Document:

Exhibit 4.1

 

SUPPLEMENTAL INDENTURE

dated as of June 9, 2016

among

AETNA INC.,

and

U.S. BANK NATIONAL ASSOCIATION,

as Trustee

 

 

 

Floating Rate Senior Notes due December
8, 2017

 

1.700% Senior Notes due June 7, 2018

 

1.900% Senior Notes due June 7, 2019

 

2.400% Senior Notes due June 15, 2021

 

2.800% Senior Notes due June 15, 2023

 

3.200% Senior Notes due June 15, 2026

 

4.250% Senior Notes due June 15, 2036

 

4.375% Senior Notes due June 15, 2046

 

    	 

    	 

    

TABLE OF CONTENTS 

 

Page

 

	Article 1 
Definitions
	Section 1.01.  Definitions	2
	Section 1.02.  Section References	7
	Article 2 
The Notes
	Section 2.01.  Issue of Notes	7
	Section 2.02.  Stated Maturity	8
	Section 2.03.  Notes Issuable as Global Securities	8
	Section 2.04.  Interest and Payment	9
	Section 2.05.  Payment of Principal, Premium and Interest	13
	Section 2.06.  Optional Redemption	13
	Section 2.07.  Special Mandatory Redemption	17
	Section 2.08.  Change of Control Offer to Purchase	17
	Section 2.09.  Applicability of Certain Provisions of the Base Indenture in Respect of the Notes	19
	Section 2.10.  Registrar and Paying Agent; Calculation Agent	19
	Section 2.11.  No Sinking Fund	19
	Section 2.12.  Minimum Denominations	19
	Article 3 
Miscellaneous
	Section 3.01.  Relation to Indenture	20
	Section 3.02.  Continued Effect	20
	Section 3.03.  Provisions Binding on Company’s Successors	20
	Section 3.04.  Certain Trustee Matters	20
	Section 3.05.  Governing Law	20
	Section 3.06.  Counterparts	20
	 	 

	Exhibit A  Form of Floating Rate Senior Note due 2017	A-1
	Exhibit B  Form of 1.700% Senior Note due 2018	B-1
	Exhibit C  Form of 1.900% Senior Note due 2019	C-1
	Exhibit D  Form of 2.400% Senior Note due 2021	D-1
	Exhibit E  Form of 2.800% Senior Note due 2023	E-1
	Exhibit F  Form of 3.200% Senior Note due 2026	F-1
	Exhibit G  Form of 4.250% Senior Note due 2036	G-1
	Exhibit H  Form of 4.375% Senior Note due 2046	H-1

    	i 

    	 

    

SUPPLEMENTAL INDENTURE (this “Supplemental
Indenture”), dated as of June 9, 2016, between AETNA INC., a corporation duly organized and validly existing under the
laws of the Commonwealth of Pennsylvania (the “Company”), having its principal office at 151 Farmington Avenue,
Hartford, Connecticut 06156 and U.S. BANK NATIONAL ASSOCIATION, as successor-in-interest to State Street Bank and Trust Company,
as trustee (the “Trustee”).

 

RECITALS

 

WHEREAS, the Company and the Trustee entered
into a Senior Indenture dated as of March 2, 2001 (the “Base Indenture”, and as supplemented by this
Supplemental Indenture, the “Indenture”) providing for the issuance from time to time of the Company’s
debentures, notes or other evidences of indebtedness (the “Securities”), to be issued in one or more series
as in the Base Indenture provided;

 

WHEREAS, Sections 201 and 301 of the Base
Indenture provide that the Company and the Trustee may establish the terms of a new series of Securities in an indenture supplemental
to the Base Indenture;

 

WHEREAS, Section 901 of the Base Indenture
provides that the Company and the Trustee may enter into an indenture supplemental to the Base Indenture, without the consent of
any Holders, to eliminate any of the provisions of the Base Indenture in respect of a new series of Securities so established pursuant
to Section 301 of the Base Indenture;

 

WHEREAS, pursuant to resolutions adopted
by the Board of Directors of the Company on July 2, 2015 and the Delegation of Authority of Mark T. Bertolini, Chairman and Chief
Executive Officer of the Company, dated May 27, 2016 (collectively, the “Company Resolutions”), the Company
has approved to be established eight new series of Securities, designated as its Floating Rate Senior Notes due December 8, 2017
(the “Floating Rate Notes”), its 1.700% Senior Notes due June 7, 2018 (the “2018 Notes”),
its 1.900% Senior Notes due June 7, 2019 (the “2019 Notes”), its 2.400% Senior Notes due June 15, 2021 (the
“2021 Notes”), its 2.800% Senior Notes due June 15, 2023 (the “2023 Notes”), its 3.200% Senior
Notes due June 15, 2026 (the “2026 Notes”), its 4.250% Senior Notes due June 15, 2036 (the “2036 Notes”)
and its 4.375% Senior Notes due June 15, 2046 (the “2046 Notes” and together with the 2018 Notes, the 2019 Notes,
the 2021 Notes, the 2023 Notes, the 2026 Notes and the 2036 Notes, the “Fixed Rate Notes” and, the Fixed Rate
Notes together with the Floating Rate Notes, the “Notes”) as in this Supplemental Indenture provided; and

 

WHEREAS, all requirements necessary to make
this Supplemental Indenture a valid, binding and enforceable instrument in accordance with its terms and to make the Notes, when
executed, authenticated and delivered by the Company, the valid, binding and enforceable obligations of the Company have been done
and performed.

 

    1

     

    

NOW, THEREFORE, in consideration of the
premises and mutual covenants herein contained and intending to be legally bound, the parties to this Supplemental Indenture hereby
agree as follows:

 

Article
1

Definitions

 

Section 1.01.            Definitions.

 

(a)            Capitalized terms used herein and
not otherwise defined herein have the respective meanings assigned to them in the Base Indenture.

 

(b)            The following terms shall have the
meanings assigned to them in this ‎‎Section 1.01(b):

 

“2018 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2019 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2021 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2023 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2026 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2036 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“2046 Notes” has the
meaning stated in the fourth recital of this Supplemental Indenture.

 

“Base Indenture” has
the meaning stated in the first recital of this Supplemental Indenture.

 

“Below Investment Grade Rating
Event” means the Notes of a series are rated below an Investment Grade Rating by each of the Rating Agencies on any date
from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention to effect
a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a Change of
Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however, that if
(i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Notes of such series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement

 

    2

     

    

would
result in a Below Investment Grade Rating Event for such series of Notes, then such 60-day period shall be extended for such time
as the rating of the Notes of such series by any such Rating Agency remains under publicly announced consideration for possible
downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment Grade
Rating could cause a Below Investment Grade Rating Event for such series of Notes. Notwithstanding the foregoing, a rating event
otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of a particular
Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for any series of Notes for purposes of the
definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to which this definition
would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s or the Trustee’s
request that the reduction was the result, in whole or in part, of any event or circumstance comprised of or arising as a result
of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control has occurred at the time
of the rating event).

 

“Business Day”, when
used with respect to any Place of Payment, means each Monday, Tuesday, Wednesday, Thursday and Friday which is not a day on which
banking institutions in that Place of Payment are authorized or obligated by law or executive order to close.

 

“Calculation Agent” means
U.S. Bank National Association, or its successor appointed as such by the Company.

 

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than
by way of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or
assets of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3)
of the Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including,
without limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in
Section 13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly
or indirectly, of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however,
that a transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a
holding company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

    3

     

    

“Change of Control Offer”
has the meaning stated in ‎‎Section 2.08(a) of this Supplemental
Indenture.

 

“Change of Control Payment”
has the meaning stated in ‎‎Section 2.08(a) of this Supplemental
Indenture.

 

“Change of Control Payment Date”
has the meaning stated in ‎‎Section 2.08(a) of this Supplemental
Indenture.

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Company” means the Person
named as the “Company” in the first paragraph of this Supplemental Indenture until a successor Person shall have become
such pursuant to the applicable provisions of the Indenture, and thereafter “Company” shall mean such successor Person.

 

“Company Resolutions”
has the meaning stated in the fourth recital of this Supplemental Indenture.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Fixed Rate Notes to be redeemed, calculated as if the Stated Maturity of the principal
of the Fixed Rate Notes were June 7, 2018 (in the case of the 2018 Notes), June 7, 2019 (in the case of the 2019 Notes), May 15,
2021 (in the case of the 2021 Notes), April 15, 2023 (in the case of the 2023 Notes), March 15, 2026 (in the case of the 2026 Notes),
December 15, 2035 (in the case of the 2036 Notes) or December 15, 2045 (in the case of the 2046 Notes) (in each case, the “Remaining
Life” of the Fixed Rate Notes of such series) that would be utilized, at the time of selection and in accordance with
customary financial practice, in pricing new issues of corporate debt securities of comparable maturity to the Remaining Life of
the Fixed Rate Notes of such series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Fixed Rate Notes of a series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“DTC” means The Depository
Trust Company.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Exchange Act” means
the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Fixed Rate Notes” has
the meaning stated in the fourth recital of this Supplemental Indenture.

 

    4

     

    

“Floating Rate Interest Determination
Date” has the meaning stated in ‎Section 2.04(a)(ii)
of this Supplemental Indenture.

 

“Floating Rate Interest Payment
Date” has the meaning stated in ‎Section 2.04(a)(i)
of this Supplemental Indenture.

 

“Floating Rate Interest Period”
has the meaning stated in ‎Section 2.04(a)(i) of this
Supplemental Indenture.

 

“Floating Rate Notes”
has the meaning stated in the fourth recital of this Supplemental Indenture.

 

“Floating Rate Regular Record Date”
has the meaning stated in ‎Section 2.04(a)(i) of this Supplemental
Indenture.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Indenture” has the meaning
stated in the first recital of this Supplemental Indenture.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under the circumstances permitting
the Company to select a replacement agency and in the manner for selecting a replacement agency, in each case as set forth in the
definition of “Rating Agencies.”

 

“London Business Day”
shall mean any calendar day on which commercial banks are open for dealings in deposits in U.S. dollars in the London interbank
market.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Notes” has the meaning
stated in the fourth recital of this Supplemental Indenture.

 

    5

     

    

“Primary Treasury Dealer”
has the meaning stated in the definition of “Reference Treasury Dealer” in this ‎‎Section
1.01(b).

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Notes of a series
or fails to make a rating of the Notes of such series publicly available for reasons outside of the Company’s control, a
“nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange Act
that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may be,
with respect to such series of Notes.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

“Remaining Life” has
the meaning stated in the definition of “Comparable Treasury Issue” in this ‎Section
1.01(b).

 

“Securities” has the
meaning stated in the first recital of this Supplemental Indenture and more particularly means any Securities authenticated and
delivered under the Indenture, including, without limitation, the Notes.

 

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

“Special Mandatory Redemption Notes”
means the 2019 Notes, the 2021 Notes, the 2026 Notes, the 2036 Notes and the 2046 Notes.

 

“Supplemental Indenture”
has the meaning stated in the first paragraph of this instrument.

 

“Three-Month LIBOR” has
the meaning stated in ‎Section 2.04(a)(iv) of this Supplemental
Indenture.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Fixed Rate Notes of a series,

 

    6

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Fixed Rate Notes of
such series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Trustee” means the Person
named as the “Trustee” in respect of the Notes in the first paragraph of this Supplemental Indenture until a successor
Trustee in respect of the Notes shall have become such pursuant to the applicable provisions of the Indenture, and thereafter “Trustee”
shall mean or include such Person who is then a Trustee in respect of the Notes.

 

Section 1.02.            Section References.
Each reference to a particular section set forth in this Supplemental Indenture shall, unless the context otherwise requires,
refer to this Supplemental Indenture. Each reference to a particular section of the Base Indenture shall refer to that particular
section of the Base Indenture.

 

Article
2

The Notes

 

Section 2.01.            Issue of Notes. The
Notes shall be issued as eight series of Securities under the Base Indenture as supplemented by this Supplemental Indenture, which
such series shall be known and designated as the “Floating Rate Notes due December 8, 2017”, the “1.700% Senior
Notes due June 7, 2018”, the “1.900% Senior Notes due June 7, 2019”, the “2.400% Senior Notes due June
15, 2021”, the “2.800% Senior Notes due June 15, 2023”, the “3.200% Senior Notes due June 15, 2026”,
the “4.250% Senior Notes due June 15, 2036” and the “4.375% Senior Notes due June 15, 2046” of the Company.
Each series of Notes shall constitute a separate series of

 

    7

     

    

Securities
for all purposes under the Indenture. The Notes shall be unsecured. The Notes shall be executed, authenticated and delivered in
accordance with the provisions of the Indenture. The aggregate principal amount of the Floating Rate Notes which may be authenticated
and delivered under the Indenture is initially limited to $500,000,000, the aggregate principal amount of the 2018 Notes which
may be authenticated and delivered under the Indenture is initially limited to $1,000,000,000, the aggregate principal amount
of the 2019 Notes which may be authenticated and delivered under the Indenture is initially limited to $1,650,000,000, the aggregate
principal amount of the 2021 Notes which may be authenticated and delivered under the Indenture is initially limited to $1,850,000,000,
the aggregate principal amount of the 2023 Notes which may be authenticated and delivered under the Indenture is initially limited
to $1,300,000,000, the aggregate principal amount of the 2026 Notes which may be authenticated and delivered under the Indenture
is initially limited to $2,800,000,000, the aggregate principal amount of the 2036 Notes which may be authenticated and delivered
under the Indenture is initially limited to $1,500,000,000 and the aggregate principal amount of the 2046 Notes which may be authenticated
and delivered under the Indenture is initially limited to $2,400,000,000 (except, in each case, for such Notes authenticated and
delivered upon registration of transfer of, or in exchange for, or in lieu of, other Notes of the same series pursuant to Sections
304, 305, 306, 906 or 1107 of the Base Indenture and except for any Notes which, pursuant to Section 303 of the Base Indenture,
are deemed never to have been authenticated and delivered thereunder). Additional Notes of a series may be authenticated and delivered
from time to time as contemplated in Section 301 of the Base Indenture; provided that if the additional Notes of a series
are not fungible with the Notes of such series for United States Federal income tax purposes, the additional Notes of the series
will have a separate CUSIP number. The entire amount of Notes of each series may immediately be executed by the Company and delivered
to the Trustee and shall be authenticated by the Trustee and delivered to or upon the order of the Company pursuant to Section
303 of the Base Indenture.

 

Section 2.02.            Stated Maturity. The
Stated Maturity of the principal of the Floating Rate Notes shall be December 8, 2017, the Stated Maturity of the principal of
the 2018 Notes shall be June 7, 2018, the Stated Maturity of the principal of the 2019 Notes shall be June 7, 2019, the Stated
Maturity of the principal of the 2021 Notes shall be June 15, 2021, the Stated Maturity of the principal of the 2023 Notes shall
be June 15, 2023, the Stated Maturity of the principal of the 2026 Notes shall be June 15, 2026, the Stated Maturity of the principal
of the 2036 Notes shall be June 15, 2036, and the Stated Maturity of the principal of the 2046 Notes shall be June 15, 2046.

 

Section 2.03.            Notes Issuable as Global
Securities.

 

(a)            The Notes shall be issued in the
form of one or more Global Securities registered in the name of DTC or its nominee, to be deposited with, or on behalf of, DTC,
New York, New York.

 

(b)            The Notes shall be in such form
or forms as may be approved by the officers of the Company as provided in the Company Resolutions, such approval to be evidenced
by any such officer’s manual or facsimile signature on the Notes, provided that

 

    8

     

    

such
forms of the Notes are not inconsistent with the requirements of the Indenture or the Company Resolutions and are substantially
in the applicable form or forms attached hereto as Exhibits A through H.

 

Section 2.04.            Interest and Payment.

 

(a)            This ‎Section
2.04(a) shall only apply to the Floating Rate Notes.

 

(i)            The Floating Rate Notes
shall bear interest from June 9, 2016, or from the most recent Floating Rate Interest Payment Date to which interest has been paid
or duly provided for, as the case may be (each of these periods, a “Floating Rate Interest Period”), at a rate
per annum equal to the Three-Month LIBOR as determined on the applicable Floating Rate Interest Determination Date plus 0.650%,
payable on each Floating Rate Interest Payment Date, beginning September 8, 2016, to the Person in whose name such Floating Rate
Notes (or one or more predecessor Floating Rate Notes) are registered at the close of business on the Regular Record Date next
preceding the applicable Floating Rate Interest Payment Date. Each March 8, June 8, September 8 and December 8 shall be a “Floating
Rate Interest Payment Date” for the Floating Rate Notes, and the February 21, May 24, August 24 or November 23 (whether
or not a Business Day), as the case may be, next preceding a Floating Rate Interest Payment Date shall be the “Floating
Rate Regular Record Date” for the interest payable on such Floating Rate Interest Payment Date.

 

(ii)            The Floating Rate Notes
shall bear interest at a rate for each applicable Floating Rate Interest Period that is determined by the Calculation Agent on
the second London Business Day immediately preceding the first day of such Floating Rate Interest Period (each a “Floating
Rate Interest Determination Date”), and computed on the basis of a 360-day year and the actual number of days that have
elapsed in the applicable Floating Rate Interest Period. The Calculation Agent has set the initial interest rate on the Floating
Rate Notes at 1.3066% per annum and will reset such interest rate for each Floating Rate Interest Period on the Floating Rate Interest
Payment Date for the preceding Floating Rate Interest Period. Promptly after a Floating Rate Interest Determination Date, the Calculation
Agent will inform the Company of the interest rate for the next Floating Rate Interest Period. Upon written request from any registered
Holder of Floating Rate Notes, the Calculation Agent will provide the interest rate in effect on the Floating Rate Notes for the
current Floating Rate Interest Period and, if such written request is made after the applicable Floating Rate Interest Determination
Date, the interest rate to be in effect for the next applicable Floating Rate Interest Period.

