Document:

Exhibit 4.2

 Exhibit 4.2 
 UNLESS THIS SECURITY IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), 55 WATER STREET, NEW YORK, NEW YORK, TO THE COMPANY (AS DEFINED
BELOW) 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. 
 THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING SET FORTH IN THE INDENTURE HEREINAFTER
REFERRED TO AND IS REGISTERED IN THE NAME OF DTC OR A NOMINEE OF DTC. THIS SECURITY IS EXCHANGEABLE FOR SECURITIES REGISTERED IN THE NAME OF A PERSON OTHER THAN DTC OR ITS NOMINEE ONLY IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE, AND MAY
NOT BE TRANSFERRED EXCEPT AS A WHOLE BY DTC TO A NOMINEE OF DTC OR ANOTHER NOMINEE OF DTC OR BY DTC OR ITS NOMINEE TO A SUCCESSOR DEPOSITORY OR ITS NOMINEE. 
  

			
	Registered No. 001	  	PRINCIPAL AMOUNT
	 CUSIP No.: 637417 AE6
	  	$325,000,000.00 (subject to
revision as set forth below)

 NATIONAL RETAIL PROPERTIES, INC. 
 3.80% NOTE DUE 2022 
 NATIONAL RETAIL PROPERTIES, INC., a corporation duly
organized and existing under the laws of the State of Maryland (herein referred to as the “Company” which term shall include any successor corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay
to CEDE & CO., or registered assigns, upon presentation, the principal sum of THREE HUNDRED TWENTY-FIVE MILLION AND 00/100THS DOLLARS ($325,000,000.00), as may be revised by the Schedule of Increases or Decreases in Global Security attached
hereto, on October 15, 2022 and to pay interest on the outstanding principal amount thereon from August 14, 2012, or from the immediately preceding Interest Payment Date to which interest has been paid or duly provided for, semi-annually
in arrears on April 15 and October 15 in each year, commencing April 15, 2013, at the rate of 3.8% per annum, until the entire principal hereof is paid or made available for payment. The interest so payable and punctually paid or
duly provided for on any Interest Payment Date will, as provided in the Indenture, be paid to the Person in whose name this Security is registered at the close of business on the Regular Record Date for such interest, which shall be the April 1
or October 1 (whether or not a Business Day), as the case may be, next preceding such Interest Payment Date. Any such interest not so punctually paid or duly provided for shall forthwith cease to be payable to the

  
 - 1 -

 
Holder on such Regular Record Date, and may either be paid to the Person in whose name this Security is registered at the close of business on a Special Record Date for the payment of such
Defaulted Interest to be fixed by the Trustee, notice whereof shall be given to Holders of the Securities not more than 15 days and not less than 10 days prior to such Special Record Date, or may be paid at any time in any other lawful manner not
inconsistent with the requirements of any securities exchange on which the Securities may be listed, and upon such notice as may be required by such exchange, all as more fully provided in the Indenture. Payment of the principal of and interest on
this Security will be made at the office or agency maintained for that purpose in the City of St. Paul, Minnesota, or elsewhere as provided in the Indenture, in such coin or currency of the United States of America as at the time of payment is legal
tender for payment of public and private debts; provided, however, that at the option of the Company payments of principal and interest on the 3.80% Notes (other than payments of principal and interest due at Stated Maturity) may be made (i) by
check mailed to the address of the Person entitled thereto as such address shall appear in the Security Register or (ii) by wire transfer to an account of the Person entitled thereto located within the United States, provided, that such Person
owns 3.80% Notes in an aggregate principal amount of at least $1,000,000 and such Person makes a written request therefor for the appropriate Interest Payment Date. 
 Securities of this series are one of a duly authorized issue of securities of the Company (herein called the “Securities”), issued and to be issued in one or more series under an Indenture,
dated as of March 25, 1998 (as supplemented, herein called the “Indenture”), between the Company and U.S. Bank National Association, as successor trustee to Wachovia Bank, National Association (formerly First Union National Bank)
(herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which Indenture and all indentures supplemental thereto, including, Eleventh Supplemental Indenture thereto, dated August 14, 2012
between the Company and the Trustee, reference is hereby made for a statement of the respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities and of the terms upon which
the Securities are authenticated and delivered. This Security is one of the series designated in the first page thereof, initially having an aggregate principal amount equal to $325,000,000, provided, that the Company may, without the consent
of the Holders of the then Outstanding 3.80% Notes, “reopen” this series of Securities so as to increase the aggregate principal amount of 3.80% Notes Outstanding in compliance with the procedures set forth in the Indenture, including
Sections 3.1 and 3.3 thereof, so long as any such additional notes have the same tenor and terms (including, without limitation, rights to receive accrued and unpaid interest) as the 3.80% Notes then Outstanding. 

