Document:

Supplemental Indenture

 Exhibit 4.2 
  
  
 SUPPLEMENTAL INDENTURE 
  
 Dated as of June 20, 2006 
 to 
 INDENTURE 
 Dated as of January 20, 2000 
 Between 
 UNIVERSAL HEALTH SERVICES, INC. 
 And

 J.P. MORGAN TRUST COMPANY, NATIONAL ASSOCIATION 
 (as successor in interest to Bank One Trust Company, N.A.), as Trustee 
  
  

 Providing for Amendments to the
Indenture 
  

 SUPPLEMENTAL INDENTURE, dated as of June 20, 2006, between UNIVERSAL HEALTH SERVICES, INC., a corporation
duly organized and existing under the laws of the State of Delaware (herein called, the “Issuer”), having its principal office at Universal Corporate Center, 367 South Gulph Road, P.O. Box 61588, King of Prussia, Pennsylvania 19406-0958,
and J.P. MORGAN TRUST COMPANY, NATIONAL ASSOCIATION (as successor in interest to Bank One Trust Company, N.A.), a national banking association duly organized and existing under the laws of the United States of America, as Trustee (the
“Trustee”). 
 WHEREAS, the Issuer and the Trustee have heretofore executed and delivered the Indenture, dated as of
January 20, 2000 (the “Indenture”), in relation to the issuance from time to time of its unsecured debentures, notes or other evidence of indebtedness (the “Securities”) to be issued in one or more series as in the Indenture
provided; 
 WHEREAS, J.P. Morgan Trust Company, National Association acquired all or substantially all of the corporate trust business of
Bank One Trust Company, N.A., effective November 15, 2003, and pursuant to the provisions of Section 6.12 of the Indenture became the successor in interest to Bank One Trust Company, N.A., as Trustee under the Indenture (the “Trustee
Change”); 
 WHEREAS, Section 8.1(f) of the Indenture provides that the Issuer and the Trustee together may amend or supplement the
Indenture without notice to or consent of any Holders to evidence and provide for the acceptance of the appointment hereunder by a successor trustee with respect to the Securities of one or more series and add to or change any of the provisions of
the Indenture as shall be necessary to provide for or facilitate the administration of the trusts thereunder by more than one trustee, pursuant to the requirements of Section 6.11; and 
 WHEREAS, the Issuer desires to amend and supplement the Indenture to reflect the Trustee Change. 
 NOW, THEREFORE, in consideration of the foregoing and for other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
Issuer and the Trustee mutually covenant and agree, for the equal and proportionate benefit of the respective holders from time to time of the Securities, as follows: 
 SECTION 1 
 DEFINITIONS 
 Capitalized terms used herein and not otherwise defined herein have the meanings assigned to them in the Indenture. The words “herein,” “hereof,” and “hereby” and other words of similar
import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section thereof. 
  

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 SECTION 2 
 OPERATION OF AMENDMENTS 
 Upon the execution of this Supplemental Indenture pursuant to the provisions of
the Indenture, the Indenture shall be and be deemed to be modified and amended in accordance herewith and the respective rights, limitations of rights, obligations, duties and immunities under the Indenture of the Trustee, the Issuer and the Holders
of Securities of each series affected hereby shall thereafter be determined, exercised and enforced hereunder subject in all respects to such modifications and amendments, and all the terms and conditions of this Supplemental Indenture shall be and
be deemed to be part of the terms and conditions of the Indenture for any and all purposes. 
 SECTION 3 
 AMENDMENTS TO THE INDENTURE 
 Section 3.1     Amendment to the Title of the Indenture. 
 (a)   The title set
forth on the cover page of the Indenture is amended in its entirety as follows: 
  
 UNIVERSAL HEALTH SERVICES, INC. 
 AND 
 J.P. MORGAN TRUST COMPANY, NATIONAL ASSOCIATION, TRUSTEE 
 (as successor in interest to Bank One Trust
Company, N.A.) 
  
  

 INDENTURE 
 Dated as of January 20, 2000

  

 (b)
  The first paragraph on page 1 of the Indenture is amended to read in its entirety as follows: 
 INDENTURE, dated
as of January 20, 2000, between Universal Health Services, Inc., a Delaware corporation (the “Issuer”), and J.P. Morgan Trust Company, National Association (as successor in interest to Bank One Trust Company, N.A.), a national banking
association, duly organized and existing under the laws of the United States of America, as trustee (the “Trustee”). 
  