 

(iii)            In any case where any
Floating Rate Interest Payment Date, other than the date of Stated Maturity, falls on a day that is not a Business Day, then such
Floating Rate Interest Payment Date shall be postponed to the next day that is a Business Day, except that, if such Business Day
falls in the next succeeding calendar month, then, unless it relates to interest payable at the date of Stated

 

    9

     

    

Maturity, such Floating Rate
Interest Payment Date shall be the immediately preceding Business Day. If the date of Stated Maturity of the Floating Rate Notes
falls on a day that is not a Business Day, then the related payment of principal and interest will be made on the next day that
is a Business Day with the same effect as if as if made on the date that the payment was first due, and no interest will accrue
on the amount so payable for the period from the date of Stated Maturity.

 

(iv)            The “Three-Month
LIBOR” shall be equal to, as of any applicable Floating Rate Interest Determination Date:

 

(A)            The offered rate to leading
banks in the London interbank market for deposits in U.S. dollars having an index maturity of three months, as such rate appears:

 

(1)            on the Reuters Monitor
Money Rates Service (“Reuters”) page LIBOR 01 (or on such other page as may replace Reuters page LIBOR 01 on
that service); or

 

(2)            if on such Floating Rate
Interest Determination Date, three-month LIBOR does not appear or is not available on Reuters page LIBOR 01 (or such other page
as may replace Reuters page LIBOR 01 on that service), on such other comparable publicly available service for displaying offered
rates for deposits in U.S. dollars in the London interbank market as may be selected by the Company with the consent of the Calculation
Agent,

 

in each case as of approximately 11:00 a.m., London
time, on such Floating Rate Interest Determination Date.

 

(B)            If such rate does not
appear on either of the pages described in clauses (A)(1) or (2) above, the Three-Month LIBOR, in respect of such Floating Rate
Interest Determination Date, will be determined as follows:

 

(1)            the Calculation Agent will
request the principal London offices of each of four major reference banks in the London interbank market, as selected by the Calculation
Agent (after consultation with the Company), to provide the Calculation Agent with its offered quotation for deposits in U.S. dollars
for the period of three months beginning on the applicable Floating Rate Interest Determination Date, to prime banks in the London
interbank market at approximately 11:00 a.m., London time, on that Floating Rate Interest Determination Date and in a principal
amount of not less than $1,000,000 for a single transaction in U.S. dollars in such market at such time. If at least two quotations
are provided to the Calculation Agent, then the

 

    10

     

    

Three-Month LIBOR on such Floating
Rate Interest Determination Date will be the arithmetic mean of such quotations.

 

(2)            If fewer than two such
quotations are provided, then the Three-Month LIBOR on such Floating Rate Interest Determination Date will be the arithmetic mean
of the rates quoted at approximately 11:00 a.m., New York City time, on such Floating Rate Interest Determination Date by three
major reference banks in New York City selected by the Calculation Agent (after consultation with the Company) for loans in U.S.
dollars to leading European banks, having an index maturity of three months and in a principal amount of not less than $1,000,000
for a single transaction in U.S. dollars in such market at such time.

 

provided, however, that if the banks selected
by the Calculation Agent are not providing quotations in the manner described in clause (B)(2), the Three-Month LIBOR determined
as of such Floating Rate Interest Determination Date will be the Three-Month LIBOR in effect for the prior applicable Floating
Rate Interest Period

 

(v)            All percentages resulting
from any calculation of any interest rate for the Floating Rate Notes will be rounded, if necessary, to the nearest one hundred
thousandth of a percentage point, with five one-millionths of a percentage point rounded upward (e.g., 3.876545% (or .03876545)
would be rounded to 3.87655% (or .0387655)), and all U.S. dollar amounts will be rounded to the nearest cent, with one-half cent
being rounded upward. Each calculation of the interest rate on the Floating Rate Notes by the Calculation Agent will (in the absence
of manifest error) be final and binding on the holders of the Floating Rate Notes, the Trustee and the Company.

 

(vi)            The interest rate on
the Floating Rate Notes shall in no event be higher than the maximum rate permitted by New York law or other applicable state law
as such law may be modified by United States law of general application. Additionally, the interest rate on the Floating Rate Notes
shall in no event be lower than zero percent.

 

(b)            The 2018 Notes shall bear interest
at the rate of 1.700% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 7 and December 7 in each year, beginning
December 7, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 7 and December 7 shall be an “Interest Payment
Date” for the 2018 Notes, and the May 23 or November 22 (whether or not a Business Day), as the case may be, next

 

    11

     

    

preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2018 Notes.

 

(c)            The 2019 Notes shall bear interest
at the rate of 1.900% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 7 and December 7 in each year, beginning
December 7, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 7 and December 7 shall be an “Interest Payment
Date” for the 2019 Notes, and the May 23 or November 22 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2019 Notes.

 

(d)            The 2021 Notes shall bear interest
at the rate of 2.400% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 15 and December 15 in each year, beginning
December 15, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 15 and December 15 shall be an “Interest Payment
Date” for the 2021 Notes, and the June 1 or December 1 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2021 Notes.

 

(e)            The 2023 Notes shall bear interest
at the rate of 2.800% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 15 and December 15 in each year, beginning
December 15, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 15 and December 15 shall be an “Interest Payment
Date” for the 2023 Notes, and the June 1 or December 1 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2023 Notes.

 

(f)            The 2026 Notes shall bear interest
at the rate of 3.200% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 15 and December 15 in each year, beginning
December 15, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 15 and December 15 shall be an “Interest Payment
Date” for the 2026 Notes, and the June 1 or December 1 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2026 Notes.

 

    12

     

    

(g)            The 2036 Notes shall bear interest
at the rate of 4.250% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 15 and December 15 in each year, beginning
December 15, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 15 and December 15 shall be an “Interest Payment
Date” for the 2036 Notes, and the June 1 or December 1 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2036 Notes.

 

(h)            The 2046 Notes shall bear interest
at the rate of 4.375% per annum, which shall accrue from June 9, 2016, or from the most recent Interest Payment Date to which interest
has been paid or duly provided for, as the case may be, payable semi-annually on June 15 and December 15 in each year, beginning
December 15, 2016, to the Person in whose name such Notes (or one or more predecessor Notes) are registered at the close of business
on the Regular Record Date next preceding the Interest Payment Date. Each June 15 and December 15 shall be an “Interest Payment
Date” for the 2046 Notes, and the June 1 or December 1 (whether or not a Business Day), as the case may be, next preceding
an Interest Payment Date shall be the “Regular Record Date” for the interest payable on such Interest Payment Date
on the 2046 Notes.

 

(i)            Interest on the Fixed Rate Notes
will be computed on the basis of a 360-day year comprised of twelve 30-day months. In any case where any Interest Payment Date
for any Fixed Rate Note is not a Business Day, then payment of interest may be made on the next succeeding Business Day without
any additional amount being payable in respect of any delay.

 

Section 2.05.            Payment of Principal,
Premium and Interest. Payment of the principal of and premium, if any, and interest on the Notes will be made at the office
or agency of the Company maintained for that purpose in the United States of America; provided, however, that at
any time that the Notes are not represented by Global Securities, at the option of the Company, payment of interest may be made
by check mailed to the address of the Person entitled thereto as such address shall appear in the Security Register.

 

Section 2.06.            Optional Redemption.

 

(a)            The Company does not have the right
to redeem the Floating Rate Notes before the Stated Maturity of the principal of the Floating Rate Notes.

 

(b)            At any time, the 2018 Notes will
be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail, in whole or in part,
at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2018 Notes being redeemed, or

 

    13

     

    

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2018 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2018 Notes being redeemed, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day
year consisting of twelve 30-day months) at the Treasury Rate plus 15 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(c)            At any time, the 2019 Notes will
be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail, in whole or in part,
at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2019 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2019 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2019 Notes being redeemed, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day
year consisting of twelve 30-day months) at the Treasury Rate plus 15 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(d)            At any time prior to May 15, 2021,
the 2021 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail,
in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2021 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2021 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2021 Notes being redeemed, in each case calculated as if the Stated Maturity of the principal of the 2021 Notes were
May 15, 2021, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day year consisting of twelve
30-day months) at the Treasury Rate plus 20 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(e)            At any time on or after May 15,
2021, the 2021 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of

 

    14

     

    

the
principal amount of the 2021 Notes being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

(f)            At any time prior to April 15, 2023,
the 2023 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail,
in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2023 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2023 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2023 Notes being redeemed, in each case calculated as if the Stated Maturity of the principal of the 2023 Notes were
April 15, 2023, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day year consisting of
twelve 30-day months) at the Treasury Rate plus 20 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(g)            At any time on or after April 15,
2023, the 2023 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount of the
2023 Notes being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

(h)            At any time prior to March 15, 2026,
the 2026 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail,
in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2026 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2026 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2026 Notes being redeemed, in each case calculated as if the Stated Maturity of the principal of the 2026 Notes were
March 15, 2026, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day year consisting of
twelve 30-day months) at the Treasury Rate plus 25 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

    15

     

    

(i)            At any time on or after March 15,
2026, the 2026 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount of the
2026 Notes being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

(j)            At any time prior to December 15,
2035, the 2036 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2036 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2036 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2036 Notes being redeemed, in each case calculated as if the Stated Maturity of the principal of the 2036 Notes were
December 15, 2035, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day year consisting
of twelve 30-day months) at the Treasury Rate plus 30 basis points,

 

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(k)            At any time on or after December
15, 2035, the 2036 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount of the
2036 Notes being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

(l)            At any time prior to December 15,
2045, the 2046 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

(i)            100% of the principal
amount of the 2046 Notes being redeemed, or

 

(ii)            the sum of the present
value of (x) 100% of the principal amount of the 2046 Notes being redeemed and (y) all required remaining scheduled interest payments
due on the 2046 Notes being redeemed, in each case calculated as if the Stated Maturity of the principal of the 2046 Notes were
December 15, 2045, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day year consisting
of twelve 30-day months) at the Treasury Rate plus 30 basis points,

 

    16

     

    

plus, in each case, any interest
accrued but not paid to, but excluding, the Redemption Date.

 

(m)            At any time on or after December
15, 2045, the 2046 Notes will be redeemable upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount of the
2046 Notes being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

(n)            Notice of any redemption will be
mailed at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each holder of the Notes of the
series to be redeemed.

 

(o)            Unless the Company defaults in payment
of the Redemption Price, interest will cease to accrue on the Notes of the series or the portions of the Notes of the series called
for redemption on and after the Redemption Date.

 

Section 2.07.            Special Mandatory Redemption.

 

(a)            If the Merger has not been completed
by December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant
to the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Special Mandatory Redemption Notes on the Special Mandatory Redemption Date at a special mandatory redemption price
equal to 101% of the aggregate principal amount of the Special Mandatory Redemption Notes, plus accrued and unpaid interest from
the date of initial issuance, or the most recent date to which interest has been paid or provided for, whichever is later, to,
but excluding, the Special Mandatory Redemption Date. There is no special mandatory redemption of the Floating Rate Notes, the
2018 Notes or the 2023 Notes.

 

(b)            The Company shall cause notice of
a special mandatory redemption to be transmitted to each Holder of Special Mandatory Redemption Notes at its registered address,
with a copy to the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption.
If funds sufficient to pay the special mandatory redemption price of the Special Mandatory Redemption Notes on the Special Mandatory
Redemption Date (plus accrued and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee
on or before such Special Mandatory Redemption Date, the Special Mandatory Redemption Notes will cease to bear interest on and
after the Special Mandatory Redemption Date.

 

Section 2.08.            Change of Control Offer
to Purchase.

 

(a)            If a Change of Control Triggering
Event occurs with respect to the Notes of a series, unless the Company has exercised its right, if any, to redeem the Notes of
such series in full pursuant to ‎‎Section 2.06 or the Company has redeemed,
or is required to redeem, the Notes of such series in full pursuant to a special mandatory redemption pursuant to ‎Section
2.07, the Company will make an offer to each Holder of Notes of

 

    17

     

    

such
series (the “Change of Control Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of
$1,000) of such Holder’s Notes of such series at a repurchase price in cash equal to 101% of the aggregate principal amount
of the Notes of such series to be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of
repurchase (the “Change of Control Payment”). Within 30 days following any Change of Control Triggering Event
with respect to the Notes of a series, the Company will mail a notice to Holders of the Notes of such series describing the transaction
or transactions that constitute the Change of Control Triggering Event and offering to repurchase the Notes of such series on
the date specified in the notice (the “Change of Control Payment Date”), which date will be no less than 30
days and no more than 60 days from the date such notice is mailed, pursuant to the procedures required by the Notes of such series
and described in such notice.

 

(b)            The Company will comply with the
requirements of Rule 14e-1 under the Exchange Act and any other securities laws and regulations thereunder to the extent those
laws and regulations are applicable in connection with the repurchase of the Notes of a series as a result of a Change of Control
Triggering Event. To the extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase
provisions of the Notes of a series, the Company will comply with the applicable securities laws and regulations and will not be
deemed to have breached its obligations under the Change of Control repurchase provisions of any Notes by virtue of such conflicts.

 

(c)            The Company will not be required
to offer to repurchase the Notes of a series upon the occurrence of a Change of Control Triggering Event with respect to the Notes
of such series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements
for an offer made by the Company, and the third party repurchases on the applicable date all Notes of such series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Notes of such series and the Indenture, a failure
by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure by the
Company to comply with its obligations to offer to purchase the Notes of such series unless the Company promptly makes an offer
to repurchase the Notes of such series at 101% of the outstanding principal amount thereof plus accrued and unpaid interest, if
any, thereon, to, but excluding, the date of repurchase, which shall be no later than 30 days after the third party’s scheduled
Change of Control Payment Date.

 

(d)            On the Change of Control Payment
Date for Notes of a series to be repurchased, the Company will, to the extent lawful:

 

(i)            accept or cause a third
party to accept for payment all Notes of such series or portions of Notes of such series properly tendered pursuant to the Change
of Control Offer;

 

(ii)            deposit or cause a third
party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect of all Notes of such series
or portions of Notes of such series properly tendered; and

 

    18

     

    

(iii)            deliver or cause to
be delivered to the Trustee the Notes of such series properly accepted, together with an officer’s certificate stating the
aggregate principal amount of Notes of such series or portions of Notes of such series being purchased.

 

Section 2.09.            Applicability of Certain
Provisions of the Base Indenture in Respect of the Notes.

 

(a)            The Event of Default specified in
Section 501(5) of the Base Indenture shall not apply to the Notes.

 

(b)            Section 1005 of the Base Indenture
shall not apply to the Notes.

 

(c)            The second line of Section 1104
of the Base Indenture is hereby amended to replace “30” with “15” for purposes of the Notes.

 

(d)            Section 704 of the Base Indenture
is hereby amended and restated to read in its entirety as follows: “The Company shall file with the Trustee and the Commission,
and transmit to Holders, such information, documents and other reports, and such summaries thereof, as may be required pursuant
to the Trust Indenture Act at the times and in the manner provided pursuant to the Trust Indenture Act; provided, however,
that any such information, document or report filed with the Commission on its Electronic Data Gathering, Analysis and Retrieval
(or EDGAR) system or any successor thereto shall be deemed to be filed with the Trustee.”

 

Section 2.10.            Registrar and Paying
Agent; Calculation Agent. U.S. Bank National Association shall act as Paying Agent and registrar with respect to the Notes.
The Calculation Agent for the Floating Rate Notes shall initially be U.S. Bank National Association, unless and until such time
as a successor is appointed. If that bank is unable or unwilling to continue to act as the Calculation Agent or if it fails to
calculate properly the interest rate on the Floating Rate Notes for any applicable Floating Rate Interest Period, the Company may
appoint another leading commercial or investment bank engaged in the London interbank market to act as Calculation Agent in its
place. The Calculation Agent may not resign its duties without a successor having been appointed.

 

Section 2.11.            No Sinking Fund. The
Company shall not be obligated to redeem or purchase the Notes of any series pursuant to any sinking fund or analogous provision,
or at the option of any Holder thereof, except as provided in Sections ‎2.07 or
‎2.08 of this Supplemental Indenture.

 

Section 2.12.            Minimum Denominations.
The Notes shall be issuable only in registered form without coupons in denominations of $2,000 and any multiple of $1,000 in
excess thereof.

 

    19

     

    

Article
3

Miscellaneous

 

Section 3.01.            Relation to Indenture.
This Supplemental Indenture shall form a part of the Indenture for all purposes, and every Holder of Securities heretofore
or hereafter authenticated and delivered under the Indenture shall be bound hereby.

 

Section 3.02.            Continued Effect. Except
as expressly supplemented and amended by this Supplemental Indenture, the Base Indenture shall continue in full force and effect
in accordance with the provisions thereof, and the Base Indenture is in all respects hereby ratified and confirmed. This Supplemental
Indenture and all its provisions shall be deemed a part of the Indenture in the manner and to the extent herein and therein provided.

 

Section 3.03.            Provisions Binding on
Company’s Successors. All of the covenants, stipulations, promises and agreements in this Supplemental Indenture by the
Company shall bind its successors and assigns whether so expressed or not.

 

Section 3.04.            Certain Trustee Matters.

 

(a)            The recitals contained herein shall
be taken as the statements of the Company, and the Trustee assumes no responsibility for their correctness.

 

(b)            The Trustee makes no representations
as to the validity or sufficiency of this Supplemental Indenture or the Notes or the proper authorization or the due execution
hereof or thereof by the Company.

 

Section 3.05.            Governing Law. This
Supplemental Indenture and the Notes shall be governed by and construed in accordance with the internal laws of the State of New
York.

 

Section 3.06.            Counterparts. This
Supplemental Indenture may be signed in various counterparts which together will constitute one and the same instrument.