Securities of this series may be redeemed prior to July 15, 2022 (which is the date three months prior to the Stated Maturity), at
any time at the option of the Company, in whole or in part from time to time, upon notice of not more than 60 nor less than 30 days prior to the Redemption Date, at a redemption price equal to the sum of (i) the principal amount of the
Securities being redeemed plus accrued and unpaid interest thereon to the Redemption Date and (ii) the Make-Whole Amount, if any, with respect to such Securities; provided, however, that if the Company redeems the 3.80% Notes on
or after July 15, 2022, the redemption price will equal 100% of the principal amount of the Securities to be redeemed plus accrued and unpaid interest thereon to the Redemption Date. 

  
 - 2 -

 The Indenture contains provisions for defeasance at any time of (i) the entire
indebtedness of the Company on this Security and (ii) certain restrictive covenants and the related defaults and Events of Default applicable to the Company, in each case, upon compliance by the Company with certain conditions set forth in the
Indenture, which provisions apply to this Security. 
 If an Event of Default with respect to the Securities shall occur and be
continuing, the principal of the Securities may be declared due and payable in the manner and with the effect provided in the Indenture. 
 As provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have the right to institute any proceeding with respect to the Indenture or for the appointment of a
receiver or trustee or for any other remedy thereunder, unless (i) such Holder shall have previously given written notice to the Trustee of a continuing Event of Default with respect to the Securities, (ii) the Holders of not less than 25%
in principal amount of the Securities of this series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event of Default as Trustee and offered the Trustee reasonable indemnity and
(iii) the Trustee shall not have received from the Holders of a majority in principal amount of Securities of this series at the time Outstanding a direction inconsistent with such request, and shall have failed to institute any such
proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the enforcement of any payment of principal hereof or any interest on or
after the respective due dates expressed herein. 
 The Indenture permits, with certain exceptions as therein provided, the
amendment thereof and the modification of the rights and obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the
Holders of not less than a majority in principal amount of the Outstanding Securities of each series of Securities then Outstanding affected thereby. The Indenture also contains provisions permitting the Holders of specified percentages in principal
amount of the Securities of each series at the time Outstanding, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with certain provisions of the Indenture and certain past defaults under the Indenture and
their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in
exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 
 No
reference herein to the Indenture and no provision of this Security or of the Indenture shall alter or impair the obligation of the Company, which is absolute and unconditional, to pay the principal of (and Make-Whole Amount, if any) and interest on
this Security at the times, place and rate, and in the coin or currency, herein prescribed. 
 As provided in the Indenture and
subject to certain limitations therein set forth, the transfer of this Security is registrable in the Security Register, upon surrender of this Security 

  
 - 3 -

 
for registration of transfer at the office or agency of the Company in any Place of Payment where the principal of (and Make-Whole Amount, if any) and interest on this Security are payable, duly
endorsed by, or accompanied by a written instrument of transfer in form satisfactory to the Company and the Security Registrar duly executed by the Holder hereof or his attorney duly authorized in writing, and thereupon one or more new Securities of
this series, of authorized denominations and for the same aggregate principal amount, will be issued to the designated transferee or transferees. 
 The Securities of this series are issuable only in registered form without coupons in denominations of $2,000 and integral multiples of $1,000 thereafter. As provided in the Indenture and subject to
certain limitations therein set forth, Securities of this series are exchangeable for a like aggregate principal amount of Securities of this series of a different authorized denomination, as requested by the Holder surrendering the same.

 This 3.80% Note is a Global Security. As provided in and subject to the provisions of the Indenture, definitive Securities
shall be issued to all owners of beneficial interests in a Global Security in exchange for such interests if: (1) the depositary with respect to the 3.80% Notes (which shall initially be DTC) notifies the Company that it is unwilling or unable
to continue as depositary for such Global Security or the depositary ceases to be a clearing agency registered under the Exchange Act, at a time when the depositary is required to be so registered in order to act as depositary, and in each case a
successor depositary is not appointed by the Company within 90 days of such notice; (2) an Event of Default has occurred and is continuing and the Security Registrar has received a request from the depositary or (3) the Company executes
and delivers to the Trustee and Security Registrar an Officers’ Certificate stating that such Global Security shall be so exchangeable. In connection with the exchange of an entire Global Security for definitive Securities pursuant to this
paragraph, such Global Security shall be deemed to be surrendered to the Trustee for cancellation, and the Company shall execute and the Trustee shall authenticate and deliver, to each beneficial owner identified by the depositary in exchange for
its beneficial interest in such Global Security, an equal aggregate principal amount of definitive Securities of authorized denominations. 
 No service charge shall be made for any such registration of transfer or exchange, but the Company may require payment of a sum sufficient to cover any tax or other governmental charge payable in
connection therewith. 
 Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and
any agent of the Company or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be
affected by notice to the contrary. 
 No recourse under or upon any obligation, covenant or agreement contained in the
Indenture or in this Security, or because of any indebtedness evidenced hereby or thereby, shall be had against any promoter, as such, or against any past, present or future shareholder, officer or director, as such, of the Company or of any
successor, either directly or through the Company or any successor, under any rule of law, statute or constitutional provision or by the enforcement of 

