO GP, LLC.
		
	By:		US Lithotripsy, L.P., its sole member
		
	By:		USGP, LLC., its general partner
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	METRO I STONE MANAGEMENT, LTD.
		
	By:		Litho GP, LLC., its general partner
		
	By:		US Lithotripsy, L.P., its sole member
		
	By:		USGP, LLC., its general partner
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	USMD ADMINISTRATIVE SERVICES, L.L.C.
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	USMD DIAGNOSTIC SERVICES, LLC
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	USMD PPM, LLC
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	USMD CANCER TREATMENT CENTERS, L.L.C.
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	USMD CANCER TREATMENT CENTERS GP, L.L.C.
		
	By:		USMD Cancer Treatment Centers, L.L.C., its sole member
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	USMD AFFILIATED SERVICES
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	MEDICAL CLINIC OF NORTH TEXAS PLLC
		
	By:		USMD Affiliated Services, its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement 

 
			
	UROLOGY ASSOCIATES OF NORTH TEXAS, P.L.L.C.
		
	By:		USMD Affiliated Services, its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer
	
	 USMD CTC (MO), LLC,
 a
Missouri limited liability company

		
	By:		USMD Cancer Treatment Centers, L.L.C., its sole member
		
	By:		USMD Inc., its sole member
		
	By:		 /s/ Carolyn Jones

	Name:		Carolyn Jones
	Title:		Chief Accounting Officer

  
 Signature Page 

Amendment No. 8 to Credit Agreement

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