 

[signatures follow]

 

    20

     

    

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

 

	AETNA INC., as the Company

	 
	 
	 
	By:	/s/ David Buda
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer
	 	 	 
	 	 	 

	U.S. BANK NATIONAL ASSOCIATION, as Trustee
	 
	 
	 
	By:	/s/ David J. Ganss
	 	Name:	David J. Ganss
	 	Title:	Vice President

     

     

    

 

Exhibit A

 

Form of Floating Rate Senior Note due 2017

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

FLOATING RATE SENIOR NOTE DUE 2017

 

CUSIP: 00817Y AR9

ISIN: US00817YAR99

 

	No. 2017-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on December
8, 2017, and to pay interest thereon from June 9, 2016 or from the most recent Floating Rate Interest Payment Date to which interest
has been paid or duly provided for, quarterly on March 8, June 8, September 8 and December 8 in each year, beginning September
8, 2016, at a rate per annum equal to the Three-Month LIBOR as determined on the Floating Rate Interest Determination Date for
the applicable Floating Rate Interest Period, plus 0.650% as calculated by the Calculation Agent, until the principal hereof is
paid or made available for payment. The Calculation Agent has set the initial interest rate on this Security at 1.3066% per annum,
and will reset such interest rate for each Floating

 

    A-1

     

    

Rate
Interest Period on the Floating Rate Interest Payment Date for the preceding Floating Rate Interest Period. The interest so payable,
and punctually paid or duly provided for, on any Floating Rate Interest Payment Date will, as provided in such Indenture, be paid
to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the
Floating Rate Regular Record Date for such interest, which shall be the February 21, May 24, August 24 or November 23 (whether
or not a Business Day), as the case may be, next preceding such Floating Rate Interest Payment Date. Any such interest not so
punctually paid or duly provided for will forthwith cease to be payable to the Holder on such Floating Rate Regular Record Date
and may either be paid to the Person in whose name this Security (or one or more Predecessor Securities) 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 Securities of this series not less than 10 calendar days prior to such Special Record Date,
or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange on which the
Securities of this series may be listed, and upon such notice as may be required by such exchange, all as more fully provided
in such Indenture. In any case where any Floating Rate Interest Payment Date is not a Business Day, then payment of interest may
be made on the next succeeding Business Day without any additional amount being payable in respect of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    A-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

[SEAL]

 

	Attest:
	 
	 
	
	Judith H. Jones

    A-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    A-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $500,000,000, subject to
future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, the Company will make an offer to each Holder of the Securities of this series
(the “Change of Control Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000)
of such Holder’s Securities of this series at a repurchase price in cash equal to 101% of the aggregate principal amount
of the Securities of this series to be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date
of repurchase (the “Change of Control Payment”). Within 30 days following any Change of Control Triggering Event
with respect to the Securities of this series, the Company will mail a notice to Holders of the Securities of this series describing
the transaction or transactions that constitute the Change of Control Triggering Event and offering to repurchase the Securities
of this series on the date specified in the notice (the “Change of Control Payment Date”), which date will be
no less than 30 days and no more than 60 days from the date such notice is mailed, pursuant to the procedures required hereby and
described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

    A-R-5

     

    

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply with its obligations to offer to purchase the Securities of this series unless the Company promptly makes
an offer to repurchase the Securities of this series at 101% of the outstanding principal amount thereof plus accrued and unpaid
interest, if any, thereon, to, but excluding, the date of repurchase, which shall be no later than 30 days after the third party’s
scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this

 

    A-R-6

     

    

series of Securities for purposes of the
definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to which this definition
would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s or the Trustee’s
request that the reduction was the result, in whole or in part, of any event or circumstance comprised of or arising as a result
of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control has occurred at the time
of the rating event).

 

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies”.

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

    A-R-7

     

    

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement rating agency for any of Moody’s, S&P or Fitch, or all of them, as the
case may be, with respect to the Securities of this series.

 

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

2.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

3.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

4.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

    A-R-8

     

    

5.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium 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 such Holder’s attorney duly
authorized in writing, and thereupon one or more new Securities of this series and of like tenor, 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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

    A-R-9

     

    

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    A-R-10

     

    

 

Exhibit B

Form of 1.700% Senior Note due 2018

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

1.700% SENIOR NOTE DUE 2018

 

CUSIP: 00817Y AS7

ISIN: US00817YAS72

 

	No. 2018-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on June
7, 2018, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 7 and December 7 in each year, beginning December 7, 2016, at the rate of 1.700%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the May 23 or November 22 (whether or

 

    B-1

     

    

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 will forthwith cease to
be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one or
more Predecessor Securities) 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 Securities of this series not less than 10 calendar
days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements
of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be required by such
exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business Day, then
payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect of any
delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    B-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

    B-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    B-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $1,000,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time, the Securities of this series
are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail, in whole
or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, discounted to, but excluding, the Redemption Date on a semi-annual
basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate plus 15 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before

 

    B-R-1

     

    

or after the Remaining Life for the
Securities of this series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue
will be determined and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding
to the nearest month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were June 7, 2018 (the “Remaining Life” of such Securities) that would be utilized, at the
time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable
maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this

 

    B-R-2

     

    

series to be redeemed. The second line of
Section 1104 of the Base Indenture is amended to replace “30” with “15” for purposes of the Securities
of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such

 

    B-R-3

     

    

offer and to complete such offer shall be
treated as a failure by the Company to comply with its obligations to offer to purchase the Securities of this series unless the
Company promptly makes an offer to repurchase the Securities of this series at 101% of the outstanding principal amount thereof
plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase, which shall be no later than 30 days
after the third party’s scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

    B-R-4

     

    

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

    B-R-5

     

    

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

3.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

4.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

5.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

6.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium and interest on this Security are payable, duly

 

    B-R-6

     

    

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 such
Holder’s attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor,
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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    B-R-7

     

    

 

Exhibit C

Form of 1.900% Senior Note due 2019

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

1.900% SENIOR NOTE DUE 2019

 

CUSIP: 00817Y AT5

ISIN: US00817YAT55

 

	No. 2019-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of           
Dollars ($          ) upon presentation and surrender of this Security on June
7, 2019, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 7 and December 7 in each year, beginning December 7, 2016, at the rate of 1.900%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the May 23 or November 22 (whether or

 

    C-1

     

    

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 will forthwith cease to
be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one or
more Predecessor Securities) 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 Securities of this series not less than 10 calendar
days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements
of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be required by such
exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business Day, then
payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect of any
delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    C-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

    C-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    C-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $1,650,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time, the Securities of this series
are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’ notice by mail, in whole
or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, discounted to, but excluding, the Redemption Date on a semi-annual
basis (assuming a 360-day year consisting of twelve 30-day months) at the Treasury Rate plus 15 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before

 

    C-R-1

     

    

or after the Remaining Life for the
Securities of this series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue
will be determined and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding
to the nearest month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were June 7, 2019 (the “Remaining Life” of such Securities) that would be utilized, at the
time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable
maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this

 

    C-R-2

     

    

series to be redeemed. The second line of
Section 1104 of the Base Indenture is amended to replace “30” with “15” for purposes of the Securities
of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Special Mandatory Redemption.

 

If the Merger has not been completed by
December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant to
the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Securities of this series on the Special Mandatory Redemption Date at a special mandatory redemption price equal to
101% of the aggregate principal amount of such Securities, plus accrued and unpaid interest from the date of initial issuance,
or the most recent date to which interest has been paid or provided for, whichever is later, to, but excluding, the Special Mandatory
Redemption Date.

 

The Company shall cause notice of a special
mandatory redemption to be transmitted to each Holder of the Securities of this series at its registered address, with a copy to
the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption. If funds sufficient
to pay the special mandatory redemption price of the Securities of this series on the Special Mandatory Redemption Date (plus accrued
and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee on or before such Special
Mandatory Redemption Date, the Securities of this series will cease to bear interest on and after the Special Mandatory Redemption
Date.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

    C-R-3

     

    

3.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full or the Company has redeemed, or is required to redeem, the Securities of this series in full pursuant to Section
2 of this Security, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply with its obligations to offer to purchase the Securities of this series unless the Company promptly makes
an offer to repurchase the Securities of this series at 101% of the outstanding principal amount thereof plus accrued and unpaid
interest, if any, thereon, to, but excluding, the date of repurchase, which shall be no later than 30 days after the third party’s
scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

    C-R-4

     

    

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of

 

    C-R-5

     

    

its subsidiaries becomes the beneficial
owner, directly or indirectly, of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided,
however, that a transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary
of a holding company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction
are substantially the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately
following that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial
owner, directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

4.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens

 

    C-R-6

     

    

on
the Common Stock of Principal Subsidiaries set forth therein, does not apply to the Securities of this series.

 

5.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

6.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

7.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium 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 such Holder’s attorney duly
authorized in writing, and thereupon one or more new Securities of this series and of like tenor, 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 any multiple of $1,000 in excess thereof. As provided in
the Indenture and subject to certain limitations therein set forth, Securities of this series

 

    C-R-7

     

    

are
exchangeable for a like aggregate principal amount of Securities of this series and of like tenor of a different authorized denomination,
as requested by the Holder surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    C-R-8

     

    

 

Exhibit D

Form of 2.400% Senior Note due 2021

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

2.400% SENIOR NOTE DUE 2021

 

CUSIP: 00817Y AU2

ISIN: US00817YAU29

 

	No. 2021-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          Dollars
($          ) upon presentation and surrender of this Security on June 15, 2021,
and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been paid or
duly provided for, semi-annually on June 15 and December 15 in each year, beginning December 15, 2016 at the rate of 2.400% per
annum until the 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 such Indenture, be paid to the Person in whose name this Security (or one
or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which shall
be the June 1 or December 1

 

    D-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 will forthwith
cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security
(or one or more Predecessor Securities) 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 Securities of this series not less than
10 calendar days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with
the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be
required by such exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business
Day, then payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect
of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    D-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

    D-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series
designated under, and referred to in, the within-mentioned Indenture.

 

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

    D-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $1,850,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time prior to May 15, 2021, the Securities
of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’ notice
by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, in each case calculated as if the Stated Maturity of the principal
of such Securities were May 15, 2021, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day
year consisting of twelve 30-day months) at the Treasury Rate plus 20 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

At any time on or after May 15, 2021, the
Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount
of the Securities being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

    D-R-1

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Securities of this
series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were May 15, 2021 (the “Remaining Life” of such Securities) that would be utilized, at the
time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of comparable
maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

    D-R-2

     

    

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this
series to be redeemed. The second line of Section 1104 of the Base Indenture is amended to replace “30” with “15”
for purposes of the Securities of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Special Mandatory Redemption.

 

If the Merger has not been completed by
December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant to
the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Securities of this series on the Special Mandatory Redemption Date at a special mandatory redemption price equal to
101% of the aggregate principal amount of such Securities, plus accrued and unpaid interest from the date of initial issuance,
or the most recent date to which interest has been paid or provided for, whichever is later, to, but excluding, the Special Mandatory
Redemption Date.

 

The Company shall cause notice of a special
mandatory redemption to be transmitted to each Holder of the Securities of this series at its registered address, with a copy to
the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption. If funds sufficient
to pay the special mandatory redemption price of the Securities of this series on the Special Mandatory Redemption Date (plus accrued
and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee on or before such Special
Mandatory Redemption Date, the Securities of this series will cease to bear interest on and after the Special Mandatory Redemption
Date.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

    D-R-3

     

    

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

3.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full or the Company has redeemed, or is required to redeem, the Securities of this series in full pursuant to Section
2 of this Security, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply

 

    D-R-4

     

    

with its obligations to offer to purchase
the Securities of this series unless the Company promptly makes an offer to repurchase the Securities of this series at 101% of
the outstanding principal amount thereof plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase,
which shall be no later than 30 days after the third party’s scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

    D-R-5

     

    

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

    D-R-6

     

    

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

4.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

5.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

6.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

7.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium and interest on this Security are payable, duly

 

    D-R-7

     

    

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 such
Holder’s attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor,
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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    D-R-8

     

    

 

Exhibit E

Form of 2.800% Senior Note due 2023

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

2.800% SENIOR NOTE DUE 2023

 

CUSIP: 00817Y AV0

ISIN: US00817YAV02

 

	No. 2023-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on June
15, 2023, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 15 and December 15 in each year, beginning December 15, 2016, at the rate of 2.800%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the June 1 or December 1

 

    E-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 will forthwith
cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security
(or one or more Predecessor Securities) 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 Securities of this series not less than
10 calendar days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with
the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be
required by such exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business
Day, then payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect
of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    E-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

 

    E-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series
designated under, and referred to in, the within-mentioned Indenture.

 

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

    E-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $1,300,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.             Optional Redemption.

 

At any time prior to April 15, 2023, the
Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, in each case calculated as if the Stated Maturity of the principal
of such Securities were April 15, 2023, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day
year consisting of twelve 30-day months) at the Treasury Rate plus 20 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

At any time on or after April 15, 2023,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount
of the Securities being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

    E-R-1

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Securities of this
series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were April 15, 2023 (the “Remaining Life” of such Securities) that would be utilized, at
the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of
comparable maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

    E-R-2

     

    

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this
series to be redeemed. The second line of Section 1104 of the Base Indenture is amended to replace “30” with “15”
for purposes of the Securities of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

    E-R-3

     

    

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply with its obligations to offer to purchase the Securities of this series unless the Company promptly makes
an offer to repurchase the Securities of this series at 101% of the outstanding principal amount thereof plus accrued and unpaid
interest, if any, thereon, to, but excluding, the date of repurchase, which shall be no later than 30 days after the third party’s
scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this

 

    E-R-4

     

    

series of Securities for purposes of the
definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to which this definition
would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s or the Trustee’s
request that the reduction was the result, in whole or in part, of any event or circumstance comprised of or arising as a result
of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control has occurred at the time
of the rating event).

 

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

    E-R-5

     

    

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

3.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

4.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

5.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

6.            Other Matters.

 

    E-R-6

     

    

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium 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 such Holder’s attorney duly
authorized in writing, and thereupon one or more new Securities of this series and of like tenor, 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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,

 

    E-R-7

     

    

or
based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    E-R-8

     

    

 

Exhibit F

Form of 3.200% Senior Note due 2026

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

3.200% SENIOR NOTE DUE 2026

 

CUSIP: 00817Y AW8

ISIN: US00817YAW84

 

	No. 2026-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on June
15, 2026, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 15 and December 15 in each year, beginning December 15, 2016, at the rate of 3.200%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the June 1 or December 1

 

    F-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 will forthwith
cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security
(or one or more Predecessor Securities) 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 Securities of this series not less than
10 calendar days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with
the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be
required by such exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business
Day, then payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect
of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    F-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

    F-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    F-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $2,800,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time prior to March 15, 2026, the
Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, in each case calculated as if the Stated Maturity of the principal
of such Securities were March 15, 2026, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a 360-day
year consisting of twelve 30-day months) at the Treasury Rate plus 25 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

At any time on or after March 15, 2026,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount
of the Securities being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

    F-R-1

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Securities of this
series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were March 15, 2026 (the “Remaining Life” of such Securities) that would be utilized, at
the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities of
comparable maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

    F-R-2

     

    

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this
series to be redeemed. The second line of Section 1104 of the Base Indenture is amended to replace “30” with “15”
for purposes of the Securities of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Special Mandatory Redemption.

 

If the Merger has not been completed by
December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant to
the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Securities of this series on the Special Mandatory Redemption Date at a special mandatory redemption price equal to
101% of the aggregate principal amount of such Securities, plus accrued and unpaid interest from the date of initial issuance,
or the most recent date to which interest has been paid or provided for, whichever is later, to, but excluding, the Special Mandatory
Redemption Date.

 

The Company shall cause notice of a special
mandatory redemption to be transmitted to each Holder of the Securities of this series at its registered address, with a copy to
the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption. If funds sufficient
to pay the special mandatory redemption price of the Securities of this series on the Special Mandatory Redemption Date (plus accrued
and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee on or before such Special
Mandatory Redemption Date, the Securities of this series will cease to bear interest on and after the Special Mandatory Redemption
Date.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

    F-R-3

     

    

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

3.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full or the Company has redeemed, or is required to redeem, the Securities of this series in full pursuant to Section
2 of this Security, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply

 

    F-R-4

     

    

with its obligations to offer to purchase
the Securities of this series unless the Company promptly makes an offer to repurchase the Securities of this series at 101% of
the outstanding principal amount thereof plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase,
which shall be no later than 30 days after the third party’s scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

    F-R-5

     

    

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

    F-R-6

     

    

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

4.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

5.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

6.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

7.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium and interest on this Security are payable, duly

 

    F-R-7

     

    

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 such
Holder’s attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor,
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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    F-R-8

     

    

 

Exhibit G

Form of 4.250% Senior Note due 2036

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

4.250% SENIOR NOTE DUE 2036

 

CUSIP: 00817Y AY4

ISIN: US00817YAY41

 

	No. 2036-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on June
15, 2036, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 15 and December 15 in each year, beginning December 15, 2016, at the rate of 4.250%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the June 1 or December 1

 

    G-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 will forthwith
cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security
(or one or more Predecessor Securities) 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 Securities of this series not less than
10 calendar days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with
the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be
required by such exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business
Day, then payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect
of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    G-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

 

    G-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    G-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $1,500,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time prior to December 15, 2035,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, in each case calculated as if the Stated Maturity of the principal
of such Securities were December 15, 2035, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a
360-day year consisting of twelve 30-day months) at the Treasury Rate plus 30 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

At any time on or after December 15, 2035,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount
of the Securities being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

    G-R-1

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Securities of this
series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were December 15, 2035 (the “Remaining Life” of such Securities) that would be utilized,
at the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities
of comparable maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

    G-R-2

     

    

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this
series to be redeemed. The second line of Section 1104 of the Base Indenture is amended to replace “30” with “15”
for purposes of the Securities of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Special Mandatory Redemption.