  
 - 4 -

 
any assessment or by any legal or equitable proceeding or otherwise, all such liability being expressly waived and released by the acceptance of this Security by the Holder thereof and as part of
the consideration for the issue of the Securities of this series. 
 All capitalized terms used in this Security which are used
herein but not defined herein shall have the meanings assigned to them in the Indenture. 
 THE INDENTURE AND THE SECURITIES,
INCLUDING THIS SECURITY, SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 
 Pursuant
to a recommendation promulgated by the Committee on Uniform Security Identification Procedures, the Company has caused “CUSIP” numbers to be printed on the Securities of this series as a convenience to the Holders of such Securities. No
representation is made as to the correctness or accuracy of such CUSIP numbers as printed on the Securities, and reliance may be placed only on the other identification numbers printed hereon. 

Unless the certificate of authentication hereon has been executed by or on behalf of the Trustee by manual signature, this Security
shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 

  
 - 5 -

 IN WITNESS WHEREOF, NATIONAL RETAIL PROPERTIES, INC. has caused this instrument to be duly
executed under its corporate seal. 
 Dated: August 14, 2012 

 

									
		 		 	NATIONAL RETAIL PROPERTIES, INC.
				
		 		 	By:	 	  

	[SEAL]	 		 		 	Name:	 	Kevin B. Habicht
		 		 		 	Title:	 	Executive Vice President,
		 		 		 		 	Chief Financial Officer,
		 		 		 		 	Assistant Secretary and Treasurer

 Attest: 
  

					
	By:	 	  

		 	Name:	 	Chris Tessitore
		 	Title:	 	Secretary

 TRUSTEE’S CERTIFICATE OF AUTHENTICATION: 
 This is one of the Securities of the series designated therein referred to in the within-mentioned Indenture. 
 Dated: August 14, 2012 
  

									
		 		 	U.S. BANK NATIONAL ASSOCIATION,
		 		 	as Trustee
				
		 		 	By:	 	  

		 		 		 	Name:	 	Terence T. Rawlins
		 		 		 	Title:	 	Vice President

  
 - 6 -

 ASSIGNMENT FORM 
 FOR VALUE RECEIVED, the undersigned hereby 
 Sells, assigns and transfers unto

  

			
	 PLEASE INSERT SOCIAL

SECURITY OR OTHER IDENTIFYING

NUMBER OF ASSIGNEE
  
	 	
	 	 	  

	  

 

 (Please Print or Typewrite Name and Address including 

Zip Code of Assignee) 
  

 
  
 the within Security of National Retail Properties, Inc. and hereby does irrevocably constitute and appoint 
  

 

			
	  
	 	(Attorney)
	to transfer said Security on the books of the within-named Company with full power of substitution in the premises.

  

			
	Dated:	 	  

		 	  

 NOTICE: The signature to this assignment must correspond with the name as it appears on the first page of the within
Security in every particular, without alteration or enlargement or any change whatever. 

  
 - 7 -

 SCHEDULE OF INCREASES OR DECREASES IN GLOBAL SECURITY 

The following increases or decreases in this Global Security have been made: 

 

									
	 Date
	  	Amount of
Decrease in
Principal Amount
of this Global
Security	  	Amount of
Increase in
Principal Amount
of this Global
Security	  	Principal Amount of
this Global Security
Following Such
Increase or Decrease	  	Signature of
Authorized Officer
of Trustee or
Custodian
		  		  		  		  	
		  		  		  		  	
		  		  		  		  	

  
 - 8 -EX-10.4

 Exhibit 10.4 
 FIRST AMENDMENT TO 
 AGREEMENT AND PLAN OF MERGER 

This AMENDMENT TO AGREEMENT AND PLAN OF MERGER (this “Amendment”), dated effective as of May 21, 2012, is by and
among USMD Holdings, Inc., a Delaware corporation, UANT Ventures, L.L.P., a Texas limited liability partnership, UANT Acquisition Company, Inc., a Texas corporation and a wholly-owned subsidiary of Ventures and The Medical Clinic of North Texas
P.A., a Texas professional association. 
 WHEREAS, the Parties previously entered into that certain Agreement and Plan of
Merger dated December 1, 2011 (the “Agreement”); and 
 WHEREAS, the Parties desire to amend certain terms
of the Agreement as set forth herein. 
 NOW, THEREFORE, in consideration of the mutual agreements, provisions and covenants
contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties hereto agree as follows: 
 ARTICLE I 
 DEFINITIONS 

Capitalized terms used but not defined herein shall have the meanings ascribed to them in the Agreement. 