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 Section 3.2     Amendment to Definition of Corporate Trust
Office. 
 The definition of “Corporate Trust Office” set forth in Section 1.1 and on page 2 of the Indenture is amended
to read in its entirety as follows: 
 “Corporate Trust Office” means the office of the Trustee at which the corporate trust
business of the Trustee shall, at any particular time, be administered, which office is, at the date as of which this Indenture is dated, located at 227 West Monroe Street, Suite 2600, Chicago, Illinois 60606, Attention: Worldwide Securities
Services, provided that for purposes of Section 3.2 of the Indenture such term shall mean the office or agency of the Trustee located in the Borough of Manhattan, the City of New York, which office is located at 4 New York Plaza, 1st Floor, New York, New York 10004-2413 Attention: Worldwide Securities Services. 
 Section 3.3     Amendment to Form of Trustee’s Certificate of Authentication. 
 With respect to any Securities executed and authenticated after the date of this Supplemental Indenture, Section 2.2 of the Indenture is amended to
read in its entirety as follows: 
 The Trustee’s certificate of authentication on all Securities shall be in substantially the
following form: 
 This is one of the Securities described in the within-mentioned Indenture. 
 Dated: 

			
	 J.P. MORGAN TRUST COMPANY, NATIONAL
 ASSOCIATION, as Trustee

		
	By:	 	  
		 	Authorized Signatory

 Section 3.4     Amendment to Offices for Payments,
etc. 
 The third sentence of Section 3.2 of the Indenture is amended to read in its entirety as follows: 
 Unless otherwise specified in accordance with Section 2.3, the Issuer hereby appoints the Trustee as paying agent and registrar and designates the
corporate trust office of J.P. Morgan Trust Company, National Association, located at 4 New York Plaza, 1st Floor,
New York, New York 10004-2413 Attention: Worldwide Securities Services, as the office to be maintained by it for each such purpose. 
  
 SECTION 4 
 MISCELLANEOUS 
 Section 4.1     Full Force and Effect. Except as they have been modified by this Supplemental Indenture, each and every provision of the
Indenture shall continue in full force 

  

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and effect, and all references to the Indenture shall be deemed to mean the Indenture as amended pursuant hereto. 
 Section 4.2     Responsibility for Recitals, Etc. The recitals herein shall be taken as the statements of the Issuer, and the
Trustee assumes no responsibility for the correctness thereof. The Trustee makes no representations as to the validity or sufficiency of this Supplemental Indenture. 
 Section 4.3     Trustee Reliance. The Trustee, subject to the provisions of Section 6.1 and 6.2 of the Indenture, enters into this Supplemental Indenture in reliance on an
Officers’ Certificate and Opinion of Counsel, as contemplated by Section 8.4 of the Indenture, and makes no independent determination that this Supplemental Indenture is authorized or permitted by the Indenture. All of the provisions in
the Indenture in respect of the rights, privileges, immunities, powers, and duties of the Trustee shall be applicable in respect of this Supplemental Indenture as fully and with like force and effect as though set forth in full herein. 

Section 4.4     Provisions Binding on the Issuer’s Successors and Assigns. All the covenants, stipulations, promises
and agreements contained in this Supplemental Indenture made by the Issuer shall bind its successors and assigns, whether so expressed or not. 
 Section 4.5     New York Law to Govern. This Supplemental Indenture shall be deemed to be a contract made under the laws of the State of New York, and for all purposes shall be construed in accordance with the
laws of said State, except as may otherwise be required by mandatory provisions of law. 
 Section 4.6     Execution
and Counterparts. This Supplemental Indenture may be executed in any number of counterparts, each of which shall be an original, but such counterparts together constitute but one and the same instrument. 
 Section 4.7     Effect of Headings. The Section headings herein are for convenience only and shall not affect the construction
hereof. 
  
 [Signature page follows.] 
  

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

			
	UNIVERSAL HEALTH SERVICES, INC.
		