 

If the Merger has not been completed by
December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant to
the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Securities of this series on the Special Mandatory Redemption Date at a special mandatory redemption price equal to
101% of the aggregate principal amount of such Securities, plus accrued and unpaid interest from the date of initial issuance,
or the most recent date to which interest has been paid or provided for, whichever is later, to, but excluding, the Special Mandatory
Redemption Date.

 

The Company shall cause notice of a special
mandatory redemption to be transmitted to each Holder of the Securities of this series at its registered address, with a copy to
the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption. If funds sufficient
to pay the special mandatory redemption price of the Securities of this series on the Special Mandatory Redemption Date (plus accrued
and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee on or before such Special
Mandatory Redemption Date, the Securities of this series will cease to bear interest on and after the Special Mandatory Redemption
Date.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

    G-R-3

     

    

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

3.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full or the Company has redeemed, or is required to redeem, the Securities of this series in full pursuant to Section
2 of this Security, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply

 

    G-R-4

     

    

with its obligations to offer to purchase
the Securities of this series unless the Company promptly makes an offer to repurchase the Securities of this series at 101% of
the outstanding principal amount thereof plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase,
which shall be no later than 30 days after the third party’s scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

    G-R-5

     

    

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

    G-R-6

     

    

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

4.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

5.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

6.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

7.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium and interest on this Security are payable, duly

 

    G-R-7

     

    

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 such
Holder’s attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor,
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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    G-R-8

     

    

 

Exhibit H

Form of 4.375% Senior Note due 2046

 

THIS SECURITY IS A GLOBAL SECURITY WITHIN THE MEANING OF THE
INDENTURE HEREINAFTER REFERRED TO AND IS REGISTERED IN THE NAME OF A DEPOSITARY OR A NOMINEE THEREOF. THIS SECURITY MAY NOT BE
TRANSFERRED TO, OR REGISTERED OR EXCHANGED FOR SECURITIES REGISTERED IN THE NAME OF, ANY PERSON OTHER THAN THE DEPOSITARY OR A
NOMINEE THEREOF, AND NO SUCH TRANSFER MAY BE REGISTERED EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. EVERY SECURITY
AUTHENTICATED AND DELIVERED UPON REGISTRATION OF TRANSFER OF, OR IN EXCHANGE FOR OR IN LIEU OF, THIS SECURITY SHALL BE A GLOBAL
SECURITY SUBJECT TO THE FOREGOING, EXCEPT IN SUCH LIMITED CIRCUMSTANCES.

 

Unless this certificate is presented by an authorized representative
of The Depository Trust Company, a New York corporation (“DTC”), to Aetna Inc. 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.

 

AETNA INC.

 

4.375% SENIOR NOTE DUE 2046

 

CUSIP: 00817Y AX6

ISIN: US00817YAX67

 

	No. 2046-1	$          

 

AETNA INC., a Pennsylvania corporation (herein
called the “Company”), which term includes any successor Person under the Indenture hereinafter referred to,
for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of          
Dollars ($          ) upon presentation and surrender of this Security on June
15, 2046, and to pay interest thereon from June 9, 2016, or from the most recent Interest Payment Date to which interest has been
paid or duly provided for, semi-annually on June 15 and December 15 in each year, beginning December 15, 2016, at the rate of 4.375%
per annum until the 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 such Indenture, be paid to the Person in whose name this Security
(or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest, which
shall be the June 1 or December 1

 

    H-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 will forthwith
cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security
(or one or more Predecessor Securities) 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 Securities of this series not less than
10 calendar days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with
the requirements of any securities exchange on which the Securities of this series may be listed, and upon such notice as may be
required by such exchange, all as more fully provided in such Indenture. In any case where any Interest Payment Date is not a Business
Day, then payment of interest may be made on the next succeeding Business Day without any additional amount being payable in respect
of any delay.

 

Payment of the principal of and premium,
if any, and interest on this Security will be made at the office or agency of the Company maintained for that purpose in the United
States of America, 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.

 

Reference is hereby made to the further
provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have the same effect
as if set forth at this place. Such provisions include, without limitation, provisions relating to redemption of this Security
by the Company.

 

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

 

    H-2

     

    

IN WITNESS WHEREOF, the Company has caused
this instrument to be duly executed under its corporate seal.

 

Dated: June 9, 2016

 

	AETNA INC.
	 
	 
	By:	 
	 	Name:	David Buda
	 	Title:	Vice President, Finance and Treasurer

 

 

 

 

	[SEAL]
	 
	 
	Attest:

         

         

         

	
	Judith H. Jones

 

 

    H-3

     

    

TRUSTEE’S CERTIFICATE OF AUTHENTICATION

 

This is one of the Securities of the series designated under,
and referred to in, the within-mentioned Indenture.

 

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

    H-4

     

    

(Back of Security)

 

This Security is 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 a Senior Indenture, dated as of March 2, 2001 (herein called the “Base Indenture”), between
the Company, as issuer, and U.S. Bank National Association (as successor in interest to State Street Bank and Trust Company), as
Trustee (herein called the “Trustee”, which term includes any successor trustee under the Indenture), as supplemented
by the Supplemental Indenture dated as of June 9, 2016, between the Company and the Trustee (together with the Base Indenture,
the “Indenture”), to which Indenture and all indentures supplemental thereto 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, and are to be, authenticated and delivered. This Security
is one of the series designated on the face hereof, initially limited in aggregate principal amount to $2,400,000,000, subject
to future issuances of additional Securities pursuant to Section 301 of the Base Indenture.

 

1.            Optional Redemption.

 

At any time prior to December 15, 2045,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to the greater of:

 

		·	100% of the principal amount of the Securities being redeemed, or

 

		·	the sum of the present value of (x) 100% of the principal amount of the Securities being redeemed and (y) all required remaining
scheduled interest payments due on the Securities being redeemed, in each case calculated as if the Stated Maturity of the principal
of such Securities were December 15, 2045, discounted to, but excluding, the Redemption Date on a semi-annual basis (assuming a
360-day year consisting of twelve 30-day months) at the Treasury Rate plus 30 basis points,

 

plus, in each case, any interest accrued
but not paid to, but excluding, the Redemption Date.

 

At any time on or after December 15, 2045,
the Securities of this series are subject to redemption upon not less than 15 calendar days’ nor more than 60 calendar days’
notice by mail, in whole or in part, at the election of the Company, at a Redemption Price equal to 100% of the principal amount
of the Securities being redeemed plus any interest accrued but not paid to, but excluding, the Redemption Date.

 

“Treasury Rate” means,
with respect to any Redemption Date for any portion of the Securities of this series,

 

    H-R-1

     

    

		·	the yield, under the heading which represents the average for the immediately preceding week, appearing in the most recently
published statistical release designated “H.15(519)” or any successor publication which is published weekly by the
Board of Governors of the Federal Reserve System and which establishes yields on actively traded United States Treasury securities
adjusted to constant maturity under the caption “Treasury Constant Maturities,” for the maturity corresponding to the
Comparable Treasury Issue (if no maturity is within three months before or after the Remaining Life for the Securities of this
series, yields for the two published maturities most closely corresponding to the Comparable Treasury Issue will be determined
and the Treasury Rate shall be interpolated or extrapolated from those yields on a straight line basis, rounding to the nearest
month), or

 

		·	if the release referred to in the previous bullet (or any successor release) is not published during the week preceding the
calculation date or does not contain the yields referred to above, the rate per annum equal to the semi-annual equivalent yield
to maturity of the Comparable Treasury Issue, calculated using a price for the Comparable Treasury Issue (expressed as a percentage
of its principal amount) equal to the Comparable Treasury Price for that Redemption Date.

 

The Treasury Rate will be calculated on
the third Business Day preceding the Redemption Date.

 

“Comparable Treasury Issue”
means the United States Treasury security selected by an Independent Investment Banker as having an actual or interpolated maturity
comparable to the remaining term of the Securities of this series to be redeemed, calculated as if the Stated Maturity of the principal
of such Securities were December 15, 2045 (the “Remaining Life” of such Securities) that would be utilized,
at the time of selection and in accordance with customary financial practice, in pricing new issues of corporate debt securities
of comparable maturity to the Remaining Life of the Securities of this series to be redeemed.

 

“Comparable Treasury Price”
means, with respect to any Redemption Date for any Securities of this series, the average of all Reference Treasury Dealer Quotations
obtained.

 

“Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the Company.

 

“Reference Treasury Dealer”
means each of Citigroup Global Markets Inc. and UBS Securities LLC. If any Reference Treasury Dealer ceases to be a primary U.S.
government securities dealer in the United States (a “Primary Treasury Dealer”), the Company shall substitute
another Primary Treasury Dealer for that dealer.

 

    H-R-2

     

    

“Reference Treasury Dealer Quotations”
means, with respect to each Reference Treasury Dealer and any Redemption Date, the average, as determined by the Company, of the
bid and asked prices for the Comparable Treasury Issue (expressed in each case as a percentage of its principal amount) quoted
in writing to the Company by that Reference Treasury Dealer at 5:00 p.m. on the third Business Day preceding the Redemption Date.

 

Notice of any redemption will be mailed
at least 15 calendar days but no more than 60 calendar days before the Redemption Date to each Holder of the Securities of this
series to be redeemed. The second line of Section 1104 of the Base Indenture is amended to replace “30” with “15”
for purposes of the Securities of this series.

 

Unless the Company defaults in payment of
the Redemption Price, interest will cease to accrue on the Securities of this series or the portions of the Securities of this
series called for redemption on and after the Redemption Date.

 

If this Security is redeemed in part only,
a new Security or Securities of this series and of like tenor for the unredeemed portion hereof will be issued in the name of the
Holder hereof upon the cancellation hereof.

 

2.            Special Mandatory Redemption.

 

If the Merger has not been completed by
December 31, 2016 (or such later date to which the End Date is extended by agreement between the Company and Humana pursuant to
the terms of the Merger Agreement) or if, prior to such date, the Merger Agreement is terminated, then the Company shall redeem
all of the Securities of this series on the Special Mandatory Redemption Date at a special mandatory redemption price equal to
101% of the aggregate principal amount of such Securities, plus accrued and unpaid interest from the date of initial issuance,
or the most recent date to which interest has been paid or provided for, whichever is later, to, but excluding, the Special Mandatory
Redemption Date.

 

The Company shall cause notice of a special
mandatory redemption to be transmitted to each Holder of the Securities of this series at its registered address, with a copy to
the Trustee, no later than 60 days after the occurrence of the event triggering the special mandatory redemption. If funds sufficient
to pay the special mandatory redemption price of the Securities of this series on the Special Mandatory Redemption Date (plus accrued
and unpaid interest, if any, to the Special Mandatory Redemption Date) are deposited with the Trustee on or before such Special
Mandatory Redemption Date, the Securities of this series will cease to bear interest on and after the Special Mandatory Redemption
Date.

 

“End Date” has the meaning
ascribed to such term in the Merger Agreement.

 

“Humana” means Humana
Inc., a Delaware corporation.

 

“Merger” means the acquisition
of Humana by the Company on the terms and subject to the conditions set forth in the Merger Agreement.

 

    H-R-3

     

    

“Merger Agreement” means
the Agreement and Plan of Merger, dated as of July 2, 2015, among the Company, Echo Merger Sub, Inc., Echo Merger Sub, LLC and
Humana, as amended from time to time.

 

“Special Mandatory Redemption Date”
means the 30th day (or if such day is not a Business Day, the first Business Day thereafter) following the transmission of a notice
of special mandatory redemption.

 

3.            Change of Control.

 

If a Change of Control Triggering Event
occurs with respect to the Securities of this series, unless the Company has exercised its right to redeem the Securities of this
series in full or the Company has redeemed, or is required to redeem, the Securities of this series in full pursuant to Section
2 of this Security, the Company will make an offer to each Holder of the Securities of this series (the “Change of Control
Offer”) to repurchase any and all (equal to $2,000 or an integral multiple of $1,000) of such Holder’s Securities
of this series at a repurchase price in cash equal to 101% of the aggregate principal amount of the Securities of this series to
be repurchased plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase (the “Change
of Control Payment”). Within 30 days following any Change of Control Triggering Event with respect to the Securities
of this series, the Company will mail a notice to Holders of the Securities of this series describing the transaction or transactions
that constitute the Change of Control Triggering Event and offering to repurchase the Securities of this series on the date specified
in the notice (the “Change of Control Payment Date”), which date will be no less than 30 days and no more than
60 days from the date such notice is mailed, pursuant to the procedures required hereby and described in such notice.

 

The Company will comply with the requirements
of Rule 14e-1 under the Securities Exchange Act of 1934, as amended from time to time, and any successor statute thereto (the “Exchange
Act”), and any other securities laws and regulations thereunder to the extent those laws and regulations are applicable
in connection with the repurchase of the Securities of this series as a result of a Change of Control Triggering Event. To the
extent that the provisions of any securities laws or regulations conflict with the Change of Control repurchase provisions of the
Securities of this series, the Company will comply with the applicable securities laws and regulations and will not be deemed to
have breached its obligations under the Change of Control repurchase provisions of the Securities of this series by virtue of such
conflicts.

 

The Company will not be required to offer
to repurchase the Securities upon the occurrence of a Change of Control Triggering Event with respect to the Securities of this
series if a third party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an
offer made by the Company and the third party repurchases on the applicable date all Securities of this series properly tendered
and not withdrawn under its offer; provided that for all purposes of the Securities of this series and the Indenture, a
failure by such third party to comply with the requirements of such offer and to complete such offer shall be treated as a failure
by the Company to comply

 

    H-R-4

     

    

with its obligations to offer to purchase
the Securities of this series unless the Company promptly makes an offer to repurchase the Securities of this series at 101% of
the outstanding principal amount thereof plus accrued and unpaid interest, if any, thereon, to, but excluding, the date of repurchase,
which shall be no later than 30 days after the third party’s scheduled Change of Control Payment Date.

 

On the Change of Control Payment Date, the
Company will, to the extent lawful:

 

		·	accept or cause a third party to accept for payment all Securities of this series or portions of Securities of this series
properly tendered pursuant to the Change of Control Offer;

 

		·	deposit or cause a third party to deposit with the Paying Agent an amount equal to the Change of Control Payment in respect
of each Security of this series or portion of a Security of this series properly tendered; and

 

		·	deliver or cause to be delivered to the Trustee the Securities of this series properly accepted, together with an officer’s
certificate stating the aggregate principal amount of Securities of this series or portions of Securities of this series being
purchased.

 

“Below Investment Grade Rating
Event” means the Securities of this series are rated below an Investment Grade Rating by each of the Rating Agencies
on any date from the earlier of (1) the occurrence of a Change of Control and (2) public notice of the Company’s intention
to effect a Change of Control, in each case until the end of the 60-day period following the earlier of (1) the occurrence of a
Change of Control and (2) public notice of the Company’s intention to effect a Change of Control; provided, however,
that if (i) during such 60-day period one or more Rating Agencies has publicly announced that it is considering the possible downgrade
of the Securities of this series, and (ii) a downgrade by each of the Rating Agencies that has made such an announcement would
result in a Below Investment Grade Rating Event for this series of Securities, then such 60-day period shall be extended for such
time as the rating of the Securities of this series by any such Rating Agency remains under publicly announced consideration for
possible downgrade to a rating below an Investment Grade Rating and a downgrade by such Rating Agency to a rating below an Investment
Grade Rating could cause a Below Investment Grade Rating Event for this series of Securities. Notwithstanding the foregoing, a
rating event otherwise arising by virtue of a particular reduction in rating will not be deemed to have occurred in respect of
a particular Change of Control (and thus will not be deemed a Below Investment Grade Rating Event for this series of Securities
for purposes of the definition of Change of Control Triggering Event) if the Rating Agencies making the reduction in rating to
which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at the Company’s
or the Trustee’s request that the reduction was the result, in whole or in part, of any event or circumstance comprised of
or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control
has occurred at the time of the rating event).

 

    H-R-5

     

    

“Change of Control” means
the occurrence of any of the following: (1) direct or indirect sale, transfer, conveyance or other disposition (other than by way
of merger or consolidation), in one or a series of related transactions, of all or substantially all of the properties or assets
of the Company and its subsidiaries taken as a whole to any “person” (as that term is used in Section 13(d)(3) of the
Exchange Act) other than to the Company or one of its subsidiaries; or (2) the consummation of any transaction (including, without
limitation, any merger or consolidation) the result of which is that any “person” (as that term is used in Section
13(d)(3) of the Exchange Act) other than the Company or one of its subsidiaries becomes the beneficial owner, directly or indirectly,
of more than 50% of the then outstanding number of shares of the Company’s voting stock; provided, however, that a
transaction will not be deemed to involve a Change of Control if (A) the Company becomes a wholly owned subsidiary of a holding
company and (B)(x) the holders of the voting stock of such holding company immediately following that transaction are substantially
the same as the holders of the Company’s voting stock immediately prior to that transaction or (y) immediately following
that transaction no “person” (as that term is used in Section 13(d)(3) of the Exchange Act) is the beneficial owner,
directly or indirectly, of more than 50% of the voting stock of such holding company. For purposes of this definition, “voting
stock” means capital stock of any class or kind the holders of which are ordinarily, in the absence of contingencies,
entitled to vote for the election of directors (or persons performing similar functions) of the Company (even if the right to vote
has been suspended by the happening of such a contingency).

 

“Change of Control Triggering Event”
means the occurrence of both a Change of Control and a Below Investment Grade Rating Event.