ARTICLE II 

AMENDMENTS; GENERAL 
 2.1 Section 1.4 of the Agreement is hereby deleted in its entirety and replaced with the following, effective as of the date hereof: 

1.4 Merger Consideration. 
 (a) Subject to the adjustments set forth in Section 1.4(c) herein, the consideration payable by Ventures to the MCNT Holders (the “Merger Consideration”) shall be paid by
Ventures at Closing to such holders in the form of Class C Partnership Interests in Ventures (the “Class C Interests”) equivalent in value to each such MCNT Holder’s pro rata percentage set forth on Schedule 1.4(a) of
the “Adjusted Equity Value” of MCNT set forth in Cell Q69 of Schedule 1.41; provided, that the Parties agree and acknowledge that no such consideration shall be paid by Ventures to any holder of Dissenting Shares, it being agreed
that such holder shall receive consideration in exchange for his or her Dissenting Shares as set forth in Section 1.3(c) above and any MCNT Holders who are not holders of Dissenting Shares shall not, by virtue of there being any Dissenting
Shares, be entitled to receive more than their pro rata percentage set forth on Schedule 1.4(a) of the “Adjusted Equity Value” of MCNT set forth in Cell Q69 of Schedule 1.41. 

(b) The Merger Consideration payable hereunder has been derived from the relative fair market values of the businesses of
MCNT, Impel, UANT and USMD as determined by fair market value appraisals (and updates to the same) conducted by experienced and independent third party appraisal companies. 

(c) The aggregate Merger Consideration payable at Closing shall be adjusted following the Closing based upon changes in
the Adjusted Equity Value of MCNT 

 
relative to, (i) changes in the Adjusted Equity Value of Impel, (ii) changes in the Adjusted Equity Value of UANT, (iii) changes in the Adjusted Equity Value of Ventures, and
(iv) changes in the Adjusted Equity Value of the shares of common stock of USMD contributed to Ventures by USMD shareholders pursuant to the UANT Agreement, in each case between September 30, 2011 and 11:59 p.m. local time in Dallas, Texas
on the Closing Date (the “Schedule 1.41 Adjustments”). The Schedule 1.41 Adjustments shall be calculated as follows: 
 (i) to reflect any changes from December 31, 2011 in “Total Subsidiary Level Debt,” “USMD Corporate Level Debt,” “Ventures/UANT Corporate Level Debt,” “Impel Level
Debt,” and “MCNT Corporate Level Debt,” as set forth in Columns D, F, G, H, and I, respectively, of Schedule 1.41; 
 (ii) to reflect any changes since September 30, 2011 in ownership percentages of the assets or investments held by either USMD, Ventures/UANT, Impel, and MCNT, as reflected in Columns J, L, N, and P,
respectively, of Schedule 1.41; 
 (iii) to reflect on Schedule 1.41 the amount of any
“Deferred Payment Obligations” of USMD, Ventures/UANT, Impel, and MCNT as set forth in Cells K62, M62, O62, and Q62, respectively. Such amounts shall be calculated in accordance with the Schedule 1.41 Deferred Payment Obligations as
defined in Article IX; 
 (iv) to reflect the amount of any “Net Working Capital Adjustments” of USMD,
Ventures/UANT, Impel, and MCNT in Cells D75 of Schedule 1.42, D68 of Schedule 1.43, D75 of Schedule 1.44, and D75 of Schedule 1.45, respectively; and 

(v) to reflect on Schedule 1.41 the amount of any mutually approved capital expenditures (A) since
December 31, 2010 relating to fixed assets of the UANT clinical practice and (B) since September 30, 2011 relating to fixed assets or mutually approved capital contributions of USMD, Ventures/UANT, Impel, and MCNT as set forth in
Cells K65, M65, O65, and Q65, including without limitation approved capital expenditures for equipment, building or tenant improvements. 
 (d) For the purposes of computing the adjustments, if any, pursuant to subsection (c) above, no adjustments to the Merger Consideration or Adjusted Equity Values reflected on Row 69 of Schedule
1.41 shall be made to the extent of any amounts already included in the calculations set forth in Rows 62-65 and Row 67 of Schedule 1.41 and the following provisions shall be applicable: 

(i) No later than forty-five (45) days following the Closing Date, the MCNT Representative shall prepare and deliver
to Ventures a calculation of the Schedule 1.41 Adjustments related to MCNT, based upon its financial statements at and as of the Closing. No later than fifteen (15) days following the delivery by the MCNT Representative of the proposed
Schedule 1.41 Adjustments related to MCNT, Ventures shall deliver to the MCNT Representative a calculation of all Schedule 1.41 Adjustments set forth in subsection (c) above. Each of the MCNT Representative and Ventures shall give to the other
any information and back-up materials reasonably requested by the requesting Party with respect to the Schedule 1.41 Adjustments. 
 (ii) The MCNT Representative shall have thirty (30) days following receipt of the calculations of Schedule 1.41 Adjustments to notify Ventures of any dispute of any item contained therein, which
notice shall set forth in reasonable detail the basis for such dispute. At any time within such thirty (30)-day period, the MCNT Representative shall be entitled to agree with any or all of the items set forth in Ventures’s calculation of the
Schedule 1.41 Adjustments. 