	By	 	/s/ Steve Filton
		 	 Name: Steve Filton
 Title:   Sr. Vice
President & CFO

  
  

			
	 JP MORGAN TRUST COMPANY, NATIONAL
 ASSOCIATION, as Trustee

		
	By	 	/s/ Sharon K. McGrath
		 	 Name: Sharon K. McGrath
 Title:   Vice
President

  

 5Form of Debt Security

 Exhibit 4.3 
 [FORM OF FACE OF [SECURITY]] 
 [GLOBAL SECURITY] 
 UNIVERSAL HEALTH SERVICES, INC. 
 [Title of Security] 
  

			
	 Principal Amount
$                                    
	  	CUSIP No.                            
	 No.                                  
	  	

 [Unless this certificate is presented by an authorized representative of The Depository Trust
Company, a New York corporation (“DTC”), to Issuer or its agent for registration of transfer, exchange, or payment, and any certificate issued is registered in the name of Cede & Co. or in such other name as is requested by an
authorized representative of DTC (and any payment is made to Cede & Co. or to such other entity as is requested by an authorized representative of DTC), ANY TRANSFER, PLEDGE, OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS
WRONGFUL inasmuch as the registered owner hereof, Cede & Co., has an interest herein.] 
 UNIVERSAL HEALTH SERVICES, INC., a
Delaware corporation (the “Issuer”), for value received, hereby promises to pay to [Cede & Co.] or registered assigns, at the agency of the Issuer in the City of New York, New York, the principal sum of
                                     DOLLARS
($                    ) on
                                , in immediately available funds in such coin or
currency of the United States of America as at the time of payment shall be legal tender for the payment of public and private debts, and to pay interest, semiannually on
                             and
                             of each year (each, an “Interest Payment Date”), commencing
                                , on said principal sum at said office or agency,
in like coin or currency, at the rate per annum specified in the title of this [Security], from the most recent Interest Payment Date to which interest has been paid or, if no interest has been paid, from
                            , until payment of said principal sum has been made or duly provided for;
provided, that payment of interest may be made at the option of the Issuer by check mailed to the address of the person entitled thereto as such address shall appear on the [Security] register. The amount of interest payable on any Interest Payment
Date shall be computed on the basis of a 360-day year of twelve 30-day months. Each payment of interest in respect of an Interest Payment Date shall include interest accrued through the day prior to such Interest Payment Date. The interest so
payable on any Interest Payment Date will, subject to certain exceptions provided in the Indenture referred to on the reverse hereof, be paid to the person in whose name this [Security] is registered at the close of business on the
                         or
                        , as the case may be, which shall be a Business Day (as defined in the Indenture) next preceding
such Interest Payment Date. 
  

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 Reference is made to the further provisions of this [Security] set forth on the reverse hereof. Such
further provisions shall for all purposes have the same effect as though fully set forth at this place. 
 This [Security] shall not be valid
or become obligatory for any purpose until the certificate of authentication hereon shall have been signed by the Trustee under the Indenture referred to on the reverse hereof. 
  

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 IN WITNESS WHEREOF, Universal Health Services, Inc. has caused this instrument to be signed [by
facsimile] by its duly authorized officers and has caused [a facsimile of] its corporate seal to be affixed hereunto or imprinted hereon. 
  

					
		 	 UNIVERSAL HEALTH SERVICES, INC.

	 [SEAL]
	 		  	
		 	By:	  	                                      
                                        
                      
		 		  	Name:
		 		  	Title:
			
		 	By:	  	                                      
                                        
                      
		 		  	Name:
		 		  	Title:

  

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 [FORM OF TRUSTEE’S CERTIFICATE OF AUTHENTICATION] 
 This is one of the Securities described in the within-mentioned Indenture. 
  

					
	Dated:	  	 J.P. MORGAN TRUST COMPANY, NATIONAL
 ASSOCIATION, as Trustee

			
		  	By:	  	  
		  		  	Authorized Signatory

  