 

“Fitch” means Fitch Ratings,
Inc.

 

“Investment Grade Rating”
means a rating by Moody’s equal to or higher than Baa3 (or the equivalent under any successor rating category of Moody’s),
a rating by S&P equal to or higher than BBB- (or the equivalent under any successor rating category of S&P), a rating by
Fitch equal to or higher than BBB- (or the equivalent under any successor rating category of Fitch), and the equivalent investment
grade credit rating from any replacement rating agency or rating agencies selected by the Company under circumstances permitting
the Company to select a replacement rating agency and in the manner for selecting a replacement rating agency, in each case as
set forth in the definition of “Rating Agencies.”

 

“Moody’s” means
Moody’s Investors Service, Inc.

 

“Rating Agencies” means
(1) Moody’s, S&P and Fitch; and (2) if any or all of Moody’s, S&P or Fitch ceases to rate the Securities of
this series or fails to make a rating of the Securities of this series publicly available for reasons outside of the Company’s
control, a “nationally recognized statistical rating organization” within the meaning of Section 3(a)(62) of the Exchange
Act that the Company selects as a replacement agency for any of Moody’s, S&P or Fitch, or all of them, as the case may
be, with respect to the Securities of this series.

 

    H-R-6

     

    

“S&P” means Standard
& Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc.

 

4.            Certain Covenants.

 

The Indenture contains certain covenants
that, among other things, limit the ability of the Company to consolidate, merge or sell all or substantially all of its assets.
These covenants are subject to a number of important qualifications and exceptions. Section 1005 of the Base Indenture, including,
without limitation, the limitation on liens on the Common Stock of Principal Subsidiaries set forth therein, does not apply to
the Securities of this series.

 

5.            Events of Default.

 

If an Event of Default with respect to Securities
of this series shall occur and be continuing, the principal of the Securities of this series may be declared due and payable in
the manner and with the effect provided in the Indenture. The Event of Default set forth in Section 501(5) of the Base Indenture,
including, without limitation, the cross-acceleration provisions thereof, does not apply to the Securities of this series.

 

6.            Amendment, Modification and Waiver.

 

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 a majority in principal amount of the Securities at the time Outstanding of each series to be affected.
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 hereof or in lieu hereof, whether or not notation
of such consent or waiver is made upon this Security.

 

7.            Other Matters.

 

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 any premium 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 for registration of transfer at the office or agency of the Company in any place where the principal of and any
premium and interest on this Security are payable, duly

 

    H-R-7

     

    

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 such
Holder’s attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like tenor,
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 any multiple of $1,000 in excess thereof. 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 and of like tenor of a different authorized denomination, as requested by the Holder
surrendering the same.

 

No service charge shall be made for any
such registration of transfer or exchange of Securities, but the Company or the Trustee may require payment of a sum sufficient
to cover any tax or other governmental charge that may be imposed in connection with any registration of transfer or exchange of
Securities, other than exchanges pursuant to Section 304, 906 or 1107 of the Base Indenture not involving any transfer.

 

Prior to due and proper 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 is overdue, and neither
the Company, the Trustee nor any such agent shall be affected by notice to the contrary.

 

The Indenture provides that the Company,
at the Company’s option, (a) will be discharged from any and all obligations in respect of the Securities (except for certain
obligations to register the transfer or exchange of Securities, replace stolen, lost or mutilated Securities, maintain paying agencies
and hold moneys for payment in trust) or (b) need not comply with certain restrictive covenants of the Indenture, in each case
if the Company deposits, in trust, with the Trustee money or U.S. Government Obligations which through the payment of interest
thereon and principal thereof in accordance with their terms will provide money, in an amount sufficient to pay all the principal
of and premium, if any, and interest on, the Securities on the dates such payments are due in accordance with the terms of such
Securities, and certain other conditions are satisfied.

 

No recourse shall be had for the payment
of the principal of and premium, if any, or interest on this Security, or for any claim based hereon, or otherwise in respect hereof,
or based on or in respect of the Indenture or any indenture supplemental thereto, against any incorporator, stockholder, officer,
employee, agent or director, as such, past, present or future, of the Company or of any successor corporation, whether by virtue
of any constitution, statute or rule of law, or by the enforcement of any assessment or penalty or otherwise, all such liability
being, by the acceptance hereof and as part of the consideration for the issue hereof, expressly waived and released.

 

All terms used in this Security which are
defined in the Indenture shall have the respective meanings assigned to them in the Indenture.

 

    H-R-8Exhibit 4.2

 

TACTILE SYSTEMS TECHNOLOGY, INC.
 AMENDED AND RESTATED INVESTORS’ RIGHTS AGREEMENT

 

THIS AMENDED AND RESTATED INVESTORS’ RIGHTS AGREEMENT is made as of September 14, 2012, by and among Tactile Systems Technology, Inc. a Delaware corporation (the “Company”), and each of the Persons listed on Schedule A hereto, each of which is referred to in this Agreement as an “Investor.”

 

RECITALS

 

A.                                    The Company and certain of the Investors are parties to the Investors’ Rights Agreement, dated as of October 25, 2007 (the “Existing Agreement”).

 

B.                                    Pursuant to that certain Series B Preferred Stock Purchase Agreement, dated as of the date hereof (as amended from time to time, the “Purchase Agreement”), by and between the Company and certain Investors, the Company has agreed to sell and issue shares of its Series B Preferred Stock to such Investors.

 

C.                                    To induce such Investors to enter into the Purchase Agreement and to induce such Investors to invest funds in the Company pursuant to the Purchase Agreement, the parties signatory hereto desire to amend and restate the Existing Agreement in its entirety as set forth in this Agreement.

 

NOW, THEREFORE, the parties hereby agree as follows:

 

1.                                      Definitions.  For purposes of this Agreement:

 

1.1                               “Affiliate” means, with respect to any specified Person, any other Person who, directly or indirectly, controls, is controlled by, or is under common control with such Person including, without limitation, any general partner, managing member, officer or director of such Person or any venture capital fund now or hereafter existing that is controlled by one or more general partners or managing members of, or shares the same management company with, such Person.

 

1.2                               “Certificate of Incorporation” means the Company’s Certificate of Incorporation, as amended from time to time.

 

1.3                               “Common Stock” means shares of the Company’s common stock, par value $0.001 per share.

 

1.4                               “Damages” means all losses, damages and liabilities (joint or several) to which a Person entitled to indemnification hereunder may become subject under the Securities Act, the Exchange Act, any other federal or state law or otherwise insofar as such losses, damages or liabilities (or any action in respect thereof) arises out of or is based upon (i) any untrue statement or alleged untrue statement of a material fact contained in any registration statement of the Company, including any preliminary prospectus or final prospectus contained therein or any amendments or supplements thereto; (ii) an omission or alleged omission to state therein a material fact required to be stated therein, or necessary to make the statements therein not misleading; or (iii) any violation or alleged violation by the indemnifying party (or any of its agents or Affiliates) of the Securities Act, the Exchange Act, any state securities law, or any rule or regulation promulgated under the Securities Act, the Exchange Act, or any state securities law.

 

1.5                               “Deemed Liquidation Event” shall have the meaning ascribed to such term in the Certificate of Incorporation.

 

1.6                               “Derivative Securities” means any securities or rights convertible into, or exercisable or exchangeable for (in each case, directly or indirectly), Common Stock, including options and warrants.

 

1

 

1.7                               “Exchange Act” means the Securities Exchange Act of 1934, as amended, and the rules and regulations promulgated thereunder.

 

1.8                               “Excluded Registration” means (i) a registration relating to the sale of securities to employees of the Company or a subsidiary pursuant to a stock option, stock purchase, or similar plan; (ii) a registration relating to an SEC Rule 145 transaction; (iii) a registration on any form that does not include substantially the same information as would be required to be included in a registration statement covering the sale of the Registrable Securities; or (iv) a registration in which the only Common Stock being registered is Common Stock issuable upon conversion of debt securities that are also being registered.

 

1.9                               “Form S-1” means such form under the Securities Act as in effect on the date hereof or any successor registration form under the Securities Act subsequently adopted by the SEC.

 

1.10                        “Form S-3” means such form under the Securities Act as in effect on the date hereof or any registration form under the Securities Act subsequently adopted by the SEC that permits incorporation of substantial information by reference to other documents filed by the Company with the SEC.

 

1.11                        “GAAP” means generally accepted accounting principles in the United States.

 

1.12                        “Holder” means any holder of Registrable Securities who is a party to this Agreement.

 

1.13                        “Immediate Family Member” means a child, stepchild, grandchild, parent, stepparent, grandparent, spouse, sibling, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law, including adoptive relationships, of a natural person referred to herein.

 

1.14                        “Initiating Holders” means, collectively, Holders who properly initiate a registration request under this Agreement.

 

1.15                        “IPO” means the Company’s first underwritten public offering of its Common Stock under the Securities Act.

 

1.17                        “Major Investor” means any Investor that, individually or together with such Investor’s Affiliates, holds at least 300,000 shares of Registrable Securities (as adjusted for any stock split, stock dividend, combination, or other recapitalization or reclassification effected after the date hereof).

 

1.18                        “New Securities” means (i) all shares of capital stock or other equity securities of the Company, whether or not currently authorized, (ii) all rights, options and warrants to purchase such shares of capital stock or other equity securities, (iii) all Derivative Securities, (iv) all securities entitling the holder thereof to participate in dividends or distributions from the Company or in the distribution of assets upon the liquidation, dissolution or winding up of the Company, (v) all phantom stock or stock appreciation rights and (vi) all other securities of any type whatsoever that are, or may become, convertible or exchangeable into or exercisable for such shares of capital stock or other equity securities, except for shares of the Company’s Series B Preferred Stock issued pursuant to the Purchase Agreement.

 

1.19                        “Person” means any individual, corporation, partnership, trust, limited liability company, association or other entity.

 

1.20                        “Preferred Stock” means shares of the Company’s Series A Preferred Stock and shares of the Company’s Series B Preferred Stock.

 

1.21                        “Registrable Securities” means (i) the Common Stock issuable or issued upon conversion of the Preferred Stock; (ii) all shares of Common Stock acquired by any Investor after the date hereof; and (iii) any Common Stock issued as (or issuable upon the conversion or exercise of any warrant,

 

2

 

right, or other security that is issued as) a dividend or other distribution with respect to, or in exchange for or in replacement of, the shares referenced in clause (i) or clause (ii) above or as a result of a stock split or other similar capital reorganization; excluding in all cases, however, any Registrable Securities sold by a Person in a transaction in which the applicable rights under this Agreement are not assigned pursuant to Section 6.1, and excluding for purposes of Section 2 any shares for which registration rights have terminated pursuant to Section 2.13 of this Agreement.

 

1.22                  “Registrable Securities then outstanding” means the number of shares determined by adding the number of shares of outstanding Common Stock that are Registrable Securities and the number of shares of Common Stock issuable (directly or indirectly) pursuant to then exercisable and/or convertible securities that are Registrable Securities.

 

1.23                  “Required Holders” means (i) the holders of at least a majority of the then outstanding shares of Series A Preferred Stock and (ii) the holders of at least 66-2/3% of the then outstanding shares of Series B Preferred Stock, voting as separate classes.

 

1.24                  “Restricted Securities” means the securities of the Company required to bear the legend set forth in Section 2.12(b) hereof.

 

1.25                  “SEC” means the Securities and Exchange Commission.

 

1.26                  “SEC Rule 144” means Rule 144 promulgated by the SEC under the Securities Act.

 

1.27                  “SEC Rule 145” means Rule 145 promulgated by the SEC under the Securities Act.

 

1.28                  “Securities Act” means the Securities Act of 1933, as amended, and the rules and regulations promulgated thereunder.

 

1.29                  “Selling Expenses” means all underwriting discounts, selling commissions, and stock transfer taxes applicable to the sale of Registrable Securities, and fees and disbursements of counsel for any Holder, except for the fees and disbursements of the Selling Holder Counsel borne and paid by the Company as provided in Section 2.6.

 

1.30                  “Series A Director” means any director of the Company that the holders of record of the Series A Preferred Stock are entitled to elect pursuant to the Certificate of Incorporation.

 

1.31                  “Series A Preferred Stock” means shares of the Company’s Series A Preferred Stock, par value $0.001 per share.

 

1.32                  “Series B Director” means any director of the Company that the holders of record of the Series B Preferred Stock are entitled to elect pursuant to the Certificate of Incorporation.

 

1.33                  “Series B Preferred Stock” means shares of the Company’s Series B Preferred Stock, par value $0.001 per share.

 

2.                                      Registration Rights.  The Company covenants and agrees as follows:

 

2.1                               Demand Registration.

 

(a)               Form S-1 Demand.  If at any time after the earlier of (i) five years after the date of this Agreement or (ii) 180 days after the effective date of the registration statement for the IPO, the Company receives a request from Holders of a majority of the Registrable Securities then outstanding that the Company file a Form S-1 registration statement with respect to outstanding Registrable Securities having an anticipated aggregate offering price, net of Selling Expenses, of at least $10,000,000, then the Company shall (i) within ten days after the date such request is given, give notice thereof (the “Demand Notice”) to all Holders other than the Initiating Holders; and (ii) as soon as

 

3

 

practicable, and in any event within 60 days after the date such request is given by the Initiating Holders, file a Form S-1 registration statement under the Securities Act covering all Registrable Securities that the Initiating Holders requested to be registered and any additional Registrable Securities requested to be included in such registration by any other Holders, as specified by notice given by each such Holder to the Company within 20 days of the date the Demand Notice is given, and in each case, subject to the limitations of Section 2.1(c) and Section 2.3.

 

(b)               Form S-3 Demand.  If at any time when it is eligible to use a Form S-3 registration statement, the Company receives a request from Holders of at least 20% of the Registrable Securities then outstanding that the Company file a Form S-3 registration statement with respect to outstanding Registrable Securities of such Holders having an anticipated aggregate offering price, net of Selling Expenses, of at least $2,500,000, then the Company shall (i) within ten days after the date such request is given, give a Demand Notice to all Holders other than the Initiating Holders; and (ii) as soon as practicable, and in any event within 45 days after the date such request is given by the Initiating Holders, file a Form S-3 registration statement under the Securities Act covering all Registrable Securities requested to be included in such registration by any other Holders, as specified by notice given by each such Holder to the Company within 20 days of the date the Demand Notice is given, and in each case, subject to the limitations of Section 2.1(c) and Section 2.3.

 

(c)                Notwithstanding the foregoing obligations, if the Company furnishes to Holders requesting a registration pursuant to this Section 2.1 a certificate signed by the Company’s chief executive officer stating that in the good faith judgment of the Company’s Board of Directors (the “Board of Directors”) it would be materially detrimental to the Company and its stockholders for such registration statement to either become effective or remain effective for as long as such registration statement otherwise would be required to remain effective, because such action would (i) materially interfere with a significant acquisition, corporate reorganization, or other similar transaction involving the Company; (ii) require premature disclosure of material information that the Company has a bona fide business purpose for preserving as confidential; or (iii) render the Company unable to comply with requirements under the Securities Act or Exchange Act, then the Company shall have the right to defer taking action with respect to such filing, and any time periods with respect to filing or effectiveness thereunder shall be tolled correspondingly, for a period of not more than 90 days after the request of the Initiating Holders is given; provided, however, that the Company may not invoke this right more than once in any 12 month period; and provided further that the Company shall not register any securities for its own account or that of any other stockholder during such 90 day period other than an Excluded Registration.

 

(d)               The Company shall not be obligated to effect, or to take any action to effect, any registration pursuant to Section 2.1(a) (i) during the period that is 60 days before the Company’s good faith estimate of the date of filing of, and ending on a date that is 90 days after the effective date of, a Company-initiated registration, provided, that the Company is actively employing in good faith commercially reasonable efforts to cause such registration statement to become effective; (ii) after the Company has effected three registrations pursuant to Section 2.1(a); or (iii) if the Initiating Holders propose to dispose of shares of Registrable Securities that may be immediately registered on Form S-3 pursuant to a request made pursuant to Section 2.1(b).  The Company shall not be obligated to effect, or to take any action to effect, any registration pursuant to Section 2.1(b) (i) during the period that is 30 days before the Company’s good faith estimate of the date of filing of, and ending on a date that is 90 days after the effective date of, a Company-initiated registration, provided, that the Company is actively employing in good faith commercially reasonable efforts to cause such registration statement to become effective; or (ii) if the Company has effected two registrations pursuant to Section 2.1(b) within the 12 month period immediately preceding the date of such request.  A registration shall not be counted as “effected” for purposes of this Section 2.1(d) until such time as the applicable registration statement has been declared effective by the SEC, unless the Initiating Holders withdraw their request for such

 

4

 

registration, elect not to pay the registration expenses therefor, and forfeit their right to one demand registration statement pursuant to Section 2.6, in which case such withdrawn registration statement shall be counted as “effected” for purposes of this Section 2.1(d).

 

2.2                               Company Registration.  If the Company proposes to register (including, for this purpose, a registration effected by the Company for stockholders other than the Holders) any of its securities under the Securities Act in connection with the public offering of such securities solely for cash (other than in an Excluded Registration), the Company shall, at such time, promptly give each Holder notice of such registration.  Upon the request of each Holder given within 20 days after such notice is given by the Company, the Company shall, subject to the provisions of Section 2.3, cause to be registered all of the Registrable Securities that each such Holder has requested to be included in such registration.  The Company shall have the right to terminate or withdraw any registration initiated by it under this Section 2.2 before the effective date of such registration, whether or not any Holder has elected to include Registrable Securities in such registration.  The expenses (other than Selling Expenses) of such withdrawn registration shall be borne by the Company in accordance with Section 2.6.