  
 -2-

 (iii) If the MCNT Representative does not notify Ventures of any such
dispute within such thirty (30)-day period, or notifies Ventures of its agreement with Ventures’s calculations, Ventures’s calculations of the Schedule 1.41 Adjustments shall be final and binding on the Parties and shall be deemed to be
final and binding for purposes of any adjustments to consideration made pursuant to the UANT Agreement. 
 (iv)
If the MCNT Representative notifies Ventures of any such dispute within such thirty (30)-day period, the Schedule 1.41 Adjustments shall be resolved as follows: 
 (A) The MCNT Representative and Ventures shall jointly determine the extent of any Schedule 1.41 Adjustments as promptly as practicable. 

(B) In the event that the MCNT Representative and Ventures are unable to agree upon any of the Schedule 1.41 Adjustments,
the Parties shall submit such matter to the Dallas, Texas office of Grant Thornton LLP (or if such firm is unwilling or unable to serve, another nationally recognizable accounting firm mutually agreed upon by the Parties), who shall make the final
determination with respect to the correctness of the proposed Schedule 1.41 Adjustments in light of the terms and provisions of this Agreement, with such determination being final and binding on the Parties and be final and binding for purposes of
any adjustments to consideration made pursuant to the UANT Agreement. 
 2.2 All other references in the Agreement to
“Schedule 1.4” shall be amended to mean “Schedule 1.41” and all other references in the Agreement to the “Schedule 1.4 Adjustments” shall be amended to mean “Schedule 1.41 Adjustments.” 

2.3 All references in the Agreement to the “MCNT Conversion” shall be amended to mean the conversion of MCNT from a Texas
professional association to a Texas professional limited liability company. 
 2.4 Schedule 1.4(a) of the Agreement is hereby
deleted in its entirety and replaced with Schedule 1.4(a) attached hereto, effective as of the date hereof: 
 2.5 Schedule 2.4
of the Agreement is hereby deleted in its entirety and replaced with Schedule 2.4 attached hereto, effective as of the date hereof: 
 2.6 Section 2.5 of the Agreement is hereby deleted in its entirety and replaced with the following, effective as of the date hereof: 

2.5 Litigation. Except as set forth on Schedule 2.5 hereto, as of the Disclosure Schedule Date, there is no
Action pending or, to MCNT’s Knowledge, threatened against or affecting MCNT that (a) adversely affects or challenges the legality, validity or enforceability of this Agreement or (b) could, if there were an unfavorable decision,
individually or in the aggregate, have or reasonably be expected to result in a Material Adverse Effect for MCNT. 

  
 -3-

 2.7 Section 4.3 of the Agreement is hereby deleted in its entirety and replaced with
the following, effective as of the date hereof: 
 4.3 No Conflicts; Consents. The execution and delivery
by Holdings of this Agreement do not, and the consummation of the Transactions and compliance with the terms hereof will not, conflict with, or result in any violation of or default (with or without notice or lapse of time, or both) under, or give
rise to a right of termination, cancellation or acceleration of any obligation or to loss of a material benefit under, or result in the creation of any Lien, other than a Permitted Lien, upon any of the shares of common stock of Holdings or
properties or assets of Holdings under, any provision of (a) the Holdings Constituent Instruments, (i) any Contract to which Holdings or any of its properties or assets are subject, or (ii) any material Law applicable to Holdings or
its properties or assets or (b) require any consent, approval, authorization or permit of, or filing with, or notification to, any Governmental Entity. 
 2.7 The definition of “MCNT Conversion Documents” shall mean the certificate of conversion, certificate of formation and company agreement of MCNT in effect following the consummation of the
MCNT Conversion, each as amended. 
 2.8 Section 4.4(a) and (b) of the Agreement are hereby deleted in their entirety
and replaced with the following, effective as of the date hereof: 
 (a) As of the date hereof, the authorized
capital stock of Holdings consists of 1,000,000 shares of preferred stock, $0.01 par value, of which no shares are issued and outstanding as of the date hereof, and 49,000,000 shares of common stock of Holdings, par value $.01 (“Holdings
Stock”), of which 35,800 are issued and outstanding as of the date hereof. As of the date hereof, up to 964,200 shares of Holdings Stock are reserved for issuance under the Holdings Equity Plan. Except as set forth above or in
connection with the UANT/USMD Contribution, no shares of capital stock or other voting securities of Holdings are issued, reserved for issuance or outstanding. 