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 [FORM OF REVERSE OF SECURITY] 
 UNIVERSAL HEALTH SERVICES, INC. 
 [Title of Security] 
 This [Security] is one of a duly authorized issue of unsecured debentures, notes or other evidence of indebtedness of the Issuer (hereinafter called the
“Securities”) of the series hereinafter specified, all issued or to be issued under and pursuant to an indenture dated as of January 20, 2000, as amended by a supplemental indenture dated as of June 20, 2006 (herein called the
“Indenture”), duly executed and delivered by the Issuer to J.P. Morgan Trust Company, National Association, as Trustee (herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which
Indenture and all indentures supplemental thereto reference is hereby made for a description of the rights, limitations of rights, obligations, duties and immunities thereunder of the Trustee, the Issuer and the Holders (as defined in the
Indenture). The Securities may be issued in one or more series, which different series may be issued in various aggregate principal amounts, may mature at different times, may bear interest (if any) at different rates, may be subject to different
redemption provisions (if any), may be subject to different sinking, purchase or analogous funds (if any) and may otherwise vary as in the Indenture provided. This [Security] is one of a series designated as the
        % [Securities] due                      of the Issuer[, limited in aggregate principal
amount to $                         (herein called the “[Securities]”)]. 
 [The [Securities] will not be redeemable prior
to                        .][The [Securities] may be redeemed at the option of the Issuer as a whole, or from time to time
in part, in the amount of $                             or any multiple thereof, on any date after and
prior to maturity, upon mailing a notice of such redemption not less than 30 nor more than 60 days prior to the date fixed for redemption to the Holders of [Securities] at their last registered addresses, all as further provided in the Indenture, at
the following redemption prices (expressed in percentages of the principal amount) together in each case with accrued interest to the date fixed for redemption: 
 If redeemed on or before
                        ,         %, and if redeemed during the
twelve-month period beginning, 
  

							
	 Year
	 	 Percentage
	 	 Year
	 	 Percentage

		 		 		 	
		 		 		 	

 and thereafter at 100% of their principal amount.] 
 In the case that one or more specified Events of Default (as specified in the Indenture) with respect to the [Securities] shall have occurred and be
continuing, the principal hereof may be declared, and upon such declaration shall become, due and payable, in the manner, with the effect and subject to the conditions provided in the Indenture. 
 The Indenture contains provisions permitting the Issuer and the Trustee, with the consent of the Holders of not less than a majority in aggregate
principal amount of the Securities at the time Outstanding (as defined in the Indenture) of all series to be affected (voting as one class), 

  

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evidenced as in the Indenture provided, to execute supplemental indentures adding any provisions to or changing in any manner or eliminating any of the
provisions of the Indenture or of any supplemental indenture or modifying in any manner the rights of the Holders of the Securities of each such series; provided, however, that no such supplemental indenture shall (i) change the final maturity
of any Security, or reduce the principal amount thereof or any premium thereon, or reduce the rate or extend the time of payment of any interest thereon, or reduce any amount payable on redemption thereof or reduce the amount of the principal of an
Original Issue Discount Security (as defined in the Indenture) payable upon acceleration thereof or the amount thereof provable in bankruptcy, or impair or affect the rights of any Holder to institute suit for the payment thereof, or, if the
Securities provide therefor, any right of repayment at the option of the Holder, without the consent of the Holder of each Security so affected, or (ii) reduce the aforesaid percentage of Securities, the Holders of which are required to consent
to any such supplemental indenture, without the consent of the Holder of each Security affected. 
 It is also provided in the Indenture that
if, at any time after the principal of the [Securities] of this series (or of all the [Securities], as the case may be) shall have been so declared due and payable, and before any judgment or decree for the payment of the moneys due shall have been
obtained or entered as provided in the Indenture, the Issuer shall pay or shall deposit with the Trustee a sum sufficient to pay all matured installments of interest upon all the [Securities] of this series (or of all the [Securities], as the case
may be) and the principal of any and all [Securities] of this series (or of all the [Securities], as the case may be) which shall have become due otherwise than by acceleration (with interest upon such principal and, to the extent that payment of
such interest is enforceable under applicable law, on overdue installments of interest, at the same rate as the rate of interest specified herein to the date of such payment or deposit) and such amount as shall be sufficient to cover reasonable
compensation to the Trustee, its agents, attorneys and counsel, and all other expenses and liabilities incurred, and all advances made, by the Trustee except as a result of negligence or bad faith, and if any and all Events of Default under the
Indenture, other than the non-payment of the principal of [Securities] which shall have become due by acceleration, shall have been cured, waived or otherwise remedied as provided in the Indenture— then and in every such case the Holders of a
majority in aggregate principal amount of all the [Securities] of this series (or of all the [Securities], as the case may be, voting as a single class) then Outstanding, by written notice to the Issuer and to the Trustee, may waive all defaults
with respect to such series (or with respect to all the [Securities], as the case may be) and rescind and annul such declaration and its consequences, but no such waiver or rescission and annulment shall extend to or shall affect any subsequent
default or shall impair any right consequent thereon. Any such consent or waiver by the Holder of this [Security] (unless revoked as provided in the Indenture) shall be conclusive and binding upon such Holder and upon all future Holders and owners
of this [Security] and any [Securities] which may be issued in exchange or substitution herefor, irrespective of whether or not any notation thereof is made upon this [Security] or such other [Securities]. 
 No reference herein to the Indenture and no provision of this [Security] or of the Indenture shall alter or impair the obligation of the Issuer, which is
absolute and unconditional, to pay the principal of and any premium and interest on this [Security] in the manner, at the respective times, at the rate and in the coin or currency herein prescribed. 
 The [Securities] are issuable only in registered form, without coupons, in denominations of $1,000 and any integral multiple thereof, and in book-entry
form. The [Securities] may be 