 

2.3                               Underwriting Requirements.

 

(a)                                 If, pursuant to Section 2.1, the Initiating Holders intend to distribute the Registrable Securities covered by their request by means of an underwriting, they shall so advise the Company as a part of their request made pursuant to Section 2.1, and the Company shall include such information in the Demand Notice.  The underwriter(s) will be selected by the Initiating Holders, subject only to the reasonable approval of the Company.  In such event, the right of any Holder to include such Holder’s Registrable Securities in such registration shall be conditioned upon such Holder’s participation in such underwriting and the inclusion of such Holder’s Registrable Securities in the underwriting to the extent provided herein.  All Holders proposing to distribute their securities through such underwriting shall (together with the Company as provided in Section 2.4(e)) enter into an underwriting agreement in customary form with the underwriter(s) selected for such underwriting.  Notwithstanding any other provision of this Section 2.3, if the managing underwriter(s) advise(s) the Initiating Holders in writing that marketing factors require a limitation on the number of shares to be underwritten, then the Initiating Holders shall so advise all Holders of Registrable Securities that otherwise would be underwritten pursuant hereto, and the number of Registrable Securities that may be included in the underwriting shall be allocated among such Holders of Registrable Securities, including the Initiating Holders, in proportion (as nearly as practicable) to the number of Registrable Securities owned by each Holder or in such other proportion as shall mutually be agreed to by all such selling Holders; provided, however, that the number of Registrable Securities held by the Holders to be included in such underwriting shall not be reduced unless all other securities are first entirely excluded from the underwriting.

 

(b)                                 In connection with any offering involving an underwriting of shares of the Company’s capital stock pursuant to Section 2.2, the Company shall not be required to include any of the Holders’ Registrable Securities in such underwriting unless the Holders accept the terms of the underwriting as agreed upon between the Company and its underwriters, and then only in such quantity as the underwriters in their sole discretion determine will not jeopardize the success of the offering by the Company.  If the total number of securities, including Registrable Securities, requested by stockholders to be included in such offering exceeds the number of securities to be sold (other than by the Company) that the underwriters in their reasonable discretion determine is compatible with the success of the offering, then the Company shall be required to include in the offering only that number of such securities, including Registrable Securities, which the underwriters and the Company in their sole discretion determine will not jeopardize the success of the offering.  If the underwriters determine that less than all of the Registrable Securities requested to be registered can be included in such offering, then the Registrable Securities that are included in such offering shall be allocated among the selling Holders in proportion (as nearly as practicable to) the number of Registrable Securities owned by each selling Holder or in such other proportions as shall mutually be agreed to by all such selling Holders.  Notwithstanding

 

5

 

the foregoing, in no event shall (i) the number of Registrable Securities included in the offering be reduced unless all other securities (other than securities to be sold by the Company) are first entirely excluded from the offering, or (ii) the number of Registrable Securities included in the offering be reduced below 30% of the total number of securities included in such offering, unless such offering is the IPO, in which case the selling Holders may be excluded further if the underwriters make the determination described above and no other stockholder’s securities are included in such offering.  For purposes of the provision in this Section 2.3(b) concerning apportionment, for any selling Holder that is a partnership, limited liability company, or corporation, the partners, members, retired partners, retired members, stockholders, and Affiliates of such Holder, or the estates and Immediate Family Members of any such partners, retired partners, members, and retired members and any trusts for the benefit of any of the foregoing Persons, shall be deemed to be a single “selling Holder,” and any pro rata reduction with respect to such “selling Holder” shall be based upon the aggregate number of Registrable Securities owned by all Persons included in such “selling Holder,” as defined in this sentence.

 

(c)                                  For purposes of Section 2.1, a registration shall not be counted as “effected” if, as a result of an exercise of the underwriter’s cutback provisions in Section 2.3(a), fewer than 50% of the total number of Registrable Securities that Holders have requested to be included in such registration statement are actually included.

 

2.4                               Obligations of the Company.  Whenever required under this Section 2 to effect the registration of any Registrable Securities, the Company shall, as expeditiously as reasonably possible:

 

(a)                                 prepare and file with the SEC a registration statement with respect to such Registrable Securities and use its commercially reasonable efforts to cause such registration statement to become effective and, upon the request of the Holders of a majority of the Registrable Securities registered thereunder, keep such registration statement effective for a period of up to 120 days or, if earlier, until the distribution contemplated in the registration statement has been completed; provided, however, that (i) such 120 day period shall be extended for a period of time equal to the period the Holder refrains, at the request of an underwriter of Common Stock (or other securities) of the Company, from selling any securities included in such registration, and (ii) in the case of any registration of Registrable Securities on Form S-3 that are intended to be offered on a continuous or delayed basis, subject to compliance with applicable SEC rules, such 120 day period shall be extended for up to one year, if necessary, to keep the registration statement effective until all such Registrable Securities are sold;

 

(b)                                 prepare and file with the SEC such amendments and supplements to such registration statement, and the prospectus used in connection with such registration statement, as may be necessary to comply with the Securities Act in order to enable the disposition of all securities covered by such registration statement;

 

(c)                                  furnish to the selling Holders such numbers of copies of a prospectus, including a preliminary prospectus, as required by the Securities Act, and such other documents as the Holders may reasonably request in order to facilitate their disposition of their Registrable Securities;

 

(d)                                 use its commercially reasonable efforts to register and qualify the securities covered by such registration statement under such other securities or blue-sky laws of such jurisdictions as shall be reasonably requested by the selling Holders; provided that the Company shall not be required to qualify to do business or to file a general consent to service of process in any such states or jurisdictions, unless the Company is already subject to service in such jurisdiction and except as may be required by the Securities Act;

 

(e)                                  in the event of any underwritten public offering, enter into and perform its obligations under an underwriting agreement, in usual and customary form, with the underwriter(s) of such offering;

 

6

 

(f)                                   use its commercially reasonable efforts to cause all such Registrable Securities covered by such registration statement to be listed on a national securities exchange or trading system and each securities exchange and trading system (if any) on which similar securities issued by the Company are then listed;

 

(g)                                  provide a transfer agent and registrar for all Registrable Securities registered pursuant to this Agreement and provide a CUSIP number for all such Registrable Securities, in each case not later than the effective date of such registration;

 

(h)                                 promptly make available for inspection by the selling Holders, any managing underwriter(s) participating in any disposition pursuant to such registration statement, and any attorney or accountant or other agent retained by any such underwriter or selected by the selling Holders, all financial and other records, pertinent corporate documents, and properties of the Company, and cause the Company’s officers, directors, employees, and independent accountants to supply all information reasonably requested by any such seller, underwriter, attorney, accountant, or agent, in each case, as necessary or advisable to verify the accuracy of the information in such registration statement and to conduct appropriate due diligence in connection therewith;

 

(i)                                     notify each selling Holder, promptly after the Company receives notice thereof, of the time when such registration statement has been declared effective or a supplement to any prospectus forming a part of such registration statement has been filed;

 

(j)                                    after such registration statement becomes effective, notify each selling Holder of any request by the SEC that the Company amend or supplement such registration statement or prospectus; and

 

(k)                                 furnish, on the date that such Registrable Securities are delivered to the underwriters for sale, if such Registrable Securities are being sold through underwriters, (i) an opinion, dated as of such date, of the counsel representing the Company for the purposes of such registration, in form and substance as is customarily given to underwriters in an underwritten public offering, addressed to the underwriters, if any, and (b) a letter dated as of such date, from the independent certified public accountants of the Company, in form and substance as is customarily given by independent certified public accountants to underwriters in an underwritten public offering addressed to the underwriters.

 

2.5                               Furnish Information.  It shall be a condition precedent to the obligations of the Company to take any action pursuant to this Section 2 with respect to the Registrable Securities of any selling Holder that such Holder shall furnish to the Company such information regarding itself, the Registrable Securities held by it, and the intended method of disposition of such securities as is reasonably required to effect the registration of such Holder’s Registrable Securities.

 

2.6                               Expenses of Registration.  All expenses (other than Selling Expenses) incurred in connection with registrations, filings, or qualifications pursuant to Section 2, including all registration, filing, and qualification fees; exchange listing fees; printers’ and accounting fees; fees and disbursements of counsel for the Company; and the reasonable fees and disbursements of one counsel for the selling Holders (“Selling Holder Counsel”), shall be borne and paid by the Company; provided, however, that the Company shall not be required to pay for any expenses of any registration proceeding begun pursuant to Section 2.1 if the registration request is subsequently withdrawn at the request of the Holders of a majority of the Registrable Securities to be registered (in which case all selling Holders shall bear such expenses pro rata based upon the number of Registrable Securities that were to be included in the withdrawn registration), unless the Holders of a majority of the Registrable Securities agree to forfeit their right to one registration pursuant to Section 2.1(a) or Section 2.1(b), as the case may be; provided further that if, at the time of such withdrawal, the Holders shall have learned of a material adverse change in the condition, business, or prospects of the Company from that known to the Holders at the time of their request and have withdrawn the request with reasonable promptness after learning of such information

 

7

 

then the Holders shall not be required to pay any of such expenses and shall not forfeit their right to one registration pursuant to Section 2.1(a) or Section 2.1(b).  All Selling Expenses relating to Registrable Securities registered pursuant to this Section 2 shall be borne and paid by the Holders that incurred such Selling Expenses.

 

2.7                               Delay of Registration.  No Holder shall have any right to obtain or seek an injunction restraining or otherwise delaying any registration pursuant to this Agreement as the result of any controversy that might arise with respect to the interpretation or implementation of this Section 2.

 

2.8                               Indemnification.  If any Registrable Securities are included in a registration statement under this Section 2:

 

(a)                                 To the extent permitted by law, the Company will indemnify and hold harmless each selling Holder, and the partners, managers, members, officers, directors, and stockholders of each such Holder; legal counsel and accountants for each such Holder; any underwriter (as defined in the Securities Act) for each such Holder; and each Person, if any, who controls such Holder or underwriter within the meaning of the Securities Act or the Exchange Act against all Damages and the Company will pay to each such Holder, underwriter, controlling Person and other aforementioned Person all legal and other expenses reasonably incurred thereby in connection with investigating or defending any claim or proceeding from which Damages may result, as such expenses are incurred; provided, however, that the indemnity agreement contained in this Section 2.8(a) shall not apply to amounts paid in settlement of any such claim or proceeding if such settlement is effected without the consent of the Company, which consent shall not be unreasonably withheld, conditioned or delayed, nor shall the Company be liable for any Damages to a Holder, underwriter, controlling Person or other aforementioned Person to the extent that they arise out of or are based upon actions or omissions made in reliance upon and in conformity with written information furnished by or on behalf of such Holder, underwriter, controlling Person or other aforementioned Person expressly for use in connection with such registration.

 

(b)                                 To the extent permitted by law, each selling Holder, severally and not jointly, will indemnify and hold harmless the Company, and each of its directors, each of its officers who has signed the registration statement, each Person (if any), who controls the Company within the meaning of the Securities Act, legal counsel and accountants for the Company, any underwriter (as defined in the Securities Act), any other Holder selling securities in such registration statement, and any controlling Person of any such underwriter or other Holder, against all Damages, in each case only to the extent that such Damages arise out of or are based upon actions or omissions made in reliance upon and in conformity with written information furnished by or on behalf of such selling Holder expressly for use in connection with such registration; and each such indemnifying Holder will pay to the Company and each other aforementioned Person all legal and other expenses reasonably incurred thereby in connection with investigating or defending any claim or proceeding from which Damages may result, as such expenses are incurred; provided, however, that the indemnity agreement contained in this Section 2.8(b) shall not apply to amounts paid in settlement of any such claim or proceeding if such settlement is effected without the consent of the Holder, which consent shall not be unreasonably withheld, conditioned or delayed; and provided further that in no event shall the aggregate amounts payable by any Holder by way of indemnity or contribution under Sections 2.8(b) and 2.8(d) exceed the proceeds from the offering received by such Holder (net of any Selling Expenses paid by such Holder), except in the case of fraud or willful misconduct by such Holder.

 

(c)                                  Promptly after receipt by an indemnified party under this Section 2.8 of notice of the commencement of any action (including any governmental action) for which a party may be entitled to indemnification hereunder, such indemnified party will, if a claim in respect thereof is to be made against any indemnifying party under this Section 2.8, give the indemnifying party notice of the commencement thereof.  The indemnifying party shall have the right to participate in such action and, to the extent the indemnifying party so desires, participate jointly with any other indemnifying party to

 

8

 

which notice has been given, and to assume the defense thereof with counsel mutually satisfactory to the parties; provided, however, that an indemnified party (together with all other indemnified parties that may be represented without conflict by one counsel) shall have the right to retain one separate counsel, with the fees and expenses to be paid by the indemnifying party, if representation of such indemnified party by the counsel retained by the indemnifying party would be inappropriate due to actual or potential differing interests between such indemnified party and any other party represented by such counsel in such action. The indemnifying party shall not be entitled to assume or maintain control of the defense of any claim and shall pay the fees and expenses of one counsel retained by the indemnified party if (1) the claim relates to or arises in connection with any criminal proceeding, action, indictment or allegation, (2) the claim seeks an injunction or equitable relief against the indemnified party or any of its affiliates or (3) the indemnifying party has failed or is failing to prosecute or defend the claim.  The failure to give notice to the indemnifying party will not relieve it of any liability that it may have to any indemnified party otherwise than under this Section 2.8, except to the extent such failure to give notice materially prejudices the indemnifying party’s ability to defend the action.  No indemnifying party in the defense of any such action shall, except with the consent of each indemnified party, consent to entry of any judgment or enter into any settlement that does not include as an unconditional term thereof the giving by the claimant or plaintiff to such indemnified party of a release from all liability in respect of such action.

 

(d)                                 To provide for just and equitable contribution to joint liability under the Securities Act in any case in which either (i) any party otherwise entitled to indemnification hereunder makes a claim for indemnification pursuant to this Section 2.8 but it is judicially determined (by the entry of a final judgment or decree by a court of competent jurisdiction and the expiration of time to appeal or the denial of the last right of appeal) that such indemnification may not be enforced in such case, notwithstanding the fact that this Section 2.8 provides for indemnification in such case, or (ii) contribution under the Securities Act may be required on the part of any party hereto for which indemnification is provided under this Section 2.8, then, and in each such case, such parties will contribute to the aggregate losses, claims, damages, liabilities and expenses to which they may be subject (after contribution from others) in such proportion as is appropriate to reflect the relative fault of each of the indemnifying party and the indemnified party in connection with the statements, omissions, or other actions that resulted in such loss, claim, damage, liability and expense, as well as to reflect any other relevant equitable considerations.  The relative fault of the indemnifying party and of the indemnified party shall be determined by reference to, among other things, whether the untrue or allegedly untrue statement of a material fact, or the omission or alleged omission of a material fact, relates to information supplied by the indemnifying party or by the indemnified party and the parties’ relative intent, knowledge, access to information, and opportunity to correct or prevent such statement or omission; provided, however, that, in any such case, (x) no Holder will be required to contribute any amount in excess of the public offering price of all such Registrable Securities offered and sold by such Holder pursuant to such registration statement, and (y) no Person guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) will be entitled to contribution from any Person who was not guilty of such fraudulent misrepresentation; and provided further that in no event shall a Holder’s liability pursuant to this Section 2.8(d), when combined with the amounts paid or payable by such Holder pursuant to Section 2.8(b), exceed the proceeds from the offering received by such Holder (net of any Selling Expenses paid by such Holder), except in the case of fraud or willful misconduct by such Holder.

 

(e)                                  Notwithstanding the foregoing, to the extent that the provisions on indemnification and contribution contained in the underwriting agreement entered into in connection with the underwritten public offering are in conflict with the foregoing provisions, the provisions in the underwriting agreement shall control.

 

(f)                                   Unless otherwise superseded by an underwriting agreement entered into in connection with the underwritten public offering, the obligations of the Company and Holders under

 

9

 

this Section 2.8 shall survive the completion of any offering of Registrable Securities in a registration under this Section 2, and otherwise shall survive the termination of this Agreement.

 

2.9                               Reports Under Exchange Act.  With a view to making available to the Holders the benefits of SEC Rule 144 and any other rule or regulation of the SEC that may at any time permit a Holder to sell securities of the Company to the public without registration or pursuant to a registration on Form S-3, the Company shall:

 

(a)                                 make and keep available adequate current public information, as those terms are understood and defined in SEC Rule 144, at all times after the effective date of the registration statement filed by the Company for the IPO;

 

(b)                                 use commercially reasonable efforts to file with the SEC in a timely manner all reports and other documents required of the Company under the Securities Act and the Exchange Act (at any time after the Company has become subject to such reporting requirements); and

 

(c)                                  furnish to any Holder, so long as the Holder owns any Registrable Securities, forthwith upon request (i) to the extent accurate, a written statement by the Company that it has complied with the reporting requirements of SEC Rule 144 (at any time after 90 days after the effective date of the registration statement filed by the Company for the IPO), the Securities Act, and the Exchange Act (at any time after the Company has become subject to such reporting requirements), or that it qualifies as a registrant whose securities may be resold pursuant to Form S-3 (at any time after the Company so qualifies); (ii) a copy of the most recent annual or quarterly report of the Company and such other reports and documents so filed by the Company; and (iii) such other information as may be reasonably requested in availing any Holder of any rule or regulation of the SEC that permits the selling of any such securities without registration (at any time after the Company has become subject to the reporting requirements under the Exchange Act) or pursuant to Form S-3 (at any time after the Company so qualifies to use such form).

 

2.10                        Limitations on Subsequent Registration Rights.  From and after the date of this Agreement, the Company shall not, without the prior written consent of (i) the Holders of a majority of the Registrable Securities then outstanding, (ii) the holders of at least a majority of the then outstanding shares of Series A Preferred Stock (if any) and (iii) the holders of at least 66-2/3% of the then outstanding shares of Series B Preferred Stock (if any), enter into any agreement with any holder or prospective holder of any securities of the Company that would allow such holder or prospective holder to (i) include such securities in any registration unless, under the terms of such agreement, such holder or prospective holder may include such securities in any such registration only to the extent that the inclusion of such securities will not reduce the number of the Registrable Securities of the Holders that are included or (ii) initiate a demand for registration of any securities held by such holder or prospective holder.