(b) Immediately following the consummation of the Merger, the Impel Merger and the UANT/USMD Contribution, (i) the
authorized capital stock of Holdings shall consists of 1,000,000 shares of preferred stock, $0.01 par value, of which no shares shall be issued and outstanding as of the Closing Date, 49,000,000 shares of Holdings Stock, of which 10,035,800 shares
are expected to be issued and outstanding as of the Closing Date and 964,200 shares shall be reserved for issuance under the Holdings Equity Plan as of the Closing Date and (ii) the capital structure of Holdings’ Subsidiaries shall be as
set forth on Schedule 4.4(b) hereto. Schedule 4.4(b) sets forth (i) the name and jurisdiction of each Subsidiary of Holdings immediately following the Closing, and (ii) a complete and accurate list of all outstanding
securities beneficially owned by Holdings or its Subsidiaries immediately following Closing. Except as set forth above, immediately following the consummation of the Merger, the Impel Merger and the UANT/USMD Contribution, no shares of capital
stock or other voting securities of Holdings shall be issued, reserved for issuance or outstanding. 
 2.9 Other than the
amendments and modifications specifically contained in this Amendment, the Agreement remains in full force and effect. 
 2.10
This Amendment may be executed in one or more counterparts, all of which shall be considered one and the same agreement and shall become effective when one or more counterparts have been signed by each of the Parties and delivered to the other
Parties. Facsimile execution and delivery of this Amendment is legal, valid and binding for all purposes. 

  
 -4-

 2.11 This Amendment shall be governed by, and construed in accordance with, the laws of the
State of Texas, regardless of the laws that might otherwise govern under applicable principles of conflicts of laws thereof. 

[the rest of this page is blank] 

  
 -5-

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to Agreement and Plan of
Merger to be duly executed by their respective authorized signatories as of the date first indicated above. 
  

			
	 HOLDINGS:

 

	 USMD Holdings, Inc., a Delaware
 corporation
  

	By:	 	  

	Name:	 	John House, M.D.
	Title:	 	Chairman and CEO
	  
 VENTURES:

 

	 UANT VENTURES, L.L.P. a Texas limited
 liability partnership
  

	By:	 	  

	Name:	 	Mark McCurdy, M.D.
	Title:	 	Authorized Partner
	  
 MERGER SUB:

 

	 UANT ACQUISITION COMPANY, Inc., a
 Texas corporation
     By UANT Ventures, LLP

    Its Sole Member
  

	By:	 	  

	Name:	 	Mark McCurdy, M.D.
	Title:	 	Authorized Partner

 Signature Page to Amendment to Agreement and Plan of Merger 

 
			
	 MCNT:

 

	 THE MEDICAL CLINIC OF NORTH
 TEXAS, a Texas professional association
  

	By:	 	  

	Name:	 	Richard Johnston, M.D.
	Title:	 	President

 Signature Page to Amendment to Agreement and Plan of Merger 

 Schedule 1.4(a) 

Merger Consideration 
  

					
	 MCNT Holder
	 	 Shares of MCNT Stock Owned
	 	 Pro Rata Percentage of Class C

Partnership Interests to be
 Received

	 Adams, Amy MD
	 	1	 	0.94%
	 Atkins, Baron MD
	 	1	 	0.94%
	 Auvenshine, Michael MD
	 	1	 	0.94%
	 Baker, Jeremy MD
	 	1	 	0.94%
	 Baker, Shannon MD
	 	1	 	0.94%
	 Barker, Thomas MD
	 	1	 	0.94%
	 Barton, Courtney MD
	 	1	 	0.94%
	 Bartos, Justin MD
	 	1	 	0.94%
	 Bates, Edward MD
	 	1	 	0.94%
	 Becerra, Oscar MD
	 	1	 	0.94%
	 Bindner, Stephen MD
	 	1	 	0.94%
	 Brock, Steven MD
	 	1	 	0.94%
	 Bucan-Kurepa, Jelena MD
	 	1	 	0.94%
	 Buschow, Robert MD
	 	1	 	0.94%
	 Carmichael, Kristen MD
	 	1	 	0.94%
	 Carnevale, Kristina MD
	 	1	 	0.94%
	 Cheng, Jung T MD
	 	1	 	0.94%
	 Childers, James MD
	 	1	 	0.94%
	 Chiniwala, Rupal MD
	 	1	 	0.94%
	 Clifford, Susan K MD
	 	1	 	0.94%
	 Conoley, Megan MD
	 	1	 	0.94%
	 Copeland, Stephanie MD
	 	1	 	0.94%
	 Cox Jr., Ralph, MD
	 	1	 	0.94%
	 Culver, Jennifer MD
	 	1	 	0.94%
	 Cummings, Fred MD
	 	1	 	0.94%
	 Dabelic, R. Kendra MD
	 	1	 	0.94%
	 Dalley, Albert MD
	 	1	 	0.94%
	 Dejecacion, Jodie MD
	 	1	 	0.94%
	 Demarie, Bryan MD
	 	1	 	0.94%
	 Dias, Keryn MD
	 	1	 	0.94%
	 Dickey, Russell MD
	 	1	 	0.94%
	 Dooley, Christina MD
	 	1	 	0.94%
	 Eldridge, Kevin MD
	 	1	 	0.94%
	 Eppstein, Roger MD
	 	1	 	0.94%
	 Fielder, Martin MD
	 	1	 	0.94%
	 Fikkert, Chimene MD
	 	1	 	0.94%
	 Finke, Mary MD
	 	1	 	0.94%
	 Freeman, John W MD
	 	1	 	0.94%
	 Gaddam, Madhavi MD
	 	1	 	0.94%
	 Gibson-Hull, Stacey MD
	 	1	 	0.94%
	 Godbey, Teresa MD
	 	1	 	0.94%
	 Godfrey, Mark MD
	 	1	 	0.94%
	 Gonzalez, Virginia MD
	 	1	 	0.94%