  

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represented by one or more Global Securities (each, a “Global [Security]”) deposited with the Depositary and registered in the name of the nominee
of the Depositary, with certain limited exceptions. So long as the Depositary or any successor Depositary or its nominee is the registered Holder of a Global [Security], such successor Depositary or such nominee, as the case may be, will be
considered the sole owner or Holder of the [Securities] represented by such Global [Security] for all purposes under the Indenture and the [Securities]. Beneficial interest in the [Securities] will be evidenced only by, and transfer thereof will be
effected only through, records maintained by the Depositary and its participants. Except as provided below, an owner of a beneficial interest in a Global [Security] will not be entitled to have [Securities] represented by such Global [Security]
registered in such owner’s name, will not receive or be entitled to receive physical delivery of the [Securities] in certificated form and will not be considered the owner or Holder thereof under the Indenture. 
 No Global [Security] may be transferred except as a whole by such Depositary to a nominee of such Depositary or by a nominee of such Depositary to such
Depositary or another nominee of such Depositary or by such Depositary or any such nominee to a successor Depositary for such series or a nominee of such successor Depositary. Global [Securities] are exchangeable for certificated [Securities] only
if (x) the Depositary notifies the Issuer that it is unwilling or unable to continue as Depositary for such Global [Securities] or if at any time the Depositary ceases to be a clearing agency registered under the Exchange Act and the Issuer
fails within 90 days thereafter to appoint a successor Depositary, (y) the Issuer in its sole discretion determines that such Global [Securities] shall be so exchangeable or (z) there shall have occurred and be continuing an Event of
Default or an event which with the giving of notice or lapse of time or both would constitute an Event of Default with respect to the [Securities] represented by such Global [Securities] and the beneficial owners representing a majority in principal
amount of the applicable series of Securities represented by one or more Global [Securities] advise the Depositary to cease acting as depositary for such Global [Securities]. In such event, the Issuer will issue [Securities] in certificated form in
exchange for such Global [Securities]. In any such instance, an owner of a beneficial interest in the Global [Securities] will be entitled to physical delivery in certificated form of [Securities] equal in principal amount to such beneficial
interest and to have such [Securities] registered in its name. [Securities] so issued in certificated form will be issued in denominations of $1,000 or any integral multiple thereof, and will be issued in registered form only, without coupons.

 The Issuer, the Trustee and any authorized agent of the Issuer or the Trustee may deem and treat the registered Holder hereof as the
absolute owner of this [Security] (whether or not this [Security] shall be overdue and notwithstanding any notation of ownership or other writing hereon), for the purpose of receiving payment of, or on account of, the principal hereof and premium,
if any, and subject to the provisions on the face hereof, interest hereon, and for all other purposes, and neither the Issuer nor the Trustee nor any authorized agent of the Issuer or the Trustee shall be affected by any notice to the contrary.

 No recourse under or upon any obligation, covenant or agreement of the Issuer in the Indenture or any indenture supplemental thereto or in
any [Security], or because of the creation of any indebtedness represented thereby, shall be had against incorporator, stockholder, officer or director, as such, of the Issuer or of any successor corporation, either directly or through the Issuer or
any successor corporation, under any rule of law, statute or constitutional provision or by the enforcement of any assessment or by any legal or equitable proceeding or otherwise, all 

  

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such liability being expressly waived and released by the acceptance hereof and as part of the consideration for the issue hereof. 
 The acceptance of this [Security] shall be deemed to constitute the consent and agreement of the Holder hereof to all of the terms and provisions of the
Indenture. Terms used herein which are defined in the Indenture shall have the respective meanings assigned thereto in the Indentures. 
 THE
INDENTURE AND THE [SECURITIES] SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK, WITHOUT REGARD TO CONFLICTS OF LAW PRINCIPLES THEREOF. 
  

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