 

2.11                        “Market Stand-off” Agreement.  Each Holder hereby agrees that it will not, without the prior written consent of the managing underwriter, during the period commencing on the date of the final prospectus relating to the registration by the Company of shares of its Common Stock or any other equity securities under the Securities Act on a registration statement on Form S-1 and ending on the date specified by the Company and the managing underwriter, such period not to initially exceed 180 days; provided, however, that if during the last 17 days of the initial lock-up period, the Company releases earnings results or material news or a material event relating to the Company occurs or prior to the expiration of the initial lock-up period, the Company announces that it will release earnings results during the 16-day period beginning on the last day of the initial lock-up period, then in each case the lock-up period will be extended until the expiration of the 18-day period beginning on the date of release of the earnings results or the occurrence of the material news or material event, as applicable, unless the managing underwriter waives, in writing, such extension, (i) lend; offer; pledge; sell; contract to sell; sell any option or contract to purchase; purchase any option or contract to sell; grant any option, right, or warrant to purchase; or otherwise transfer or dispose of, directly or indirectly, any shares of Common

 

10

 

Stock or any securities convertible into or exercisable or exchangeable (directly or indirectly) for Common Stock held immediately before the effective date of the registration statement for such offering or (ii) enter into any swap or other arrangement that transfers to another, in whole or in part, any of the economic consequences of ownership of such securities, whether any such transaction described in clause (i) or (ii) above is to be settled by delivery of Common Stock or other securities, in cash, or otherwise.  The foregoing provisions of this Section 2.11 shall apply only to the IPO, shall not apply to the sale of any shares to an underwriter pursuant to an underwriting agreement, and shall be applicable to the Holders only if all officers, directors and stockholders individually owning more than 1% of the Company’s outstanding Common Stock (after giving effect to conversion into Common Stock of all outstanding Preferred Stock) are subject to the same restrictions.  The underwriters in connection with such registration are intended third-party beneficiaries of this Section 2.11 and shall have the right, power, and authority to enforce the provisions hereof as though they were a party hereto.  Each Holder further agrees to execute such agreements as may be reasonably requested by the underwriters in connection with such registration that are consistent with this Section 2.11 or that are necessary to give further effect thereto.  Any discretionary waiver or termination of the restrictions of any or all of such agreements by the Company or the underwriters shall apply pro rata to all Holders subject to such agreements, based on the number of shares subject to such agreements.

 

2.12                        Restrictions on Transfer.

 

(a)                                 The Preferred Stock and the Registrable Securities shall not be sold, pledged, or otherwise transferred, and the Company shall not recognize and shall issue stop-transfer instructions to its transfer agent with respect to any such sale, pledge, or transfer, except upon the conditions specified in this Agreement, which conditions are intended to ensure compliance with the provisions of the Securities Act and state securities laws.  A transferring Holder will cause any proposed purchaser, pledgee, or transferee of the Preferred Stock and the Registrable Securities held by such Holder to agree to take and hold such securities subject to the provisions and upon the conditions specified in this Agreement.

 

(b)                                 Each certificate or instrument representing (i) the Preferred Stock, (ii) the Registrable Securities, and (iii) any other securities issued in respect of the securities referenced in clauses (i) and (ii), upon any stock split, stock dividend, recapitalization, merger, consolidation, or similar event, shall (unless otherwise permitted by the provisions of Section 2.12(c)) be stamped or otherwise imprinted with a legend substantially in the following form:

 

THE SECURITIES REPRESENTED HEREBY HAVE BEEN ACQUIRED FOR INVESTMENT AND HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933 OR ANY STATE SECURITIES LAWS.  SUCH SHARES MAY NOT BE SOLD, PLEDGED, OR TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION OR A VALID EXEMPTION FROM THE REGISTRATION AND PROSPECTUS DELIVERY REQUIREMENTS OF SAID ACT AND SUCH LAWS.

 

THE SECURITIES REPRESENTED HEREBY MAY BE TRANSFERRED ONLY IN ACCORDANCE WITH THE TERMS OF AN AGREEMENT BETWEEN THE COMPANY AND THE STOCKHOLDER, A COPY OF WHICH IS ON FILE WITH THE SECRETARY OF THE COMPANY.

 

The Holders consent to the Company making a notation in its records and giving instructions to any transfer agent of the Restricted Securities in order to implement the restrictions on transfer set forth in this Section 2.12.

 

(c)                                  The holder of each certificate representing Restricted Securities, by acceptance thereof, agrees to comply in all respects with the provisions of this Section 2.  Before any proposed sale, pledge, or transfer of any Restricted Securities, unless there is in effect a registration

 

11

 

statement under the Securities Act covering the proposed transaction, the Holder thereof shall give notice to the Company of such Holder’s intention to effect such sale, pledge, or transfer.  Each such notice shall describe the manner and circumstances of the proposed sale, pledge, or transfer in sufficient detail and, if reasonably requested by the Company, shall be accompanied at such Holder’s expense by either (i) a written opinion of legal counsel who shall, and whose legal opinion shall, be reasonably satisfactory to the Company, addressed to the Company, to the effect that the proposed transaction may be effected without registration under the Securities Act and state securities laws; (ii) a “no action” letter from the SEC to the effect that the proposed sale, pledge, or transfer of such Restricted Securities without registration will not result in a recommendation by the staff of the SEC or a state securities regulator that action be taken with respect thereto; or (iii) any other evidence reasonably satisfactory to counsel to the Company to the effect that the proposed sale, pledge, or transfer of the Restricted Securities may be effected without registration under the Securities Act and state securities laws, whereupon the Holder of such Restricted Securities shall be entitled to sell, pledge, or transfer such Restricted Securities in accordance with the terms of the notice given by the Holder to the Company.  The Company will not require such a legal opinion or “no action” letter (x) in any transaction in compliance with SEC Rule 144 or (y) in any transaction in which such Holder distributes Restricted Securities to an Affiliate of such Holder for no consideration; provided that each transferee agrees in writing to be subject to the terms of this Section 2.12.  Each certificate or instrument evidencing the Restricted Securities transferred as above provided shall bear, except if such transfer is made pursuant to SEC Rule 144, the appropriate restrictive legend set forth in Section 2.12(b), except that such certificate shall not bear such restrictive legend if, in the opinion of counsel for such Holder and the Company, such legend is not required in order to establish compliance with any provisions of the Securities Act or state securities laws.

 

2.13                        Termination of Registration Rights.  The right of any Holder to request registration or inclusion of Registrable Securities in any registration pursuant to Section 2.1 or Section 2.2 shall terminate upon the earlier to occur of:

 

(a)                                 the closing of a Deemed Liquidation Event (provided that if the occurrence of a Deemed Liquidation Event was waived under the Certificate of Incorporation, a Deemed Liquidation Event shall not be deemed to occur for purposes of this provision);

 

(b)                                 the date on which all shares of Registrable Securities held by such Holder may be sold under Rule 144; or

 

(c)                                  that is the third anniversary of the consummation of the IPO.

 

3.                                      Information Rights.

 

3.1                               Delivery of Financial Statements.  The Company shall deliver to each Major Investor:

 

(a)                                 as soon as practicable, but in any event within 150 days after the end of each fiscal year of the Company (i) a balance sheet as of the end of such year, (ii) statements of income and of cash flows for such year, and (iii) a comparison between (x) the actual amounts as of and for such fiscal year and (y) the comparable amounts for the prior year and as included in the Budget (as defined in Section 3.1(e)) for such year, with an explanation of any material differences between such amounts and a schedule as to the sources and applications of funds for such year, and (iv) a statement of stockholders’ equity as of the end of such year, with the financial statements set forth under (i), (ii) and (iv) above to be audited and certified by independent public accountants of nationally recognized standing selected by the Company;

 

(b)                                 as soon as practicable, but in any event within 45 days after the end of each of the first three quarters of each fiscal year of the Company, unaudited statements of income and of cash flows for such fiscal quarter, and an unaudited balance sheet as of the end of such fiscal quarter, all prepared in accordance with GAAP (except that such financial statements may (i) be subject to normal

 

12

 

year-end audit adjustments and (ii) not contain all notes thereto that may be required in accordance with GAAP);

 

(c)                                  as soon as practicable, but in any event within 45 days after the end of each quarter of each fiscal year of the Company, a statement showing the number of shares of each class and series of capital stock and securities convertible into or exercisable for shares of capital stock outstanding at the end of the period, the Common Stock issuable upon conversion or exercise of any outstanding securities convertible or exercisable for Common Stock and the exchange ratio or exercise price applicable thereto, and the number of shares subject to issued stock options and stock options not yet issued but reserved for issuance, if any, all in sufficient detail as to permit the Major Investors to calculate their respective percentage equity ownership in the Company, and certified by the chief financial officer or chief executive officer of the Company as being true, complete, and correct;

 

(d)                                 as soon as practicable, but in any event within 30 days of the end of each month, an unaudited income statement and statement of cash flows for such month, and an unaudited balance sheet as of the end of such month, all prepared in accordance with GAAP (except that such financial statements may (i) be subject to normal year-end audit adjustments and (ii) not contain all notes thereto that may be required in accordance with GAAP);

 

(e)                                  as soon as practicable, but in any event 30 days before the end of each fiscal year, a budget and business plan for the next fiscal year (collectively, the “Budget”), approved by the Board of Directors and prepared on a monthly basis, including balance sheets, income statements, and statements of cash flow for such months and, promptly after prepared, any other budgets or revised budgets prepared by the Company;

 

(f)                                   with respect to the financial statements called for in Section 3.1(a), Section 3.1(b) and Section 3.1(d), an instrument executed by the chief financial officer or chief executive officer of the Company certifying that such financial statements were prepared in accordance with GAAP consistently applied with prior practice for earlier periods (except as otherwise set forth in Section 3.1(b) and Section 3.1(d)) and fairly present the financial condition of the Company and its results of operation for the periods specified therein; and

 

(g)                                  such other information relating to the financial condition, business, prospects, or corporate affairs of the Company as any Major Investor may from time to time reasonably request; provided, that the Company shall not be obligated to provide information the disclosure of which would adversely affect the attorney-client privilege between the Company and its counsel.

 

If, for any period, the Company has any subsidiary whose accounts are consolidated with those of the Company, then in respect of such period the financial statements delivered pursuant to the foregoing sections shall be the consolidated and consolidating financial statements of the Company and all such consolidated subsidiaries.

 

Notwithstanding anything else in this Section 3.1 to the contrary, the Company may cease providing the information set forth in this Section 3.1 during the period starting with the date 30 days before the Company’s good-faith estimate of the date of filing of a registration statement if it reasonably concludes it must do so to comply with the SEC rules applicable to such registration statement and related offering; provided that the Company’s covenants under this Section 3.1 shall be reinstated at such time as the Company is no longer actively employing its commercially reasonable efforts to cause such registration statement to become effective.

 

3.2                               Inspection.  The Company shall permit each Major Investor and its agents, at such Major Investor’s expense, to visit and inspect the Company’s properties; examine its books of account and records; and discuss the Company’s affairs, finances, and accounts with its officers, during normal business hours of the Company as may be reasonably requested by the Major Investor; provided,

 

13

 

that the Company shall not be obligated to provide information the disclosure of which would adversely affect the attorney-client privilege between the Company and its counsel.

 

3.3                               Termination of Information Rights.  The covenants set forth in Section 3.1 and Section 3.2 shall terminate and be of no further force or effect upon the earlier of (i) the date immediately before the consummation of the IPO or (ii) the date that the Company first becomes subject to the periodic reporting requirements of Section 12(g) or 15(d) of the Exchange Act.

 

3.4                               Confidentiality.  Each Investor severally agrees that such Investor will keep confidential and will not disclose, divulge, or use for any purpose (other than to monitor its investment in the Company or to enforce its rights under this Agreement or otherwise) any confidential information obtained from the Company pursuant to the terms of this Agreement (including notice of the Company’s intention to file a registration statement), unless such confidential information (a) is known or becomes known to the public in general (other than as a result of a breach of this Section 3.4 by such Investor), (b) is or has been independently developed or conceived by such Investor without use of the Company’s confidential information, or (c) is or has been made known or disclosed to such Investor by a third party without a breach of any obligation of confidentiality such third party may have to the Company; provided, however, that an Investor may disclose confidential information (i) to its attorneys, accountants, consultants, and other professionals to the extent necessary to obtain their services in connection with monitoring its investment in the Company or to enforce its rights under this Agreement or otherwise; (ii) to any prospective purchaser of any Registrable Securities from such Investor, if such prospective purchaser agrees to be bound by the provisions of this Section 3.4; (iii) to any existing or prospective Affiliate, partner, member, stockholder, or wholly owned subsidiary of such Investor in the ordinary course of business, provided that such Investor informs such Person that such information is confidential and directs such Person to maintain the confidentiality of such information; or (iv) pursuant to a court decree, subpoena, or other judicial or administrative order or process reasonably believed by such Investor to compel disclosure of such confidential information, provided that, to the extent permitted by applicable law, such Investor promptly notifies the Company of such disclosure and takes reasonable steps to minimize the extent of any such required disclosure.

 

4.                                      Rights to Future Stock Issuances.

 

4.1                               Right of First Offer.  Subject to the terms and conditions of this Section 4.1, if the Company proposes to offer or issue any New Securities, the Company shall first offer such New Securities to each Major Investor.  A Major Investor shall be entitled to apportion the right of first offer hereby granted to it among itself and its Affiliates in such proportions as it deems appropriate.  Each Major Investor that desires to exercise his, her or its rights under this Section 4 must be an “accredited investor” within the meaning of Regulation D as promulgated under the Securities Act.

 

(a)                                 The Company shall give notice (the “Offer Notice”) to each Major Investor, stating (i) its bona fide intention to offer such New Securities, (ii) the number of such New Securities to be offered, and (iii) the price and terms, if any, upon which it proposes to offer such New Securities.  If the consideration to be paid by others for the New Securities is not cash, the fair market value of the consideration shall be determined in good faith by the Board of Directors and a reasonably detailed explanation of the Board of Director’s determination of such value shall be included in the Offer Notice.  All Major Investors electing to participate in the offering of such New Securities shall pay the cash equivalent thereof as so determined.

 

(b)                                 By notification to the Company within 20 days after the Offer Notice is given, each Major Investor may elect to purchase or otherwise acquire, at the price and on the terms specified in the Offer Notice, up to that portion of such New Securities which equals the proportion that the sum of the number of shares of Common Stock issued and then held by such Major Investor as a result of the conversion of Preferred Stock and the number of shares of Common Stock issuable upon conversion of the Preferred Stock then held by such Major Investor bears to the sum of the number of

 

14

 

shares of Common Stock issued and outstanding as a result of the conversion of Preferred Stock and the number of shares of Common Stock issuable upon conversion of the then outstanding shares of Preferred Stock.  At the expiration of such 20 day period, the Company shall promptly notify each Major Investor that elects to purchase or acquire its full ratable portion of the New Securities available to it (each, a “Fully Exercising Investor”) of any other Major Investor’s failure to do likewise.  During the ten day period commencing after the Company has given such notice, each Fully Exercising Investor may, by giving notice to the Company, elect to purchase or acquire, in addition to its portion of the New Securities specified above, up to that portion of the New Securities for which Major Investors were entitled to subscribe but that were not subscribed for by the Major Investors which is equal to the proportion that the sum of the number of shares of Common Stock issued and then held by such Fully Exercising Investor who desires to purchase such unsubscribed New Securities as a result of the conversion of Preferred Stock and the number of shares of Common Stock issuable upon conversion of the Preferred Stock then held by such Fully Exercising Investor bears to the sum of the number of shares of Common Stock issued and then held by all Fully Exercising Investors who desire to purchase such unsubscribed New Securities as a result of the conversion of Preferred Stock and the number of shares of Common Stock issuable upon conversion of the Preferred Stock then held by all Fully Exercising Investors who desire to purchase such unsubscribed New Securities.  The closing of any sale pursuant to this Section 4.1(b) shall occur within the later of 90 days of the date that the Offer Notice is given and the date of initial sale of New Securities pursuant to Section 4.1(c).

 

(c)                                  If all New Securities referred to in the Offer Notice are not elected to be purchased or acquired as provided in Section 4.1(b), the Company may, during the 90 day period following the expiration of the periods provided in Section 4.1(b), offer, sell or enter into an agreement to sell the remaining unsubscribed portion of such New Securities to any Person or Persons at a price not less than, and upon terms no more favorable to the offeree than, those specified in the Offer Notice.  If the Company does not enter into an agreement for the sale of the New Securities within such period, or if such agreement is not consummated within the later of such 90 day period or 30 days of the execution thereof, the right provided hereunder shall be deemed to be revived and such New Securities shall not be offered unless first reoffered to the Major Investors in accordance with this Section 4.1.

 

(d)                                 The right of first offer in this Section 4.1 shall not be applicable to (i) Exempted Securities (as defined in the Certificate of Incorporation) and (ii) shares of Common Stock issued in the IPO.

 

4.2                               Termination.  The covenants set forth in Section 4.1 shall terminate and be of no further force or effect upon the earlier of (i) the date immediately before the consummation of the sale of shares of Common Stock to the public at a price of at least $4.05 per share (subject to appropriate adjustment in the event of any stock dividend, stock split, combination or other similar recapitalization) in a firm-commitment underwritten public offering pursuant to an effective registration statement under the Securities Act of 1933, as amended, resulting in at least $30,000,000 of aggregate proceeds, net of the underwriting discount and commissions, to the Company and after which the Common Stock is listed on a United States national securities exchange; or (ii) the date of a Deemed Liquidation Event (provided that if the occurrence of a Deemed Liquidation Event was waived under the Certificate of Incorporation, a Deemed Liquidation Event shall not be deemed to occur for purposes of this provision).