					
	 Graham, Robert MD
	 	1	 	0.94%
	 Guthrie, William MD
	 	1	 	0.94%
	 Haq, Seema MD
	 	1	 	0.94%
	 Harris, Carolyn MD
	 	1	 	0.94%
	 Harris, Timothy MD
	 	1	 	0.94%
	 Hays, Brad MD
	 	1	 	0.94%
	 Hunter, David MD
	 	1	 	0.94%
	 Hutcheson, Richard MD
	 	1	 	0.94%
	 Isaacs, Emily MD
	 	1	 	0.94%
	 Jeffers, John MD
	 	1	 	0.94%
	 Johnson, Steven E MD
	 	1	 	0.94%
	 Johnston, Mark MD
	 	1	 	0.94%
	 Johnston, Richard MD
	 	1	 	0.94%
	 Jones, Carrie MD
	 	1	 	0.94%
	 Jones, Christina MD
	 	1	 	0.94%
	 Kallam, G. Byron MD
	 	1	 	0.94%
	 Kier, Carlos MD
	 	1	 	0.94%
	 Krombach, R. Stephen MD
	 	1	 	0.94%
	 Krum, Theodore MD
	 	1	 	0.94%
	 Lam, Van MD
	 	1	 	0.94%
	 Lehmann, Claudio MD
	 	1	 	0.94%
	 Lester, Lynn MD
	 	1	 	0.94%
	 Lorimer MD, Douglas D
	 	1	 	0.94%
	 Mace-Motta, Cynthia DO
	 	1	 	0.94%
	 Machos Jr., Robert MD
	 	1	 	0.94%
	 Martin, John R MD
	 	1	 	0.94%
	 Matthews, Edwin MD
	 	1	 	0.94%
	 Maust, Joel MD
	 	1	 	0.94%
	 McColm, Vincent MD
	 	1	 	0.94%
	 Mewis, Beth MD
	 	1	 	0.94%
	 Meyer, Carissa MD
	 	1	 	0.94%
	 Meyer, Matthew MD
	 	1	 	0.94%
	 Morrill, Audrey MD
	 	1	 	0.94%
	 Nelson Jr., Edward MD
	 	1	 	0.94%
	 Oei, Bing MD
	 	1	 	0.94%
	 Olivo, Julie MD
	 	1	 	0.94%
	 Parrill, Ellen MD
	 	1	 	0.94%
	 Pavey, Scott MD
	 	1	 	0.94%
	 Penny, Richard MD
	 	1	 	0.94%
	 Phipps, Lowell MD
	 	1	 	0.94%
	 Raja, Kalyani MD
	 	1	 	0.94%
	 Rathkamp, Quynh MD
	 	1	 	0.94%
	 Readinger, James MD
	 	1	 	0.94%
	 Reddy, Himabindu MD
	 	1	 	0.94%
	 Russell, David MD
	 	1	 	0.94%
	 Sanders, J. Paul MD
	 	1	 	0.94%
	 Shore, Kenneth MD
	 	1	 	0.94%
	 Smitherman, Robert Kent MD
	 	1	 	0.94%
	 So, Ashley Unwoo MD
	 	1	 	0.94%

					
	 Speaks, Lynn DO
	 	1	 	0.94%
	 Strittmatter, Marla MD
	 	1	 	0.94%
	 Summakia, Mohammed MD
	 	1	 	0.94%
	 Talbot, Scott MD
	 	1	 	0.94%
	 Teng, Jay MD
	 	1	 	0.94%
	 Teng, Li Ray MD
	 	1	 	0.94%
	 Tran, Khang MD
	 	1	 	0.94%
	 Viktorin, Gina MD
	 	1	 	0.94%
	 Walker, Joel MD
	 	1	 	0.94%
	 Wallace, Erin Elizabeth MD
	 	1	 	0.94%
	 Walsh, Heather MD
	 	1	 	0.94%
	 Williams, Celeste DO
	 	1	 	0.94%
	 Wittenberg, John MD
	 	1	 	0.94%
	 Wood, John P MD
	 	1	 	0.94%