 

5.                                      Additional Covenants.

 

5.1                               Insurance.  The Company shall maintain, with financially sound and reputable insurers, Directors and Officers liability insurance in an amount and on terms and conditions satisfactory to the Board of Directors and the Required Holders and shall not be cancelable by the Company without prior written approval by the Board of Directors and the Required Holders.  The Company shall maintain, with financially sound and reputable insurers, a term “key-person” life insurance on the Chief Executive Officer of the Company in the amount of at least $1,000,000 and on terms and conditions satisfactory to

 

15

 

the Board of Directors and the Required Holders and the policy or binder for such insurance shall name the Company as loss payee and shall not be cancelable by the Company without prior written approval by the Board of Directors and the Required Holders.  Within 60 days after the date hereof, the Company shall increase the amount of its product liability insurance coverage to $5,000,000 and, thereafter, maintain such coverage with financially sound and reputable insurers on terms and conditions satisfactory to the Board of Directors and the Required Holders and the policy or binder for such insurance shall not be cancelable by the Company without prior written approval by the Board of Directors and the Required Holders.

 

5.2                               Employee Agreements.  The Company will cause (i) each person now or hereafter employed by it or by any subsidiary (or engaged by the Company or any subsidiary as a consultant/independent contractor) with access to confidential information and/or trade secrets to enter into a nondisclosure and proprietary rights assignment agreement and (ii) its Chief Executive Officer and Vice President of Sales to enter into a one year noncompetition and nonsolicitation agreement, substantially in the form approved by the Board of Directors.  In addition, the Company shall not amend, modify, terminate, waive, or otherwise alter, in whole or in part, any of the above-referenced agreements or any restricted stock agreement between the Company and any employee, without the consent of the Board of Directors.

 

5.3                               Employee Stock.  Unless otherwise approved by the Board of Directors, all future employees and consultants of the Company who purchase, receive options to purchase, or receive awards of shares of the Company’s capital stock after the date hereof shall be required to execute restricted stock or option agreements, as applicable, providing for (i) vesting of shares over a four year period, with the first 25% of such shares vesting following 12 months of continued employment or service, and the remaining shares vesting in equal monthly installments over the following 36 months, and (ii) a market stand-off provision substantially similar to that in Section 2.11.  In addition, unless otherwise approved by the Board of Directors, the Company shall retain for all future employees and consultants of the Company who purchase, receive options to purchase, or receive awards of shares of the Company’s capital stock after the date hereof a “right of first refusal” on employee transfers until the Company’s IPO and shall have the right to repurchase unvested shares at cost upon termination of employment of a holder of restricted stock.

 

5.4                               Matters Requiring Investor Director Approval.  So long as the holders of Series A Preferred Stock are entitled to elect two Series A Directors or the holders of Series B Preferred Stock are entitled to elect two Series B Directors, the Company shall not, without approval of the Board of Directors (or a committee thereof), which approval must include the affirmative vote of at least one of the Series A Directors and at least one of the Series B Directors:

 

(a)               make, or permit any subsidiary to make, any loan or advance to any Person, including, without limitation, any employee or director of the Company or any subsidiary, except advances and similar expenditures in the ordinary course of business or under the terms of an employee stock or option plan approved by the Board of Directors;

 

(b)               guarantee, directly or indirectly, or permit any subsidiary to guarantee, directly or indirectly, any indebtedness except for trade accounts of the Company or any subsidiary arising in the ordinary course of business;

 

(c)                make any investment inconsistent with any investment policy approved by the Board of Directors;

 

(d)               otherwise enter into or be a party to any transaction with any director, officer, or employee of the Company or any “associate” (as defined in Rule 12b-2 promulgated under the Exchange Act) of any such Person, except for transactions contemplated by this Agreement, the Purchase Agreement; or transactions made in the ordinary course of business and pursuant to reasonable

 

16

 

requirements of the Company’s business and upon fair and reasonable terms that are approved by a majority of the Board of Directors; or

 

(e)                (i) issue awards exceeding 2,334,026 shares of Common Stock under the Company’s 2007 Omnibus Stock Plan (provided, that awards that are issued but terminate prior to the actual issuance of shares of Common Stock without restrictions shall not be counted towards the 2,334,026 share limit once the shares are returned for issuance to the Company’s 2007 Omnibus Stock Plan), (ii) amend the 2007 Omnibus Stock Plan to increase the number of shares issuable under the Plan, (iii) otherwise issue any shares of Common Stock, options, warrants or other securities under any other equity incentive plan or arrangement established for the benefit of the employees, officers, directors and/or consultants of the Company or the subsidiary or (iv) adopt any new equity incentive plan or arrangement established for the benefit of the employees, officers, directors and/or consultants of the Company or the subsidiary.

 

5.5                               Board Matters.  Unless otherwise determined by the vote of a majority of the directors then in office, the Board of Directors shall meet at least quarterly in accordance with an agreed-upon schedule.  The Company shall reimburse the nonemployee directors for all reasonable out-of-pocket travel expenses incurred in connection with attending meetings of the Board of Directors or the meetings of the board of directors (or other governing body) of any subsidiary of the Company or in connection with other activities requested by the Company.  The Company shall maintain an audit and compensation committee, each of which shall consist solely of non-management directors.  At least one Series A Director and at least one Series B Director shall be entitled in such person’s discretion to be a member of each committee of the Board of Directors and each committee of the board of directors (or other governing body) of any subsidiary of the Company (if any).  The Company’s board of directors shall be permitted to elect a chair by majority vote.

 

5.6                               Successor Indemnification.  If the Company or any of its successors or assignees consolidates with or merges into any other Person and is not the continuing or surviving corporation or entity of such consolidation or merger, then to the extent necessary, proper provision shall be made so that the successors and assignees of the Company assume the obligations of the Company with respect to indemnification of members of the Board of Directors as in effect immediately before such transaction, whether such obligations are contained in the Company’s Bylaws, the Certificate of Incorporation, or elsewhere, as the case may be.

 

5.7                               Reservation of Capital Stock.  The Company shall at all times reserve and keep available, solely for issuance and delivery upon the conversion of the Preferred Stock, all Common Stock issuable from time to time upon such conversion.  The Company shall at all times reserve and keep available, solely for issuance and delivery upon the payment of accrued dividends on the shares of Series B Preferred Stock in accordance with the terms of the Certificate of Incorporation, such number of shares of Series B Preferred Stock from time to time to ensure that there will be sufficient shares of Series B Preferred Stock available for issuance to the holders of shares of Series B Preferred Stock in connection with the payment of such dividends.

 

5.8                               Directors’ Liability and Indemnification.  The Company’s and each of its subsidiaries’ certificate of incorporation, bylaws and other organizational documents shall provide (a) for elimination of the liability of directors to the maximum extent permitted by law and (b) for indemnification of directors for acts on behalf of the Company and its subsidiaries to the maximum extent permitted by law.

 

5.9                               Proprietary Rights Agreement.  The Company and each of its subsidiaries shall require all employees, officers and consultants hired after the date hereof to execute and deliver an Employee Confidentiality and Assignment of Inventions Agreement that is substantially in the form attached to the Purchase Agreement.

 

17

 

5.10                        Chief Clinical Officer Recruitment.  The Company promptly shall recruit a part- or full-time employee or consultant to become the Company’s Chief Clinical Officer or Chief Medical Officer who shall be responsible for, among other things, developing and executing on the Company’s clinical development program (trial strategy, trial administration, key opinion leader relations and publishing) and who shall be acceptable to the Board of Directors including the approval of the Series B Directors.

 

5.11                        Convertible Securities.  All securities or obligations that are exercisable for, convertible into or exchangeable for shares of capital stock of the Company, other than shares of the Company’s Preferred Stock, shall, by their terms, terminate in their entirety at the time of a Deemed Liquidation Event if not exercised, converted or exchanged into shares of the Company’s capital stock immediately prior to such Deemed Liquidation Event.

 

5.12                        Termination of Covenants.  The covenants set forth in this Section 5, except for Section 5.6, shall terminate and be of no further force or effect upon the earlier of (i) the date immediately before the consummation of a Qualified IPO, as such term is defined in the Certificate of Incorporation or (ii) the date of a Deemed Liquidation Event (provided that if the occurrence of a Deemed Liquidation Event was waived under the Certificate of Incorporation, a Deemed Liquidation Event shall not be deemed to occur for purposes of this provision).

 

6.                                      Miscellaneous.

 

6.1                               Successors and Assigns.  The rights under this Agreement may be assigned (but only with all related obligations) by a Holder to a transferee of Registrable Securities that (i) is an Affiliate of a Holder; (ii) is a Holder’s Immediate Family Member or trust for the benefit of an individual Holder or one or more of such Holder’s Immediate Family Members; or (iii) after such transfer, holds at least 100,000 Registrable Securities (subject to appropriate adjustment for stock splits, stock dividends, combinations, and other recapitalizations); provided, however, that (x) the Company is, within a reasonable time after such transfer, furnished with written notice of the name and address of such transferee and the Registrable Securities with respect to which such rights are being transferred; and (y) such transferee agrees in a written instrument delivered to the Company to be bound by and subject to the terms and conditions of this Agreement, including the provisions of Section 2.11.  For the purposes of determining the number of shares of Registrable Securities held by a transferee, the holdings of a transferee (1) that is an Affiliate or stockholder of a Holder; (2) who is a Holder’s Immediate Family Member; or (3) that is a trust for the benefit of an individual Holder or such Holder’s Immediate Family Member shall be aggregated together and with those of the transferring Holder; provided further that all transferees who would not qualify individually for assignment of rights shall have a single attorney-in-fact for the purpose of exercising any rights, receiving notices, or taking any action under this Agreement.  The terms and conditions of this Agreement inure to the benefit of and are binding upon the respective successors and permitted assignees of the parties.  Nothing in this Agreement is intended to confer upon any party other than the parties hereto or their respective successors and permitted assignees any rights, remedies, obligations or liabilities under or by reason of this Agreement, except as expressly provided herein.

 

6.2                               Governing Law. This Agreement shall be governed by, and construed in accordance with, the laws of the State of Delaware, regardless of the laws that might otherwise govern under applicable principles of conflicts of law.

 

6.3                               Counterparts; Facsimile.  This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.  This Agreement may also be executed and delivered by facsimile or other electronic signatures and in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

 

18

 

6.4                               Titles and Subtitles.  The titles and subtitles used in this Agreement are for convenience only and are not to be considered in construing or interpreting this Agreement.

 

6.5                               Notices.  All notices and other communications given or made pursuant to this Agreement shall be in writing and shall be deemed effectively given upon the earlier of actual receipt or: (i) personal delivery to the party to be notified; (ii) when sent, if sent by electronic mail or facsimile during the recipient’s normal business hours, and if not sent during normal business hours, then on the recipient’s next business day; (iii) five days after having been sent by registered or certified mail, return receipt requested, postage prepaid; or (iv) one business day after the business day of deposit with a nationally recognized overnight courier, freight prepaid, specifying next-day delivery, with written verification of receipt.  All communications shall be sent to the respective parties at their addresses as set forth on Schedule A hereto, or to the principal office of the Company and to the attention of the Chief Executive Officer, in the case of the Company, or to such email address, facsimile number, or address as subsequently modified by written notice given in accordance with this Section 6.5.  If notice is given to the Company, a copy shall also be sent to Faegre Baker Daniels LLP, 2200 Wells Fargo Center, 90 South Seventh Street, Minneapolis, MN 55402-3901, Attention Jonathan R. Zimmerman.

 

6.6                               Amendments and Waivers.  Any term of this Agreement may be amended and the observance of any term of this Agreement may be waived (either generally or in a particular instance, and either retroactively or prospectively) only with the written consent of the Company, the holders of a majority of the Registrable Securities then outstanding and the Required Holders; provided that the Company may in its sole discretion waive compliance with Section 2.12(c) (and the Company’s failure to object promptly in writing after notification of a proposed assignment allegedly in violation of Section 2.12(c) shall be deemed to be a waiver); and provided further that any right of any party hereunder may be waived by the waiving party on such party’s own behalf, without the consent of any other party.  Notwithstanding the foregoing, this Agreement may not be amended or terminated and the observance of any term hereof may not be waived with respect to any Investor without the written consent of such Investor, unless such amendment, termination, or waiver applies to all Investors in the same fashion (it being agreed that a waiver of the provisions of Section 4 with respect to a particular transaction shall be deemed to apply to all Investors in the same fashion if such waiver does so by its terms, notwithstanding the fact that certain Investors may nonetheless, by agreement with the Company, purchase securities in such transaction).  The Company shall give prompt notice of any amendment or termination hereof or waiver hereunder to any party hereto that did not consent in writing to such amendment, termination, or waiver.  Any amendment, termination, or waiver effected in accordance with this Section 6.6 shall be binding on all parties hereto, regardless of whether any such party has consented thereto.  No waivers of or exceptions to any term, condition, or provision of this Agreement, in any one or more instances, shall be deemed to be or construed as a further or continuing waiver of any such term, condition, or provision.

 

6.7                               Severability.  In case any one or more of the provisions contained in this Agreement is for any reason held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality, or unenforceability shall not affect any other provision of this Agreement, and such invalid, illegal, or unenforceable provision shall be reformed and construed so that it will be valid, legal, and enforceable to the maximum extent permitted by law.

 

6.8                               Aggregation of Stock.  All shares of Registrable Securities held or acquired by Affiliates shall be aggregated together for the purpose of determining the availability of any rights under this Agreement and such Affiliated persons may apportion such rights as among themselves in any manner they deem appropriate.

 

6.9                               Entire Agreement.  This Agreement (including any Schedules and Exhibits hereto) constitutes the full and entire understanding and agreement among the parties with respect to the subject matter hereof, and any other written or oral agreement relating to the subject matter hereof existing between the parties (including, without limitation, the Existing Agreement) is expressly canceled.

 

19

 

The Existing Agreement is hereby amended in its entirety and restated herein.  All provisions of, rights granted under and covenants made in the Existing Agreement are hereby waived, released and superseded in their entirety and shall have no further force or effect.

 

6.10                        Delays or Omissions.  No delay or omission to exercise any right, power or remedy accruing to any party under this Agreement upon any breach or default of any other party under this Agreement shall impair any such right, power, or remedy of such nonbreaching or nondefaulting party nor shall it be construed to be a waiver of or acquiescence to any such breach or default or to any similar breach or default thereafter occurring, nor shall any waiver of any single breach or default be deemed a waiver of any other breach or default theretofore or thereafter occurring.  All remedies, whether under this Agreement or by law or otherwise afforded to any party, shall be cumulative and not alternative.

 

6.11                        Acknowledgment.  The Company acknowledges that the Investors are in the business of venture capital investing and therefore review the business plans and related proprietary information of many enterprises, including enterprises which may have products or services which compete directly or indirectly with those of the Company.  Nothing in this Agreement shall preclude or in any way restrict the Investors from investing or participating in any particular enterprise whether or not such enterprise has products or services which compete with those of the Company.

 

[Remainder of Page Intentionally Left Blank]

 

20

 

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above.

 

	
 
    	
TACTILE   SYSTEMS TECHNOLOGY, INC.
    
	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Gerald R. Mattys
    
	
 
    	
 
    	
Gerald R. Mattys
    
	
 
    	
 
    	
Chief Executive Officer
    
	
 
    	
 
    	
 
    

 

	
 
    	
INVESTORS:
    
	
 
    	
 
    
	
 
    	
GALEN PARTNERS V, L.P.
    
	
 
    	
By: Galen V, L.L.C.,   its general partner
    
	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Zubeen Shroff
    
	
 
    	
Name:
    	
Zubeen Shroff
    
	
 
    	
Title:
    	
Managing Partner
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
GALEN PARTNERS   INTERNATIONAL V, L.P.
    
	
 
    	
By: Galen V, L.L.C.,   its general partner
    
	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Zubeen Shroff
    
	
 
    	
Name:
    	
Zubeen Shroff
    
	
 
    	
Title:
    	
Managing Partner
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
RADIUS VENTURE PARTNERS III, L.P.
    
	
 
    	
 
    
	
 
    	
By:
    	
Radius Venture Partners III, LLC,
    
	
 
    	
 
    	
its General Partner
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Jordan Davis
    
	
 
    	
 
    	
Jordan Davis
    
	
 
    	
 
    	
Managing Partner
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
WORTHY VENTURE   RESOURCES, LLC
    
	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Peter H. Soderberg
    
	
 
    	
Name:
    	
Peter H. Soderberg
    
	
 
    	
Title:
    	
Managing Partner
    

 

 

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above.

 

	
 
    	
INVESTORS:
    
	
 
    	
 
    
	
 
    	
RADIUS VENTURE PARTNERS   III QP, L.P.
    
	
 
    	
 
    
	
 
    	
By:
    	
Radius Venture Partners   III, LLC,
    
	
 
    	
 
    	
its General Partner
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Jordan Davis
    
	
 
    	
 
    	
Jordan Davis
    
	
 
    	
 
    	
Managing Member
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
RADIUS VENTURE PARTNERS   III (OHIO), L.P.
    
	
 
    	
 
    
	
 
    	
By:
    	
Radius Venture Partners   III (Ohio) LLC,
    
	
 
    	
 
    	
its General Partner
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
Radius Venture Partners   III LLC,
    
	
 
    	
 
    	
its Manager
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Jordan Davis
    
	
 
    	
 
    	
Jordan Davis
    
	
 
    	
 
    	
Managing Member

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00259-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00259-of-00352.parquet"}]]