 Schedule 2.4 
 Capital Structure 
  

			
	 MCNT Holder
	 	 Shares of MCNT Stock Owned

	 Adams, Amy MD
	 	1
	 Atkins, Baron MD
	 	1
	 Auvenshine, Michael MD
	 	1
	 Baker, Jeremy MD
	 	1
	 Baker, Shannon MD
	 	1
	 Barker, Thomas MD
	 	1
	 Barton, Courtney MD
	 	1
	 Bartos, Justin MD
	 	1
	 Bates, Edward MD
	 	1
	 Becerra, Oscar MD
	 	1
	 Bindner, Stephen MD
	 	1
	 Brock, Steven MD
	 	1
	 Bucan-Kurepa, Jelena MD
	 	1
	 Buschow, Robert MD
	 	1
	 Carmichael, Kristen MD
	 	1
	 Carnevale, Kristina MD
	 	1
	 Cheng, Jung T MD
	 	1
	 Childers, James MD
	 	1
	 Chiniwala, Rupal MD
	 	1
	 Clifford, Susan K MD
	 	1
	 Conoley, Megan MD
	 	1
	 Copeland, Stephanie MD
	 	1
	 Cox Jr., Ralph, MD
	 	1
	 Culver, Jennifer MD
	 	1
	 Cummings, Fred MD
	 	1
	 Dabelic, R. Kendra MD
	 	1
	 Dalley, Albert MD
	 	1
	 Dejecacion, Jodie MD
	 	1
	 Demarie, Bryan MD
	 	1
	 Dias, Keryn MD
	 	1
	 Dickey, Russell MD
	 	1
	 Dooley, Christina MD
	 	1
	 Eldridge, Kevin MD
	 	1
	 Eppstein, Roger MD
	 	1
	 Fielder, Martin MD
	 	1
	 Fikkert, Chimene MD
	 	1
	 Finke, Mary MD
	 	1
	 Freeman, John W MD
	 	1
	 Gaddam, Madhavi MD
	 	1
	 Gibson-Hull, Stacey MD
	 	1
	 Godbey, Teresa MD
	 	1
	 Godfrey, Mark MD
	 	1
	 Gonzalez, Virginia MD
	 	1

			
	 Graham, Robert MD
	 	1
	 Guthrie, William MD
	 	1
	 Haq, Seema MD
	 	1
	 Harris, Carolyn MD
	 	1
	 Harris, Timothy MD
	 	1
	 Hays, Brad MD
	 	1
	 Hunter, David MD
	 	1
	 Hutcheson, Richard MD
	 	1
	 Isaacs, Emily MD
	 	1
	 Jeffers, John MD
	 	1
	 Johnson, Steven E MD
	 	1
	 Johnston, Mark MD
	 	1
	 Johnston, Richard MD
	 	1
	 Jones, Carrie MD
	 	1
	 Jones, Christina MD
	 	1
	 Kallam, G. Byron MD
	 	1
	 Kier, Carlos MD
	 	1
	 Krombach, R. Stephen MD
	 	1
	 Krum, Theodore MD
	 	1
	 Lam, Van MD
	 	1
	 Lehmann, Claudio MD
	 	1
	 Lester, Lynn MD
	 	1
	 Lorimer MD, Douglas D
	 	1
	 Mace-Motta, Cynthia DO
	 	1
	 Machos Jr., Robert MD
	 	1
	 Martin, John R MD
	 	1
	 Matthews, Edwin MD
	 	1
	 Maust, Joel MD
	 	1
	 McColm, Vincent MD
	 	1
	 Mewis, Beth MD
	 	1
	 Meyer, Carissa MD
	 	1
	 Meyer, Matthew MD
	 	1
	 Morrill, Audrey MD
	 	1
	 Nelson Jr., Edward MD
	 	1
	 Oei, Bing MD
	 	1
	 Olivo, Julie MD
	 	1
	 Parrill, Ellen MD
	 	1
	 Pavey, Scott MD
	 	1
	 Penny, Richard MD
	 	1
	 Phipps, Lowell MD
	 	1
	 Raja, Kalyani MD
	 	1
	 Rathkamp, Quynh MD
	 	1
	 Readinger, James MD
	 	1
	 Reddy, Himabindu MD
	 	1
	 Russell, David MD
	 	1
	 Sanders, J. Paul MD
	 	1
	 Shore, Kenneth MD
	 	1
	 Smitherman, Robert Kent MD
	 	1
	 So, Ashley Unwoo MD
	 	1

			
	 Speaks, Lynn DO
	 	1
	 Strittmatter, Marla MD
	 	1
	 Summakia, Mohammed MD
	 	1
	 Talbot, Scott MD
	 	1
	 Teng, Jay MD
	 	1
	 Teng, Li Ray MD
	 	1
	 Tran, Khang MD
	 	1
	 Viktorin, Gina MD
	 	1
	 Walker, Joel MD
	 	1
	 Wallace, Erin Elizabeth MD
	 	1
	 Walsh, Heather MD
	 	1
	 Williams, Celeste DO
	 	1
	 Wittenberg, John MD
	 	1
	 Wood, John P MD
	 	1

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00207-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00207-of-00352.parquet"}]]